On March 27, a New York state that law that requires the electronic prescribing of all controlled and non-scheduled drugs went into effect. The law is part of the state’s Internet System for Tracking Over Prescribing (I-STOP) legislation, put in place in 2012 to curb prescription drug abuse, medical errors and fraud.
While the digital prescribing requirement was initially set to go into effect in March 2015, because so few providers were ready, the deadline for compliance was delayed a year. Now, in order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements. Throughout the state of New York, providers seem to be quickly adapting to this new mandate.
Recent data from Surescripts, the Arlington, Va.-based operator of a national clinical electronic network, found that doctors in New York are outpacing their counterparts in other states, with just 8 percent of providers enabled for EPCS nationwide compared to 47 percent in New York. This is a significant improvement compared to just one year ago, when fewer than two percent of providers in New York were ready. Since March 1, the number of New York providers enabled for electronic prescribing of controlled substances increased 28 percent, according to the data. Indeed, this rapid increase in adoption was made possible because of electronic health record (EHR) software vendors’ certification of the technology, which is a necessity in order for prescribers to start using it. Currently, EHRs serving 96 percent of prescribers in New York are certified for EPCS, according to Surescripts.
The benefits of e-prescribing are logical, as it provides for a safer and more convenient way of ensuring that a prescription reaches a pharmacy. Also, it improves patient medication adherence; drug diversion is a major concern when it comes to controlled substances, with diverted drugs for abuse sometimes being tied to fraud or forgery of paper prescriptions. Certainly, the concept of e-prescribing is not a new one, but the mandate to require paperless prescribing is. If providers do not comply with this requirement, they face the possibility of fines, loss of license or even jail time. Other states, such as Minnesota, have similar e-prescribing mandates, but its Department of Health says there is currently no enforcement for non-compliance.
On the contrarian side of the argument, a December 2015 study from the Rockville, Md.-based DrFirst and the Medical Society of the State of New York (MSSNY) found that 44 percent of the 900 MSSNY physician members who were surveyed said they were not ready for EPCS. The reasons the providers gave ranged from their EHR not being ready (37 percent); I don’t write many scripts (28 percent) to ‘I resent the mandate” (14 percent).
To this end, as Healthcare Informatics Senior Contributing Editor David Raths wrote last month, a recent Wall Street Journal article noted that several health systems in the New York, including Mount Sinai Health System, Montefiore Health System, Northwell Health and NYU Langone have applied for waivers for some of their providers, seeking more time to comply to the March 27 deadline. However, it’s not that the providers at these patient care organizations do not agree with e-prescribing, but rather the details in the requirement made it tough to be ready by March 27, Raths reported, via the WSJ article.
One N.Y. Hospital’s Prep Pays Off
Nevertheless, for one healthcare organization in upstate New York, the Plattsburgh-based Champlain Valley Physicians Hospital, only about 30 miles from Canada, the clinical informatics team was ready for this requirement long before the March 27 date. In fact, they were prepared for it to take place as originally intended—March 2015, says Lisa Rabideau, R.N., clinical informatics manager at the hospital. “We were one of the first organizations that Imprivata (Lexington, Mass.) installed their two-factor authentication software for. Our clinicians find [e-prescribing] seamless for the most part, and the ones who are doing it like it quite a bit,” Rabideau says. “Like any other mandate, some are early adopters while others aren’t jumping on board even though the law took effect [recently]. The positive is that this specific mandate is on the providers, so we don’t police it. We have to make it available and they are the ones who have to comply,” she says.
Champlain Valley Physicians Hospital uses Surecripts’ e-prescribing network, in addition to Imprivata’s software for single-sign on capabilities and its two-factor authentication. The technology gives three options for its two-factor authentication, notes Rabideau, with one of them being a password, which is required, with the other two options being biometric (fingerprint) or soft token, which can be an app downloaded on a mobile device that creates a single-use login PIN. Prescribing clinicians can choose between these two options, she says. For controlled substances, the two-factor authentication piece does add some complexity, but those are the Drug Enforcement Administration’s (DEA) regulations which you cannot get past, she adds.
Rabideau says that clinicians at the hospital have not had any major e-prescribing issues so far, though some of its pharmacies have misunderstood the regulations and actually refused to fill paper prescriptions when they were generated because of technological difficulties. “I have had some providers who have had their credentials [disappear] all of a sudden, and we have to re-enroll them which takes 24 hours for that to be re-synced with the pharmacies. So we can’t re-send the prescriptions until that happens, meaning we will write a paper prescription so the patient doesn’t go without medication,” she explains. But, some of the pharmacies interpreted that incorrectly, wrongly assuming that they couldn’t fill a prescription that was given on paper, Rabideau notes. She adds that the state of New York recently sent a notice out to pharmacies that said they could fill paper prescriptions, as it’s not the pharmacy’s responsibility to validate that.
While there are not many exceptions to the e-prescribing legislation in New York, one is when the practitioner is issuing a prescription to be dispensed by a pharmacy located outside the state. This exemption hits home for Champlain Valley Physicians Hospital, as many of their patients are not only out-of-state but out-of-nation, from Canada. Rabideau says that the hospital discovered, via trial-and-error, that you can electronically send the prescription out-of-state, although it’s not required. However, if the patient has a Canadian billing address on his or her insurance, it will not go through Surescripts’ platform. Then, the prescribing provider would have to print the prescription for the patient to take to a local pharmacy, Rabideau notes.
While most clinical informaticists support e-prescribing broadly and have been doing it for years, naysayers of the New York mandate will point to the fact that patients, as consumers, don’t have as much flexibility when it comes to shopping around for the best medication prices. Since the prescription is in the technology system rather than with the patients themselves, they lose some control. Rabideau says that this is the one complaint her hospital has heard from patients, though she adds that most patients like it better to have the script ready when they get to the pharmacy—a benefit that supersedes the downside of not shopping the prescription around. “Some do miss the ability to shop around, but that’s not to say they couldn’t have the conversation before they’re discharged and make some phone calls about which pharmacy to send it to. They can tell us which pharmacy to send it to as long as the one they choose accepts them electronically, which all of our local pharmacies do,” Rabideau says.
What’s more, those opposed to the law also say that e-prescribing comes with its own risks of error such as choosing the wrong drug or dose on a drop-down menu. Rabideau hasn’t seen an issue with this at her organization, but notes that with the Surescripts system, the one challenge is that sometimes clinicians will type in the brand name, and if the system has already gone to generic, the brand name might not have the dose they want to prescribe. As such, they have to remember to type it in as generic so they can get all the dose choices, she says. As far as her personal opinion, Rabideau says that she supports the requirement in the state “so long as the software works.” She adds, “There are tiny technical frustrations that our clinicians might have, but they will adapt and get used to them. It’s just like anything else.”