E-prescribing: What’s now and what’s coming

July 29, 2015

Electronic prescribing of both controlled and non-controlled substances may not currently be top of mind for many healthcare organizations, given other large-scale technology initiatives (ICD-10 and Meaningful Use, for example) sitting on the front burner. Yet, as healthcare providers in New York gear up for a 2016 e-prescribing mandate, there has never been a better time to discuss the importance of automating medication orders.

The current state of e-prescribing

Hospitals and physician practices have been e-prescribing non-controlled medications (such as cholesterol medication, antibiotics, or birth control pills) for quite some time. However, other types of healthcare organizations, including long-term care and assisted-living facilities, have traditionally shied away from e-prescribing, relying instead on paper-based processes. With the lack of Meaningful Use dollars coming into these types of facilities, there is little financial incentive to embrace electronic health records (EHRs) that facilitate automated medication orders.

Even organizations that do electronically prescribe medications often do not use technology to order controlled substances, such as narcotics. In fact, controlled substance e-prescribing is rather rare across all healthcare settings.

To bring everyone onto the same playing field, the state of New York is requiring organizations of all kinds to engage in e-prescribing for both controlled and non-controlled substances. The mandate stems from New York’s iSTOP program, which collects data about controlled medication prescriptions from pharmacies and other dispensing agencies, and houses the information in a registry. The law requires providers to review the registry before prescribing a controlled substance. The thought is by sharing critical information across healthcare settings, organizations can prevent overprescribing and limit the likelihood of drug abuse.

In addition to supporting more controlled prescription information exchange, New York’s mandate pushes for greater physician involvement in prescribing, demanding the physician submit the prescription instead of delegating the work to a nurse or physician’s assistant. While this is the usual course of operations in hospitals and doctors’ offices, it represents a substantial process change for many long-term care organizations.

Postponing the mandate

Although New York is committed to wide-scale e-prescribing, it recently delayed mandate compliance until March 2016. There are two reasons behind the decision. First, while many EHR vendors currently offer the ability to e-prescribe, only a few have received the necessary federal certification to allow for the e-prescribing of controlled substances. The delay gives the federal government more time to certify vendors. Unfortunately, if a vendor is not located in New York, it may choose to defer certification until other states enforce a mandate.

Second, moving the deadline gives provider organizations additional time to onboard and/or upgrade e-prescribing systems. In the case of providers who are still paper-based, such as long-term care organizations, it gives them the opportunity to work through the various workflow changes and get an EHR up and running.

All that said, the process to become compliant with an e-prescribing mandate takes time, so all providers need to start preparing now to avoid missing deadlines or other potentially negative consequences.

Why prepare now?

Even though New York is the only state with an e-prescribing mandate on the books, the shift to prescription automation for both controlled and non-controlled substances is inevitable as more states embrace the idea and keep a close watch on New York’s activities. As such, healthcare organizations should be taking steps now to get ready for compliance.

Although it may be tempting to delay in favor of other pressing initiatives, one should not underestimate the amount of work that goes into achieving compliance. Technology implementation takes time, and if organizations put off starting until closer to the mandate deadline or, even worse, wait for their own state to enforce a mandate, they may be rushed to get a system in place. EHR vendors will be challenged to get all customers up to speed on controlled substance prescribing. In a worst-case-scenario situation, waiting until a compliance deadline is looming to implement an EHR system could result in scheduling conflicts for the vendor, which would then endanger the organization’s likelihood of meeting compliance in a timely manner.

Starting early also lets an organization garner full physician buy-in to an automated process. For example, less-than-enthusiastic physician engagement can be a significant barrier to e-prescribing, especially in long-term care organizations and other areas where providers must learn new workflows as a result of the mandate. Allowing sufficient time and resources to fully educate physicians and gain their support is crucial to achieving success.

The benefits of e-prescribing

While some healthcare organizations outside of hospitals and physician practices may be hesitant to adopt e-prescribing, there are many benefits to automating medication orders, including the following:

  • Mitigates common problems with paper. E-prescribing substantially reduces poor handwriting issues often associated with paper-based prescriptions. These can cause dosing errors or medication mix-ups that lead to serious patient harm. Automation also removes the need for the pharmacy to transcribe prescriptions because it will receive structured, formatted data directly from the prescriber. This not only saves time but also increases prescription accuracy and prevents misinterpretation.
  • Avoids negative drug interactions. A noteworthy e-prescribing benefit is that the technology automatically checks for drug interactions, evaluating possible concerns and sending an alert to the prescriber. This ensures a clinician doesn’t inadvertently order a medication that would interact poorly with other therapies, exacerbating the patient’s condition instead of treating it.
  • Prevents overprescribing. As mentioned before, controlled substance prescriptions have fallen outside the e-prescribing purview up to this point, requiring additional (and inefficient) steps that are written and tracked manually. With the mandate, prescribers must input prescriptions directly into an application or EHR, streamlining the process and preventing error. This ensures all necessary documentation is included in controlled substance prescriptions, unlike paper processes in which critical documentation can easily get lost or misplaced. Moreover, by capturing controlled prescriptions electronically, organizations can easily share that information with other providers through secure data repositories such as New York’s iSTOP program, preventing overprescribing and significantly curbing medication abuse.
  • Helps with care transitions. As healthcare becomes increasingly interoperable, organizations of all types must find ways to share data across settings, and medication data is a critical type of information to exchange. From acute care facilities to long-term care organizations, if data is not in electronic format, it’s harder to share. Automated solutions, however, can seamlessly send information to a designated health information exchange (HIE) or directly to another provider’s EHR.

For some, gearing up for e-prescribing will mean updating already existing systems to enable controlled substance prescriptions. However, for others this effort will require revamping workflows and onboarding all-new technology – in some cases for the first time. The reality is, the sooner an organization gets started down the road to e-prescribing, the smoother the transition will be.

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