Is Electronic Prescribing of Controlled Substances Around the Corner?

Sept. 20, 2013
An area ripe with security and technical barriers, ePrescribing of controlled substances (EPCS) is still very much a work in progress for most healthcare organizations. In this Q&A, HCI Associate Editor Gabriel Perna speaks with Todd Richardson CIO of Aspirus Health in Wausau, Wisc., an organization that has its eyes on EPCS and is beginning to put the dual-factor authentication technology that will ultimately enable it.

If there were ever an area of healthcare informatics that could truly be called a “work in progress” it’s ePrescribing of controlled substances (EPCS).

For starters, it was only in 2010 that EPCS actually became legal, when the Drug Enforcement Agency (DEA) issued its interim final rule (IFR) on the activity. Until then, it was a no-go.  Since then, while the process has received an uptick in adoption (428 percent over the last six months of 2012, according this vendor-provided study), it’s still very much an area ripe with both security and technical barriers.

Just meeting the DEA’s measures for EPCS requires a significant investment of time and resources into authentication. The final rule required providers to use two factor authentication protocols when prescribing a controlled substance electronically. This part of the rule, according to a research survey that appeared in a 2012 edition of the Journal of the American Medical Informatics Association, was unpopular with care providers, one-third of whom said this would discourage their adoption.

Some provider leaders, like Todd Richardson, are just beginning to dip their toes in EPCS’ uncertain waters. Richardson is the CIO of Aspirus Health in Wausau, Wisc., a six-hospital health system with one main 250-bed campus in Wausau, Wisc. and five critical access hospitals (CAHs) throughout Wisconsin and Michigan.

Todd Richardson

Under Richardson, Aspirus has made a strong commitment to health IT. Its main hospital has been an Epic Systems (Verona, Wisc.) shop since 2003-2004 and is at “pretty full deployment,” he says. It attested to Stage 1 of meaningful use under the Health Information Technology for Economic and Clinical Health (HITECH) Act and is on track for Stage 2 as well as the transition to ICD-10, he says.

Along with those commitments to IT, Aspirus has begun ePrescribing for non-controlled substances. Understanding the philosophy behind this swift evolution towards an electronic environment is a big part of Aspirus’ intrigue with EPCS.  HCI Associate Editor Gabriel Perna spoke with Richardson about the possibilities and challenges of EPCS and the organization’s specific plans. Below are excerpts from that interview.

What’s the appeal of EPCS? With the security barriers, some might just say, “Why bother?”

I see it as a natural progression; if you look at the trajectory of where we are with technology, where we are from moving from paper to the electronic world, prescribed controlled substances is kind of that last bastion that makes us deal with paper. That’s not as efficient clearly as the electronic prescription for non-controlled substances. That’s pretty seamless for us and our patients are used to it.

Dealing in a world of dichotomy, some patients, in some out, they don’t always understand it [the differences in regulations for prescription of controlled and non-controlled substances]. They don’t understand when you’re prescribing multiple prescriptions for a patient and some are done electronically and some you’re writing on a piece of paper. Clearly, it’ll be a satisfier for our patients if we can do it one way.

What kinds of plans, from a technical standpoint, do you have for EPCS?

With the technology that surrounds it, we’re thinking about using Imprivata [a Lexington, Mass.-based health security software vendor] with the fingerprint readers for the dual-factor authentication. That serves two purposes for us. We’re using Imprivata today  with badges that certainly have made the doctor’s lives better from a log in and log out perspective,  but it’s not as elegant as using the finger print readers.

So prescribed substances aside, if we’re moving to a product that deals with biometrics, we can log our providers in and out faster and it secures the record better from a security and compliance perspective – you can’t hack a finger print. It raises the bar on security of patient information and at the same time provides a better mechanism for getting providers in and out of the applications that they are doing hundreds of times per day. The third kicker is that it provides us with the foundation for EPCS. So it’s a good thing on three fronts.

The fingerprint reader, which provides Aspirus with the foundation for EPCS

Source: Imprivata

Obviously, there are some legal entanglements when it comes to this sort of thing with the DEA and the state board of pharmacy. Has this been a reason for Aspirus to not go forward with this in the past?

As we look through the regulations we’ll leverage our legal department to keep us out of the weeds. I think philosophically, a healthcare system is going to come down on one of two sides of this. They’re going to enable as much as they can to make everything as efficient as they can or they are going to be a laggard and do it when someone forces them to do it. It’s not the right answer for everyone, it falls in line with the philosophical approach that your health system is going to take to your technology and providing tools to providers and patients.

How lenient is the state of Wisconsin when it comes to ePrescribing for controlled substances?

I’m not sure. I believe they do allow it, which is why are going down this path. It’s still out on our horizon. We have not established a timeline for doing it. Going through the final details and getting our ducks in a row is not on my project list right now. We’re putting the foundation in place. We’re getting ready for it by putting the enabling technology out there. When we pull the trigger and do it? That will be a bigger project for another team to decide. We haven’t set a timeline. The bottom line is the biometrics is not being driven by EPCS.

Where do you expect EPCS to be in the next five years? Do you see a point where it becomes a widespread system?

I don’t know how you are going to stop it. It’s the next logical progression. If you’re doing part of your prescriptions electronically, why not all of them when the regulatory and technology issues have caught up to it? To continue to maintain a paper world, I can’t see any part of our healthcare industry going backwards in paper or holding onto something that is a dying technology, and lack of a technology. When will it happen? I wouldn’t speculate.

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