What It’s Like to Be an EPCS Pioneer

April 19, 2016
The old saying is that “the pioneers take the arrows; the settlers take the land.” But is that always true? Sometimes early movers find that implementing something new isn’t as painful as it is made out to be.

The old saying is that “the pioneers take the arrows; the settlers take the land.” But is that always true? Sometimes early movers find that implementing something new isn’t as painful as it is made out to be.

A case in point is electronically prescribed controlled substances (EPCS). At Healthcare Informatics we have written quite a bit about the challenges involved in making the transition from handwritten to digital prescriptions for controlled substances. Last year at this time I wrote about the EPCS efforts of Nebraska Methodist Health System in Omaha based upon a great presentation I saw at the American Nursing Informatics Association 2015 Annual Conference in Philadelphia.  Colleague Rajiv Leventhal just interviewed Lisa Rabideau, R.N., clinical informatics manager at Plattsburgh, N.Y.-based Champlain Valley Physicians Hospital about its roll-out to meet an EPCS mandate that took effect in New York on March 27.

I recently had the chance to speak with Todd Smith, M.D., chief medical information officer at St. Paul, Minn.-based HealthEast Care System, which has four hospitals and 14 primary-care clinics. HealthEast made the interesting decision to launch an EPCS effort in conjunction with an enterprise-wide switch from Allscripts to Epic in 2014. Unlike the folks in New York, HealthEast was under no regulatory pressure to make the switch by a certain deadline. Instead, they saw it as a patient safety, clinician satisfaction and efficiency gain.

“We knew we wanted to do the EPCS, and were wondering when the time would be right,” Smith said.  “We decided to do it when we were changing EHRs because Epic has the capability of doing it, while the former EHR we were on didn’t. We wanted to see how we could make them line up.

They worked with a vendor that develops fingerprint technology and single-sign-on capability.  “We implemented single sign-on the month before we changed to Epic, and the EPCS started when we switched the flip to Epic,” Smith said. “I think our providers are pleased. It is amazing that we went from ideation to rollout in just over six months. “The interesting thing is that when we surveyed providers and asked them what the best part of the Epic implementation was, many said it was our EPCS process, which technically wasn’t Epic, but they perceived it as one big change.”

Smith said the project was successful because they matched the technology with what they needed to do from a legal and regulatory perspective, and then tried to make the providers as happy with it as possible. The key is working together as a team, rather than IT trying to do it in isolation. “Some providers that have tried doing it have not had that kind of balance we have between security and ease of use. They made it so secure and didn’t involve providers from the beginning, and the solution was really clunky.”

Smith and colleagues gave a presentation at HIMSS in Las Vegas to a roomful of 200 people. He said approximately 50 came up afterwards to ask questions. “If I could stress anything, it is the partnership of providers, security and technology,” he said. “Get those three in a room together to say, ‘This is what we want to accomplish, these are the guidelines we have, and this is the tool we have. Let’s work together to see how we could make it smooth and work out better.’”

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