ePrescribing: Ready for Prime Time. But is Your Government?

Jan. 1, 2009

Ordering cheeseburgers at fast-food joints triggers more technology than getting a prescription written for Vicodin. Crazy? It’s also true. That was part of the U.S. Senate testimony offered by my colleague, Laura Adams, president and CEO of Rhode Island Quality Institute, during testimony to Congress on why ePrescribing’s time had come. I also testified and said the technology to handle such a need exists and has been proven for nearly a decade. We argued that not only is ePrescribing of controlled substances ready for prime time, it’s well past due. It can and should be legal for all major classes of drugs, including Schedule II narcotics; however, our government doesn’t think so — at least not yet.

Ordering cheeseburgers at fast-food joints triggers more technology than getting a prescription written for Vicodin. Crazy? It’s also true. That was part of the U.S. Senate testimony offered by my colleague, Laura Adams, president and CEO of Rhode Island Quality Institute, during testimony to Congress on why ePrescribing’s time had come. I also testified and said the technology to handle such a need exists and has been proven for nearly a decade. We argued that not only is ePrescribing of controlled substances ready for prime time, it’s well past due. It can and should be legal for all major classes of drugs, including Schedule II narcotics; however, our government doesn’t think so — at least not yet.

By replacing pen and paper with bytes and bits, we argued, lives will be saved, inefficiencies and errors will be wrought out of the system, disease trends will be spotted, and bad docs and rogue pharmacists will go to jail — a cost that is orders of magnitude less expensive than with paper. Too Pollyannaish? Not necessarily.

Past Legal Hurdles

In spite of all the evidence that technology brings to the table (e.g., reduced costs, decreased errors and greater efficiencies) the U.S. Drug Enforcement Administration (DEA) has only allowed hand-written prescriptions to dispense Schedule II narcotics. This is the case even though, as Newt Gingrich famously noted, “paper kills.”

The DEA traditionally has maintained that, in spite of the known advantages technology offers, there has always been room for error, unscrupulous docs, lack of control and a “wild west” mentality. These are the same fears that previously blocked online retail purchasing some 15 years ago, during the Internet’s infancy. Today, thousands of consumers shop online, trusting their credit histories to bits and bytes over the Web. They do this because the system now contains enough built-in safeguards that protect identity and banking information to invoke trust.

Healthcare, for all of its clinical advances, has just taken the slow administrative road to technology adoption, as witnessed by the 75 percent or so of physicians that still use paper files for pretty much all patient records and prescriptions. Some say the solution is to use both systems (paper and electronic) side-by-side until there is enough trust in ePrescribing. Yet, time after time, physicians have shown that they just won’t use two systems. Redundancy of parallel systems, they say, is just too cumbersome and too much of a bother.

Present Legal Hurdles

I told Sen. Sheldon Whitehouse, who championed this cause, that healthcare needs to look to other industries that already have solved similar problems of security and identity. These companies shared a common goal of safely and securely exchanging vast amounts of sensitive data outside of their organizational walls.

The automotive industry, for example, formed a collaboration hub a decade ago (Covisint) that securely enables the sharing of specific inventory, purchasing, engineering and administrative data. Hundreds of thousands of employees in this industry securely exchange large amounts of sensitive information and access remote applications on a daily basis.

With a four-digit code and a piece of plastic, banking consumers trust that their identities will remain intact whether they’re withdrawing ATM cash or making impulse purchases on Paris’ Avenue des Champs-Élysées. Major stock exchanges also have no problem electronically transacting tens of billions of dollars daily.

Security is the lynch pin upon which all success rests for both the automotive and banking industries. Same goes for healthcare, which could literally transform itself overnight by aggressively adopting technology and, in ePrescribing’s case, save lives while also saving money.

What’s Next

A number of good signs have emerged since our December 2007 testimony. Namely, Attorney General Michael Mukasey penned a letter signed by 19 U.S. Senators, including President-elect Barack Obama, Ted Kennedy, John Kerry, Lindsey Graham, Arlen Specter and Tom Coburn, which urged the DEA to adopt the security technology used by other industries to enable ePrescribing. The DEA has finally begun to listen. Earlier this year, it proposed a new set of rules regarding the electronic prescribing of controlled substances. These new rules will allow electronic prescribing of controlled substances under a set of security controls, which are still being reviewed by the Office of Management and Budget.

What You Need to Know and Do

Keep informed and stay active. Follow the DEA’s actions, and keep in touch with your legislator or your physician’s association. They value your input.

Take your time. Don’t be duped into the first shiny new system that some sales person drops into your lap with all of its electronic bells and whistles. Ask your colleagues what they like, what has proven successful, and tailor your questions based on your experience and the feedback others give you.

Change is coming, so be prepared. You likely will soon implement ePrescribing for controlled substances. Train your key personnel on the new systems in advance and adopt systems aggressively.

Brace for resistance. Contrarily, leveraging technology is not second-nature to many in healthcare — there will be detractors. Know that a cultural change is afoot and deal with that before the technology enters your workplace. Now is the time to start that process.

Final Thoughts

The DEA is currently in a review period for the newly proposed rule on ePrescribing as it relates to controlled substances. The public comment period is now over and the DEA is determining what changes, if any will be made to the rule. If no changes are made this rule will become part of the DEA regulation.

I continue to consult with Sen. Whitehouse on the security and identity intricacies involved in enabling such legislation. There is hope that healthcare may finally catch up to other industries and adopt secure technologies that make real differences in people’s lives. Perhaps, soon, writing prescriptions for controlled substances will actually trigger more technology — and security — than does ordering a Big Mac.

David Miller is chief security officer for Covisint. Contact him at [email protected].

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