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E-prescribing's Next Steps: Controlled Substances

   March 28, 2017

The reason EPCS became imperative in New York state had everything to do with the prescription opioid drug abuse epidemic, which had ravaged rural and urban areas of the state. "The New York Bureau of Narcotic Enforcement (BNE) was seeking to utilize technology to forensically discover the providers who are abusing narcotics dispensing," Hickman says.

By implementing e-prescribing and multifactor authentication, the BNE and other state and federal enforcement agencies, such as the U.S. Drug Enforcement Administration, aim to reduce theft of prescriber passwords and prescribing pads intended for controlled substance prescriptions. But first, information systems of prescribers had to be made ready by the vendors and provider organizations.

In Cambridge Health Alliance’s case, EPCS technology provider Imprivata integrated EPCS into Epic, Cambridge Health Alliance’s EHR. "The biggest challenge is really getting the [physicians] in and doing the registration in person so that you can verify their identification," Herrick says.

Healthcare's battle to curtail prescription drug abuse is being fought on multiple fronts. In many states, physicians already have to log into a prescription drug monitoring programs (PDMP) database to review the history of any controlled substances prescribed to a patient.

"The PDMPs have been around for 30 or 40 years depending on the state," says Thomas Sullivan, MD, chief strategic officer at DrFirst. The problem is, "they just weren't adequately funded. They weren't online, and they're completely under the control of each state," Sullivan says.

Piecemeal Mandates
States have implemented piecemeal mandates for use of PDMP and EPCS. Prior to its 2016 EPCS mandate deadline, New York in 2012 had mandated prescribers use its PDMP website by 2013, known as I-STOP (Internet System for Tracking Over-Prescribing Act). Neighboring state Massachusetts enacted severe penalties beginning in January for prescribers who do not consult its PDMP, says Sullivan.

With the I-STOP PDMP, "the real impact on curbing drug-seeking behaviors really kicked in long before electronic prescribing," says Michael Oppenheim, MD, chief medical information officer at Northwell Health, which operates 21 hospitals and approximately 550 ambulatory sites in metropolitan New York and Florida.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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