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In recent years, EHRs and medical providers started to dispose of the paper prescription pad and began to send some prescriptions electronically from their EHRs. Those that know Alto Pharmacy know that we want all prescriptions to be sent electronically. It’s more efficient for providers and safer for patients.

The Case for E-Prescribing

Did you know that Electronic Health Record Systems (EHRs) have been around since the 1960s? Pretty much as soon as we got computers we realized that they could be used to make healthcare more efficient and more effective. Despite the massive forward leap in adopting EHRs, the tools used for prescribing medication didn’t change for another 50 years.

In recent years, EHRs and medical providers started to dispose of the paper prescription pad and began to send some prescriptions electronically from their EHRs. Those that know Alto Pharmacy know that we want all prescriptions to be sent electronically. It’s more efficient for providers and safer for patients. Whenever we broach this topic with medical providers we often hear them say “It’s illegal to send Schedule Two Narcotics (CIIs) electronically.”

The DEA made EPCS (Electronic Prescribing of Controlled Substances) a legally acceptable option for prescribing in June of 2010. Unfortunately the belief that it’s illegal to e-prescribe CIIs is widespread among medical providers and undoing it requires an awareness campaign. In 2012 the State of New York recognized the benefits of EPCS and passed legislation making it mandatory to E-prescribe all medications as of March 2016. We believe many more states will soon follow.

The Center for Disease Control and Prevention (CDC) has declared prescription drug abuse in the US an epidemic. Nearly 10% of all prescriptions written are pain relievers (opioids), which too frequently lead to patient dependence and abuse. It’s important to remember that seventy-eight Americans die every day from an opioid overdose.

As long as these prescriptions are written on a piece of paper, the pharmacies dispensing the medications can be easily manipulated and the dispensing cannot be easily tracked. Electronic prescribing saves lives by making it harder to commit fraud.

Did you know that the street value of the paper in a prescription printer is over $20,000? Get your hands on one of these printers (or even easier, a paper prescription pad) and you can mint whatever prescriptions you want. As long as you take each prescription to a different pharmacy and always pay cash, it’s hard to get caught. The result of this paper based prescription process and the large volume of CIIs being prescribed in the US is causing epidemic scale drug abuse and nearly 29,000 preventable deaths every year.

Although undocumented, medical errors have recently been estimated as the number-three cause of death in the United States. As an example, today it is far too easy for a pharmacy to accidentally translate a handwritten prescription for Oxycontin (extended release) into Oxycodone (immediate release). Depending on the prescription strength and the patient’s tolerance for opioids this could be a very serious medical error that in some cases may result in death. EPCS significantly reduces the risk of this medical error and saves lives by eliminating room for interpretation.

3) Make Medication Reconciliation Accurate

Reducing medical errors and helping prevent opioid abuse are great reasons to get rid of all paper prescription pads, but there’s another reason that’s not so obvious. When a patient’s prescriptions are sent electronically they can be easily tracked, which means they can also be used in medical reconciliation. Imagine if you had a complete and accurate view of all of your patient’s prescription medications? Imagine if your EHR allowed you to see everything that was prescribed in the last two years and when it was last picked up? Now imagine the power of this information in an emergency inpatient setting. How many lives could be saved?

PDMP is currently enacted in every state except Missouri, and is invaluable in helping pharmacists track controlled substance transactions. PDMP, also known as ‘CURES’ in California, requires pharmacies to report controlled substance dispensing to a searchable database. In California, pharmacies are able to log into CURES and view data on all reported dispensing of controlled substances.

‘Red-flags’ dispensing pharmacies look for:

Multiple controlled substances dispensed under multiple providers.

Large quantities of controlled substances regularly dispensed.

Patients that often don’t use insurance for their controlled substance prescription.

CURES allows dispensing pharmacies to make informed decisions that can curb the abuse of medications. CURES, however, isn’t always checked. Retail chain pharmacies are frequently challenged with an increasing volume of prescriptions with less manpower, and checking the database doesn’t happen at all pharmacies 100% of the time. For this reason we believe tracking the prescriptions through an E-Rx network is a better solution and a more accurate source of truth.

How does a prescription get to the pharmacy from my EHR?

In 2015 Surescripts electronically delivered over 9.7 billion prescriptions and connected over 240 million patients. If your practice is using a moderately popular EHR it’s most likely integrated with the gold standard eRx network, Surescripts. When you select a pharmacy in your EHR and send the prescription, you are using Surescripts to deliver the prescription. When the prescription arrives in the Pharmacy Management System, it indicates that this is a legal prescription sent by a legally authorized medical provider.

What other medical providers support EPCS?

In the 2015 National Progress Report we saw a 667% increase in EPCS from 2014, with over 12.8 million e-prescriptions of controlled substances sent on the Surescripts network.

Looking at this chart it’s pretty clear that EPCS is on the rise and eventually every provider will be e-prescribing. Due to the severity of the issues associated with paper prescriptions, we urge you not to wait. Here you can see a list of all medical providers near you that have enabled EPCS. We ask that you do everything in your power to join them in their efforts to save lives and make healthcare more efficient.

Most major EHRs support EPCS. If you are part of a large hospital system, please contact your Director of Pharmacy and request EPCS access. If you are part of a private clinic you can verify if your system supports EPCS here. If your EHR supports EPCS, simply ask your administrator to enable it. If your EHR is not on the long list of systems that support EPCS please contact their support, requesting a timeline for when they plan to enable it. If it’s not on their radar, they forgot the ‘e’ in EHR. In this case please consider alternative EHR solutions that will ultimately save lives.

When you ask your EHR provider to enable EPCS, they will verify that you are legally authorized to prescribe CIIs by verifying your DEA and NPI numbers. Once verified they may ask for a small fee to enable the licensing for e-prescribing. Notably, systems like Epic do not charge any fees for enabling EPCS.

When prescribing CIIs your EHR will ask you for a temporary key code for every prescription. This is the digital equivalent of the“wet signature” that is required when you write a prescription on paper. This is also known as Two-Factor Authentication (2FA). Other forms of 2FA include the increasingly popular biometric method. You can learn more here. Once you successfully enter your temporary key code or satisfy the 2FA requirement in some other way, the EHR will send the CII prescription to the pharmacy of your choice.

In the process of verifying you as a medical provider that can lawfully prescribe schedule II narcotics, your EHR will outfit you with a tool that supports Two-Factor Authentication. This will either be a tool you log into on your computer or smartphone, or a device you cary with you. When you log into the tool or press the button on the device, it will give you a temporary code that is unique to you. You simply enter that sequence of numbers into your EHR and the prescription is ‘signed’ and ready to send electronically.

Once verified by your EHR, you’re all set. You can now E-Prescribe Schedule II Narcotics. This is a very big deal! This change in prescribing means fewer cases of opioid abuse and dependence, fewer medical errors, and a much more efficient and convenient process for you and your patients. You are now leading the industry in a new way of administering healthcare, and we welcome you as a proud partner of Alto Pharmacy.

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The Case for E-Prescribing

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