ePrescribing – Mainstream, but still room to expand and improve

Electronic prescribing – the process of writing a prescription using a computer and transmitting it electronically to the pharmacy – is, at last, a mainstream process.   ePrescribing has come a long way from the seminal days in the 90’s when gadget-loving early adopters began using their DOS-based PCs and Palm Pilots to write prescriptions.   Fast forward to today, and Surescripts (the primary electronic data interchange (EDI) EDI network used for transmission of prescriptions to pharmacies) reports that 1.4  billion prescriptions were ePrescribed in 2015.
Basic ePrescribing, described as writing a prescription using a computer, checking it for drug interactions and formulary status and transmission to the pharmacy, is ubiquitous.  With the majority of providers using electronic health records (EHRs) and ePrescribing being a core functionality of an EHR, it is estimated that 75% of all prescriptions are electronically prescribed.
It’s tempting to think that “our work here is done”.  There are, however, a few frontiers still to be conquered on the ePrescribing front.
One of those frontiers is electronic prescribing of controlled substances (EPCS).  A few years ago, the DEA removed the final remaining hurdles which had prevented CS prescriptions from being ePrescribed.  Today, EPCS is legal in all 50 states and supported by the most EHRs.  There are some unique requirements for EPCS, including the need for special credentialing and use of additional security features (known as dual factor authentication).
Some providers, especially those who write only a few CS prescriptions, have opted not to adopt EPCS even if they ePrescribe non-controlled prescriptions.  There are significant patient safety and public safety benefits accrued from the use of EPCS.   Electronic prescriptions feature a trackable electronic audit trail and are not able to be diverted for unlawful fulfillment.  Addressing our country’s “opioid crisis” is top-of-mind at the State and Federal level, and there is a focus on mandating EPCS.
Some states, such as New York and Minnesota already mandate electronic prescribing for all medications and a number of states have adopted rules required ePrescribing of controlled substances.  When the New York rule, called I-Stop, went into effect, the number of providers enrolling and getting trained at the last minute overwhelmed the industry.  Many providers ended up missing the deadline and risked penalties because they weren’t able to get set up quickly enough.  Rather than wait for a legislative mandate, it makes sense to plan ahead and adopt EPCS ahead of a requirement.
Another frontier is that of electronic prior authorization, or ePA.    ePA enables a prescriber to gather and electronically communicate the information required by the payer for prior authorization, at the time of prescribing.  Using ePA benefits the prescriber by identifying additional requirements that must be met before the patient can receive their medication.  ePA also benefits patients because it reduces the delays caused by a paper-based prior authorization process. To coin a phrase, use of ePA reduces the “days to therapy”, which measures the amount of time it takes from when a patient is prescribed a medication and the time they begin taking the medication.   While ePA doesn’t eliminate prior authorization, it does speed up the process and reduces at least some of the administrative burden.
Several EHRs have integrated ePA into their ePrescribing function, and many have plans to do so.  As an interim solution, there are web-portal based applications which providers can use to automate the submission of prior authorization information.  As with EPCS, there is ongoing legislative activity which will require pharmacy benefit managers (PBMs) and payers to accept ePA, as well as require providers to submit ePA.   Similarly, it makes sense to integrate ePA into the workflow well before the mandate, to avoid the last-minute rush.  It also makes sense to make requests of your EHR vendor to integrate ePA, if it is not already a feature.
We’ve come a long way since the 90’s.  Taking advantage of a few additional functions will go a long way toward 100% electronic ePrescribing, with all the patient and public health benefits associated with safe pharmacotherapy.

Michael Burger is a senior consultant with Point of Care Partners, a healthcare IT consulting firm. Michael can be reached at michael.burger@pocp.com or at www.pocp.com.

Last Updated on May 12, 2017