How to set up e-prescribing for controlled substances

By most accounts, the United States is in the midst of a public health crisis: premature death from opioid-related problems. In 2016 alone, more than 40,000 people died during this epidemic (JAMA Network Open 2018; 1:e180217). Most agree that the source of the crisis lies in the addictive nature of opiates and historical overprescribing and availability of these drugs (MMWR Morb Mortal Wkly Rep 2017; 66:697-704).

The diversion of prescription drugs is a well-documented event and occurs in urology practices and patient populations. Most states have now created some form of Prescription Drug Monitoring Program (PDMP); typically, the PDMP encourages or requires prescribers to consult a database prior to prescribing controlled substances and/or imposes a reporting requirement on the dispensing of same. Some states have tied continuing education on controlled substance prescribing to professional licensure. Many states have required tamperproof forms for written prescriptions, some of which are compatible with electronic health record printing. Some states still allow verbal prescriptions for controlled substances under some circumstances.

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Yet one of the most powerful tools for streamlining workflow, preventing diversion, and monitoring the prescribing habits of physicians is still not widely adopted-electronic prescribing of controlled substances (EPCS). One vendor estimates that only about 25% of prescribers nationwide are using EPCS, but over 90% of pharmacies are accepting it (bit.ly/EPCSinformation). EPCS has been permitted under federal regulation since 2011 (bit.ly/DEAonEPCS). Local jurisdictions took some time to update their statutes, regulations, and rules (state boards), but EPCS is now technically permitted in all 50 states.

Implementing EPCS in a practice requires multiple steps and the involvement of third parties (often managed by your EHR vendor). The biggest barrier to EPCS may simply be a lack of information on the subject. In this article, I will review the steps necessary to begin EPCS.

Next: Is your software certified for EPCS?Is your software certified for EPCS?

The first step in the process is to ensure that your e-prescribing software, typically imbedded in an EHR, has been certified for EPCS. You can either ask your vendor or check this website: bit.ly/ePrescribingsoftware. In this author’s experience, most of the EHRs in common use in urology practices across the country have met the certification requirements for EPCS.

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The second step in the process is identity proofing. This setup step confirms your identity with a trusted third party, such as a credit bureau or identity management service. (This step may also be managed by your EHR vendor and/or a third party.) Because identity proofing requires access to your credit history, it may be necessary to allow that access by removing an account freeze or enabling your identity protection account (eg, LifeLock, Identity Guard, etc.) The process will match the information you entered with identity records, and you may be asked to answer some security challenge questions. This step is complete when you receive confirmation that your identity has been verified.

The third step, which may happen in conjunction with identity proofing, is establishing a two-factor authentication method. Two-factor authentication typically grants secure access to an account holder based on something they have-like an ATM card or hard token-and something they know, like a PIN or password. Two-factor authentication setup may occur during identity proofing so that the information is tightly coupled to your identity record. Smartphones may allow you to keep the token in a secure application (soft token).

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The final step in the setup process is establishing access within the administrative section of your EHR/prescribing software and enabling providers who have completed identity proofing and two-factor authentication to actually use EPCS. This step may require your EHR administrator and someone who has actually completed identity proofing (like a provider) be physically present together.

Next: Many benefits for providers, patientsMany benefits for providers, patients

While the setup is necessarily rigorous, once EPCS has been set up for a provider, it should be similar to e-prescribing any other drug, with the additional two-factor step. Many providers report they find EPCS fast, easy, effective, more convenient for patients, and more secure for peace of mind (bit.ly/EPCSbenefits). EPCS should reduce or eliminate callbacks from pharmacists. EPCS should ensure that all controlled substance prescribing is now captured in the EHR, providing a more accurate list of medications and history. It will allow accurate reports and monitoring of prescribing activity across larger organizations, enabling physician leaders to recognize irregular prescribing habits and facilitate education about best practices for prescribing controlled substances (bit.ly/CDCopioidguideline).

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EPCS comes at a cost-typically a setup fee and a modest per-provider subscription paid to your EHR vendor. There may be a tangible return on this investment if EPCS saves a few seconds or minutes of provider timethat might otherwise have been spent on walking to a printer, manually filling out a written prescription, answering phone calls from pharmacists, or dealing with “lost” prescriptions. One need only reflect on the benefits and efficiencies of e-prescribing for all other drugs to question why controlled substances remains the exception instead of the rule.

Bottom line: EPCS is now live in all states, available through most EHR vendors, and probably cost effective in your practice. EPCS may result in less drug diversion and fewer opioid-related deaths in the U.S. Check with your EHR vendor to get started.