- UPDATE: On March 13, New York Governor Andrew Cuomo signed into law a bill that delays the e-prescribing of controlled substances by a full year.
New York healthcare providers and pharmacies are approaching an important deadline for electronic prescribing of controlled substances (ePCS) that goes into effect later this month.
Effective March 27, 2015, all prescriptions for controlled substances must be transmitted electronically as a result of regulations included as part of the Internet System for Tracking Over-Prescribing (I-STOP) Act. Although New York healthcare providers have had two years to prepare, many are still unprepared and more than likely supporting a bill to delay ePCS implementation.
“As the medical society and other specialty groups in New York started to get focused on this, they have made the judgment that providers are not far enough along, which is why there are bills in the legislature to delay it,” says Ken Whittemore, SVP of Professional and Regulatory Affairs at Surescripts.
Last week, the Associated Press reported that New York legislators had voted in favor of postponing the state’s ePCS deadline by one year and now awaits the signature of Governor Andrew Cuomo.
Based on data from its network, the disparity in the progress of prescribers and pharmacies in terms of ePCS preparation is overwhelmingly apparent. The former (Figure 1) are nowhere close to catching up with the latter (Figure 2) when it comes to ePCS enablement.
According to Whittemore, the cause for this disparity results from the requirements the regulations place on healthcare providers.
“There is a certain amount of lead time that is involved there,” he maintains. “It’s not something you can just get done in a week for sure.”
On the one hand, healthcare organizations must rely on their EHR vendors to complete crucial activities.
“There is nothing that New York State prescribers can do unless their vendors have done the coding and development on their end,” Whittemore explains. “Once that is done, the vendor needs to an ePCS certification on our network. We have a basic e-prescribing certification process, but then we had an add-on. In addition to that (and more of a hurdle) is the fact that the DEA requires that these applications be audited by a third party to ensure that what they have done meets the DEA’s ePCS requirements.”
On the other hand, physicians have their own tasks to complete before beginning to undertaking ePCS.
“The physicians then have a few things to do,” Whittemore reveals. “They have to go through an identity-proofing process. The result of that process is that they are issued a two-factor authentication credential for signing ePCSs. Then and only then in the State of New York, they also have to apply for approval from the Bureau of Narcotic Enforcement.”
Onus is on providers, not vendors
While healthcare providers have to rely heavily on their EHR vendors to have ePCS capabilities enabled in their EHR technology, they still have plenty of work to complete in-house, says Cerner Senior Strategist Matt Moore.
“My advice to all clients is that it sounds daunting but read the DEA’s IFR. When you get down to it, the last ten pages are the requirements because it does put the onus on the healthcare provider, not the EHR,” he claims.
Moore is referring to the contents the Drug Enforcement Administration’s interim final rule that put in place the current March 27 deadline. Although ePCS requires EHR technology to work, it requires much more than that, says Moore.
“ePCS is tremendously complex. It involves a number of software considerations but also policy-, procedure-, and governance-type implications for the healthcare provider,” he explains. “It is a lot to consume. New things may need to be instantiated. Having folks understand what it is and all of it involves has been the challenge and it speaks to the slow rise in the adoption curve.”
Echoing Whittemore from Surescripts, Moore again highlights the critical role non-software processes play in a healthcare organization’s successful handling of the ePCS mandate. This is especially the case for Cerner whose technology has included ePCS functionality for some time.
“We tackled this quite a long time ago, really before a lot of people were ready including pharmacies,” says Moore. “ePCS is fully baked into the EHR. It’s the same workflow regardless of venue. It was already entrenched in our EHR when the New York I-STOP legislation came around.”
Unfair blame for the messenger
Unlike healthcare providers, New York pharmacies and their staff appear quite capable of dealing with the March deadline for mandatory ePCS, but that isn’t likely to remove the growing pains associated with helping patients deal with filling their prescriptions in a new way.
“Pharmacy has been ready all along. The impact on pharmacy is going to be a change in workflow as a result of receiving prescriptions in a different manner on a more consistent basis,” says Tracy Russell, CAE, Executive Director of the Pharmacist Society of the State of New York (PSSNY) for the past 18 months.
While the pharmacy community has worked closely with the Bureau of Narcotic Enforcement and state officials on the I-STOP, they are not immune to the effects of the provider community failing to implement ePCS efficiently and effectively. There is no passing the buck in this case.
“If the prescribers are not totally onboard or doing something right, it’s going to fall on the pharmacist to solve the situation,” adds Russell.
It is easy enough for Russell to imagine scenarios where pharmacists must serve as the bearers of bad news, such as when the pharmacy lacks the inventory to fill a prescription and a new ePCS must be transmitted to another location. This has PSSNY pushing state officials to offer guidance.
“Pharmacy is not the police; they are not there to determine whether or not a prescriber has received those legitimate means not to e-prescribe,” she explains. “The concern for the pharmacy on that end is that we need guidelines from the Bureau of Narcotic Enforcement and Medicaid and the Department of Health so that there is not a misunderstanding — that they are allowed to fill other prescriptions as long as they deem them to be legitimate.”
Regardless of when the ePCS deadline goes into effects, its purpose to reduce the abuse of controlled substance and improve patient safety remains the same. Still much work needs to be done in order for healthcare organizations and providers to ensure that this aim is met.