- For those looking to address the abuse of controlled substances, an important mandate goes into effect this weekend in New York State requiring electronic prescribing of controlled substances (ePCS) for all prescribers.
The effective date for ePCS under the Internet System for Tracking Over-Prescribing (I-STOP) Act was scheduled to begin last March 27, but New York Governor Andrew Cuomo signed into law a one-year delay last spring pushing the date to March 27, 2016.
Since that delay was signed into law, focus on the abuse of controlled substances, namely opioids, has risen in prominence. The Department of Health & Human Services reports that 44 people die each day as a result of opioid overdose and has issued a call for action. Additionally, opioid abuse has attracted Congressional interest.
One obvious way of reducing the abuse of controlled substances is greater control over the prescription process, the impetus behind the New York law mandating ePCS.
EHRIntelligence.com caught up with Ken Whittemore, SVP of Professional and Regulatory Affairs at Surescripts, to discuss the upcoming compliance deadline and its implications for similar regulation in other states that have kept a close on the approach taken in New York.
EHRINTELLIGENCE.COM: What is the current status of New York providers in implementing and use ePCS?
KEN WHITTEMORE: There has been dramatic improvement since this time last year, most particularly over the past several months. Because the deadline is so close, we have been tracking this every week to see how much things have improved. And even since the end of February there have been dramatic increases in terms of the number of e-prescribers in New York rising and those who are enabled for ePCS.
Right now, 70 percent of prescribers in New York are now active e-prescribers, and 47 percent of the prescribers in New York are ePCS. Another way to look at that is of those e-prescribing in New York, 68 percent of them can also e-prescribe controlled substances. I’m pretty sure this time last year, we were in single digits. I attribute it all to I-STOP and the deadline that comes up this Sunday.
EHRIntel: Are mandates more effective than incentives in promoting health IT use such as ePCS?
KW: From the standpoint of providers, they probably prefer incentives like the federal government offered through HITECH — if they had their choice. Also, putting a deadline and saying there are penalties if you don’t meet this deadline also obviously has an effect.
Clearly, the legislature and Governor Cuomo’s administration giving them another year to prepare was helpful. We saw a lot more uptake with respect to the EHR vendors over the past 12 months. Vendors that account for 96 percent of the prescribers in New York have done all the work. In very few cases can people point to their vendor and say, “My technology just doesn’t allow me to do this yet.” And in those cases, there is a waiver process that was built into the rule. We know that there have been quite a few prescribers who have applied for wavers. The law does allow the Department of Health to grant a waiver for up to a year.
EHRIntel: Beyond e-prescribing, what else is involved in providers achieving compliance with the ePCS mandate?
KW: The I-STOP law did not just mandate ePCS and e-prescribing. It also made some changes to the Prescription Drug Monitoring Program in New York. One of the changes it made was requiring that physicians access the PDMP database before they prescribe controlled substances, which obviously includes opioids. Over that time they have observed that has reduced doctor shopping by over 75 percent. So you have that aspect going on.
With regard to ePCS, we have a much higher level of security. These prescriptions aren’t alterable. Patients alter these like they sometimes would alter handwritten prescriptions or what not. And you don’t have the issues associated with people stealing the official New York State prescription blanks and using them to write bogus prescriptions. That can’t be done either. In addition, because electronic prescribing gives providers access to patient medication histories, they also have that additional data source that they can see what other medications have been prescribed for a patient and by whom.
EHRIntel: Will New York be a model that other states can follow with respect to addressing the abuse of controlled substances?
KW: If you look nationally, it’s going to be awhile before we really see those aspects of ePCS brought into play in terms of reducing opioid use and what not. But in New York because of how widespread it has become very quickly, we’re going to see some tangible evidence pretty quick. If things continue the way they are tracking right now, it’s conceivable that we’ll see one million ePCS transmitted this month, which is just about half of the controlled substance prescriptions that are written in New York in a month. We’re getting very close to a significant effect.
We feel strongly and we certainly have heard anecdotal of this that there are a number of states that are very closely watching what happens in New York and will likely follow suit with some kind of mandate. Currently, there are bills in the Massachusetts and Maine legislatures that would do this with respect to opioid. I don’t know what the chances of those bills passing right not is. California took a run at this two years ago and at that time the physicians in health systems thought it was too early. But again when you can see something work like this in a very widespread fashion in a state such as New York where there are a lot of controlled substance prescriptions written, that’s going to be proof positive to other states that this is something they ought to consider.
Prescribers for a while felt this wasn’t going to work well with their workflows. They have their reservations before they actually adopt it, but then when they start using it they find out that it’s really not that difficult.
EHRIntel: What work remains for providers and other affected organizations after the compliance deadline?
KW: We are aware that there might be one or two vendors that for whatever reason had not been able to do what they needed to do. And some health systems and hospitals were very close, but they weren’t going to meet the deadline so they applied for waivers. Clearly, any entity that has received a waiver should continue to be doing what they need to do in order to comply and working toward the point where they don’t need the waiver any longer. The infrastructure itself is pretty much built out and scalable. From the standpoint of our network, there is nothing that we need to do — we just watch the transactions build if you will.
I’m quite sure folks in the New York government are going to be tracking a number of parameters to hopefully be able to report out that when this rule took effect they saw these changes with respect to abuse and misuse of controlled substances, not just opioids. It’s a little hard to track. We have been trying to get our head around as well because we would like to do some of that analysis. But it’s hard to know what the universe of fraudulent prescriptions is out there and then be able to tell how much you have reduced that. You have to look at other proxy measures. Hopefully, we will see reductions in emergency room visits and even deaths from opioids and what not. That’s something you could possibly associated back with this type of technology being adopted.