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Electronic prescribing of controlled substances poised to take off

E-prescribing has come of age.

Now it’s e-prescribing of controlled substances’ (EPCS) turn.

In 2014, 56% of U.S. physicians and 95% of pharmacies processed 1.2 billion electronic prescriptions on the Surescripts Inc. network, according to a new report from the company, which hosts the dominant U.S. e-prescription network.

But while e-prescribing has become commonplace, e-prescribing of controlled substances — such as Vicodin, Xanax, Adderall and other popular but potentially dangerous or addictive drugs — is still rare.

Even though EPCS increased 400% last year, according to Surescripts, to a total of 1.67 million controlled substances, the practice is still nearly unknown among physicians despite 73% of pharmacies being ready to receive electronic prescriptions for the controlled drugs.

The biggest challenge to EPCS adoption is the high security standards set by the U.S. Drug Enforcement Administration (DEA), said Sean Kelly, M.D., an emergency room physician at Boston’s Beth Israel Deaconess Medical Center and CMO of Imprivata Inc., an IT security vendor that sells authentication systems to healthcare providers.

However, Kelly, who is quoted in the Surescripts release announcing the EPCS study this week, told SearchHealthIT that the DEA’s recent reclassification of Vicodin and other opioid painkillers from Class III to more restricted Class II controlled substances – in response to opioid abuse – may end up driving more EPCS.

Because Vicodin, for example, is one of the most prescribed drugs, its ubiquity may spur more EPCS because CMS’ meaningful use program requires at least 40% of prescriptions to be sent electronically in stage 2, and the proposed stage 3 meaningful use rule ups that measure to 80%, Kelly noted.

“Printing out all those prescriptions really hurts your meaningful use numbers,” he said.

To counter abuse and fraud, prescribers can’t call in scripts for Class II drugs to pharmacies. That’s why most patients go home from medical procedures or doctor’s visits with old-fashioned paper prescriptions – unless, perhaps, they live in one of the 10 states that have certified a substantial number of e-prescribers.

Kelly said new DEA-approved authentication systems — like those from Imprivata that work by verifying a prescriber’s identity and require the prescriber to use a unique physical token, badge or biometric sign-on — can make EPCS happen now.

“The technology has arrived,” Kelly said. “Now it’s going to start taking off.”

In the report, Surescripts ranked the 10 ECPS states by a combination of the percentage of prescribers enrolled in EPCS, the percentage of enabled pharmacies, and the percentage of controlled substances prescribed electronically.

For the record, those states are, in order:

  • Nebraska
  • California,
  • Michigan
  • Massachusetts
  • Delaware
  • Illinois
  • Iowa
  • Rhode Island
  • Arizona
  • Minnesota

Among the top 10 states, the percentage of prescribers enabled for EPCS ranges from 9.07% to 1.39%, but in some of the states with fewer current e-prescribers, higher percentages of pharmacies are ready to handle EPCS.

In the top 10, percentages of EPCS-ready pharmacies range from 91.4% to 54.1%.

In most other states, the percentage of prescribers enrolled for EPCS is around 1%, though in most states the percentage of enabled pharmacies is well above 70%.