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Meaningful Health Care Informatics Blog

Feb 6 2011   9:48PM GMT

The faith of e-prescribing controlled substances



Posted by: RedaChouffani
Controlled substance, e-prescribing

With several medical organizations seeking to become paper-less with the implementation of an EHR, they are still dealing with paper based documents in many clinical areas.  But fortunately, physicians are more eager to completely eliminate some of the paper documents, especially given 10% of their prescriptions written on Pads are for controlled substances.

Up until June of 2010, all controlled substance prescriptions were required to be on paper. Fortunately, after that date, and with the final ruling from the Drug Enforcement administration (DEA), all schedule II and V substances can now be transmitted electronically to pharmacies.  Unlike other prescriptions, controlled substances have some additional requirements in order to ensure compliance with the DEA regulations and state laws.

With this change, there are some tangible benefits from an EPCS (Electronic Prescription of Controlled Substance).   For many physicians, having one workflow for all prescriptions clearly makes for a simpler process. It will also ensure efficiency as well as reduce double data entry.  In addition, under the new ruling, new programs in collaboration with several pharmacies will be put in place to help reduce fraud and abuse of these substances. There are still several questions around some of these programs, however, such as PMP (Prescription Monitoring Program), since physicians can’t pull a patient’s medication history unless given prior permission, and this would require patient consent if physicians suspect a case of a drug seeking.

Participation for electronically prescribing controlled substances is voluntary,  but with that comes few requirements from participants such as:
Two-Factor Authentication (Something you have, you know or you are)
(A password + fingerprint or palmscan)
(A password + generated token)
(A token + Bionmetric authentication)
Secure Network (Secured connection to the prescription Hubs or clearinghouse)
Access control

At this point, there are several things that are going to be taking place to ensure the security, including third party security and technology auditors for pharmacies and the certification of products being used.  But with much of the progress already made in some of the pilot programs, and value of digitizing these prescriptions, the timeline that have been put in place are aggressive.  At this stage the goal is get certification by the first quarter of 2011 and plan to have all pharmacies live with electronic controlled substance prescription by 2013.

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