JAMIA: The woes of e-prescribing controlled substances
To better understand the barriers associated with adoption and use of e-prescribing of controlled substances (EPCS), a practice recently established by the U.S. Drug Enforcement Administration (DEA), Cindy Parks Thomas, PhD, a professor at Brandeis University in Waltham, Mass., and colleagues in a Sept. 21 article in the Journal of the American Medical Informatics Association, described their research on e-prescribing of controlled substances.
From the outset, researchers said the majority of prescribers expected EPCS to improve the accuracy of prescriptions, reduce medication errors, and result in fewer pharmacy call-backs. Another issue with paper prescribing of controlled substances was the high rate of lost prescriptions and prescription fraud or forgery. EPCS should eliminate the problem of lost prescriptions (by directly transmitting the prescription to the pharmacy) and prescription forgery (eliminating prescription pads). Most prescribers also expected EPCS to help identify other forms of diversion and misuse of controlled substances, such as doctor shopping.
Of the 246 prescribers (response rate of 64 percent) surveyed 43.1 percent currently user e-prescribing for non-controlled substances. E-prescribing is an integral component of health IT, and is required for achieving meaningful use. Parks Thomas and colleagues said e-prescribing has the potential to improve the safety, quality, and efficiency of healthcare, as well as reduce medication costs. Until 2010, the DEA prohibited EPCS (narcotics, stimulants and other medications included in Schedules II, III, IV, or V of the Controlled Substances Act).
While controlled substances only account for 11 percent of all prescriptions issued, they are prescribed by 90 percent of prescribers, making it important to incorporate controlled substances into e-prescribing systems.
The most common issues reported to have occurred three or more times in the prior six months were prescriptions not covered by insurance (49.1 percent) and loss of a prescription by the patient requiring issuance of a replacement prescription (26 percent). More than 20 percent of prescribers reported prescription fraud at least one or two times in the prior six months, including: prescription altered by patients (18.8 percent); counterfeit prescription (6.4 percent); or stolen prescription pads (3.5 percent).
Medication errors were common: 35.1 percent of prescribers reported having prescribed the wrong medication at least once in the past six months (52 percent three or more times) and more than 20 percent reported pharmacy errors (wrong drug dispensed, 14.4 percent; or incorrect dose or strength, 22 percent).
Overall, 43.1 percent of the surveyed prescribers were using e-prescribing for non-controlled substance prescriptions. On average, 49.9 percent of e-prescriptions were entered by assistants rather than the prescriber following the patient encounter. Prescriptions input by medical assistants are forwarded to the prescriber for signature and sending
In this sample, the majority of the systems are not embedded in an EHR, and required separate documentation into a dictated progress note, paper chart, or EHR. Seventy-six percent of prescribers felt comfortable with their ambulatory e-prescribing system, but many reported recurring technical issues.
Prescribers estimated the following had occurred at least three times in the prior 6 months: system unreliability such as the computer crashing (36.7 percent); the pharmacy did not receive the prescription in a timely manner (66.9 percent); and the pharmacy called back to clarify prescription information (58.7 percent). Other issues (stated in the survey's open-ended comments) noted periodic delays in accessing the system once logged on, and preferences regarding what information is available in the interface (e.g., would prefer a longer prescription history, or lack of availability of prescribing history for physicians not using the system).
Overall, 43 percent of the prescribers surveyed had adopted e-prescribing as of 2009, equivalent to Massachusetts’ overall adoption in 2008. This is higher than national estimates of 25 percent for office-based prescribers. Although the number of prescribers adopting e-prescribing has doubled each year since 2007, the e-prescribing adoption rate is still far from universal, researchers said.
From the outset, researchers said the majority of prescribers expected EPCS to improve the accuracy of prescriptions, reduce medication errors, and result in fewer pharmacy call-backs. Another issue with paper prescribing of controlled substances was the high rate of lost prescriptions and prescription fraud or forgery. EPCS should eliminate the problem of lost prescriptions (by directly transmitting the prescription to the pharmacy) and prescription forgery (eliminating prescription pads). Most prescribers also expected EPCS to help identify other forms of diversion and misuse of controlled substances, such as doctor shopping.
Of the 246 prescribers (response rate of 64 percent) surveyed 43.1 percent currently user e-prescribing for non-controlled substances. E-prescribing is an integral component of health IT, and is required for achieving meaningful use. Parks Thomas and colleagues said e-prescribing has the potential to improve the safety, quality, and efficiency of healthcare, as well as reduce medication costs. Until 2010, the DEA prohibited EPCS (narcotics, stimulants and other medications included in Schedules II, III, IV, or V of the Controlled Substances Act).
While controlled substances only account for 11 percent of all prescriptions issued, they are prescribed by 90 percent of prescribers, making it important to incorporate controlled substances into e-prescribing systems.
The most common issues reported to have occurred three or more times in the prior six months were prescriptions not covered by insurance (49.1 percent) and loss of a prescription by the patient requiring issuance of a replacement prescription (26 percent). More than 20 percent of prescribers reported prescription fraud at least one or two times in the prior six months, including: prescription altered by patients (18.8 percent); counterfeit prescription (6.4 percent); or stolen prescription pads (3.5 percent).
Medication errors were common: 35.1 percent of prescribers reported having prescribed the wrong medication at least once in the past six months (52 percent three or more times) and more than 20 percent reported pharmacy errors (wrong drug dispensed, 14.4 percent; or incorrect dose or strength, 22 percent).
Overall, 43.1 percent of the surveyed prescribers were using e-prescribing for non-controlled substance prescriptions. On average, 49.9 percent of e-prescriptions were entered by assistants rather than the prescriber following the patient encounter. Prescriptions input by medical assistants are forwarded to the prescriber for signature and sending
In this sample, the majority of the systems are not embedded in an EHR, and required separate documentation into a dictated progress note, paper chart, or EHR. Seventy-six percent of prescribers felt comfortable with their ambulatory e-prescribing system, but many reported recurring technical issues.
Prescribers estimated the following had occurred at least three times in the prior 6 months: system unreliability such as the computer crashing (36.7 percent); the pharmacy did not receive the prescription in a timely manner (66.9 percent); and the pharmacy called back to clarify prescription information (58.7 percent). Other issues (stated in the survey's open-ended comments) noted periodic delays in accessing the system once logged on, and preferences regarding what information is available in the interface (e.g., would prefer a longer prescription history, or lack of availability of prescribing history for physicians not using the system).
Overall, 43 percent of the prescribers surveyed had adopted e-prescribing as of 2009, equivalent to Massachusetts’ overall adoption in 2008. This is higher than national estimates of 25 percent for office-based prescribers. Although the number of prescribers adopting e-prescribing has doubled each year since 2007, the e-prescribing adoption rate is still far from universal, researchers said.