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    Is electronic prescribing a potential solution to the opioid crisis?

    Despite the opioid crisis facing the country, few physicians prescribe narcotics electronically. But doctors who do electronic prescribing of controlled substances (EPCS) say it helps prevent diversion of these drugs and say it isn’t hard to do.

    Internist Jeffrey Kagan, MD, and his partner in Newington, Connecticut, have been doing EPCS for about a year, even though the state doesn’t require it. Their practice embraced EPCS, Kagan says, because it was more efficient than paper prescriptions, and it reduced the chance of drug diversion.

    Previously Kagan had to print a narcotic prescription from his electronic health record (EHR). If the patient wasn’t in the office at the time, he or she would have to come to the office to pick it up. This process wasted staff time. Sometimes the prescription would get lost or the patient would say it had been lost, and then it would have to be reissued. There was also the risk of someone copying a prescription and selling it. EPCS prevents all of this, says Kagan, who is also a member of the Medical Economics Editorial Advisory Board.

    Christine Doucet, MD, a primary care physician in Patchogue, New York, has also adopted EPCS, partly because of a state law that requires it. But she also admits that the murder of four people by an opioid addict at a nearby pharmacy five years ago played a role in her decision.

    “The killings were down the street from me,” she notes. “And that was tragic. [We] had to do something.”

    While some doctors view EPCS as a moral imperative, many other physicians are dissatisfied with their dual workflow of paper and electronic prescriptions. Yet they may be deterred from adopting EPCS because of a perception that it is too complex. To bridge that gap involves understanding EPCS and what it entails. 

     

    The lack of EPCS awareness

    The U.S. Drug Enforcement Administration (DEA) approved EPCS in 2012. Two states, New York and Maine, mandate it. (Minnesota requires e-prescribing, but without an enforcement mechanism.) Moreover, all of the leading EHRs in the marketplace now include EPCS modules.

    Yet nationally, only 6% of prescribers did EPCS last year, according to the 2015 annual report of Surescripts, a company that connects physician offices to pharmacies online. While that’s nearly a fourfold jump in adoption from 2014, it still represents only a tiny portion of physicians and other prescribers. 

    There is considerably more awareness of prescription drug monitoring programs, which now exist in 42 states. These programs include online databases that list all of the narcotic prescriptions that individuals have filled in a particular state and sometimes in multiple states. For example, Kagan says Connecticut’s controlled substance registry enables him to see data from 20 states.

    Charles Rothberg, MD, a Patchogue ophthalmologist who is president-elect of the Medical Society of the State of New York, supports the goal of New York’s EPCS mandate. Still, he wonders how much more effective it is in preventing narcotic diversion than the New York drug database, which doctors must consult when they prescribe a controlled substance.

    Doucet agrees that the state registry is more effective than EPCS in preventing drug diversion. She points out that it’s very difficult to mimic the special paper she uses to print out a prescription or to rewrite anything in it. But she believes that the EPCS mandate makes sense because some doctors may be careless in writing prescriptions for controlled substances. 

    John Franco, MD, a primary care physician and medical director of the Independent Practice Association (IPA) of Nassau/Suffolk Counties, says that the organization and its 800 members recognize the legitimacy of the EPCS mandate. “Our doctors’ complaints have declined,” he says. “They’ve adapted and have recognized that the law is here to stay and that EPCS has a societal benefit, although it might not be realized for some time.”

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