By Tony Schueth, CEO & Managing Partner
ePrescribing has become an integral component of healthcare delivery and the preferred method of prescribing non-controlled medications. Last year, 58% of eligible non-controlled prescription were transmitted electronically through the Surescripts network. In addition, 73% of office-based physicians ePrescribed, a 4% increase over 2012. The 4% increase is less than I would have expected in year 3 of Meaningful Use (MU), 11 years after the passage of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) and 6 years after the passage of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), landmark pieces of legislation that paved the way for ePrescribing.
Electronic prescribing of controlled substances (EPCS), however, is just starting to take root after the DEA’s Interim Final Rule allowed it on June 1, 2010. In 2013, 13% of our total 3.85 billion retail prescriptions were for controlled drugs and 330,000 NewRx EPCS messages were sent across the Surescripts network. This means that approximately .07% of controlled prescriptions were electronically prescribed via Surescripts last year. At NCPDP’s August Workgroup meeting, Surescripts reported that through July 31, 570,000 EPCS prescriptions (or .11%) were transmitted via their network.
What can we do as an industry to meaningfully advance EPCS? Consider that a significant percentage of EPCS prescriptions last year were filled in Arizona, where a focused multi-stakeholder initiative to advance EPCS was orchestrated through the Arizona Health-e Connection (AzHeC). As reported in a previous POCP blog, this initiative removed EPCS barriers and provided a model for achieving EPCS growth.
From May to December 2013, Arizona saw a greater than 10-fold increase in the number of ePrescribing Controlled Substances (EPCS) prescribers, and an increase from less than 200 to nearly 16,000 EPCS transactions transmitted per month via five different EHR and ePrescribing systems. This effort worked because of a coordinated state-wide effort, eliminating the “which comes first, the chicken or the egg?” problem; meaning, in some areas pharmacies were ready but physicians not, or vice versa. Point-of-Care Partners supported the state’s Regional Extension Center (REC) in this effort.
The 2013 Results: Arizona EPCS By The Numbers
The DEA believes that EPCS could save up to $700 million annually. Between 3% and 9% of drugs that are diverted for abuse are tied to fraud and forgery of paper prescriptions. EPCS holds great promise for reducing drug-related deaths and improving medication management through EHRs and pharmacy systems, if these systems are enabled and their users are prepared for EPCS. This is no small task, considering that the requirements for each contributor to the EPCS equation are unique and laws vary by state.
As conveyed in our AzHeC case study, “Each state — and situation — is different, and a multitude of key variables must be taken into account in putting together a successful plan. While Arizona achieved noteworthy success with its program, the fact is, what worked in Arizona worked in Arizona, and may not be optimal for other geographies.”
“Danger, Danger” Healthcare Industry
So, as an industry we’ve accomplished a heck of a lot when it comes to ePrescribing. Is it enough? The answer is absolutely not, especially when it comes to EPCS. For MU, EPCS is just part of the ePrescribing equation, and physicians can achieve their measures if they don’t prescribe controlled substances electronically.
For EPCS, regulations aren’t going to get us where we need to go. ePrescribing still requires geographically-focused efforts, particularly for EPCS, to reach its potential and justify EHR and other investments. We need more AzHeC-like initiatives.
As an industry, we don’t want it to take 10 years for EPCS to reach the tipping point, and we do not want ePrescribing to lose momentum. With focused efforts and the continued support of industry leaders, we can spur EPCS adoption and begin to reap its many benefits in much less time.