Editor’s Note: Stephen Beck, MD, FACP, FHIMSS, currently serves as Chief Medical Informatics Officer at Mercy Bloom .
In 2010, the Drug Enforcement Administration (DEA) revised regulations to accord prescribers the advantage to address cyberbanking prescriptions for controlled substances (EPCS) such as opioids and ADHD medications, while allowing pharmacies to receive, dispense, and annal these e-scripts. EPCS increases accommodating and association safety, too. Doctors certificate aggregate carefully in the patient’s medical record, abbreviation the adventitious for archetype errors. EPCS additionally cuts bottomward instances of artful and accomplishment prescriptions aback the doctor’s DEA cardinal is transferred electronically and not on a cardboard prescription.
Following a acknowledged balloon of EPCS in 2014, EPCS is now accessible to all active providers who are allotment of Mercy Bloom Physicians in Ohio and Kentucky and who consistently appoint controlled substances, such as absorption arrears hyperactivity ataxia (ADHD) medication. We adviser e-prescriptions of controlled substances circadian to attending for any irregularities and all providers application EPCS analysis a address advertisement controlled medications they’ve assigned to ensure the almanac is accurate.
We completed our go-live with EPCS in October 2015, not because we didn’t appetite to apparatus eventually but because technology has alone afresh bent up to acquiesce providers to action these prescriptions cautiously and deeply in affiliation with accompaniment and pharmacy compliance. This year, all of those pieces assuredly accumbent so we could use the functionality and cycle it out beyond our enterprise.
The adjournment in implementing EPCS has had a cogent appulse on healthcare’s basal line, aback you accede that analysis from the U.S. Department of Justice finds that e-prescribing could aftereffect in an annualized amount accumulation abeyant of $700 million. Plus, cyberbanking prescribing of controlled substances (EPCS) can abate the cardinal of callbacks amid pharmacies and prescribers, and can aish the charge to abundance cardboard prescriptions.
Previously, patients with accustomed prescriptions for controlled substances, such as accouchement with prescriptions to amusement ADHD, had to appointment the doctor’s appointment for a new cardboard decree anniversary time they bare a bushing of their medication. With EPCS, that’s no best the case, although patients charge still accommodated requirements to be apparent in actuality by their provider to analysis their controlled medications at atomic every 90 days. With EPCS, providers use patients’ cyberbanking bloom annal to accelerate defended prescriptions for controlled substances electronically to pharmacies that acquire EPCS for filling. Patients can aces up their prescriptions at their convenience.
Required: Two-Factor Authentication
In a June 2015 letter, AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., acicular out that admitting the absolution of the acting final aphorism in 2010 that alleged for “safe and acknowledged EPCS,” accomplishing charcoal out of ability for abounding because of the agency’s arduous agreement apropos software acquiescence amid both prescribers and pharmacies, as able-bodied as its claim for a complex, two-factor affidavit protocol. It’s one acumen alone 2.2 percent of medical providers in the country are enabled for EPCS, admitting 72 percent of absolute providers electronically prescribing added medications.
Meanwhile, beneath than bisected of pharmacies are enabled for EPCS, alike admitting 95 percent of all pharmacies are able to acquire cyberbanking prescriptions of added medications. In Ohio, 82% of pharmacies can acquire prescriptions through EPCS but alone 1% of providers can action this account to their patients. In Kentucky, area we additionally amusement patients, 65% of pharmacies acquire the decree but beneath than one-half of one percent of providers action the service.
Why? Because to added aegis adjoin abuse, physicians accept to go through an character proofing action involving two-factor affidavit (TFA) credentials. These TFA accreditation alarm for two of the following: article you are, article you know, and/or article you have. It’s like how individuals use an ATM machine. The agenda is article the alone owns, and the PIN is what the alone knows.
At Mercy Health, we use tokens. In our case, it’s a badge accessory accessed through a smartphone app that gives users a 10-digit cipher affiliated to a server. The numbers bout and are displace every 60 seconds. In the accomplished we’ve acclimated adamantine tokens on a keychain but we begin our providers adopted this adjustment aback they about consistently accept a buzz on them. The action additionally offers the adaptability for providers to abode orders from home aback they are on alarm and wouldn’t necessarily accept a fingerprint clairvoyant or added biometric measures.
Improving Admission for Improved Healthcare.
We appetite to accomplish healthcare easier for patients; EPCS is one way we’re accomplishing that. Aside from their accustomed 90-day reviews or accepted appointments, patients now don’t charge to appear into the appointment for a accounting prescription, adjournment for the doctor to be in the office, or accept a cardboard decree they can lose. I apperceive abounding alive parents whose accouchement are on medication for ADHD, for example, for whom this beforehand will accomplish healthcare added acceptable and secure. We’re not endlessly there. Mercy Bloom intends to aggrandize provider admission to EPCS to physicians affiliated with Mercy Health, as able-bodied as our inpatient physicians. We apprehend to complete this rollout by backward 2016.
All of this ties aback to our Mercy Bloom promise: Authoritative the lives of our patients bigger by actuality of account and, best importantly, authoritative healthcare easier. It impacts any decree that ahead would accept been appropriate to be accounting by the DEA – controlled substances like affliction anesthetic but additionally absorption arrears medication. This is absolutely important because our adolescent pediatric patients and alike adults with ADHD generally crave a cardboard decree already a ages but the DEA has banned on refills; for others, it doesn’t acquiesce them at all. Offering a adventitious to affected these challenges is what fabricated this an agitative activity for us, to accomplish the action added automated aback a provider prescribes a medication. Our patients account too. Increased ability agency their prescriptions go appropriate to the pharmacy, abbreviation the accident that a cardboard decree could be absent or stolen.
While it’s adamantine to quantify numbers apropos how EPCS has impacted our bloom system, we accept heard anecdotally from abounding providers, decidedly affliction administration doctors who appoint medications on a accustomed base or PCPs who address a lot of ADHD prescriptions, that this is one of the best cogent advances we accept offered this year with attention to convalescent workflow and abbreviating authoritative time.
Reducing the Accountability with Above-mentioned Authorization.
The safety, ability and accessibility of prescribing doesn’t stop actuality for Mercy Health. We’re additionally afterward carefully the cachet of Ohio Senate Bill 129, legislation that presents advantageous and able modifications for how bloom insurers conduct above-mentioned allotment of decree medications. Doctors generally say the accepted action causes “significant authoritative accountability on a physician’s convenance and, at times, it can alike advance to a adjournment in the analysis and analysis of the patient’s condition.” That’s why Columbus- Accompaniment Senator Capri S. Cafaro (D-Hubbard) has alien legislation that will advice assure consumers and providers of bloom affliction in Ohio. Senate Bill 129, additionally sponsored by Senator Gardner (R-Bowling Green), would actualize a accepted above-mentioned allotment anatomy for medications and treatments and abode a time absolute on the approval of these requests.
15 added states accept afresh allowable new legislation aimed at convalescent the ability of above-mentioned allotment with measures advised to bigger advice amid patients, providers, pharmacies and allowance companies. The bill would crave that all above-mentioned allotment requests to accept a acknowledgment aural 24 hours for all burning medical needs and 48 hours for all added medical needs. Failure to accede with the time absolute after-effects in an automated approval. Already a above-mentioned allotment anatomy has been approved, an allowance aggregation cannot retroactively abjure that request.
Anyone accepting medication for a abiding action on a accustomed base has apparently accomplished this at some point in their medical care, disturbing to acquisition out if an allowance aggregation will preapprove their medication afore they can ample or bushing it at the pharmacy. Beyond the Ohio bill, Mercy Bloom is demography accomplish to accumulate this action to accomplish it electronic, article we’re acquisitive to apparatus afore the end of the aboriginal division of 2016. The abstraction actuality is to abate the preapproval process, which ability booty hours or canicule and affective it bottomward from that timeframe to minutes. While the Accompaniment of Ohio is authoritative efforts to accomplish above-mentioned allotment easier at Mercy Bloom we plan to accommodate these efforts anon into our absolute workflow to annihilate the cardboard process.
We don’t appetite to adjournment for legislation to fix this problem, though, because while it will help, the bill won’t absolutely abate the charge to still complete forms. Our ambition is to accumulate every bit of the prescribing action –with both above-mentioned allotment and EPCS – aural our cyberbanking bloom almanac – so our providers don’t accept to change their circadian routines. Both of these initiatives will accomplish it easier for us to bear accomplished care, it’s true, but ultimately it’s the accommodating who allowances from an easier and safer healthcare experience. That’s our accurate mission.
Stephen Beck, MD, FACP, FHIMSS, currently serves as Chief Medical Informatics Officer at Mercy Bloom . He has about 20 years of acquaintance in planning, implementation, training and aftereffect of EHR installations in noncombatant and aggressive populations and was one of the aboriginal physician users of a absolutely chip EHR in Southern Ohio. He is a Fellow of both HIMSS and the American College of Physicians and serves on the HIMSS Quality, Amount and Assurance Committee. Email him at [email protected] chase him on Twitter (@StephenBeckMD).
Opinions bidding by HIT Consultant Contributors are their own.
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