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Electronic Prescribing Of Controlled Substances Rates Spiking

Posted on September 1, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Back in the day, say a decade ago or so, when e-prescribing itself was a new and big deal, the feds – especially the DEA – didn’t think much of the e-prescribing of controlled drugs like opiates. But a few years later the agency eventually came around. In June of 2010, it released a rule which allowed providers to issue such prescriptions nd pharmacies to receive, dispense and archive these scripts electronically nationwide.

Since then, electronic prescribing of controlled substances (EPCS) has taken off, according to a story in Search HealthIT. In fact, EPCS has been growing rapidly, particularly during 2015, according to national pharmacy IT network Surescripts.

Specifically, the number of ECPS transactions shot up 600% last year, from 1.67 million to 12.8 million scripts issued, according to Surescripts’ 2015 National Progress Report. Part of the reason for this surge is that providers are getting on board at a brisk pace. The number of providers enabled to use EPCS grew 359% last year.

Among the interesting stats to be culled from the Surescripts report is that 32% of drugs prescribed were opioids. This statistic should draw a lot of interest from public officials and enforcement agencies trying to stem the tide of opioid overdoses which killed more than 28,000 Americans in 2014. That’s four times as many who died of this cause in 2010, according to Surescripts’ sources.

A Drop in the Bucket

It’s worth noting that the number of EPCS transactions still pales in contrast to the number of transactions hosted on the Surescripts network that year. The network handled 9.7 billion transactions in 2015, up 40% from the previous year, the company reported. That means the EPCS is still a drop in the bucket overall.

Also, levels of EPCS-enabled pharmacies and physicians vary across the U.S. For example, 91% of pharmacies are EPCS-enabled in New York, the top state for such pharmacies. (A New York State rule requiring every practitioner in the state to e-prescribe all medications went into effect in March.) Other top-ranked states for pharmacy penetration included Massachusetts, California and Texas. On the other hand, only 73% of pharmacies were EPCS-enabled in Georgia and Florida.

Still, with adoption levels seemingly evening out between states – and the gap small enough to close over the next few years – it seems like EPCS is becoming an established practice. Surescripts contends that this is for the best, and argues that EPCS reduces fraud and improper prescribing by making it easier to track such medications. And with states like New York mandating e-prescribing for all providers, the growth in EPCS is likely to stay healthy.

However, for every action there’s a reaction, and the other shoe may not have dropped where EPCS risks are concerned. It may take a few years to find out whether the confidence some have in this approach was merited.

Connected Care and Patient Experience Survey Results

Posted on September 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Surescripts recently put out the results of a survey they did on Connected Care and the Patient Experience. If you’re like me, whenever you see a survey, you want to see the questions and raw data from the survey. The good news is that Surescripts has shared the survey result data here.

We could dig into a lot of the data, but this chart was the one that really stood out to me:
Patient Engagemnt and Healthcare Information

No doubt Surescripts has a bit of bias when it comes to wanting to get organizations to share healthcare data. They started with sharing prescription data, but they’re working on sharing much more data. This Surescripts bias aside, aren’t we all biased towards wanting the right information to be shared in the right place at the right time? That’s the nirvana of healthcare data that all of us as patients want.

Put another way, can I please fill out a health history form one time and never have to fill one out again?

This is a feeling that resonates with so many patients. It’s felt particularly strong when you fill out essentially the same paperwork possibly on the same day for 2 specialists that both work for the same company. Brutal to even consider, but it’s the reality of healthcare data sharing today.

I understand many of the reasons why this isn’t happening and it is a very complex problem with no easy solutions. There are a lot of organizations and people involved and many of them aren’t motivated to change. Change is hard when you’re motivated. Change is almost impossible when you’re not motivated.

Back to the graphic above, I love how it frames the issue. The challenge of poor information is bad on multiple levels including: slowing down the patient visit and improper care. The graphic above illustrates so well how much better we can do at getting the right information to the doctor. Doing so will make a doctor more efficient and help them provide better care.

ePrescribing of Controlled Substance (EPCS) Now Allowed Nationwide

Posted on September 1, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This is really exciting news. Especially for me since the only post I’ve ever taken down after it was published was a post I did about an FDA pilot of controlled substances on September 13, 2009. It turns out the press release I got was premature and so I took down the post since it wasn’t accurate information. About 6 years later (technically the DEA first proposed the rule in 2008), we finally have ePrescribing of controlled substance available in all 50 states.

Surescripts put together this great animated gif to celebrate the occasion.

We still have some work to do to get every doctor on board with ePrescribing, let alone ePrescribing controlled substances, but we’re getting there. In fact, I suggested today at me EHR workshop in Dubai that ePrescribing has been one of the most successful standards in healthcare. Can you think of any other healthcare standard that’s been more successful? HL7 lab data comes close, but I still take ePrescribing.

How long until we have near 100% adoption of ePrescibing? Any predictions?

Healthcare Entrepreneurship-as-a-Service

Posted on May 7, 2014 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

We are witnessing a dramatic unbundling of the services that power business. Almost every aspect of business can be unbundled into a monthly service.

My startup, Pristine, runs on a number of unbundled cloud services that until recently, would have traditionally been outsourced to HR firms or mega-IT companies. We run Pristine on ZenPayroll, RelateIQ, Google Apps, Expensify, Maxwell Health, Xero, Resumator, MediaTemple and more. Similarly, we’ve built our flagship service, EyeSight, on top of a broad array of development tools and services (check out the Pristine Engineering Blog to learn more about how the sausage is made). We’ve made it a priority to invent and do as little as possible by utilizing 3rd party stacks and services everywhere possible.

Healthcare is not immune to this trend. There are a number of companies that are unbundling health IT entrepreneurship:

This list should be 10x longer than it is. With all of the capital and startups entering the health IT space, companies providing the infrastructure to accelerate growth will thrive. As the old saying goes, “During a gold rush, sell pickaxes.” The companies listed above are selling pickaxes to proverbial gold miners.

I’ll conclude this post with some areas that can be commoditized as a service. Feel free to leave comments on other areas or companies that I missed.

  • Interoperability as a service (in lieu of HL7)
  • HIPAA compliant videostreaming as a service
  • HIPAA compliant image / video sending as a service
  • Analytics as a service

SureScripts Becomes ONC-ATCB EHR Certification Body

Posted on December 30, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In the weirdest news I’ve seen in a while, SureScripts has become an ONC-ATCB. Here’s the details from Health Data Management:

In a Dec. 23 announcement, the Office for the National Coordinator for Health IT said that Arlington, Va.-based Surescripts can verify that e-prescribing, privacy and security modules meet the standards laid out in the meaningful use requirements. Surescripts is the sixth authorizer to be approved by ONCHIT, but it’s the only one with limited certification abilities—the five others have ONCHIT’s blessing to certify Complete EHRs and EHR modules.

Doesn’t this scream conflict of interest? They run a nationwide e-Prescribing network, and yet they can certify ePrescribing for ONC. I guess you could make the argument that they know ePrescribing well and so they are qualified to do it. Although, it is just weird and awkward to consider them as an ATCB. I wonder which ePrescribing companies will actually use them. Why did SureScripts even go to the effort to become an ATCB?

Summary of ePrescribing Challenges

Posted on October 8, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

ePrescribing seems like the in vogue thing to do these days. It’s part of the proposed meaningful use matrix and so no doubt we’re going to hear a lot more about it (and we should). However, ePrescribing isn’t without its challenges. A little while ago I put the question to you my readers about the challenges associated with ePrescribing. The following are a couple of the responses that I received from people about their experience with ePrescribing.

Doctor’s advocate that I am, I’ll start off with a doctor’s experience…
E-Rx has been one of the best additions to our EHR. We have reduced paper use significantly, and rarely have problems with transmission. The problems mainly relate to the extra work of entering which pharmacy the patient ants to use.

Oftentimes patients decide to change from what they had requested previously and then you have to search the database for the correct pharmacy. If you live in a large city that can be cumbersome. Our clinical coordinator has entered cross streets into the database to make this easier.

Our state does not permit transmission of controlled substances which in a pediatric practice is primarily psychostimulant medications. Another minor issue is that you have to have the correct units before it will transmit – e.g. if you want 30 of a capsule you have to put 30 caps in the amount field even though you ordered capsules in the medication field. This is not the way most docs are accustomed to writing prescriptions but certainly more accurate.

If there are pharmacies that do not use E-Rx it goes by fax which can be very slow. Some pharmacies are better than others about keeping up with their -rxs coming in and it won’t be ready when the patient arrives. We tell the patient to call the pharmacy when leaving the office to let them know they are coming.

Overall, e-rx has been a very positive experience – saving time, paper and money. Our e-rx with Dr. First integrates fully into the EHR making the documentation seamless.

From someone who use to work for an ePrescribing company…
(1) There was a saying “Free is not cheap enough” i.e. even if you give away the service, many, if not most doctors are not interested in it, because of the time and effort to implement e-prescribing (HW, networks, training etc). The MIPPA incentives definitely helped, but many doctors still felt that they were insubstantial compared to the cost (mostly their time) that they would have to invest in this.

(2) You still cannot prescribe Schedule drugs (primarily narcotics) via e-prescribing. This made it a tough sell to several specialties (pain, ortho, etc.). However, I have heard that is in the process of changing over time.

(3) Some of the clients that I dealt with did not want to implement eprescribing if it meant implementing another system to be integrated with whatever they had via HL7. They just wanted to wait until their existing vendor came out with a solid integrated solution.

I agree with you that e-prescribing is an area where there is almost universal agreement that this is a service that is much better than the traditional paper and pen method. All the doctors I have spoken to agree on this. Over time, it will become more and more popular, especially as EHRs penetrate the market. The last data I saw from SureScripts indicated that over 100,000 providers were now eprescribing, which is significantly higher than even just last year.

From the owner of an EMR company talking about integration with an ePrescribing solution and challenges associated with it…
One of the links I found on the AMA web site (several months ago) referred me to iScribe. This site is sponsored by Caremark. It has, in my opinion, a relatively simple to use interface.

We’ve been able to figure out how to feed data into it (we recommend using Firefox for a web browser and a third-party app called iMacros – which is something developers should know about) and extract data out so that we can keep our systems in sync.

The price for iScribe is $0. There are some aspects that take more time on the part of the doctor/nursing staff, but then there are other things where life is greatly simplified. There is a learning curve and there are some quirks. Their phone support is superb, their e-mail support non-existent.

The first hurdle to overcome was to figure out a way to map their list of pharmacies with ours. Is it “Wal-mart” or “Walmart” or “Wal Mart”? Or, “Savon”, “Sav-on”, “Sav on”, “Albertsons”? It almost became a hand to hand combat to map.

The second hurdle was figuring out to map their list of drugs to ours. Tougher, because we had mis-spellings on our side.

Then there are the issues of dealing with controlled substances. Can’t send them electronically, so then the staff wonders why are we bothering with these extra steps? (Drug-drug interaction checking is the answer.)

In the beginning, the nurses would call the pharmacy. “Did you get our e-request?” The little pharmacies would always say yes. Early on, the big chains seemed to be hit and miss – which was odd.

The nurses have become a little bolder and have learned how to poke around in iScribe and now find reports to help them do their job more easily.

One interesting side note, I did an “edit” function on a patient we had sent prescriptions. On the iScribe side, they had ALL the insurance information on the individual. Which, btw, we had never provided. So in some method, the pharmacies already have all detail and have shared it all over the Caremark network.

Any practice can use the service and there is no need to even interface to existing EMR or practice management systems.

Some interesting information for those looking at ePrescribing. I’d love to hear more experiences in the comments.