There’s not a week that goes by that we don’t receive a comment from a physician that goes something like this; “We love the ePrescribing module in MediTouch EHR – we wish we could use it on all prescriptions (controlled substances also)”. We thought it would be a good idea to “clear the air” on why there are two workflows for prescribing and why providers should not hold their collective breath on a change in the status quo. Let’s start with some background on prescribing of controlled substances.

The New Law
On June 1, 2010 the government enacted the Electronic Prescriptions for Controlled Substances law. The purpose of the EPCS law is to revise DEA regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. The new regulations are an addition to, not a replacement of, the existing rules. The goal of the new regulations is to provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining a tight system of controls on controlled substances. In fact you may have received a letter from the DEA that said a law was passed that allowed for EPCS. Legally there is now a path to EPCS but it is just the first baby step toward that goal. The letter that most providers received was misleading because it raised the expectation of providers that EPCS was possible immediately and that was just not true although with the passage of the law now EPCS is (theoretically) possible.

About Controlled Substances
The Drug Enforcement Agency (DEA) provides national rules for prescribing controlled substances, also known as scheduled drugs. There are 5 schedules, reflecting the drug’s abuse potential. “1” is for drugs that are felt to have no therapeutic use such as heroin and, in practice, is never used. “2” is strong narcotics such as Dilaudid or morphine as well as other drugs with a high abuse potential such as Adderall, an amphetamine drug used for ADHD. Schedule “3” includes weaker narcotics such as Vicodin or codeine. “4” and “5” include a wide variety of drugs such as Valium and Ambien. (A few states add other drugs such as Soma, a muscle relaxant.)

Today, Schedule 2 substances still must be handwritten and cannot be called in to the pharmacy. Schedule 3,4,5 can be “called in” or manually signed and then manually faxed. No scheduled drug can be electronically faxed or transmitted via Surescripts. DEA regulations specifically disallow any use of a stamped bit-map signature on a controlled substance prescription. Nonetheless, some electronic prescribing systems do work that way. Per the DEA, the pharmacist and the doctor are breaking the law and are both liable for use of a bit-map stamped signature.

Three New Types of Certification
The new regulations specify 3 types of “certification: Doctors, eRx software and pharmacies.

Each prescriber (doctor or midlevel) will need to be “identify proofed.” This may be as simple as referring to hospital credentialing or may require a visit to a police station or other government agency. The prescriber will be given a unique ID that will be entered into the prescribing system and forwarded to the pharmacy as required. A third party will probably administer this and there will be a cost to the provider for becoming identity proofed initially and for bi-annual updates. We expect the cost to be a few hundred dollars.

e-Prescribing software
Each system, including MediTouch must build infrastructure to support the DEA workflow and technical requirements. An example of workflow: a unique ID must be manually entered for each session of EPCS. This means that, when a scheduled drug and a pharmacy able to receive are selected, the prescriber will obtain a code number, possibly via text message, that must be entered to proceed. This may prove to be very time consuming; unfortunately the DEA has required a workflow that is awkward to the point that many prescribers may choose to stick to the current processes. We are still waiting for specifics on what will be required. In addition MediTouch must be audited by a company meeting national auditing standards, equivalent to an industry standard such as the NIST SAS 70, and certified as meeting all DEA requirements.

Pros – Now there is a law that permits EPCS – the first baby step. Behind the scenes more baby steps are being taken by SureScripts and the nations’ pharmacies. One day it will happen.

Cons – The national network is not ready for EPCS and it won’t be in the short term. When it comes, it will add to the expense of ePrescribing and take longer than a non-scheduled eRx.

Our advice – don’t throw out your printer, pen or fax machine just yet.

This blog was written with content supplied by Larry Susnow M.D. of NewCrop Rx.