Guest Column | March 6, 2017

Opioid Abuse: If EPCS Is The Answer, Why Hasn't It Worked?

Peter N. Kaufman, M.D., Chief Medical Officer, DrFirst

By Peter N. Kaufman, M.D., Chief Medical Officer, DrFirst

With an ever-increasing focus on addressing the opioid epidemic from key stakeholders — law enforcement, legislators, and healthcare providers — one would expect to see improvement. Yet opioid misuse and abuse continues unabated.

Healthcare providers and healthcare IT vendors thought they had discovered the cure to this ill: e-prescribing for controlled substances (EPCS). Since e-prescribing for legend drugs has been accepted by the majority of providers — more than 70 percent — EPCS should have been a natural progression, especially given the vital need to slow the runaway train of opioid abuse.

This logic has not prevailed. As of September 2016, only 20 percent of e-prescribing providers submitted prescriptions electronically for controlled substances, such as opioid painkillers, and less than 4 percent of all e-prescribing transactions were for controlled substances.  

What’s the missing piece to this adoption puzzle? In this case, it’s two pieces. The first: address physician fears EPCS will disrupt existing clinical workflows. The second: educate clinicians about the tangible benefits of EPCS and e-prescribing overall, including improved patient safety, security, workflows, cost savings, patient satisfaction, and more.

Enhanced Patient Safety
Today’s modern-day translation of the Hippocratic Oath to “do no harm” could easily be “patient safety is your number one priority.” It’s well documented e-prescribing improves patient safety and the quality of care, which would lead one to think e-prescribing and EPCS would be fully embraced by physicians.

The first step towards realizing this vision of large-scale adoption is to help clinicians understand e-prescribing systems can seamlessly interface with electronic medical record (EMR) solutions, enabling critical access to a patient’s medication history and offering timely clinical alerts to guard against drug-to-drug and drug-to-allergy interactions, inappropriate dosing, and duplicate therapies. These e-prescribing systems can also advise providers of potential problems with patient conditions such as pregnancy or breast-feeding.

Additionally, e-prescribing reduces common errors inherent to paper-based prescribing, including illegible handwriting, misinterpreted abbreviations, and unclear dosages. Combining enhanced medication histories with automated clinical decision support also helps to avoid over-prescribing or the prescribing of medications that could adversely interact with a patient’s existing medication therapy.

Increased Security
Another benefit of e-prescribing is enhanced security. For example, providers can be assured pharmacists receive prescriptions exactly as written, which is an especially important benefit when prescriptions are for controlled substances. Unlike with paper prescriptions, which can be subject to tampering and theft, e-prescribed transactions are sent directly to the pharmacies without the risk of any changes to dosages or to the number of refills. In addition, the physician’s DEA number is not exposed, which reduces the risk of physician identity theft.

Reduced Risk Of Doctor Shopping
More and more, drug-seeking patients are shopping doctors to obtain prescription painkillers. E-prescribing technology can be linked with a patient’s complete medication history, including some states’ prescription drug databases, so that clinicians have a more comprehensive view of the patient’s prescription records. This information is available to providers at the point of encounter so they can review medication histories and look for any suspicious trends that might indicate a patient is doctor shopping for prescription opioids.

Improved Workflows
Despite concerns e-prescribing could be disruptive to clinician workflows, the reality is e-prescribing can actually make workflows more efficient. For example, a provider may have fewer interruptions from pharmacists needing orders clarified because of unclear dosage requirements or poor prescription legibility. Furthermore, providers that already use e-prescribing for legend drugs can use the same workflow for EPCS rather than maintaining separate workflows for legend drugs and controlled substances.

Cost Savings For Patients
As patients take on a more participatory role in their care, they are expecting more from their physicians. No longer are they the receivers of information and care. Now it’s a partnership, with the provider and patient jointly deciding on the best medication(s) for their health issue. To do this effectively, physicians need access to patient-specific, cost-related data to inform that decision-making process. E-prescribing meets that need by supplying clinicians with point-of-care exposure to health plan details, presenting patient co-pay amounts and lower-cost medication alternatives. These details can then guide physicians — and patients—– to the most cost-effective and therapeutically appropriate alternatives, saving patients money and driving medication adherence.

Higher Patient Satisfaction
E-prescribing also enhances patient satisfaction by streamlining the prescription-filling process. When prescriptions are forwarded to a pharmacy electronically, a patient spends less time waiting to have the order filled. Usually by the time a patient arrives at their pharmacy, the formulary compliance checks have been completed and medications have been prepared for pick-up. In the case of controlled substances, pharmacies must have either a paper prescription signed by the clinician, or an electronically forwarded order. If a refill is required, a doctor using EPCS can save the patient the hassle of driving to the office to pick up a paper prescription. This convenience drives higher patient satisfaction and also helps support medication adherence.

Furthermore, for controlled drug prescriptions, the physician can send a smaller quantity, knowing s/he can easily renew the prescription if the patient needs more. Currently, many physicians give extra pills “just in case,” but that often leaves narcotics in patients’ medicine cabinets and could lead to abuse by them, a family member or a friend.

Facilitates Prescription Analysis
Finally, with e-prescribing, organizations can analyze prescription data to better understand what medications are being prescribed in which dosages and for which medical conditions, potentially leading to treatment breakthroughs. Providers can also identify variations in prescribing patterns among peers and look for outlier patterns — and perhaps avoid unexpected inquiries from law enforcement, other regulators, and news media.

The Answer To The EPCS Question
EPCS is well poised to make a significant contribution to fighting the country’s growing opioid epidemic. As the once reticent clinicians learn more about the numerous benefits of EPCS and embrace the solution, the nation will finally experience a turning point in the opioid crisis. Because EPCS is still the answer — but mainstream adoption is the key to success.

About The Author
Peter N. Kaufman, M.D., is the Chief Medical Officer for DrFirst. Dr. Kaufman is a board-certified gastroenterologist, a member of the ONC’s Health IT Standards Committee, Privacy and Security Workgroup, and a former co-chair of the Physicians EHR Consortium.