Complex software but simple workflow: A look into Nemours Children's EPCS platform

As of April 2016, healthcare providers in New York are required to electronically submit prescriptions for controlled substances. The law requiring these electronic prescriptions intends to boost transparency and information regarding controlled substance prescriptions to help curb opioid abuse and overuse. While New York is the first state to mandate electronic prescriptions, enforced by civil and criminal penalties, other states are following suit, and the demand for an Electronic Prescriptions for Controlled Substances (EPCS) platform will likely increase.

Already, Minnesota requires electronic prescriptions by law, and Maine recently passed a law requiring the same, set to go into effect next year.

According to data released in March from Surescripts, just 9 percent of providers nationwide are electronic prescribers, but as legislation similar to the laws in New York, Minnesota and Maine is enacted, more providers will require the capability. In fact, Sheila Loy, director of healthcare solutions at HID Global, a provider of access controls and secure identity solutions, said in a recent webinar hosted by Becker's Hospital Review that state legislation is the key driver for increased adoption of EPCS among providers.

Nemours Children's Health System is one system that sought to get ahead of the EPCS curve. Joe Summanen, a technical architect with the Jacksonville, Fla.-based health system, started looking into partners for EPCS about two years ago. The health system's telemedicine program was taking off, and Nemours was seeking an additional innovative service to provide patients and their families, as well as clinicians and staff. Mr. Summanen said the health system viewed EPCS as a key component to the telemedicine program's success.

"It's providing families another time-saving service when their child is receiving care at Nemours," Mr. Summanen said in the webinar. "With an additional service that we're able to offer those patients during a telehelath sessions, it's the fact that that patient will have a better overall healthcare experience."

In addition to its Florida headquarters, Nemours has hospitals and clinics in Delaware, Maryland, New Jersey and Pennsylvania. While none of those states yet require EPCS, Mr. Summanen said Nemours wanted to be proactive about implementing such a platform. "We didn't want to be in a position where we were rushing to implement a solution," he said.

As such, he turned to HID Global, with whom Nemours already had a partnership for other enterprise-wide services, to provide its EPCS solution and support.

When planning an EPCS program, Mr. Summanen said Nemours identified key elements that would be critical for success. The first was ease of use by providers; Nemours leaders wanted providers to have the same process to submit electronic prescriptions no matter where they were located, be it in the office or remotely connecting. This would also be beneficial for information systems support. "If our provider had an issue, our service desk could follow the same workflow instructions to resolve those issues or answer any questions," he said.

Additionally, Mr. Summanen mentioned the importance of reconciling compliance and legal teams to work with HID and ensure the product was compliant with the Drug Enforcement Agency's requirements for electronic prescriptions of controlled substances. Those requirements include validating provider credentials.

Mr. Summanen outlined the actual credential provisioning process. There are two parallel processes occurring to credential a provider. First, a provider who wants to enroll in the EPCS program logs on to Nemours' internal system to indicate they would like to enroll. That generates a ticket requesting access to the EPCS module in the EHR; Nemours uses Epic. The provider is sent to a step-by-step registration process that starts the identity vetting process. It is at this point in the process where the DEA requires a certain level of assurance for identity proofing, a level 3 on a 4-point scale.

If the provider's identity proofing is successful, the provider will receive an activation letter in the mail. The provider takes the letter to what Nemours calls a local issuance station to complete the credentialing process. Once the process is complete, the provider gains access to the EPCS module in the EHR.

"Even though this solution is a somewhat complex or sophisticated back-end workflow, it has a very simple process on the front-end, which is exactly what you want for an end-user experience," Mr. Summanen said.

And the ease of use was apparent when Nemours was ready to pilot the system in December 2015. The pilot rollout included seven providers total, five psychiatrists at AlfredI.duPontHospital for Children in Wilmington, Del., and two at the Jacksonville Clinic in Florida. Charisse Geslani, an EMR associate analyst with Nemours Children's Health System, said the objective for the pilot was for each provider to prescribe at least 10 controlled substances in a month. If that happened, the health system would make the EPCS solution available across the enterprise. After one provider e-prescribed 70 controlled medications successfully the first two weeks he went live, Nemours made the program available systemwide. 

The efficiency of the system has produced measurable results for Nemours, Mr. Summanen said, and that makes the project a success.

"Our providers and our staff love the efficiency and the time that it saves them each week. I spoke to one office where it saves them anywhere from four to eight hours per week, not having to print, sign, mail, re-send, verify with the family and on and on," Mr. Summanen said. "That's the most rewarding part. You're actually making a difference in someone's day-to-day workload."

To watch the webinar, click here.

To view webinar slides, click here.

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