As more providers move to reduce paper prescriptions in favor of electronic prescribing, hospitals can leverage technologies for prescribing controlled substances that increase workflow efficiency and boost patient care, particularly for populations with limited provider access.
After La Crosse, Wis.-based Gundersen Health System implemented a new EHR system, the 325-bed hospital began electronically prescribing non-controlled substances. But for controlled substances, providers were still required to use paper prescriptions, resulting in a frustrating and inefficient dual prescribing workflow that affected physicians and patients. The system required patients to travel long distances to receive paper prescriptions and upped the hospital's risk of theft as paper prescriptions were printed to centralized locations.
To address this issue, Gundersen partnered with health IT security company Imprivata to implement an electronic prescribing solution for controlled substances. The system allowed Gundersen's providers to reduce paper prescriptions and improve workflow efficiency while meeting Drug Enforcement Administration requirements.
In a June 5 webinar sponsored by Imprivata and hosted by Becker's Hospital Review, Amy Loos, RN, clinical informaticist at Gundersen Health System, and Michael Redman, MD, surgeon and chief medical information officer at Gundersen Health System, discussed how the solution helped the hospital reduce paper prescriptions, tips for a successful go-live and getting providers on board with the solution.
Addressing the challenge of paper prescriptions
"One of the reasons we moved forward with this project was to address the burden of patients having to travel to pick up paper prescriptions," Ms. Loos said. "We have a lot of small clinics and patients who often travel up to an hour to get their prescriptions every month. That was a key part of increasing patient satisfaction."
Additionally, inefficient workflows between paper prescribing and e-prescribing left providers and patients frustrated. Nursing staff had to spend time printing the prescriptions and finding the provider, while patients had to travel to get their prescriptions — making the process lengthier than necessary, Ms. Loos noted.
To decrease this burden on staff and patients, Gundersen implemented fingerprint biometrics its EPCS system, allowing providers to quickly access their e-prescribing application. "We decided Imprivata would allow for a seamless integration into our EHR, Epic, where there would be a single platform to implement and manage prescribing," Ms. Loos said. "It also allows for consistent administration and reporting as well as a solution for meeting EPCS compliance requirements."
Ms. Loos discussed several regulatory issues for hospitals to consider before going live with an EPCS solution. The DEA requires a two-factor authentication for providers when electronically prescribing medication. Providers must have two of the following three components: a token (such as a provider's cell phone), password or fingerprint biometrics.
Gundersen decided to combine a password and fingerprinting for this process, Ms. Loos said, adding that having hospital staff in place to enroll each of the providers' fingerprints helped the hospital successfully launch the solution.
"The results of our recent go-live at one of our clinics showed a significant reduction in paper," Ms. Loos said. Additionally, Gundersen's providers showed increased interest in transitioning to e-prescribing. "There was a huge buy-in with our adoption of the solution," she added. "We saw a seven-fold increase in EPCS in four months."
6 tips for a successful go-live
Ms. Loos shared several strategies for ensuring a successful go-live when launching an EPCS solution, such as considering where to place fingerprint devices, focusing on team work and ensuring consistent communication among staff.
Here are six tips for a successful go-live:
1. Communicate with staff. "This project turned out to be much bigger than most of us anticipated, so communication is essential in knowing who needed to be involved," Ms. Loos said. "I think a key part of our implementation plan is that we met with managers to make sure they knew to consistently communicate to their staff on where the new devices would be and what changes would be happening prior to the go-live."
2. Develop a comprehensive rollout plan. Gundersen started their solution plan by outlining the necessary steps for a successful rollout at each clinic location, making sure the plan worked for each location. "We had a game plan," Ms. Loos said. "Everyone knew what their rollout [responsibility] was and we knew what we had to do at each location."
3. Keep device placement consistent. "Prior to our go-live, we rounded in the hospital, the clinics and with directors and providers to get a feel for where it would or would not make sense to put each of the devices," Ms. Loos said. "We figured out where the providers would be sitting so we could make sure that area had a device with a fingerprint reader in it."
4. Understand the project's complexity. "This was a huge undertaking for our staff," Ms. Loos said. "It involved getting more people on board as we dove deeper into the project, which is crucial to recognize prior to your go-live."
5. Delegate responsibilities and focus on teamwork. "To make it a successful project, you need to make sure everyone on your staff is on board," Ms. Loos said. This team effort involved not only physicians and nurses, but also hospital leaders and administrators.
6. Conduct pharmacy outreach prior to go-live. "Since we were the first in our area to go live with EPCS, we had local pharmacies deny prescriptions to patients because the pharmacists didn't think they could accept the prescriptions," Ms. Loos said. "We had to do a lot of reaching out to them and educate them on the new process."
Getting providers on board with EPCS solutions
Ms. Loos and Dr. Redman also discussed the provider response to the EPCS solution and how Gundersen made sure providers were on board with the prescribing process.
In addition to providing educational resources to managers and meeting with them on a weekly basis in preparation for the go-live, Gundersen conducted a pilot with providers to assess the solution before initiating systemwide implementation. The response was widely positive, which helped breed a sense of eager anticipation among providers around the system.
"This change in the prescribing process is a huge benefit for practicing physicians," Dr. Redman said. "As a surgeon, I would write prescriptions that would often get lost or misplaced. Now, in doing this project, we e-prescribe as much as we can. "
Ms. Loos agreed, adding that providers were satisfied with how the solution improved patient care. "I had a voicemail when I came to work that said this solution was the best invention since sliced bread," Ms. Loos said. "We have a lot of patients who travel in and our providers were grateful that families didn't have to travel to the clinic before going to the pharmacy. Everyone has been grateful for the workflow change, and that this process is ultimately helping their patients."
To listen to the webinar recording, click here.