No news is good news: 6 weeks of electronic prescribing in New York

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In the six weeks since providers in New York state were required to start electronically submitting prescriptions, little news and commentary has come out about the transition, which appears to indicate it has been going smoothly.

As of March 27, paper prescriptions were essentially banned in New York, and providers have to use electronic prescriptions instead. While not the first state to require electronic prescriptions — Minnesota also requires electronic prescriptions by law — New York is the only state to impose penalties on providers who do not comply.

The law is known as I-STOP, which stands for Internet System for Tracking Over-Prescribing, and aims to boost transparency and information regarding controlled substance prescriptions to help curb opioid abuse and overuse. While much of the law's focus is on monitoring controlled substances, non-controlled substances also must be electronically prescribed. Those who do not comply may face civil or criminal penalties.

In order to electronically prescribe controlled substances per requirements of the new law, providers must use software certified by the Drug Enforcement Agency, undergo an identity proofing process, obtain two-factor authentication and register the DEA-certified electronic prescription software with the Bureau of Narcotic Enforcement.

A fact sheet from the New York State Department of Health's Bureau of Narcotic Enforcement says electronic prescribing also has the potential to help minimize medication errors for patients, integrate prescription records directly into EHRs and reduce prescription theft and forgery. 

Many providers in New York were already electronically prescribing substances, so there wasn't a steep learning curve to using new software. The required two-factor authentication for schedule II through V substances appeared to be the biggest change for providers, which Sanford Friedman, MD, a cardiologist at Mount Sinai Hospital in New York, says doesn't really change much.

"I feel exactly the same," Dr. Friedman says, referring to changes in workflow and the idea that the two-factor authentication increases prescription security.

Debra Brooks, MD, a physician with Northwell-GoHealth, an urgent care company in New York, agrees, saying the authentication doesn't really affect workflow. However, she's not sure the new law will do much in the way of curbing opioid abuse. For the past three years, providers have been required to consult the Prescription Monitoring Program Registry, part of the I-STOP law, when writing prescriptions for controlled substances. The PMP Registry is a database of all controlled substances prescribed by providers and reported by pharmacists.

"I don't know [how effective the electronic prescription mandate will be in curbing the opioid use and abuse problem] because it should already have been curbed by having everything logged," Dr. Brooks says, though she adds maybe behaviors will change. "Maybe some people aren't taking the time to look it up. Maybe physicians will feel a little more uncomfortable to prescribe without [first checking the registry]."

Dr. Friedman says having a patient's list of prescriptions is helpful in discerning whether a patient is shopping around and receiving prescriptions from multiple providers, information he says he previously couldn't know unless he took the time to actively seek it out.

Overall, Dr. Friedman says the law runs into some controversial territory, as it may blur the line between what are deemed necessary versus unnecessary prescriptions. "The fact is there are patients who need lots of opioids. Who's going to decide that, the government? On the other hand, there are doctors who are careless prescribers," Dr. Friedman says. "The wisdom of it is, how do you find a way not to penalize doctors who have to prescribe opioids for the right reasons versus docs prescribing opioids for the wrong reasons?"

New York can now be viewed as a testing ground of sorts for electronic prescriptions. According to data from health information network Surescripts, as of March 31, 77 percent of prescribers in New York were active e-prescribers, compared to 60 percent nationwide, and 58 percent of prescribers were electronically prescribing controlled substances, compared to 9 percent of prescribers nationwide.

Ken Whittemore, senior vice president of professional and regulatory affairs at Surescripts, says New York's higher rates of electronic prescription and electronic prescriptions of controlled substances are almost entirely due to the mandate. But unlike the physicians, Mr. Whittemore is more optimistic about how electronic prescriptions of controlled substances will change under the law.

"There's no real data yet, but we have reason to believe it's going to have a significant effect," Mr. Whittemore says. "It's far less likely to suffer from fraud and abuse than the traditional methods of prescribing opioids, and certainly it's going to allow physicians to better track what's going on."

The rest of the country may start looking to New York to see how the law plays out, and some states are already following suit. In April, Maine Gov. Paul LePage signed into law a bill requiring physicians to electronically submit opioid prescriptions. 

More articles on opioids:

Warrant identifies MD who prescribed Prince medication before his death 
4 ways nurses can help fight opioid abuse 
Surgeon General calls for more robust physician training for opioid prescribing 

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