To prevent drug diversion, prescription forgery and "physician shopping" while also improving patient safety and physician satisfaction, hospitals are implementing electronic prescriptions for controlled substances (EPCS) solutions.
Looking to improve its prescription workflows, Danville, Pa.-based Geisinger adopted an EPCS program. The Drug Enforcement Administration has various requirements for EPCS programs, including identity proofing, two-factor authentication and credential enrollment.
An EPCS solution allows hospitals and health systems to improve workflow inefficiencies, without investing an entire budget in a new health IT infrastructure. EPCS also limits long wait times at pharmacies as well as prescription errors and inaccuracies.
During a June 20 webinar presented by Becker's Hospital Review and sponsored by Imprivata, Amanda Pursel, EHR systems analyst at Geisinger, and Dan Borgasano, director of product marketing at Imprivata, discussed how hospitals can use multifactor authentication to improve protocols around the prescription of controlled substances.
Geisinger recycles paper for electronic prescriptions
Many hospitals and health systems, including Geisinger, are moving away from paper prescriptions and toward electronic prescriptions for controlled substances. Executives are not only turning to electronic prescriptions to improve efficiencies, but to also reduce the risks of prescription forgery.
"Forgery, diversion and fraud are known issues with printed prescriptions," Ms. Pursel said. "The printed prescriptions also give limited visibility into medication adherence. Ultimately, they end up being less efficient workflows for providers."
With the decision to turn to electronic prescriptions, Geisinger had to determine which EPCS solution was most appropriate. Ms. Pursel and her team assessed information technology security requirements, such as protecting health data and centralized reporting, as well as workflow efficiency.
Since the health system had already partnered with Imprivata for other solutions, Geisinger decided to expand its partnership to include Imprivata's multifactor authentication solution Confirm ID.
Prior to adopting the comprehensive authentication platform, it took clinicians around seven seconds to gain access to a patient's EHR, according to Ms. Pursel. Now, physicians at Geisinger can get access to an EHR and verify a prescription in four seconds.
Results outpace processing time
At Geisinger, physicians can download Imprivata's Confirm ID app and go through the DEA-required steps to get approved for multifactor authentication. The app pushes through alerts to the provider’s phone when a prescription has been requested. All a provider has to do is press accept and the prescription is sent electronically.
To make the installation a success, Geisinger positioned its IT and clinical collaboration teams to work seamlessly together. With the help of physician champions, staff throughout the health system were eager to adopt EPCS.
"We've had a lot of success using this system. Part of this success was due to early involvement of our implementation team," Ms. Pursel said. "We recognized that EPCS was going to be a mandate in the future, so we put a lot of importance on communicating this tool early and often."
Within two months of go-live, approximately 90 percent of controlled substances prescribed by Geisinger clinicians were done so electronically, increasing patient safety and satisfaction, and improving physician workflows. Within the first five months, the health system's 126 clinics transitioned 100 percent of prescriptions to electronic form, saving the health system around $850,000 a month due to time efficiency improvements.
Geisinger's main takeaway from this experience: electronic prescribing for controlled substance is not as complicated as providers may think.
What's next for multifactor authentication?
Today, New York, Maine and Connecticut require all controlled substance prescriptions to be electronic. More than twenty other states have passed EPCS mandates with approaching deadlines or have filed EPCS legislation. Hospitals and healthcare organizations need to adapt to these fast-approaching regulatory changes.
"In addition to state regulations, the SUPPORT for Patients and Communities Act was signed into law at a federal level," Mr. Borgasano said. "One of the components was an [electronic prescription] requirement for all controlled substances prescribed as a Medicare Part D program. By January 2021, any prescription for a controlled substance for Medicare Part D must be sent electronically.”
Walmart has also adopted electronic prescribing methods. By 2020, the retailer's pharmacy arm will only accept electronic prescriptions for controlled substances. So, while not all states are requiring electronic prescriptions, other larger players in the prescription market are making big changes that will alter how medicine is consumed.
Geisinger is an example of a forward-looking health system that took note of industry and regulatory trends and adjusted. Instead of pushing back, the health system took on the challenge and responsibility of curbing cyberattacks and the opioid epidemic.
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