Advancing Care with Electronic Prescribing of Controlled Substances (EPCS)


Last week at the HIMSS15 Conference in Chicago, Surescripts sponsored a panel discussion titled Advancing Care with Electronic Prescribing of Controlled Substances (EPCS). The session was streamed live on the web, with 161 people joining remotely. The conversation was led by Santosh Kalkar, vice president, prescription routing at Surescripts, and covered the impact of EPCS for prescribers, pharmacists, and patients. It also included opinions from notable healthcare experts, including:

  • Rajiv Pramanik, M.D., CMIO at Contra Costa Regional Medical Center
  • Sean P. Kelly M.D., CMO, Imprivata and emergency physician at Beth Israel Deaconess Medical Center
  • Paul Calatayud, CISO, Surescripts

The group discussed the relatively slow adoption of EPCS among care providers, despite the fact that electronic prescribing of non-controlled substances has been swiftly embraced by prescribers and pharmacists. According to Santosh Kalkar, today in the U.S. about five percent of providers and 71 percent of pharmacies are enabled with EPCS. 

Yet the group sees those statistics changing, due largely to the fact that technology has advanced to the point where, according to Dr. Kelly, "good technology; systems that don’t slow us down and distract us from caring for our patients, are now available” for EPCS.  Acknowledging the potential of EPCS to improve efficiency, increase patient safety, and help stem drug diversion, the group agreed that other states will begin to follow in New York's footsteps to enact similar laws to I-STOP in order to reap its outsized benefits. 

Dr. Pramanik, who is an early adopter of Imprivata’s EPCS solution at Contra Costa Regional Medical Center, described the challenges that arise when prescriptions are sent to the pharmacist using multiple methods.  The combination of electronic, faxed, and written prescriptions is confusing and inefficient for prescribers and pharmacists who have to adapt to multiple workflows, and inconvenient for patients who are burdened with pharmacy wait-times and regular office visits to pick up paper prescriptions.  For patients with conditions spanning from ADHD to cancer, EPCS can give them easier access to the medications they need. 

The group discussed the role of secure two-factor authentication—using a combination of password, finger biometrics, one-time password tokens—in order to maintain end-to-end prescription integrity from prescriber to pharmacist to patient.  "Dr. Kelly and Dr. Pramanik, both emergency physicians, agreed that burying the authentication process behind the scenes - making it invisible - was key to speeding adoption among prescribers."

"If technology is a barrier to our workflows and interferes with care, physicians won't want to use it," commented Dr. Pramanik.  He went on to describe a new, “hands-free” form of authentication that has been recently approved by the DEA and introduced by Imprivata at HIMSS.  Imprivata’s new technology uses blue tooth connectivity to wirelessly retrieve and verify a one-time password form a user’s mobile device (even if it is locked) without requiring any manual interaction. This allows prescribers who have their smart phones within proximity of their workstation to simply type their password or swipe their fingerprint to authorize the electronic prescription of a controlled substance. 

Paul Calatayud brought up the by-products of EPCS from a broader perspective, in terms of addressing additional risk factors.  “Once 2-factor authentication is introduced to the process of accessing records and authorizing orders around a patient's care, it tends to expand and boosts the overall security at hospitals and practices,” he commented. 

The panel agreed that EPCS becomes increasingly valuable in the advent of e-consults and e-visits.  “For certain patients, such as those who are in severe pain with cancer or in hospice, an office visit should not be required to get them the medications they need,” said Dr. Kelly.