How can pharmacists successfully implement EPCS?

Q&A with Michele Higgins, PharmD, MBA

Michelle-Higgins-how-can-pharmacists-successfully-implement-EPCSMichele Higgins, PharmD, MBA, is the pharmacy informatics coordinator for Nebraska Methodist Health System in Omaha, Nebraska. Higgins’ experience, spanning over 20 years, includes implementing systems for automated dispensing cabinets, carousels, pharmacy information systems, bedside barcoding, and setting up a pharmacy department in a brand new facility with a new NICU population utilizing 100% CPOE. Her most recent project has been implementing electronic prescribing of controlled substances (EPCS) for providers across Nebraska Methodist Health System. Recently, Higgins spoke about her EPCS implementation experience and advice:

Q: From your perspective as a pharmacist, what were the challenges associated with paper and oral prescriptions for controlled substances?

A: Before electronic prescriptions of controlled substances (EPCS), paper and oral prescriptions of controlled substances were not automatically added to hospitals’ electronic health records (EHRs), and wouldn’t necessarily show up in patients’ individual records. There were also logistical challenges - because, if the prescription was printed from the EHR, you’d need the doctor’s signature and DEA number on the physical prescription, which was often difficult to coordinate in a timely fashion.

Q: How did these challenges affect clinical staff, pharmacists, and patients?

A: The biggest challenge of paper and oral prescriptions for controlled substances for clinical staff, pharmacists, and patients alike was dissatisfaction. When doctors were going through their discharge work, paper prescriptions disrupted their workflow because they had to find prescription paper, fill it out, sign it, and physically hand it to their patient. EPCS has helped to increase our PRC satisfaction scores by an average of 2% for both physicians and patients.

From the patient’s point of view, EPCS really improves their prescription experience. Now they don’t have to wait and hand carry a paper prescription to their pharmacy. Instead, their prescription is ready, or at least closer to being ready, when they get to the pharmacy. When patients are in pain, this expedited prescription service really makes a difference and makes everything easier for the patient.

From the pharmacist’s perspective, EPCS offers us better visibility into who is prescribing what and how often. We also have much more complete medical records for our patients. Now, I have a complete medication list for each patient. I no longer have to worry that there are prescriptions being written for patients that aren’t recorded, and that I don’t know about.

Q: Do you think EPCS helps reduce prescription drug abuse? If so, how?

A: Yes. Prescribers no longer have to use prescription pads that drug-seekers can steal. EPCS is almost impossible to dupe, as two-factor authentication makes it very secure. And electronic record keeping allows provider and patient history to be analyzed in a centralized database, so we now have a much better way of tracking what’s being prescribed, by which doctors, to which patients, when, and how often.

In the past, if patients arrived in the pharmacy with a paper prescription for controlled substances, and paid for their medication with cash, the pharmacy would have to enter all the data from their visit manually, which wasn’t a fool-proof record keeping method. Now, if you have electronic systems on both ends – with a Prescription Monitoring Program (PMP) and EPCS – you get a lot more information and insight into potentially fraudulent drug seeking behavior. Overall, I think implementing EPCS is a very rare kind of IT project because it’s a triple win for care providers, patients, and pharmacists.

Q: What were your e-prescribing rates before and after implementing EPCS?

A: In our hospitals, we achieved an 85 percent increase in electronic prescribing, and a 30-40 percent increase across the entire organization. As a result, we’ve reached 97 percent e-prescribing rate for all medications. At the moment, we’re processing roughly 15,000 electronic prescriptions of controlled substances per month and have more than 200 doctors using EPCS technologies in the clinic.

Q: Are there any aspects to the DEA or EPCS legislation that pharmacists should pay particular attention to? What would you tell a fellow pharmacist who is considering introducing EPCS to their pharmacy?

A: EPCS touches so many different departments - including legal, IT, pharmacy, medical staff, and administrative office staff. So you have to develop a stellar onboarding process to drive adoption and consider who owns each step of the EPCS process, including:

  1. Identity proofing (pre-nomination) - when providers sign up, they’ll need to provide a copy of their driver’s license, DEA number, and signature.
  2. Nomination – done with computer system
  3. Approval process – separate from nomination

I’d also recommend that pharmacists who are considering EPCS should think about what their clinical colleagues are going to use from a two-factor authentication standpoint. Some important questions include:

  • Which two factor authentication methods are DEA-compliant?
  • And, just as importantly, which two-factor authentication methods are easy to use and don’t disrupt clinical workflows? If the two-factor authentication methods are cumbersome or disruptive, clinical staff will prefer to revert to paper prescriptions, which will undermine your EPCS efforts.  

I’d also recommend considering the auditing and reporting capabilities of the EPCS solution you choose. Who gets access to the audits and reports? And what do you do with them?

Lastly, hospitals considering EPCS should make sure to communicate with retail pharmacies in their area, letting them know that you plan to implement EPCS soon. Because if you don’t coordinate with your pharmacy community early enough, you may have to deal with rejected prescriptions and modality arguments. So long as you have a comprehensive EPCS implementation plan, good technology partners, and community buy-in from pharmacists, prescribers, and administrative staff alike, the resulting benefits of your EPCS implementation will be very worthwhile.

If you’re interested in learning more strategies for successfully implementing EPCS, you can find more detailed tips in our EPCS whitepaper and our Imprivata Confirm ID customer case studies:


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