Physicians optimistic about potential for electronic prescribing but barriers to adoption still existElectronic prescribing is growing in its use by clinicians, but physicians are wary of the burden placed by several techniques to provide security for electronic prescribing of controlled substances (EPCS), a new survey finds. The use of electronic prescribing for controlled substances was banned by the Drug Enforcement Administration prior to 2010 because of the potential for such drugs to be diverted or cause addiction. Although controlled substances account for only 11 percent of all prescriptions, they are ordered for patients by 90 percent of prescribing clinicians.
The researchers found that 43 percent of the 246 clinicians who responded to their survey already used electronic prescribing for noncontrolled drugs. The most common issues reported about written (non-electronic) controlled substance prescriptions were the pharmacy reporting lack of coverage by the patient's insurance (64 percent of prescribers), the patient reporting loss of a written prescription that had to be rewritten (60 percent of prescribers), or medication interactions that were unknown at the time the prescription was written (37 percent of prescribers).
The researchers asked the clinicians whether proposed security measures for EPCS would likely prove to be an acceptably small, large but acceptable, or large but unacceptable burden. Three measures were viewed as so inconvenient that about one-fourth of the clinicians reported they might not want to use EPCS for prescribing controlled medications. These included requiring a token or flash drive with the prescriber's electronic signature to be used to authenticate and send all controlled substance prescriptions (26 percent of clinicians); requiring the prescriber to keep the token in their possession at all times (35 percent); and requiring the report of a lost or stolen token within 12 hours (24 percent). The researchers surveyed 246 clinicians who do outpatient prescribing (a response rate of 64 percent) affiliated with a regional health system in western Massachusetts.
The study was funded by the Agency for Healthcare Research and Quality (HS17157). A follow up survey of prescribers 6 months after implementation of a pilot of EPCS in the same community setting has also been conducted, and is now under review.
More details are in "Prescribers' expectations and barriers to electronic prescribing of controlled substances," by Cindy Parks Thomas, PhD, M.S., Meelee Kim, M.A., Ann McDonald, and others in the May 2012 Journal of the American Medical Informatics Association 19(3), pp. 375-381.