Electronic Prescribing of Controlled Substances (EPCS) saves lives; now more than ever

September 22, 2020

Best practices to follow to meet regulatory requirements and improve patient care.

Healthcare Delivery Organizations (HDOs) are fighting a pandemic within the COVID-19 pandemic...the opioid crisis. Disruptions in healthcare delivery and social services, coupled with social isolation and increased mental illness have all led to increasing morbidity and mortality from a familiar enemy: opioid addiction, dependency, and overdose. More people are suffering and dying from opioid use than ever.

As an emergency physician, I know from firsthand experience that we cannot ignore one disease to fight another. In fact, it has become more important than ever to implement technologies that fight both crises at once. Electronic Prescribing of Controlled Substances (EPCS) is one such tool whose time has come. HDOs should be implementing EPCS as soon as possible, and they can easily do so securely, efficiently, and in compliance with DEA requirements.

COVID-19 and the adoption of telehealth have made EPCS all the more important for providers and patients alike. Furthermore, the January 2021 deadline for healthcare providers to enable EPCS for Medicare Part D patients is rapidly approaching. In short, there are a number of reasons for healthcare organizations to make the switch as soon as possible.

For one, electronic prescriptions are a perfect fit for the telehealth model that many providers have adopted during the COVID-19 crisis. By prescribing electronically and cutting down on face-to-face interactions with patients, providers can limit patient-and-provider exposure to the virus. Providers can minimize the trips patients need to take outside their homes to obtain necessary medications—an especially important consideration for older and sicker patients, who are more at risk for negative outcomes if they are infected with coronavirus. 30 states have adopted their own EPCS regulatory mandates, with varying deadlines, and as anyone who has ever participated in a major healthcare IT initiative knows: things always seem to take a bit longer than planned. There is much coordination and planning involved to enroll providers in EPCS, and it shouldn’t be left to the last minute.

Renown Health, a Reno, NV-based healthcare system with three hospitals and more than 70 clinics, recently implemented EPCS to address patient safety concerns and regulatory compliance requirements. Here are some best practices they learned that other HDOs can follow to meet regulatory requirements and improve patient care through EPCS:

Know What You Know (and What You Don’t)

At Imprivata, we’ve worked with a large number of healthcare organizations on their EPCS rollouts, providing professional services that fill gaps in their internal IT staffers’ knowledge and experience. As one of the only healthcare systems in northern Nevada, Renown Health sees patients from a wide geographic area, meaning that the move to EPCS is saving some patients from having to drive several hours to see their physicians. Still, IT and clinical leaders at the healthcare system knew they needed help to make the transition. With 400 employed physicians and 1,400 credentialed affiliated physicians, the move was a major undertaking, and the organization relied on Imprivata professional services for about 85 percent of its enrollment effort.

“We certainly could have done many of these pieces on our own, but there’s a lot of regulatory risk, a lot of legal risk, a lot of trying to recreate a wheel that already exists,” Dr. Patrick Woodard, chief medical information officer and vice president of clinical systems for Renown Health, said in a recent webinar. “We simply felt it wasn’t something that we wanted to get into the business of doing.”

Don’t Forget the Human Component

Making a major change to a healthcare organization’s prescription system isn’t just a matter of implementing new technology. Clinical and IT leaders must also keep in mind that they’re requiring perhaps hundreds of professionals to adopt new tools and processes. That takes time.

“The hardest component of this, I think, is not the technological one,” Woodard said. “Anybody who’s gone through any sort of implementation knows that the human factor is the part that becomes difficult. There are a lot of folks who are going to have to be dragged kicking and screaming to something that’s new, even if it ultimately does benefit them.”

Adapt to Changing Conditions 

Renown Health’s rollout of EPCS was interrupted by the COVID-19 crisis, forcing the organization to shift both its timeline and its enrollment process for physicians. Renown sped up implementation to accommodate telehealth workflows for patients, a move that was only possible because the DEA issued updated guidance clarifying that remote institutional identity proofing was allowed (as long as healthcare organizations met additional requirements). Leaders at Renown used prescribing data to identify the first round of physicians to be enrolled, prioritizing anyone who had prescribed a controlled substance in the previous three months. “

We no longer had to have physicians come into the office or to an enrollment fair to get enrolled,” Woodard noted. “That opened a lot of doors for us to be able to meet the criteria on a quick time frame.”

Simplify Authentication

Renown enrolled 50 percent of its total providers in about a month; three weeks after the organization’s EPCS go-live date, 47.5 percent of prescriptions were electronic. Much of this early success is due to the organization opting for enrollment and authentication options that met the needs of its clinicians. The DEA requires two-factor authentication for EPCS, and Renown leaders chose a password combined with an Imprivata ID phone-based token. Because this set-up doesn’t require providers to be physically near a fingerprint reader or other biometric scanning device, it’s a good fit for remote authentication.

“It’s just a push notification. You click approve, and then it goes,” Woodard said. “So it’s significantly faster than a lot of people are used to, which will help drive adoption.”

While many providers are already EPCS-enabled, much work remains to be done before widespread industry adoption takes hold. Meantime, a worrisome trend is taking shape. Amidst the COVID-19 pandemic, evidence shows the opioid abuse problem is getting worse. More than 30 states are now reporting increases in opioid-involved overdose deaths. The federal mandate slated to take effect this January will help curb opiate abuse by creating more accountable and secure practices for those who prescribe and dispense controlled substances. But hospitals and providers need to implement the technology now, as soon as possible, or we could undo all the critical progress that’s been made so far.

About the Author

Dr. Sean Kelly is the Chief Medical Officer at Imprivata where he heads the company’s Clinical Workflow Productivity team and advises on the clinical practice of healthcare IT security. In addition to serving as Imprivata CMO, Dr. Kelly practices medicine and teaches at Beth Israel Deaconess Medical Center, a level one trauma center and academic teaching hospital in Boston, MA. He is also an Assitant Clinical Professor of Emergency Medicine at Harvard Medical School. He trained at Harvard College, University of Massachusetts Medical School, and Vanderbilt University, where he served as resident and Chief Resident. He is board certified in Emergency Medicine and is a Fellow in the American College of Emergency Physicians.