The “perils of paper” are likely consequences of the Drug Enforcement Administration’s final interim rule for e-prescribing controlled substances, according to one national health IT professional.
Consultant Maria Friedman, an e-prescribing expert who retired as a senior adviser from the Centers for Medicare and Medicaid Services in 2006, is envisioning an unintended outcome among small group and solo practitioners.
The March 31 directive follows a 2008 proposed rule, that evoked about 200 comments from pharmacy organizations, state health licensing boards, and state health departments, as technology opened the doors to digital prescriptions. Though prescriptions for controlled substances make up less than 11 percent of all prescribed drugs, according to the DEA, the rule has raised concerns among industry watchers.
“It’s going to be a disincentive,” Friedman said. “I think (practitioners) will drop back to paper for controlled substance prescriptions. If they have an EHR, they will print out the prescription, hand-sign it, and hand it to the patient.”
Friedman said the new rule, filed on March 31, would not help the DEA’s goal of drug diversion.
“First of all,” she said, “it keeps the door open for the perils of paper and all of the quality and safety problems associated with paper prescriptions.”
But a recent statement issued by Surescripts, the nation’s largest e-prescription network, supports the interim final rule, which remains open for comments until June 1, when physicians can begin e-prescribing.
“Properly designed and implemented, we believe that the e-prescription of controlled substances will have a positive impact on e-prescribing adoption and use, and significantly increase the efficiency and safety of a prescribing process relied on by millions of patients every day,” said Harry Totonis, president and CEO of Surescripts.
The 334-page rule requires authentication by using two out of three options: Prescribers must: use a password or answer a challenge question to which only they know the answer; submit to an iris or fingerprint scan or some other biometric measure; or insert a card or token, similar to ATM cards at bank machines.
Wes Rishel, an analyst at Gartner, Inc., an information technology and research company, said authentication requirements will create a long adoption curve for doctors, but eventually will simplify their workflow.
“Fundamentally, it allows them to be less distracted,” he said.
But Friedman said the interim rule requiring individual practitioners to seek out a third-party authenticator would slow down adoption because of the time involved in finding one.
“They have significantly disadvantaged small group and solo providers because of the extra credentialing it will take for them to be able to e-prescribe controlled substances,” she said.
Gary Boggs, executive assistant in the DEA Office of Diversion Control, acknowledged that it would take time for the dust to settle. Boggs said he anticipates that authenticating companies will help refine the process for small practitioners.
“There are going to be some growing pains,” he said, “but over time you’ll see the system improve more and more, and there will be competition to help reduce overall costs.”
