Health IT, Hospitals

Docs at HealthEast seem to love e-prescribing for controlled drugs

Since HealthEast Care System in St. Paul, Minnesota, became the first health system in the state to go live with EPCS two years ago, clinicians have saved an aggregate of about 500 hours per month in time spent writing prescriptions for controlled drugs, CHIME attendees heard Wednesday.

By Neil Versel on November 02, 2016

Joanne Sunquist, CIO of HealthEast, speaks at CHIME’s 2016 Fall CIO Forum in Phoenix.

Want physicians to stop hating health IT? Try supporting e-prescribing of controlled substances and make sure the requisite extra security measures aren’t intrusive.

Since HealthEast Care System in St. Paul, Minnesota, became the first health system in the state to go live with EPCS two years ago, clinicians have saved an aggregate of about 500 hours per month in time spent writing prescriptions for controlled drugs. At HealthEast, 72 percent of such prescriptions are now completed electronically, including upwards of 90 percent in primary care clinics, according to CIO Joanne Sunquist.

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“We still have a ways to go. We’d like this to be 90 percent everywhere,” Sunquist said.

Perhaps more surprising is the medical staff’s attitude toward the e-prescribing technology. “The doctors were very excited about it and very willing to participate,” Sunquist said Wednesday at the College of Healthcare Information Management Executives (CHIME) Fall CIO Forum in Phoenix.

That is because paper prescribing of controlled substances necessitated dual systems, since HealthEast had previously enabled e-prescribing for non-scheduled drugs. That was unwieldy and time consuming — and explains why only 6 percent of prescribers nationally were using EPCS technology as of May 1, according to e-prescribing connectivity network Surescripts, Sunquist noted.

It also explains why physicians groaned when the Drug Enforcement Agency reclassified hydrocodone in 2014 as a Schedule II controlled substance, meaning that pharmacies could no longer process refills or phoned-in orders. Sunquist cited a 2014 poll conducted by the publication Pharmacy Times, in which 72 percent of pharmacists said the rescheduling of hydrocodone would slow down their workflow.

But EPCS has been slow to take off because the DEA requires identity proofing, provider enrollment, two-factor authentication and other security measures for anyone interested in writing electronic scripts for controlled drugs. The rules came into force in July 2010, but vendors needed a couple of years to get their technology up to DEA standards. EPCS also was not legalized in all 50 states until August 2015, when Vermont came on board.

Given that e-prescribing helps meet a requirement of the federal Meaningful Use electronic health records incentive program, reduce errors and cut patient wait times at pharmacies, HealthEast was eager to implement the technology. In the case of controlled substances, e-prescribing also can prevent fraud, drug diversion and theft of DEA prescriber numbers, according to Sunquist.

HealthEast contracted with health IT security and communications company Imprivata for single sign-on and dual-factor authentication technology that is integrated with the Epic Systems EHR. (CORRECTION: An earlier version of this story incorrectly reported that Epic does not offer native support for EPCS.)

It actually took six months from contract signing to go-live because the EPCS project was run in conjunction with an EHR upgrade, Sunquist said; it otherwise should be a much faster transition.

“We think it’s best if you can simplify it with a single, multi-purpose solution with a single sign-on versus using disparate technologies and manual processes,” Sunquist said. It also was imperative that the e-prescribing was integrated with the EHR.

“As we went live in all the clinics, we made [EPCS] mandatory as part of the training for Epic,” Sunquist explained. Enrolling in EPCS has since become part of credentialing and training for all new HealthEast providers, she said.

The health system created multiple types of interfaces to give users options for logging in as simply and securely as possible, including Imprivata’s “Tap N Go” system on tablets and embedded fingerprint readers on computer keyboards. Sunquist said physician informaticists asked for the fingerprint option because it was easier to use than a hard token for the second authentication factor.

Prescribers at HealthEast now write 15,000-20,000 e-prescriptions for controlled drugs each month, yet nurses rarely have to get involved in verifying scripts anymore. Sunquist said nursing involvement has gone down from 40 refills per day to zero in most of the HealthEast clinics as a result of the e-prescribing system for controlled substances.

Sunquist said that while preparing her CHIME presentation, she could not find a single ticket at the IT service desk complaining about EPCS — except for the one-day outage in February that caused a lot of calls.

“The best part of our whole EHR go-live was EPCS,” one physician reported, according to Sunquist.

Sunquist showed this video describing the EPCS program at HealthEast:

Photo: Neil Versel/MedCity News