Be Warned: e-Prescribing's 6 Big Challenges for Doctors

Kenneth J. Terry, MA


November 01, 2012

In This Article

Workflow: Not Well Integrated Into the Staff Routine

Many physicians prescribe electronically just enough to avoid the penalties and attest to meaningful use of their electronic health records (EHRs), notes Rosemarie Nelson, a principal of MGMA Health Care Consulting Group. However, "they don't make e-prescribing part of their routine. Many have not incorporated it into the way they write scripts."

When Nelson looks below the surface of doctors' resistance to e-prescribing, she often finds that they're having trouble because their staff hasn't done their part. The nurses or medical assistants may not have entered the medication lists for patients who haven't seen since the doctor started e-prescribing. In some cases, they haven't asked patients about their preferred pharmacies and put those in the system.

According to a study published last year in the Journal of the American Medical Informatics Association (JAMIA),[1] many practices encounter obstacles in maintaining complete medication lists during the rollout of their e-prescribing systems. Staff members have to enter this data manually. Because many physicians haven't maintained up-to-date medication lists in their paper charts, doctors are forced to review the lists and consult with patients to fill in missing information.

Depends on the e-Prescribing Software

If a physician uses the e-prescribing module in his or her EHR, the insurance and demographic information for established patients is already in the system. But if the doctor is using standalone e-prescribing software and doesn't have an interface with the practice management system, all of those data have to be entered manually. That's not something a busy doctor wants to do.

Physicians who don't write electronic prescriptions consistently will have an inefficient dual workflow as they switch from e-prescribing to paper and back again. The continuing problems with e-prescribing of controlled substances guarantees a dual workflow, in any case. But Nelson points out that this would be much less of an issue if doctors wrote all other prescriptions electronically.

Physicians could also improve workflow by programming their own "favorites" among medications into their e-prescribing applications, she says. "You can overcome some of that data entry if you create your own little subset. Most doctors will tell you that there are 30 medications they prescribe 80% of the time. So if they can build that subset, that would save time."

Controlled Substances: Plenty of Hoops to Jump Through

In 2010, the Drug Enforcement Administration issued a regulation, Electronic Prescriptions for Controlled Substances (EPCS), that allows e-prescribing of controlled substances under federal law. As a result, you might think that the obstacles to this type of e-prescribing would be gone. But you would be wrong. Relatively few physicians write e-scripts for controlled substances today, Steve Waldren notes. He attributes this to a lack of support from some software vendors and the persistence of restrictive laws in many states.

According to Surescripts,[2] a national clinical e-prescribing network, EPCS is illegal or has an unclear legal status in about a dozen states. In other states, physicians may prescribe some or all controlled substances. But some of those states make it so difficult to do EPCS that most doctors don't want to bother.

In addition, Surescripts requires software vendors to get certification for EPCS before prescribers can use their programs for that purpose. Prescribers must get an audit report from the vendor and must submit to "2-factor authentication" before digitally signing an electronic prescription for a controlled substance. Not many vendors and doctors have jumped through all these hoops.

James R. Morrow, MD, a solo family physician in Cummings, Georgia, notes that his inability to do EPCS disrupts his workflow. For schedule 2 drugs, he can't even fax prescriptions, but must instead handwrite them on special paper. He doesn't see how paper prescribing makes prescribing controlled substances safer. Neither does family physician Stephen H. Mascio, DO, of Follansbee, West Virginia, who says that narcotics seekers have impersonated his office staff when calling pharmacies to obtain controlled substances.