New York e-Prescribing Mandate May Go Into Effect This Month

Ken Terry

March 04, 2015

Editor’s note: On March 13, Gov. Andrew Cuomo signed legislation that will postpone the mandate to file all presriptions electronically by 1 year, to March 27, 2016.

Physicians in New York State face a March 27, 2015, legislative deadline to prescribe all medications electronically, including controlled substances.

A bill to postpone implementation of that mandate for 1 year has passed the New York State Senate, and prospects appear to be good for its passage in the state assembly, said Andrew Kleinman, MD, president of the Medical Society of the State of New York (MSSNY), in an interview with Medscape Medical News. Whether New York Governor Andrew Cuomo would sign the bill is unclear, Kleinman added.

Minnesota passed an electronic prescribing mandate that took effect in 2011, and other states are said to be looking carefully at what happens in New York as a result of its e-prescribing law, which was adopted in 2012.

The state legislature passed the e-prescribing law to eliminate the prescribing of controlled substances to patients who "shop" practices to get these prescriptions. Since 2013, New York physicians have had to consult a statewide electronic database before they prescribe controlled substances. When the e-prescribing portion of the law goes into effect, doctors will have to use electronic health records (EHRs) or stand-alone e-prescribers certified by the US Drug Enforcement Administration (DEA) to write such prescriptions. They must also be identity-proofed and authenticated under a strict protocol.

A Question of Preparedness

A major reason why the effective date of the e-prescribing mandate should be postponed, Kleinman said, is that many EHR and e-prescribing software vendors have not obtained their DEA certifications yet.

According to Surescripts, the company that electronically connects physician offices with pharmacies, EHRs used by more than half of New York State doctors do have versions that have been DEA- approved. But not all of these physicians have implemented the upgraded versions, David Yakimischak, executive vice president/general manager of medication services for Surescripts, told Medscape Medical News.

Whatever the state of e-prescribing software, only 12% of New York State providers ― 6000 out of nearly 49,000 ― have been enabled to do electronic prescribing of controlled substances (EPCS). That's about twice the national percentage, but still leaves 88% of physicians who must become enabled by the end of March ― or by a year from March, if the current bill is passed.

In contrast, 65% of New York pharmacies are already prepared for EPCS, according to Surescripts.

Nearly 96% of New York providers who prescribe medications did so electronically as of February 1, Surescripts said. That's a big increase from the 70% of providers who e-prescribed in September, so the law is clearly having an effect. If doctors don't embrace e-prescribing, they will lose their ability to prescribe in New York after March 27.

A Done Deal

Although the state health department is willing to grant exceptions to physicians on the grounds of economic hardship or technologic limitations that are not under a practitioner's control, those will last for only 1 year. Aside from those waivers, physicians may prescribe on paper only if their system is down, in an emergency, or if the pharmacy they're sending the prescription to is out of state, according to an article on the website of the American College of Physicians' New York chapter.

Some physicians who are not currently e-prescribing write few prescriptions, Kleinman noted. But others are doctors who have let the digital age pass them by.

"I'm a little concerned about older physicians who don't use computers in their offices," he said. "Especially in some areas of upstate New York, where there's a shortage of physicians, this might drive those physicians into retirement."

Many physicians have vociferously protested the e-prescribing mandate, writing letters to their state representatives, he noted. But, considering that the measure passed unanimously in the legislature and has widespread public support, the state medical society views it as a done deal that doctors must prepare for.

To that end, both MSSNY and the New York ACP chapter have procured discounts for the e-prescribing software of Dr First, a leading vendor in that space. Dr First is offering a 40% discount to MSSNY members, Kleinman said.

Physicians can also obtain free or low-cost e-prescribers, he noted. For example, Allscripts offers a free application that is DEA approved for EPCS.

In the end, Kleinman predicted, most New York doctors will comply with the electronic prescribing mandate. But MSSNY wants to limit the pain both for physicians and for patients, who might not be able to get their prescriptions renewed if the law is implemented too quickly, he said.

Yakimischak said he believes the mandate will be "good for patients and doctors and pharmacists, in terms of reducing fraud and abuse."

To qualify for EPCS, he noted, a physician must get identity-proofed and go through a "two-factor" authentication process so that only the doctor can sign and send a prescription for a controlled substance to a pharmacy. This might involve the use of mobile phones, smart cards, fob tokens, USB thumb drives, and biometrics such as fingerprint scanners.

EHR vendors have to integrate this process with their software, so they have to either work with physicians directly or hire identity-proofing companies to get physicians onboard, explained Yakimischak.

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