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Pharmacy Leads the Way
with ePrescribing of
Controlled Substances
March 24, 2015
Pharmacy Town Hall Series
Presentation Description
The majority of pharmacies are now capable of
receiving electronic prescriptions for controlled
substances (EPCS).
Find out why EPCS utilization by prescribers is low and
what is being done to advance progress.
Explore current initiatives and practical approaches to
start (or enhance) your EPCS activities.
About NCPDP
Founded in 1977, NCPDP is a not-for-profit, ANSI-accredited,
Standards Development Organization with nearly 1,600 members
representing virtually every sector of the pharmacy services industry.
NCPDP members have created standards such as the
Telecommunication Standard and Batch Standard, the SCRIPT
Standard for ePrescribing, the Manufacturers Rebate Standard and
more to improve communication within the pharmacy industry.
Our data products include dataQ®, a robust database of information on
more than 76,000 pharmacies, and HCIdea®, a database of
continually updated information on more than 2.3 million prescribers.
NCPDP's RxReconn® is a legislative tracking product for real-time
monitoring of pharmacy-related state and national legislative and
regulatory activity. www.ncpdp.org
About Surescripts
Surescripts is committed to unleashing the potential of
American healthcare by creating a more connected and
collaborative healthcare system. Our nationwide health
information network connects doctor’s offices, hospitals,
pharmacists, and health plans through an integrated and
technology neutral platform.
For more information, go to www.surescripts.com and
follow us at twitter.com/surescripts
About HIMSS
HIMSS is a global, cause-based, not-for-profit
organization focused on better health through information
technology. HIMSS leads efforts to optimize health
engagements and care outcomes using information
technology. www.himss.org
Vision
Better health through information technology.
Today’s Speaker
Patricia Hale, M.D., Ph.D., FACP, FHIMSS
Associate Medical Director, Informatics
Albany Medical Center
Patricia L. Hale M.D., Ph.D., FACP, FHIMSS, Associate Medical Director for
Informatics, Albany Medical Center. Dr. Hale has over 20 years of clinical experience
in Internal Medicine as well as clinical application of medical informatics. She is board
certified in Internal medicine and subspecialty board certified in Clinical
Informatics. Dr. Hale has lead EMR implementation projects for ePrescribing, data
exchange, physician order entry, clinical decision support and clinical documentation.
Previously, Dr. Hale was Deputy Director of the Office of Health Information
Technology and Transformation at the New York State Department of Health where
she helped direct a state wide strategy for health information technology
implementation.
Dr. Hale is a member of the HIMSS board of directors and she has been active in
many national informatics initiatives. She is co-author of several textbooks and reports
on electronic health records and electronic prescribing as well as editor of a book on
electronic prescribing for clinicians published by HIMSS. She continues part-time
clinical practice in Internal Medicine.
Today’s Speaker
Ken Whittemore, Jr., R.Ph., MBA
Senior Vice President, Professional & Regulatory Affairs
Surescripts, LLC
Ken Whittemore, Jr., R.Ph., MBA, Senior Vice President, Professional &
Regulatory Affairs, Surescripts, LLC. He works with federal and state
laws and regulations pertaining to health information technology and
serves as the liaison to pharmacy boards and associations.
Formerly, Ken worked at the National Community Pharmacists
Association (NCPA) and also co-owned a successful independent
pharmacy in Maryland.
Ken is a graduate of the University of Maryland School of Pharmacy, is
licensed to practice pharmacy in Maryland, and holds an MBA degree
from Mount Saint Mary’s University.
HIMSS & NCPDP 2015 Pharmacy
Informatics Town Hall Webinar Series,
sponsored by Surescripts
• Please insert all questions in the Q&A box located
on the bottom right of your screen
• A copy of the recording, slides and CPE forms will
be available for download within 24 hours on the
HIMSS Pharmacy Informatics webpage
http://www.himss.org/library/pharmacy-informatics
Accreditation Statement
The Institute for Wellness and Education is accredited by the
Accreditation Council for Pharmacy Education as a provider of
continuing pharmacy education. Attendees who participate in
the interactive portion and submit the completed evaluation
form at the conclusion of the program will have credit for 1.0
hour(s) of continuing pharmacy education (0.10 CEU) uploaded
to CPE Monitor within 60 days after the program date.
Please provide accurate NABP number.
ACPE program numbers are:
0459-0000-15-014-H03-P & 0459-0000-15-014-H03-T
Learning Objectives
• Describe the national status of EPCS state regulations
and technology readiness to meet these requirements.
• Examine EPCS readiness requirements for local
pharmacies and medical practices.
• Illustrate real-word experience with EPCS and provide
practical approaches to keep patient safety and quality
at the forefront.
Pre-test Questions
1) How is electronic prescribing of controlled
substances (EPCS) beneficial?
2) Regulations supporting EPCS are approved in
how many states?
3) What is a key barrier to EPCS utilization?
Controlled Substances are an
Important Medication Option
13%
of all prescriptions
• Narcotics, opioids and psychoactive
medications
• Regulated to 5 schedules of abuse potential
1. National Association of Chain Drug Stores (NACDS) 2013 dispense data for all new prescriptions, refills, and renewals in the US.
Misuse of Controlled Substances has
Become an Epidemic
4.8%
of the U.S. population has used an opioid pain reliever
non-medically
1.2M
emergency department visits related to substance
abuse in 2009
3X
increase in drug overdoses since 1995
The Health Care Threat is Growing
Drug Overdose Death Rates
Paper Prescriptions for Controlled
Substances: Additional Risk & Work
MANY
DUAL
3% - 9% States
Work
Of diverted
drugs for abuse
are tied to fraud
and forgery of
When both paper
Require special
paper Rx pads
and records²
Rx pads and
ePrescribing are
used³
paper prescriptions¹
• Pharmacies and prescribers are intervention points, also subject to investigations and
loss of license
1. Butler SF, Budman SH, Licari A, et al. National addictions vigilance intervention and prevention program (NAVIPPRO): a real-time, product-specific, public health surveillance
system for monitoring prescription drug abuse. Pharmacoepidemiol Drug Saf 2008;17:1142–54. ALSO, Rosenblum A, Parrino M, Schnoll SH, et al. Prescription opioid abuse
among enrollees into methadone maintenance treatment. Drug Alcohol Depend 2007; 90:64–71.
2. Agency for Healthcare Research and Quality (AHRQ), Reducing and Preventing Adverse Drug Events to Decrease Hospital Costs, Publication #01-0020
3. Economic Impact Analysis of the Interim Final Electronic Prescription Rule, DEA, U.S. Department of Justice, March 2010
Electronic Prescribing of Controlled
Substances (EPCS) Can Reduce Risks
• Lower fraud and abuse
• Secure electronic records
• Improved safety & patient care
DEA, U.S. Department of Justice, Economic Impact Analysis of the Interim Final Prescription Rule, March 2010
EPCS Legislation is Established in All
States, Except for Two Pending
New York State Will Mandate EPCS
Designed to address prescription drug abuse and diversion, providing
law enforcement and medical professionals tools to stop abuse and
diversion before it occurs
o Allowed EPCS in the state and makes ePrescribing mandatory for
both controlled and non-controlled substances as of 03/27/16
o Created a prescription drug monitoring program (PDMP) for New York
that requires real-time reporting of PDMP information
o NY State Department of Health, Bureau of Narcotic Enforcement (BNE)
released required packets for pharmacies and prescribers to register
their certified electronic prescribing applications
*I-STOP bill announced, introduced, passed and signed in 2012
Key Actions for EPCS Setup
Provider EHR Vendor
Pharmacy IT Vendor
Vendor Updates Software
Vendor Updates Software
•
•
•
•
• EPCS Certification
• Verified Audit
• Rollout update to local pharmacy
EPCS Certification
Select Identify Proofing
Verified Audit
Rollout update to local practice
Local Provider Actions
•
•
•
•
ID Proofing Setup
Two-Factor Authentication Setup
Set Access Controls
Training
Ready to send EPCS
EHR
Systems connect to
Surescripts network
to enable EPCS
Local Pharmacy Actions
• Set Access Controls
• Training
Ready to receive EPCS
PMS
EHR & Pharmacy Software Systems
get certified and connected by Surescripts
Pharmacy
Physician
EHR
PBM
enabling the exchange of
electronic prescriptions of controlled substances
Software Application Certification
for EPCS
Pharmacy software status
• major chains are ready
• most pharmacy system vendors
are certified
Provider EHR software status
• Top 10 companies have at least
some of their applications certified
o
Representing the market majority
• Hundreds of applications are still
not in the queue for EPCS
• Once certified, enablement and
activation may take months
Nationally, Over 70% of Pharmacies
are Enabled for EPCS
Provider/EHR Enablement for EPCS
Significantly Trails Pharmacy at 3-5%
setup requirements for
doctors is more complex
Many Doctors and Some Pharmacist are
Still Not Aware EPCS is Legally Available
I wish I could electronically
prescribe controlled substances.
I’m not sure if we are able to
accept EPCS
EPCS Adoption Barriers
Competing Workload
Priorities
Cost Concerns
3rd Party Audits for
Software
False
Knowledge
Changing regulatory
requirements
Education
Gaps
Fear of non-compliance / legality
Limited provider / pharmacy
coordination
Limited
Time
Gaps between pharmacy
and provider readiness
Uncertain action steps
Pharmacy & Provider
Software Updates
Provider Practice DEA
Requirements for setup
DEA•Practice
Requirements
IdentifyLevel
proofing
•
Identify proofing
• • Two-factor
authentication
Two-factor authentication
Setting access
controls
• • Access
controls
Providers have more required setup
steps than pharmacies.
Industry Experts Collaborated
to Create Simple Education on
Key Actions Providers Need to Get EPCS
EHR
EHR
Software Update
Identify Proofing
Two Factor
Authentication
Set Access Security
getEPCS.com Offers Education, Videos and
Guidance Designed for You to Share
• Embed education
module to sit on your
own webpage
• Post on LinkedIn
• Tweet EHR status
• Email action steps
getEPCS.com Let’s You Watch Each Step
and Look Up EHR Software Status
Go Online to See Who is Getting EPCS Today
Other Medical Practice/EHR Tips
for Successful Rollout of EPCS
•
Create cross functional project team
o
IT, App Team, Clinical, Pharmacy, Compliance
• Identify physician champions
o
o
o
Ensure clinical adoption
Review workflows for ease of use
Biometrics and Tokens
• Reach out to local pharmacies before EPCS goes live
• Establish the right team to make key decisions, especially with
respect to clinical workflow requirements
• Prepare Clinical Users
o
o
o
Develop training materials
Educate users on DEA requirements
Train users on new workflows
EPCS Contributes Value
•
•
•
•
•
Saves time with electronic renewals
Supports safer medication decisions
Reduces manual record keeping requirements
Supports attainment of meaningful use
Increases patient convenience and care
Educate, Communicate, Collaborate to
Realize the Full Value of EPCS
Post-test Question #1
1) How much of the CDC reported drug overdose
deaths were related to dispensed prescriptions?
a) 5%
b) 10%
c) 35%
d) More than 50%
Post-test Answer #1
1) How much of the CDC reported drug overdose
deaths were related to dispensed prescriptions?
a) 5%
b) 10%
c) 35%
d) More than 50%
Post-test Question #2
2) How many states have legislation in support of
EPCS?
a) 5
b) 10 plus the District of Columbia
c) 46
d) 48 plus the District of Columbia
Post-test Answer #2
2) How many states have legislation in support of
EPCS?
a) 5
b) 10 plus the District of Columbia
c) 46
d) 48 plus the District of Columbia
Post-test Question #3
3) Nationally, what percent of prescribers have EHR
systems enabled for EPCS?
a) 1-2%
b) 3-4%
c) 5-6%
d) 10%
Post-test Answer #3
3) Nationally, what percent of prescribers have EHR
systems enabled for EPCS?
a) 1-2%
b) 3-4%
c) 5-6%
d) 10%
Post-test Question #4
4) What actions must be completed before a prescriber’s
EHR system is set-up to legally send electronic
prescriptions for controlled substances?
a) Electronic health records (EHR) software update and
certification for EPCS
b) Establish identity proofing and signing credentials with twofactor authentication
c) Set-up access control to ensure system security
d) All of the above
Post-test Answer #4
4) What actions must be completed before a prescriber’s
EHR system is set-up to legally send electronic
prescriptions for controlled substances?
a) Electronic health records (EHR) software update and
certification for EPCS
b) Establish identity proofing and signing credentials with twofactor authentication
c) Set-up access control to ensure system security
d) All of the above
Post-test Question #5
5) How can you determine who in your local community
are enabled for EPCS and help provide guidance for
getting EPCS established with medical practices?
a) Call or email local doctors
b) Share educational support found on www.getEPCS.com
c) Post educational information on your website
d) All of the above
Post-test Answer #5
5) How can you determine who in your local community
are enabled for EPCS and help provide guidance for
getting EPCS established with medical practices?
a) Call or email local doctors
b) Share educational support found on www.getEPCS.com
c) Post educational information on your website
d) All of the above
Q&A
Save the Date – Future Town Halls
Pharmacy’s Role in Interoperability
May 14, 2015 | 12:00 pm central
Pharmacy, Leadership and the Optimization of
ePrescribing Quality
June 4, 2015 | 12:00 pm central
Register Today!
http://www.himss.org/library/pharmacy-informatics
See you at HIMSS15 | April 12-16
www.himssconference.org
Register Today | NCPDP 2015
http://ncpdp.org/ac/index.aspx