Electronic prescribing of controlled substances reduces fraud and keeps patients from getting multiple prescriptions for the same drug, but only three states require it and one doesn't even enforce its law.
As much of the country struggles with record overdose deaths, often from opioid painkillers, industry officials say this legislative lapse needs to be remedied as part of a broad drug control policy.
Although paper prescriptions were once considered safer, all states now allow e-prescribing for drugs, including opioid painkillers and other controlled substances. Still, only 7% of doctors do so, according to Surescripts, which links doctors with pharmacies for e-prescribing.
Between 3 and 9% of opioid abusers use forged prescriptions, says Paul Uhrig, Surescripts' chief legal officer. E-prescribing would prevent that and many of the overdose deaths cause by so-called doctor-shopping — people who get narcotic prescriptions from several physicians, he says.
Databases known as Prescription Drug Monitoring Programs show doctors all controlled-substance prescriptions patients get and should be linked with the electronic health records (EHRs) that allow doctors to e-prescribe, health IT experts agree.
Busy parents who have to pick up a paper ADHD prescription for their child know it can be frustrating and time consuming — just as it is for people who legitimately need pain medication.
That may change soon as there’s new pressure — including a push Thursday by insurer Cigna — for doctors to check state databases before they write prescriptions controlled substances.
All states and Washington, D.C., have the drug monitoring databases, but fewer than five require their use. Less than 20% of doctors use the databases when it isn't required.
If these databases were fully used by states, Cigna CEO David Cordani says about 97% of the 7.5 million people at high risk of addiction could have been identified when doctors saw "the amount of narcotics or opiates they were in possession of."
"The more electronic exchange of information that can be available, the better off everyone is," says Douglas Nemecek, a psychiatrist who is Cigna's chief medical officer for behavioral health.
Cigna is also announcing plans to reduce its customers' opioid prescriptions by 25% over the next three years.
Here's what states are doing on e-prescribing.
• New York. The state's 2012 e-prescribing law, which requires doctors to check the PDMP database before prescribing narcotics, went into effect March 27. Nearly half of doctors in the state now use EPCS, up from about 13% last year. Those who continue to use paper pads are subject to fines, jail time or both.
• Maine. Drug overdose deaths were up 31% last year, the state's attorney general's office said in March. Most were for heroin, fentanyl or opioid painkillers. In April, the state became the third to require EPCS. After January 2017, physicians who don't use electronic prescriptions will also be subject to fines, jail time or both.
• Minnesota. New data from the Minnesota Department of Health show drug overdose deaths jumped 11% from 516 deaths in 2014 to 572 deaths last year. The state was first to require e-prescribing but the legislation doesn't allow enforcement or penalties for doctors that don't adhere. Just 3.5% of doctors were using EPCS this year, Surescripts says. Marty LaVenture, director of the Minnesota office of health IT and e-health, says the health department will consider this summer which "policy levers could be used to encourage full adoption and use of e-prescribing capabilities," including possible financial incentives.
Experts emphasize that e-prescribing can create problems and hardly solves all of them.
"It's another tool to help make it harder to get some of these drugs, but the flip side to all of this is that if they have a hard time getting the prescription, that’s when many switch to heroin," says Becky Vaughn, vice president of addictions at the National Council for Behavioral Health.
Caryl Brymialkiewicz, chief data officer for the Department of Health and Human Services' inspector general, says she is "cautiously optimistic" about e-prescribing's potential, but says there still might be ways (people) are going to manipulate the system."