New York State has officially delayed the requirement to send all prescriptions electronically one year until March 27, 2016. The delay came just two weeks before the original I-STOP mandate was set to go into effect. Under I-STOP, providers will be required to send both non-controlled and controlled substances electronically. Paper prescriptions will no longer be allowed.

The main reason for the delay was stated as a lack of software vendors being ready.  While most software has the ability to electronically send non-controlled prescriptions, some are still lacking the ability to electronically prescribe controlled substances (EPCS). EPCS capability requires completing an audit by a DEA-approved auditor to prove that certain security measures are in place. 

The advantages of e-Prescribing are plentiful from patient safety to efficiency in prescribing to combatting doctor shopping. However, many of these benefits could be lost by either using software that isn’t truly ready or rushing into trying to use software that is complex. The additional time will be beneficial for prescribers. Providers can now pick the solution that is right for them without being rushed and get their practice adjusted to e-prescribing more slowly.

The delay will also take some of the pressure off those vendors who are still trying to add EPCS capabilities. While MDToolbox was one of the first vendors to be approved by the DEA for sending controlled substances, we understand the complexities involved in becoming an approved vendor. It is not an easy process. This additional year will give EHRs and other software vendors the necessary time to implement the requirements as smoothly as possible into their workflows and ensure they do not lose their providers to other vendors. Many vendors have chosen to partner with other vendors to help them meet the requirements. This is a great way to integrate EPCS and the required features such as Identity Proofing, 2-factor authentication, and Permissions without having to exert many resources. Having all of the required features come together in a package that can seamlessly integrate takes a lot of the legwork, expenses, and stress out of the process.

Whatever path vendors and prescribers choose to take, they must seize this opportunity to guarantee they are fully ready when the new deadline comes around.

Click here for further information on adding MDToolbox EPCS to your software

Click here for further information on MDToolbox standalone e-Prescribing software

Keeping in line with our previous posts on the benefits of e-Prescribing software, this week we focus on the benefits of integrating e-Prescribing software with existing healthcare software programs like EHRs/EMRs (Electronic Health Record Systems and Electronic Medical Record Systems).  While several options exist for integration, here we concentrate on embedding certified e-Prescribing screens. 

5) Maintenance done for you

E-Prescribing requires a lot of data.  One of the main reasons to use an e-Prescribing vendor is so that the EHRs don’t have to worry about the data upkeep.  For example, MDToolbox provides a complete drug database that is updated monthly, a database for interactions, monographs and education materials that is also updated monthly, formulary information based on patients’ insurance plans that is updated weekly, and a pharmacy lookup that is updated nightly.  See more about MDToolbox’s e-Prescribing services. 

4) Additional Features through API

In addition to being able to add e-Prescribing to their product, there are often several other features available through the API that EHRs can add into their product.  These don’t have to be part of just e-Prescribing, they can be added wherever fits best in the EHR (by calling the API directly from EHR screens).  A few examples of some functions MDToolbox offers as part of e-Prescribing and also available to EHR screens include:

• Allergy Search
• Condition/Problem List Search
• Pharmacy Search
• Drug Research, Patient Education and Decision Support Materials

3) Meet Meaningful Use

E-Prescribing is a big part of certifying for Meaningful Use.  By adding an e-Prescribing system that already meets Meaningful Use, EHRs can focus their time on meeting the rest of the qualifications.  See which Meaningful Use criteria MDToolbox meets.

2) Faster

It can take countless development hours to design screens for e-Prescribing.  In order to electronically route prescriptions to pharmacies nationwide, you must connect to a hub.  The hubs have many rules and regulations that e-Prescribing screens must meet in order to connect.  Surescripts® (the nation’s largest hub) has strict certification requirements and the certification process can take a lot of time.  EHRs must register with Surescripts and take classes, as well as a series of tests, in order to get certified.  The process can take upwards of 4 months.  

An EHR will have a much faster time to market by embedding already certified screens.  Adding an eRx system like MDToolbox-Rx can be done in as quick as 2 weeks.  The system can be integrated and tested in one week and the next week a quick call (20 min or less) with Surescripts completes the process to go live. 

1) Cheaper

Obviously, less time spent on development equals money saved.  As mentioned above, in order to e-Prescribe, a lot of data is needed.  The cost to acquire and maintain this data can also be quite large and on-going. 

• Databases – MDToolbox maintains over 200 Gigabytes worth of data that needs to be continually updated from many sources.  As an example, according to the FDA¹, 5 new drug products were approved in October alone.  It is not only important to keep data updated to have the latest information available to prescribers, it is mandated to maintain status on the e-Prescribing Network.  In order to be certified through Surescripts, you must obtain approved vendor provided databases and update them regularly. 

• Federal, State and Hub Requirements and Regulations - The regulations are continually being updated and new rules put in place which requires constant product and coding updates.  E-Prescribing vendors keep up with the regulations and product updates, so EHRs who have integrated with them don’t have to worry about it.  These regulations include DEA rules and individual state rules.  For example, recently the State of New York passed the “I-STOP” Laws to help the state fight prescription drug abuse.  According to a posting at nysenate.gov², the new laws mandate medication history lookups for controlled substances, mandate ALL prescriptions be e-Sent by March 27, 2015, and updates the controlled substance schedules of many drugs to safer levels.  

In addition to the lower development and data costs, EHRs can also save big on certification costs. 

• Surescripts® Certifications - The Surescripts certification process not only takes time, it is an additional expense.  Thousands of dollars can be saved by embedding an e-Prescribing system that is already certified.   As Surescripts® (or other hubs) come out with new rules, changes, and updates, additional product certifications for the e-Prescribing system are required.  The process is an ongoing expense.

• EPCS Certification/Audits - If EHRs want to be able to electronically prescribe controlled substances, they must also go through a full DEA 1311 audit.  This can cost upwards of $15,000 dollars.  However, if an EHR adds an e-Prescribing system that has already been through the full audit, such as MDToolbox-Rx, this eliminates or greatly reduces the size and price of the audit (depending on type of integration).  Additionally, the DEA mandates that the audit be re-preformed every two years and re-audited any time the product is changed, equaling more ongoing costs.

Some EHRs may think the ability to create their own screens to match their system outweighs the above benefits.  However, a few e-Prescribing vendors allow customization with their screen integrations to allow for a seamless workflow.  Such things like the screen colors and fonts can be matched to the EHR's theme.  MDToolbox even allows private labeling, so an EHR can add e-Prescribing screens that completely match their current interface and their end users will have no idea that they used an e-Prescribing vendor.  So, we pose the question – With the many benefits of using already certified screens AND the ability to customize those screens, why would anyone want to go through the hard work of building and maintaining their own e-Prescribing system?

1. “New Drugs at FDA: CDER’s New Molecular Entities and New Therapeutic Biological Products of 2013.” U.S. Food and Drug Administration, Last Updated November 5, 2013. http://www.fda.gov/drugs/developmentapprovalprocess/druginnovation/default.htm
2. Montgomery, Velmanette. “New I-STOP Law To Help State Fight Prescription Drug Abuse.”  New York State Senate, September 6th, 2012 http://www.nysenate.gov/press-release/new-i-stop-law-help-state-fight-prescription-drug-abuse