37 States Now Sharing Prescription Data

Posted by on Comments (0)

Massachusetts, New Hampshire, New York and Texas are the four most recent states to join the prescription monitoring program (PMP) run by the National Association of Boards of Pharmacy (NABP) – NABP PMP InterConnect1. This brings the total number of states connected to 37, making it the largest prescription data sharing network. Over 3.9 million requests and 8.2 million responses are processed through the system each month.

The complete list of connected states includes: Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Nevada, New Jersey, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia and Wisconsin.

It is expected that other states will be joining soon too. “We’re excited about the growth and response to PMP InterConnect,” said NABP President Hal Wand, MBA, RPh. “Our goal is to reach every state with a PMP to guarantee a true connection across our country in an effort for greater medical knowledge and our patients’ safety.”

There is no charge to the states to use the system and it’s setup to enforce each state’s data-access rules. Authorized healthcare professionals including physicians and pharmacists in each of the connected states are able to access multi-state histories of their patients’ controlled substance prescriptions. This is an important tool in combating prescription drug abuse and identifying potential problems by allowing providers to see a comprehensive history, especially for those patients who cross state lines.

1. "Four States Join NABP PMP InterConnect, the Nation’s Largest Prescription Data Sharing Network," National Association of Boards of Pharmacy (NABP) https://nabp.pharmacy/four-states-join-nabp-pmp-interconnect-nations-largest-prescription-data-sharing-network/

2017 Brings Changes to Medicare Incentive Programs and Meaningful Use

Posted by on Comments (0)

As we ring in the new year, medical providers now can say goodbye to the CMS’s “Meaningful Use Incentive Program” (MU) and start preparing for the new Medicare incentive program.

Providers who used qualified systems in 2016 can still attest to Meaningful Use for the 2016 year (you must have been a “meaningful user” of certified electronic medical record system(s) for the minimum reporting period. Visit this website for more info on how the previous year’s MU programs worked and deadlines for attesting: 

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2016ProgramRequirements.html

Now in 2017, Meaningful Use will become one of four components of the new “Merit-Based Incentive Payment System” or MIPS. MIPS is part of the bigger Medicare Access and CHIP Reauthorization or MACRA.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment penalties for 13 years.  

The MACRA program introduces two paths that Medicare providers can choose from for participation:

  • Advanced Alternative Payment Models (APMs) (providers apply for a special payment model program) or
  • The Merit-based Incentive Payment System (MIPS)  (a performance-based program)

 

Who Does this Affect?

Providers who are in an Advanced APM or who bill Medicare for more than $30,000 a year and care for more than 100 Medicare patients a year are affected. Providers with less than that are not affected and not part of the program.3  This includes:

  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

 

Advanced Alternative Payment Models (APMs)

The Advanced APMs program allows certain providers to apply for the APM track. This gives added incentive payments to provide high-quality and cost-efficient care. See the APM website for more information on the special programs and how providers can apply:

https://qpp.cms.gov/learn/apms

 

The Merit-based Incentive Payment System (MIPS)

Most Medicare Providers will be part of MIPS. They will earn a payment adjustment based on evidence-based and practice-specific quality data submitted. According to CMS, the Quality Payment Program policy will reform Medicare payments for more than 600,000 clinicians across the U.S.

Providers participating in the program in 2017 will submit their data by March 2018 and based on submission, their 2019 Medicare payments will be adjusted up, down, or not at all. 

MIPS is broken down into four categories and is setup so that the more Providers participate (and attest to), the higher score (and incentive) providers will get. A Medicare provider who does not participate at all (0%) may see up to 4% negative adjustment in 2019. A provider with a minimal amount of participation (e.g. submit one measure) may be able to avoid adjustment. For partial submission (submit the minimums for a partial year) they will see neutral or positive adjustments, and submit a full year and earn a positive payment adjustment.

CMS has setup a new website for the Quality Program4 which breaks down the four components of the MIPS:

  • Quality (replaces PQRS)   (60%)
  • Improvement Activities (new)  (25%)
  • Advancing Care Information (replaces Meaningful Use)   (15%)
  • Cost (replaces Value Based Modifier)   (0% in 2017)

Image Credit:  MIPS Quality Payment Program Website:  https://qpp.cms.gov/measures/performance

 

If we take a quick look at how each category works:

  •  Quality
    •  Most Providers will report up to 6 quality measures (including an outcome type measure). Quality measures selected should be focused based on type of care and specialty as appropriate.
    •  Reporting period must be a minimum of 90 days.
    • There are over 250 quality measures available, be sure to check your health record software system to see which ones they support (can help gather data for you) when planning.
    • Measures go across many specialties and problem sets:  For example, “Age Appropriate Screen Colonoscopy” – Report the percentage of patients greater than 85 years old seen by the Provider who received a colonoscopy screening Jan 1 to December 31.
  •  Improvement Activities
    • Most Providers will attest to completing a minimum of 4 improvement activities for at least 90 days.
    • As of the writing of this blog, the CMS tools shows 92 activities to choose from.
    • Activities range from care coordination, patient safety changes and beneficiary engagements.
    • Examples: Join and participate (for a minimum of 6 months) in your States Prescription Monitoring Program (PMP). Or another example: Engage patients, family and caregivers in developing a plan of care and prioritizing their goals for action, documented in the certified EHR technology.
  • Advancing Care Information
    • Use a qualified (certified) product (or products) for a minimum of 90 days.
    • There are two different programs to pick from depending on your Electronic Health Record Software Certification. For 2017, you will be able to use either a 2014 Certified Product (previously called Stage 2 MU Certification) or a 2015 certified product (certified for the MU Final Ruling criteria). Attest to a minimum of:
      • E-Prescribing
      • Provide Patient Access
      • Send Summary of Care Records
      • Receive Summary of Care Records
      • Report up to 9 additional measures for bonus credits
  • Cost
    • No actions required: Cost will be computing from your claims
    • The cost category will be calculated in 2017, but will not be used to determine your payment adjustment. In 2018, CMS will start using the cost category to determine your payment adjustment.

 

Medicare Providers will want to research the programs and decide their level of participation early in 2017. Full year participation would require making sure their Electronic Health Record system is setup for minimal data tracking and other required features like E-Prescribing and Direct Messaging.

 

References

  1. 2017 Program requirements:

    https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2017ProgramRequirements.html

  2. MIPS and MACRA:

    http://www.impact-advisors.com/meaningful-use/mips-macra-mu-the-next-evolution-of-healthcare-payment-reform/#sthash.vMkVGSvN.dpuf

  3. https://qpp.cms.gov/docs/Quality_Payment_Program_Overview_Fact_Sheet.pdf

  4. MIPS Quality Payment Program Website: 

    https://qpp.cms.gov/measures/performance

The Evolution of EPCS

Posted by on Comments (0)

Electronic prescribing of controlled substances (EPCS) is just starting to gain ground.  The Drug Enforcement Agency (DEA) rule allowing prescribers to electronically write prescriptions for controlled substances actually went into effect over three years ago.  However, its adoption has been slow. 

The need to be able to send controlled substances electronically is definitely there.  Approximately 11% of all prescriptions written are for controlled substances and 90% of prescribers write prescriptions for such drugs1.  If these prescriptions can’t be sent electronically, prescribers must handwrite or print them.  This can be a big interruption and slowdown in a prescriber’s workflow.  In addition, EPCS increases safety and decreases fraud.  So why is it taking so long for EPCS to become a norm? 

The DEA’s Interim Final Rule (IFR) first approved electronic sending and receiving of controlled substances in March 2010, and it went into effect on June 1, 2010.  Though in order to actually use EPCS, prescribers, e-Prescribing software, and pharmacy software must meet strict regulations.  Prescribers are required to go through stringent identity proofing and receive two-factor authentication credentials.  Each time they send a controlled substance, prescribers must use their two-factor authentication.  The two-factor has to be two of the following three items:

1) Something only the prescriber KNOWS, like a password or an answer to a challenge question

2) Something the prescriber IS, biometric data such as a fingerprint or 

3) Something the prescriber HAS like a device or token separate from the computer he is prescribing on.   

E-Prescribing software and pharmacy software must go through a DEA Certification or third-party audit to verify they comply with the regulations.  The IFR requires e-Prescribing software to have a two-factor authentication protocol, have access controls so only prescribers with the proper permissions can send controlled substance prescriptions, and put extra security and auditing measures in place.  Pharmacy software is also required to have access controls and stricter security measures, as well as additional features to be able to receive electronic controlled substance prescription orders.

In addition to the Federal DEA requirements, each state has their own laws and regulations concerning EPCS.  While 47 states have approved EPCS, there is still a small percentage of pharmacies in each of these states that are able to receive electronic prescriptions for controlled substances. 

It is clear that meeting all of these requirements can be challenging and takes ample time and money for all involved.  This has caused the progression to be quite slow.  Here’s how it looks on a year-by-year basis:

2010: DEA IFR goes into effect and states begin aligning their rules with those of the DEA.

2011: Software vendors working to meet requirements.

2012: First e-Prescribing and pharmacy software vendors certified.  Surescripts® reports a “modest number of EPCSs” transmitted in eight states as of May 2012.   

2013: About 14,000 pharmacy stores signed up for EPCS in 44 states, but only about 1,000 prescribers nationwide using EPCS as of Mid-2013.

2014: About 20,000 pharmacy stores signed up for EPCS in 47 states.  However, only 14 e-Prescribing systems certified for EPCS out of over 600 prescribing applications on the Surescripts® network. 2

 

Out of almost 70,000 total pharmacies and more than half a million e-Prescribing prescribers, the numbers of those using EPCS are still small.  However, that’s changing as EPCS growth takes off.

As one of the 14 certified Prescriber EPCS systems, MDToolbox is at the forefront of the EPCS movement.  We see now as the time that EPCS is going to take off.  MDToolbox is offering both standalone EPCS for prescribers and EPCS plug-in modules for EHRs looking for a quick and inexpensive way to get on-board with the movement.  With laws like New York’s I-STOP mandating ALL prescriptions be sent by March 27, 2015, we believe EPCS will see huge growth in 2014. 

What do you think?  We would love to hear from you and get your feedback, comments and questions. Leave a comment below or feel free to contact us at info@mdtoolbox.com.     

 

  1. Rannazzisi JT. A Prescription for Waste: Controlled Substance Abuse in Medicaid. Drug Enforcement Administration (DEA). September 30, 2009. www.justice.gov/dea/pr/speeches-testimony/2012-2009/ct093009.pdf. Accessed January 27,2014.
  2. Surescripts - http://www.surescripts.com/medication-network-services/e-prescribing-of-controlled-substances/regulatory-status-map

e-Prescribing Software: Top 5 Benefits for EHRs/EMRs

Posted by on Comments (0)

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 

e-Prescribing Software: Top 5 Benefits for Patients

Posted by on Comments (0)

Our post last week covered the top 5 benefits of using e-Prescribing software for providers.  If you missed it, check it out here.  This week we focus on the benefits as they relate to patients.  

 

5) Patient Education Materials

Most e-Prescribing software includes drug reference information, including leaflets that can be printed and given to the patient (or electronic).  These leaflets are often available in several different languages, as well as adult and pediatric forms.  They include warnings, possible side effects, how to take the drug, and any other important information the patient needs to know about the drug.  Some products, including MDToolbox, also provide patient education information on patient conditions that can be printed and given to the patient as well.  

4) Compliance

An estimated 20% of all paper prescriptions are never filled 1.  Eliminating the need to drop off the prescription at the pharmacy and reducing wait times aid in patient compliance.  Some providers may worry that the patient may forget to pick up a prescription that was e-Sent.  However, software like MDToolbox provides an auto print out of a “Prescription Receipt” that the prescriber can hand to the patient so they remember to go pick it up, as well as which pharmacy it was e-Sent to.  The print out also includes the prescription directions so that the patient is clear on how the prescription should be taken.

3) Saves Patients Time

Using e-Prescribing software significantly reduces the time the patient has to wait at the pharmacy and in most cases, the prescriptions are ready for the patient as soon as they get to the pharmacy.  Multiple trips to the pharmacy are eliminated and time spent waiting for physicians to reply to refill requests is reduced as well.

2) Saves Patients Money

Through most e-Prescribing programs, prescribers have access to a patient’s formulary information at the time of prescribing.  This allows the prescriber to view which drugs will be covered for the patient and which ones are not.  Many times co-pay information is also available.  This way the prescriber can pick the lowest cost drug available for the patient.  A study by Decision Resources found that 75% of the doctors surveyed said when they e-Prescribe they pay more attention to the costs for their patients2.

1) Improves Patient Safety

We stated it last week, but it’s worth stating again (and again) because it is so important: e-Prescribing software greatly improves patient safety. 

Patients who see a provider who uses e-Prescribing do not have to worry about the pharmacist being able to interpret the prescriber’s handwriting.  They can be sure that the prescription the prescriber intended to write is readable in a standard, clear format by the pharmacist.  MDToolbox even uses tall man lettering, a way of distinguishing look-alike drug names, to maximize the amount of medication errors reduced. A survey by the Institute for Safe Medication Practices (ISMP) reported that 64% of all respondents stated that the use of tall man letters had prevented them from providing the wrong medication3.  

Through software systems like MDToolbox, prescribers can even access the patient’s medication history available from pharmacies and PBMs, so even if a patient forgets to report a medication they are currently taking, the prescriber will still have a record of it.  Having a complete, current medication list is important so prescribers can check for harmful and even possibly lethal drug interactions.  Prescribers can check against the patient’s records not only for drug-drug interactions, but also drug-allergy, drug-condition, duplicate therapy, body weight, age, and correct dosing. 

It’s clear from all of these benefits, e-Prescribing is a great tool to aid providers in giving patients the safe, affordable care they need.  

 

  1. Koroneos, George, "Hard of (Ad)hering", Pharmaceutical Executive, August 1, 2008
  2. Moore, Roy, “E-Prescribing and Electronic Health Records: Impact of Technology on Prescribing for Hypertension and Diabetes”, Decision Resources, February 2013
  3. Institute for Safe Medication Practices (ISMP) Survey on tall man lettering to reduce drug name confusion. ISMP Med Saf Alert! 2008;13(10):4.

 

 

 

e-Prescribing Software: Top 5 Benefits for Providers

Posted by on Comments (0)

As an industry leader in e-Prescribing software, it seems appropriate that our first blog post would be about why using e-Prescribing software is so important.  The team here at MDToolbox is passionate about e-Prescribing, not just because it’s a “cool” project to work on, but because it’s revolutionizing the healthcare workflow and can literally save lives.

E-prescribing, or electronic prescribing, is the method of writing and sending a prescription using an electronic device.  Instead of handwriting  a prescription on paper, the provider electronically sends the prescription to the pharmacy.  It’s as easy as sending an e-mail. While there is a plethora of reasons providers should be using e-Prescribing software, we have narrowed it down to our top 5.

 

5) Use Anywhere, Any Time, on Any Device 

Most e-Prescribing software is web-based, allowing providers to log in and prescribe from anywhere they have access to the internet, on any device (iPads, tablets, smartphones, etc.) and at any time.  Patients’ medication records and e-prescribing can be accessed wherever prescribers need it – at the office, hospital, home, even the golf course.   

4) Secure

Using e-Prescribing software offers a more secure way of prescribing medications.  A study in the Journal of the American Medical Informatics Association1, found that over 20% of prescribers had experienced prescription fraud in the past 6 months before the study.  These included the prescriptions being altered by the patients, counterfeited prescriptions, and stolen prescription pads.   By prescribers directly electronically sending prescriptions to pharmacies, this prescription fraud can be eliminated. 

3) Incentives/Penalties

The Centers for Medicare & Medicaid Services (CMS) created the Electronic Prescribing (eRx) Incentive Program in 2009 to encourage prescribers to use e-Prescribing software.  At that time they were giving incentive payments to eligible prescribers; however, they are now penalizing providers who do not use e-prescribing software with payment adjustments.  In 2013, the payment adjustment is 1.5% and in 2014 it will increase to 2.0%.

Meaningful Use, another CMS program, also provides incentives to providers for using certified electronic health record systems.  There are several core requirements and menu items that a provider must meet in order to attest to Meaningful Use.  Using e-Prescribing software will help meet many of these requirements.

2) Saves Time and Money   

Using e-Prescribing software allows providers and their staff to spend more time focused on patient care, and less time looking up drugs, on the phone with pharmacies, and writing out prescriptions.

 A complete drug database is available for prescriber to search.  Many e-Prescribing vendors offer several ways to search for drugs including common libraries, drug class, indication, supplies, and more.  Complete drug reference information, as well as recommended dosages is also often available.  MDToolbox even provides dosing recommendation and a dosing calculator right at the point of prescribing, so it’s easy to calculate the correct dosages. There is no need to go searching for calculators and through drug references books, everything needed for prescribing is available in one place. 

Physicians and their staff can spend hours on the phone a day responding to requests from pharmacies to clarify prescriptions, discuss formulary issues, and authorize refills.  A study by the Medical Group Management Association (MGMA) Center for Research, reported these calls can cost a practice almost $20,000 a year 2.  Using e-Prescribing software reduces these callbacks and allows refill requests to be responded to electronically, rather than over the phone.  Refill requests are all stored in one place and can be approved or denied within a matter of seconds.  The prescriptions sent are clear, in a standard format, and the prescriber has access to the patient’s formulary information right at the time of prescribing, reducing the need to discuss them with the pharmacy.

 Another way prescribers can save time is by using favorite lists.  These allow the prescriber to save a favorite prescription, including directions and amounts, to a list.  The prescriber can then use this list to quickly pick and prescribe from and send the prescriptions to the pharmacy within seconds.  

1) Improves Patient Safety

The number one priority for providers and for the MDToolbox Team is patient safety.  Writing prescriptions by hand causes a significant amount of errors.  A study by professor of medical informatics at Weill Cornell Medical College, Rainu Kaushal and colleagues 3, found 37 errors for every 100 paper prescriptions.  The study also found a remarkable 88 legibility errors per 100 prescriptions.  Providers using e-Prescribing software cut the number of errors down to 7 for every 100 prescriptions and completely eliminated legibility errors. 

Using e-Prescribing software not only does away with handwriting errors, it also provides necessary alerts at the time of prescribing.  Prescribers can access a patient’s medication history, verify their medications, and in turn, receive a warning if they pick a drug to prescribe that could cause a possible adverse reaction (or even death).  These include drug-drug, drug-allergy, drug-condition, and duplicate therapy alerts.  With today’s available technology, there is no excuse for the possible harm that could come from these preventable medication errors. Every prescriber should be using e-Prescribing software.  

 

1.       Thomas CP, Kim M, McDonald A, Kreiner P, Kelleher SJ Jr, Blackman MB, Kaufman PN, & Carrow GM. Prescribers' expectations and barriers to electronic prescribing of controlled substances.  J Am Med Inform Assoc 2012;19:375-381.

2.       Medical Group Management Association (MGMA) Center for Research. Analyzing the Cost of Administrative Complexity. http://www.mgma.com/about/default.aspx?id=280

3.       Kaushal R, Kern LM, Barrón Y, Quaresimo J, Abramson EL. Electronic prescribing improves medication safety in community-based office practices. J Gen Intern Med. 2010 June; 25(6): 530–536.