Prescribers' expectations and barriers to electronic prescribing of controlled substances

Abstract

Objective: To better understand barriers associated with the adoption and use of electronic prescribing of controlled substances (EPCS), a practice recently established by US Drug Enforcement Administration regulation.

Materials and methods: Prescribers of controlled substances affiliated with a regional health system were surveyed regarding current electronic prescribing (e-prescribing) activities, current prescribing of controlled substances, and expectations and barriers to the adoption of EPCS.

Results: 246 prescribers (response rate of 64%) represented a range of medical specialties, with 43.1% of these prescribers current users of e-prescribing for non-controlled substances. Reported issues with controlled substances included errors, pharmacy call-backs, and diversion; most prescribers expected EPCS to address many of these problems, specifically reduce medical errors, improve work flow and efficiency of practice, help identify prescription diversion or misuse, and improve patient treatment management. Prescribers expected, however, that it would be disruptive to practice, and over one-third of respondents reported that carrying a security authentication token at all times would be so burdensome as to discourage adoption.

Discussion: Although adoption of e-prescribing has been shown to dramatically reduce medication errors, challenges to efficient processes and errors still persist from the perspective of the prescriber, that may interfere with the adoption of EPCS. Most prescribers regarded EPCS security measures as a small or moderate inconvenience (other than carrying a security token), with advantages outweighing the burden.

Conclusion: Prescribers are optimistic about the potential for EPCS to improve practice, but view certain security measures as a burden and potential barrier.

Figure 1

The e-prescribing process used in this demonstration project. The e-prescribing process for controlled substances involves several main steps: 1) Prescriber credentialed to prescribe controlled substances; 2) Prescriber enters the prescription information into the e-prescribing system using a computer; 3) If the prescriber has not already done so, he/she inserts the security token (size of a USB flash drive) into the computer and enters his/her signature password; 4) The e-prescribing network verifies: (a) The provider in the project is authorized to issue prescriptions for controlled substance, and (b) That the CSRx is from a valid prescriber; 5) The prescription is electronically transmitted to the pharmacy of choice; 6) The pharmacist fills the prescription and dispenses the drug to the patient; 7) The pharmacy prints and archives the CSRx. Note: Digital signature will be an option under the IFR. DEA, US Drug Enforcement Administration; CSRx; controlled substances prescriptions.