COVID-19 stoked the adoption of electronic prescribing, yet issues remain

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published September 13, 2022

Key Takeaways

  • Following increased adoption of telemedicine, electronic prescribing (e-prescribing) has flourished during the COVID-19 pandemic.

  • Benefits of e-prescribing include integration with EHR, billing, and formularies, as well as checking for drug alternatives, drug-drug interactions, and safety. Limitations include security concerns, complexity, and lack of standardization.

  • To address security concerns, physicians should utilize safeguards such as two-factor identification, identity proofing, and secure access when electronically prescribing controlled substances.

E-prescribing has surged during the COVID-19 pandemic, along with a rise in telemedicine and videoconferencing.

Yet despite the benefits of e-prescribing, the technology does have certain limitations that need to be addressed by clinicians.[]

Status quo

In its early days, e-prescribing involved data entry followed by fax. Now, it’s a comprehensive application replete with network connectivity that links pharmacies to various healthcare settings. It offers error-checking capabilities, and additional features are added routinely.

Experts expect that in the future, all e-prescribing will seamlessly incorporate into EHR.

Various states have enacted legal mandates governing e-prescription, while others have not. Some states allow for e-prescription in a general sense; however, strict e-signature requirements limit its use. Other restrictions involve patient examination or consultation.[]

Benefits

At its best, e-prescription can streamline the communication process and automatically connect the prescriber to the pharmacy, as well as integrate with EHR and billing.

Benefits of such automation include the generation of legible prescription orders, and easy data entry with options including drug name, dose, and directions provided. E-prescription also references resources including patient information, available formularies, safety alerts, drug alternatives, and drug-drug interactions.[]

Limitations

Although e-prescription technology is improving, it’s far from standardized, with no universal interface in place.

Other issues include the following:

  • Complexity/usability—Not all offices use technology extensively.

  • Integration into workflow—To be successful, e-prescribing should seamlessly integrate into EHR, billing, scheduling, and so forth.

  • Financial burden—It’s unclear who should pay for the implementation of e-prescribing.

  • New errors—Although e-prescribing may help eliminate errors, it may also introduce new ones. For instance, fragmented displays could offer an incomplete view of medication history, or pharmacy inventory displays could be misconstrued for dosage guidelines. Additionally, non-customizable ordering formats could result in wrong orders.

  • Security concerns—Patient confidentiality could be breached during the electronic transfer at the office, pharmacy, or elsewhere.

Controlled substances

The DEA and other stakeholders are especially concerned about the e-prescribing of controlled substances (EPCS).

EPCS has been rolled out in most healthcare practices and pharmacies, according to a review published in the Journal of Medical Regulation.[] Although there’s little research on the limitations of EPCS, the review revealed that EPCS can potentially decrease overprescribing, fraud, and errors, as well as improve cost and efficiency.

“The CDC guidelines for safe and appropriate prescribing of opioids recommend that providers review the patient’s history of controlled substance prescriptions using PDMP [predication drug monitoring program] data prior to prescribing,” wrote the authors. “In our review, the evidence is unclear whether combining PDMPs with EPCS reduces overprescribing."

"Preliminary research suggests that linking pharmacy benefit managers, instead of just a PDMP, could be more helpful for providers to detect and reduce dangerous prescribing."

Achar, et al.

Securely setting up EPCS

The Michigan State Medical Society has provided guidance on how to set up EPCS.[] Although this organization and several others in the state oppose the legal adoption of e-prescribing and EPCS, the Michigan state legislature wanted to comply with the Medicare mandate for EPCS, and to align with other states that do have EPCS mandates.

For prescribers who already use an EHR, the society advises them to “check with their EHR vendor to determine which compliance pathway they must follow (depends on whether the system is registered to an individual DEA number or to an institutional or shared DEA number) and whether the EHR software version their practice is using is certified and approved for EPCS. If not, an updated version will be necessary before proceeding.”

Once the proper compliance pathways are assured, tips to help ensure security include identity proofing and two-factor authentication, as well as software access including at least one DEA registrant and another employee of the practice.

Watching online tutorials may help clinicians better understand how to utilize e-prescribing.

For practices that don’t utilize EHR, another option to consider is purchasing software with e-prescribing and EPCS only.

What this means for you

Increased dissemination of e-prescribing and EPCS represents the current state of practice. Physicians, pharmacists, and others concerned with security, privacy, integration, and access should take steps to protect patient interests, such as two-factor authentication, identity proofing, and protocols for secure access. Fortunately, the technology is improving.

Read Next: 4 ways the pandemic has changed medical care

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