E-prescribing: Are You Ready?
September 8, 2020In its summer newsletter, the Kentucky Board of Medical Licensure announced changes to prescribing of controlled substances in the Commonwealth. Kentucky Revised Statute 218A.182 mandates the electronic prescribing of controlled substances (EPCS) in Kentucky effective January 1, 2021.
Our practice has extensive experience with e-prescribing. Four and half years ago, we were one of the earliest adopters of this technology. It is convenient for both patient and doctor; I can write a prescription anytime and anywhere and get it to the patient’s pharmacy. It is secure; rarely do I get “the dog ate my prescription”. It is another cost of approximately $1000/ year per provider, and of course, it is a cost that we must “eat” in our practice. It sounds great, and in 2021, it is high time that medicine gets into the digital age.
But there is a rub to the whole process that I am sure was not accounted for. E-prescribing can be very time consuming. First of all, e-prescribing of controlled substances cannot be delegated to a nurse or an assistant. Only the doctor can sign off on the prescriptions. In a two doctor plus two APP practice such as ours, we can generate between 80 to 120 prescriptions per day. Every prescription must be opened and signed individually, and the electronic signing process requires two factor authentication. This password is continuously generated every 30 seconds. Therefore, it takes about 60 minutes to process 90 controlled substance prescriptions.
So in a busy pain practice such as ours, nearly 1.5 hours of our day is spent clicking mindlessly. Despite this, we still feel it is the most effective method to prescribe controlled substances. It does provide convenience and security, and we remain committed to doing things the right way.
However, we cannot help but wonder about the infrequent prescriber of these medications. What will they do? Will their patients be forced to seek care elsewhere just to get a short term prescription of hydrocodone for an acute problem? How about our post surgical patients? Remember too, that gabapentin is a controlled substance, and it is frequently prescribed by our primary care providers. At the very least, all of this is going to add time to your day, and that time is going to be spent very inefficiently.
In the end, I applaud the efforts to bring medicine into the real world with this roll out of e-prescribing. It is long overdue. Yet, I can only guess that little consideration was given regarding the herculean time constraints this will have on the practice of medicine. Frankly, e-prescribing is a time consuming activity. Our clinic is prepared to handle this new requirement, but come January 1, 2021, we are worried that other clinics may not want to undergo this change with patients left in the lurch. We wonder if our providers will just throw up their hands, send us their patients and say, “you do it”.
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