At the end of March 2016, a new mandate went into effect requiring New York State practitioners to issue all prescriptions electronically.1 Additionally, electronic prescriptions for controlled substances must be processed using a Drug Enforcement Agency (DEA)-certified software application that meets specific federal requirements, and clinicians and pharmacies must register their chosen application with the state’s Bureau of Narcotic Enforcement. There are few exceptions to the rule, including technological and electrical failure and certain other circumstances.
The mandate is based on the Internet System for Tracking Over-Prescribing (I-STOP) Act, which aims to reduce medication errors, theft, and forgery, and to facilitate the integration of prescription records into patients’ electronic health records. Although Minnesota also has an e-prescribing law, clinicians who fail to comply are not penalized as they will be under the New York mandate.
“The evidence for the benefits of e-prescribing is strongest around the important issues of reduction of medication errors and adverse drug events,” says Matthew O. Hurford, MD, vice president of medical affairs at Community Care Behavioral Health Organization in Pittsburgh and clinical associate with the department of psychiatry at the University of Pennsylvania. For instance, e-prescribing is a proven strategy to reduce the risk of errors associated with illegibility of prescriber handwriting. “In psychiatry, e-prescribing systems may be especially helpful to support best practices for therapeutic drug monitoring for medications such as antipsychotics and some mood stabilizers [that] require lab tests,” he told Psychiatry Advisor.
Researchers at several US universities conducted a review and meta-analysis of studies investigating the use of computerized provider order entry (CPOE) in hospital-based settings. Their findings, published in Systematic Reviews in 2014, show that the CPOE was linked with approximately half as many preventable adverse effects and medication errors vs paper-order entry.2 In a study that appeared in 2011 in the Journal of Psychiatric Practice, researchers from the department of psychiatry at Johns Hopkins University found a reduction in medical errors after the implementation of an error-reporting system and CPOE in a psychiatric setting.3
On a systemic level, “e-prescribing can be a powerful tool for population health management strategies,” says Dr Hurford. The inclusion of electronic pharmacy data in patient or disease registries can facilitate more accurate assessment of quality and effectiveness of care for large groups of patients. Additionally, it can aid medical directors in monitoring practitioners’ use of best practices in prescribing medications. “In both cases, e-prescribing allows for tracking and trending of medications to help identify gaps and opportunities in care,” he says.
For practitioners who are interested in implementing an e-prescribing system, Dr Hurford suggests that they seek feedback from colleagues — ideally those working in similar clinical areas — who are already using an e-prescribing system. “I’d encourage them to sit down alongside another prescriber and ask them to walk them through how the system works, find out what they like about it and what their frustrations are.” He recommends going through this process with several different systems, if possible, before deciding which system to implement.
1. New York State Department of Health, Bureau of Narcotic Enforcement. Frequently asked questions for electronic prescribing of controlled substances. Available at: http://www.health.ny.gov/professionals/narcotic/electronic_prescribing/docs/epcs_faqs.pdf. Accessed April 6, 2016.
2. Nuckols TK, Smith-Spangler C, Morton SC, et al. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Syst Rev. 2014;3:56.
3. Jayaram G, Doyle D, Steinwachs D, Samuels J. Identifying and reducing medication errors in psychiatry: creating a culture of safety through the use of an adverse event reporting mechanism. J Psychiatr Pract. 2011; 17(2):81-88.