EPCS prescribing rates also vary greatly among states. New York, which has mandated EPCS since March 2016, has 72% of its prescribers EPCS-enabled and sent almost 92% of its controlled substance prescriptions electronically in 2016. By contrast, Minnesota, which has a mandate but no enforcement provision, has much lower EPCS adoption: in 2016 just 14% of prescribers were EPCS-enabled and less than 20% of the controlled substance prescriptions were sent electronically.
New York, which was the first state to implement penalties for noncompliance, provides a good example of how a combination of legislative requirements and technology can help reduce opioid-prescription rates. Since initiating its I-STOP program, the number of painkillers prescribed to New York City residents has declined 12%.
One likely reason for the overall slow adoption of EPCS nationwide is the complex, time-consuming process for supplemental DEA registration and credentialing. Nevertheless, in states like New York that penalize prescribers for non-use, physicians and health systems are more motivated to invest the time and money to comply with the requirements. In states that lack mandates and penalties, prescribers are more likely to not adopt EPCS and continue with paper despite transmitting the great majority of their legend drugs electronically.
Prescription Drug Monitoring Programs
State controlled PDMPs increase prescriber visibility into patient drug histories through the collection and analysis of prescribing and dispensing data. If the data is made available and user friendly at the point of care, prescribers would be better equipped to assess risk and have meaningful conversations with patients.
Unfortunately, even when PDMP technology is available, prescribers don’t always consult these databases because the process can be onerous. Typically, PDMP data is not integrated into electronic health record ((EHR) workflows so a physician must leave the system, access PDMP data with a separate log-in ID and then return back to the EHR.