The Drug Enforcement Administration has banned the use of e-prescribing for controlled substances, and that means doctors will have to stick with paper for about 12 percent of the prescriptions they write.
In addition, some states have paper-based requirements for narcotics prescriptions, such as requiring that they be written in triplicate.
Those requirements will be among the major challenges in moving more doctors and hospitals to e-prescribing. A number of public and private organizations are calling for a greater focus on standards and incentives to increase the use of that technology.
But some experts say the ban does more harm than good.
If doctors must write some prescriptions electronically and others on paper, “that creates nothing but chaos and confusion,” said Dr. Douglas Henley, executive vice president at the American Academy of Family Physicians and a member of the American Health Information Community.
The e-Prescribing Controlled Substances Coalition agreed. In a letter to President Bush, the coalition wrote that DEA should immediately issue regulations that would allow e-prescribing of controlled substances.
DEA officials argue that e-prescribing may not be fully secure and might make it harder to prove that doctors wrote improper prescriptions.
But the coalition disputed those objections, saying that “current e-prescribing systems offer significantly more protection from illicit prescribing, doctor shopping and drug diversion than the current system of paper and oral prescriptions.”
— Nancy Ferris
It seemed as if someone had decided to declare last week e-Prescribing Week in Washington.
There were rumors that a forthcoming Medicare bill in the Senate Finance Committee would require doctors to use e-prescribing in a trade-off for getting higher fees for their services.
Then a high-level advisory committee recommended that the Health and Human Services Department seek permission from Congress to mandate e-prescribing in Medicare.
Next, the e-Prescribing Controlled Substances Coalition, composed of more than two dozen companies and organizations, sent a letter to President Bush asking the government to remove a major barrier to widespread e-prescribing.
The Senate Judiciary Committee scheduled a hearing this week on that same barrier — the Drug Enforcement Administration’s rules that prohibit e-prescribing of controlled substances such as narcotics.
Even the American Medical Association is climbing aboard the e-prescribing bandwagon. In an Oct. 31 letter to senators, it said it “is deeply committed to the adoption of e-prescribing into clinical practice” and proposed steps that the government should take, including financial incentives for doctors.
The American Health Information Community (AHIC), which advises HHS, said not all the necessary groundwork has been laid for a national move to e-prescribing. It outlined conditions to be met in the next year or two before a mandate could take effect.
All of this work signifies the escalating pressure on the federal government, Congress, and medical and commercial business associations to decide how to get health information technology, and more specifically e-prescribing, adopted nationwide.
There was some opposition to AHIC’s recommendations from representatives of doctors, who said the recommendation was too strong, and from insurers, who called it too weak.
HHS Secretary Michael Leavitt, who leads AHIC, had urged the committee to recommend the mandate as part of a strategy for gaining adoption of e-health records. E-prescribing often is described as the easiest and most rewarding element of health IT for doctors, hospitals and pharmacies to adopt.
E-prescribing not only transmits prescriptions electronically from a doctor to a pharmacy but also eliminates reliance on doctors’ notoriously poor handwriting.
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