“Remember that Oath?”: EPCS and the Fight Against Opioid Abuse


As doctors, we all took an oath when we graduated from medical school to “do no harm” to patients. It is, therefore, our duty to speak up and take action when there is an opportunity to prevent harm and improve patient care, safety and well-being. On average, the opioid crisis is killing more Americans on a monthly basis than traumatic injuries. It is time for the medical community to raise its voice even more loudly in support of proven technology that helps curb this crisis.

This month, California Governor Jerry Brown became the latest state lawmaker to embrace electronic prescribing for controlled substances (EPCS) — joining nearly a dozen other states that have passed legislation mandating that health care providers and pharmacies use the technology. The Golden State law was signed at the same time the U.S. Senate passed a bill requiring e-prescriptions for any reimbursement under Medicare Part D.

Clearly, EPCS is emerging as a key tool in the fight against opioid abuse. And legislators aren’t alone in driving the trend — corporations are playing a key role as well. Walmart, one of the nation’s largest pharmacy chains, is requiring EPCS by January 1, 2020. In their press release, it was noted that “E-prescriptions are proven to be less prone to errors, they cannot be altered or copied and are electronically trackable.”

While this legislative and corporate policy momentum is encouraging, more work needs to be done to get this important technology effectively integrated into clinical practice. In the current political climate, despite overwhelming support, it is still unclear exactly when a national bill might be signed into law by the President. And in California, providers have until 2022 — another four years — to fully implement EPCS. Dozens of other states – including Florida, where the number of opioid deaths is expected to climb even higher as the epidemic broadens in scope and impact — have yet to even introduce a bill. Meanwhile, addiction and overdose rates continue to climb upward.

Most care providers would agree that we should be using every tool at our disposal to fight this growing epidemic now – before more lives are lost. In fact, many forward-thinking healthcare facilities across the country are already on their way to implementing e-prescribing systems regardless of state or federal mandates, simply because it is the right thing to do for patient safety. The good news is that the technology is becoming more wide-spread and adoption can be rapid when stakeholders buy-in. In Connecticut, for example, providers had less than six months to meet the state deadline for implementation – and in many cases, they were successful in doing so. Take, for example, Dr. Spencer Erman at Hartford Health, who is now well ahead of the e-prescription curve.

Electronic prescribing of opioids and other controlled substances takes the paper prescription—and the prescriber’s U.S. Drug Enforcement Administration (DEA) registration number—out of the hands of patients. Instead, prescriptions are sent online directly to the pharmacy, improving security, privacy, and transparency, and making it more difficult to commit fraud, theft, or abuse. Compliance with DEA regulations is ensured, while audit trails and reporting functionality make it easier for healthcare systems and providers to analyze practice patterns, perform quality control, and improve patient care.

Of course, healthcare organizations and prescribers will have to meet a number of specific requirements to comply with DEA regulations designed to create a secure, auditable chain of trust through the entire EPCS process. But, with the right technology, these requirements do not need to be a financial burden or even impediments to clinical workflows.  Data from Geisinger Health System in Pennsylvania found EPCS actually resulted in significant workflow and financial benefits. The technology helped reduce overall opioid prescribing by about 50%, while also creating a cost savings of about $1 million per month in recouped lost clinical productivity and diversion control costs.

Of course, EPCS alone is not a “magic pill” for solving our nation’s growing opioid epidemic. But many of us have experienced first-hand the vital role technology can play in preventing over-prescribing, addiction, misuse, and abuse before it begins. And in addition to preventing fraud and abuse, EPCS actually makes it easier for providers to get pain relief and other medications to those that legitimately need treatment (in an accountable and transparent manner). By implementing EPCS, providers can do their part to help ensure that opioids are prescribed securely and appropriately, increase patient safety (as well as satisfaction), reduce patient harm, and improve the overall quality of care. This, after all, is what we promised when we took the Hippocratic Oath and swore to care for patients and their health and well-being.

Sean Kelly is the Chief Medical Officer at Imprivata and emergency physician at Beth Israel Deaconess Medical Center in Boston


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4 replies »

  1. Well written.
    The opioid epidemic is a complex challenge today. It is important to track patients who have already receive opioid prescriptions. Healthcare technology will be of help here. A patient referral management solution will be of help to track and have the patient data.

  2. I think meltoots is quite right….lots of negatives too!

    ECPS will also allow more facile state control of physicians in many ways: It could be applied to other classes of drugs such as expensive proptietary, or drugs outside physicians typical specialty use. It could require authentication stamps and permission from patients ( e.g. do you agree to accept this expensive drug while we see this other generic is appropriate?).

    The ways go on and on…

  3. Should we NOT mention that this MD is the CMO of Imprivata? He has a SIGNIFICANT conflict of interest, as Imprivata is THE provider of fingerprint dual authentication necessary for DEA ECPS. Also, he glowingly describes EPCS without stating ANY of the negatives.

    1. It is MARKEDLY more complex to do ECPS in EHRs. Period. It does not save money nor time. ANYONE will tell you that. It does not save MONEY nor TIME to do this in an EHR.
    2. If he REALLy does practice, how many times did he get call backs that the eRx did NOT arrive to the intended pharmacy? Or the Pharmacy was CLOSED? The ECPS system does NOT tell you the hours of operation. AND what if the patient wants to use a closer or more accessible pharmacy that is on the way home and not the default one? Paper makes that easy. ECPS impossible.
    3. Paper Rx’s are never copied as ALL of them have to have anti-copy watermarks, Nearly zero are altered, and certainly paper Rx’s are still electronically tracked. Hello PDMP?
    4. Abuse of ECPS or paper Rx will still occur, doesn’t matter the means.
    5. ECPS is not tied to the Hippocractic Oath, that is just nuts.
    6. Legitimate opioid prescribing, is NOT the problem. In FACT, in every state that the use of MD prescribed opioids has REDUCED, the USE of illegal opioids has gone UP! Ohio, my state is a perfect example. Year after year the use of prescribed opioids have gone down, the use of illegal opioids have gone up, with more OD than ever.
    7. ECPS is VERY EXPENSIVE and complicated to implement in EHRs and sit down, the company that he is the CMO, supplies the necessary hardware to do dual authentication required. Whoa, did he mention that?

    The HCB should MAKE him state his financial conflict of interest in writing this ridiculously, one sided, obviously conflicted article.

  4. Great compilation. I enjoy reading health blogs. So many amazing articles that truly useful for everyday living

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