Federal Law Would Fight Opioid Epidemic with E-prescribing

The Every Prescription Conveyed Securely Act would require electronic prescriptions for controlled substances under Medicare.

Sean Kelly, MD, sees the devastating effects of the opioid epidemic firsthand almost every day. "We see a lot of overdoses, I would say more this year than last year. Pretty much every shift has one or two," he says.

Kelly is an attending ED physician at Beth Israel Deaconess Medical Center in Boston. He is also chief medical officer of Imprivata and an assistant clinical professor of emergency medicine at Harvard Medical School.

But it's not only overdosed patients who come into the ED comatose or coding.

"We see a lot of secondary effects of the epidemic," Kelly says. "Because of the drug addiction issue, it's led to other things in their life."

Many patients have lost their jobs, have depression and other mental health issues, or have experienced accidents, fights, and violent crime. Some even have lung, brain, or heart valve infections from IV drug use, leading to hospital admissions, long ICU stays, and bad neurologic outcomes.

All of those consequences of the opioid crisis have led to money being funneled into things like addiction treatment and naloxone distribution, but in many ways, those efforts are like trying to build a dam with toothpicks.

"From an ER doctor perspective, I see a lot of efforts out there to combat the downstream effect after people are addicted," Kelly says. "All of these are very necessary, but at the same time we need to invest in more preventive medicine."

That's why Kelly is so encouraged by the Every Prescription Conveyed Securely Act, which would require electronic prescriptions for controlled substances under Medicare.

Congresswoman Katherine Clark (D-MA) and Congressman Markwayne Mullin (R-OK) introduced H.R. 3528 at the end of July.

"Modernizing public health practices to include electronic prescriptions will curb the over-prescribing of opioids, eliminate the costs and inefficiencies of paperwork, and strengthen communication between doctors and patients," Clark said in a statement.

Already, a handful of states have mandated electronic prescribing of controlled substances (EPSC), which experts say can help to reducing prescription fraud, ensure that physician orders are followed accurately, and give prescribers access to a patient's medication history.

New York State enacted an EPCS mandate last year that's already had a significant effect.

"It's been amazing the impact that that's had in the state of New York," Ken Whittemore, vice president of professional and regulatory affairs of Surescripts told HealthLeaders in June.

He pointed to Surescripts data showing that New York was the No. 1 state for EPCS, with 72.1% of prescribers enabled and 91.9% of controlled substances prescribed electronically.

Overall, the Surescripts 2016 National Progress Report showed that there were 45.34 million prescriptions for controlled substances delivered electronically in 2016, representing a 256% increase over the year before.

Kelly says that the new Every Prescription Conveyed Securely Act is a major step forward.

"This bill that's proposed in the House of Representatives is now the first federal bill that would require electronic prescribing of controlled substances" he says. "We have seen a lot of momentum state by state, and I'm happy to see that there's federal interest in this."

And barriers that existed only a few years ago are swiftly being hurdled—namely DEA rules allowing providers to use EPCS but only with strict security standards—because state laws have forced many e-prescribing vendors and providers systems to update their capabilities.

"The market is ready for the ability to do this with controlled substance," Kelly says.

In addition, with so many health plans, and now even health systems such as Intermountain, setting goals to reduce the number of opioid prescriptions, EPCS will likely make meeting those goals even easier.

"We talk a lot about education and changing behavior. The truth is maximizing the use of safety mechanism that are built into electronic systems really can help," Kelly says.

"If you make the right thing the easy thing, and also the default, that's the easiest way to get compliance."