Starting Easter Sunday, March 27, electronic prescribing for both controlled and non-controlled substances will be required in New York, making it the first state to require all prescriptions be created electronically. Physicians who fail to comply with the mandate face fines and imprisonment.

While Minnesota already has laws on the books mandating e-prescribing, the Empire State is the first to threaten financial penalties and jail time for those found in violation. Not surprisingly, the healthcare industry and state legislatures around the country are watching to see how this experiment in enforcement turns out.

Ken Whittemore, senior vice president for professional and regulatory affairs at Surescripts, believes that, with a little more than a week left until the deadline, most providers will be able to meet New York’s Internet System for Tracking Over Prescribing (I-STOP) mandate.

“The effect of I-STOP in New York with respect to prescriber enablement has been nothing short of dramatic,” says Whittemore.

An IT vendor that supports e-prescription, Surescripts data from the end of February shows that New York is leading the nation in terms of percentage of providers who are able to electronically prescribe controlled substances (EPCS). In New York, 37.2 percent of total prescribers are able to digitally prescribe controlled substances, compared with just 7 percent of prescribers nationally.

In addition, 63.7 percent of New York State prescribers are actively transmitting electronic prescriptions, compared with 58.1 percent nationally.

“In terms of percentages, there are five times more physicians in New York that are prepared to transmit electronic prescriptions for controlled substances versus the national average,” Whittemore says. “In terms of actual transaction volume for electronic prescriptions for controlled substances, if you look back to November 2014 there were about 8,000 transactions per month that went across our network for the entire State of New York. In February 2016, it was about 750,000 transactions. That’s compared with just a little over 2 million [a month] for the entire country. So about one-third of the electronic prescriptions for controlled substances that are going across on our network nationally are accounted for by New York.”

The Surescripts data also reveals that New York pharmacies have also stepped up, with 94.2 percent of them able to electronically receive prescriptions for controlled substances versus 84.2 percent nationally.

However, critics contend that despite these encouraging percentages in New York, there are still a significant number of doctors who are not prepared to meet the March 27 deadline.

“Our perspective is that those who are currently signed up, enabled and doing it are those that do the most prescribing,” Whittemore says. “There apparently are a fairly sizable number of physicians in the state that don’t do a lot of e-prescribing and one would expect that they will probably be the last ones to come to the table.”

However, these procrastinators are quickly running out of time and excuses. New York Gov. Andrew Cuomo signed legislation in March 2015 granting a one-year extension for prescribers to comply with the I-STOP requirements because providers were not able to meet last year’s deadline.

“The problem was on the provider side and also some of the health systems. Their IT departments hadn’t done what was necessary in order to be able to transmit the controlled substances,” says Whittemore, who notes that the U.S. Drug Enforcement Agency rules for controlled substances are very rigorous, with a “greater portion of the requirements falling on the EHR side versus the pharmacy side—so there is more of a list that they have to take care of.”

Complicating matters, he reveals that “there have been a couple of instances—and it’s hard for us to know exactly how many EHRs this might apply to—where vendors for whatever reason are not going to be able to enable their end users to comply.” Whittemore declined to name the health IT companies involved.

Under I-STOP, EPCS requirements include having a certified EHR and working with a vendor to implement the additional security requirements needed for e-prescribing of controlled substances, as well as registering with the New York’s Bureau of Narcotic Enforcement.

New York State’s Department of Health data show that more than 60,000 prescribers are already e-prescribing, and other prescribers are continuing to register their certified software with DOH. Providers can receive a waiver from the mandate in limited circumstances.

To qualify for a waiver, a prescriber must demonstrate that their ability to issue an electronic prescription is unduly burdened by economic hardship, technological limitations that are not reasonably within the control of the prescriber, or other exceptional circumstance demonstrated by the prescriber. The waiver is good for up to one year at which time the prescriber must reapply for a continuation of the waiver and set forth an updated statement of facts detailing the continuing circumstances in support of the renewal.

“We suspect that there will be quite a few of these waivers issued,” concludes Whittemore.

James Plastiras, a DOH spokesperson, says the department is reviewing waiver applications on a case-by-case basis, and “grants them based on the individual factual circumstances to which the applicants attest.” He disclosed that more than 2,600 waiver requests have so far been approved “for over 10,600 distinct practitioners.”

At the same time, Plastiras says that EHR vendors have neither indicated to DOH or to their customers that they cannot meet the March 27 deadline to support prescribers from a technological perspective.

“Prescribers should not wait until the last minute to engage them, because implementing, testing and learning how to use a software system to e-prescribe may take some time,” he warns. “The e-prescribing mandate was passed into law in August 2012, and since then the Department has been encouraging prescribers to educate themselves about the variety of software options available.”

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