Why docs were slow to embrace secure prescribing controls
When Oswego Health in New York implemented state-mandated secure electronic prescribing software for controlled substances, physicians initially did not like the fact that they were forced to use the technology, but it did not take them long to embrace it, says Barry Ryle, CIO.
Before the mandate, Oswego had a hybrid prescribing system, with electronic prescriptions being done for most patients and paper scripts for controlled substances. The intent of electronic prescribing for controlled substances was to enable the state to track patients on these medications and identify “doctor shoppers,” who are patients that get prescriptions from multiple physicians, according to Ryle.
“We have the ability when e-prescribing to see medication history for pharmacies participating in the controlled substances program,” Ryle explains. Oswego uses e-prescribing software from Dr. First. As the system was implemented, there were loose ends to tie up, such as how to get prescriptions to the pharmacy if the prescribing system was down. If a prescription cannot go through, notice of the failure must be documented with the reason why, and the physician must be notified via secure messaging.
Implementation of controlled substances e-prescribing included a lengthy process to sign up providers to use two-factor authentication. Each prescribing provider had to register with a certification authority and was given a token that displays a random set of verification numbers that are entered into the order. The controlled substances prescribing system also offers clinical alerts to physicians and care managers when patients are discharged from the hospital or emergency department.
Physicians, Ryle said accepted that they needed to go through a verification process, but they didn’t like the extra step in using the token, which can get lost or left at home. Over time, most had the token application installed on their smartphones.
Now, Oswego is moving toward secure texting as a backup for when controlled substances prescriptions fail to go through. A secure texting app on physician phones can get the script where it needs to go. And that will help support Oswego’s accountable care initiative, which includes developing an integrated delivery system and the care coordination and care management processes that come with accountable care and payment reform initiatives, according to Ryle.