Pharmacy Leads the Way with ePrescribing of

Controlled Substances

March 24, 2015

Pharmacy Town Hall Series

Presentation Description

The majority of pharmacies are now capable of receiving electronic prescriptions for controlled substances (EPCS).

Find out why EPCS utilization by prescribers is low and what is being done to advance progress.

Explore current initiatives and practical approaches to start (or enhance) your EPCS activities.

About NCPDP Founded in 1977, NCPDP is a not-for-profit, ANSI-accredited, Standards Development Organization with nearly 1,600 members representing virtually every sector of the pharmacy services industry.

NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for ePrescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry.

Our data products include dataQ®, a robust database of information on more than 76,000 pharmacies, and HCIdea®, a database of continually updated information on more than 2.3 million prescribers. NCPDP's RxReconn® is a legislative tracking product for real-time monitoring of pharmacy-related state and national legislative and regulatory activity. www.ncpdp.org

About Surescripts Surescripts is committed to unleashing the potential of American healthcare by creating a more connected and collaborative healthcare system. Our nationwide health information network connects doctor’s offices, hospitals, pharmacists, and health plans through an integrated and technology neutral platform.

For more information, go to www.surescripts.com and follow us at twitter.com/surescripts

About HIMSS

HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology. HIMSS leads efforts to optimize health engagements and care outcomes using information technology. www.himss.org

Vision

Better health through information technology.

Today’s Speaker Patricia Hale, M.D., Ph.D., FACP, FHIMSS Associate Medical Director, Informatics Albany Medical Center

Patricia L. Hale M.D., Ph.D., FACP, FHIMSS, Associate Medical Director for Informatics, Albany Medical Center. Dr. Hale has over 20 years of clinical experience in Internal Medicine as well as clinical application of medical informatics. She is board certified in Internal medicine and subspecialty board certified in Clinical Informatics. Dr. Hale has lead EMR implementation projects for ePrescribing, data exchange, physician order entry, clinical decision support and clinical documentation. Previously, Dr. Hale was Deputy Director of the Office of Health Information Technology and Transformation at the New York State Department of Health where she helped direct a state wide strategy for health information technology implementation. Dr. Hale is a member of the HIMSS board of directors and she has been active in many national informatics initiatives. She is co-author of several textbooks and reports on electronic health records and electronic prescribing as well as editor of a book on electronic prescribing for clinicians published by HIMSS. She continues part-time clinical practice in Internal Medicine.

Today’s Speaker Ken Whittemore, Jr., R.Ph., MBA Senior Vice President, Professional & Regulatory Affairs Surescripts, LLC

Ken Whittemore, Jr., R.Ph., MBA, Senior Vice President, Professional & Regulatory Affairs, Surescripts, LLC. He works with federal and state laws and regulations pertaining to health information technology and serves as the liaison to pharmacy boards and associations. Formerly, Ken worked at the National Community Pharmacists Association (NCPA) and also co-owned a successful independent pharmacy in Maryland. Ken is a graduate of the University of Maryland School of Pharmacy, is licensed to practice pharmacy in Maryland, and holds an MBA degree from Mount Saint Mary’s University.

HIMSS & NCPDP 2015 Pharmacy Informatics Town Hall Webinar Series, sponsored by Surescripts

• Please insert all questions in the Q&A box located on the bottom right of your screen

• A copy of the recording, slides and CPE forms will be available for download within 24 hours on the HIMSS Pharmacy Informatics webpage http://www.himss.org/library/pharmacy-informatics

Accreditation Statement

The Institute for Wellness and Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Attendees who participate in the interactive portion and submit the completed evaluation form at the conclusion of the program will have credit for 1.0 hour(s) of continuing pharmacy education (0.10 CEU) uploaded to CPE Monitor within 60 days after the program date.

Please provide accurate NABP number.

ACPE program numbers are: 0459-0000-15-014-H03-P & 0459-0000-15-014-H03-T

Learning Objectives

• Describe the national status of EPCS state regulations and technology readiness to meet these requirements.

• Examine EPCS readiness requirements for local pharmacies and medical practices.

• Illustrate real-word experience with EPCS and provide practical approaches to keep patient safety and quality at the forefront.

Pre-test Questions

1) How is electronic prescribing of controlled substances (EPCS) beneficial?

2) Regulations supporting EPCS are approved in how many states?

3) What is a key barrier to EPCS utilization?

Controlled Substances are an Important Medication Option

• Narcotics, opioids and psychoactive

medications

• Regulated to 5 schedules of abuse potential

13% of all prescriptions

1. National Association of Chain Drug Stores (NACDS) 2013 dispense data for all new prescriptions, refills, and renewals in the US.

Misuse of Controlled Substances has Become an Epidemic

of the U.S. population has used an opioid pain reliever non-medically

emergency department visits related to substance abuse in 2009

increase in drug overdoses since 1995

4.8%

3X

1.2M

The Health Care Threat is Growing

Drug Overdose Death Rates

3% - 9% Of diverted drugs for abuse are tied to fraud and forgery of paper prescriptions¹

States MANY

Require special paper Rx pads and records²

Work DUAL

When both paper Rx pads and ePrescribing are used³

1. Butler SF, Budman SH, Licari A, et al. National addictions vigilance intervention and prevention program (NAVIPPRO): a real-time, product-specific, public health surveillance system for monitoring prescription drug abuse. Pharmacoepidemiol Drug Saf 2008;17:1142–54. ALSO, Rosenblum A, Parrino M, Schnoll SH, et al. Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug Alcohol Depend 2007; 90:64–71.

2. Agency for Healthcare Research and Quality (AHRQ), Reducing and Preventing Adverse Drug Events to Decrease Hospital Costs, Publication #01-0020 3. Economic Impact Analysis of the Interim Final Electronic Prescription Rule, DEA, U.S. Department of Justice, March 2010

Paper Prescriptions for Controlled Substances: Additional Risk & Work

• Pharmacies and prescribers are intervention points, also subject to investigations and loss of license

Electronic Prescribing of Controlled Substances (EPCS) Can Reduce Risks

• Lower fraud and abuse

• Secure electronic records

• Improved safety & patient care

DEA, U.S. Department of Justice, Economic Impact Analysis of the Interim Final Prescription Rule, March 2010

EPCS Legislation is Established in All States, Except for Two Pending

Designed to address prescription drug abuse and diversion, providing law enforcement and medical professionals tools to stop abuse and diversion before it occurs o Allowed EPCS in the state and makes ePrescribing mandatory for

both controlled and non-controlled substances as of 03/27/16 o Created a prescription drug monitoring program (PDMP) for New York

that requires real-time reporting of PDMP information o NY State Department of Health, Bureau of Narcotic Enforcement (BNE)

released required packets for pharmacies and prescribers to register their certified electronic prescribing applications

*I-STOP bill announced, introduced, passed and signed in 2012

New York State Will Mandate EPCS

Pharmacy IT Vendor Vendor Updates Software • EPCS Certification • Select Identify Proofing • Verified Audit • Rollout update to local practice

Key Actions for EPCS Setup

Vendor Updates Software • EPCS Certification • Verified Audit • Rollout update to local pharmacy

Local Pharmacy Actions • Set Access Controls • Training

Local Provider Actions • ID Proofing Setup • Two-Factor Authentication Setup • Set Access Controls • Training

EHR

Ready to send EPCS PMS

Ready to receive EPCS

Provider EHR Vendor

Systems connect to Surescripts network

to enable EPCS

EHR & Pharmacy Software Systems get certified and connected by Surescripts

Physician

Pharmacy

EHR

PBM

enabling the exchange of electronic prescriptions of controlled substances

Software Application Certification for EPCS

Pharmacy software status Provider EHR software status

• major chains are ready

• most pharmacy system vendors are certified

• Top 10 companies have at least some of their applications certified o Representing the market majority

• Hundreds of applications are still not in the queue for EPCS

• Once certified, enablement and activation may take months

Nationally, Over 70% of Pharmacies are Enabled for EPCS

Provider/EHR Enablement for EPCS Significantly Trails Pharmacy at 3-5%

setup requirements for doctors is more complex

Many Doctors and Some Pharmacist are Still Not Aware EPCS is Legally Available

I wish I could electronically prescribe controlled substances.

I’m not sure if we are able to accept EPCS

EPCS Adoption Barriers

False Knowledge Competing Workload

Priorities

Changing regulatory requirements

Education Gaps

Cost Concerns

Fear of non-compliance / legality Limited Time

3rd Party Audits for Software

DEA Practice Level Requirements

• Identify proofing • Two-factor authentication • Setting access controls

Uncertain action steps

Limited provider / pharmacy coordination

Gaps between pharmacy and provider readiness

Pharmacy & Provider Software Updates

Providers have more required setup steps than pharmacies.

Provider Practice DEA Requirements for setup • Identify proofing • Two-factor authentication • Access controls

Industry Experts Collaborated to Create Simple Education on Key Actions Providers Need to Get EPCS

EHR

EHR Software Update

Identify Proofing Two Factor Authentication

Set Access Security

getEPCS.com Offers Education, Videos and Guidance Designed for You to Share

• Embed education module to sit on your own webpage

• Post on LinkedIn

• Tweet EHR status

• Email action steps

getEPCS.com Let’s You Watch Each Step and Look Up EHR Software Status

Go Online to See Who is Getting EPCS Today

• Create cross functional project team o IT, App Team, Clinical, Pharmacy, Compliance

• Identify physician champions o Ensure clinical adoption o Review workflows for ease of use o Biometrics and Tokens

• Reach out to local pharmacies before EPCS goes live

• Establish the right team to make key decisions, especially with respect to clinical workflow requirements

• Prepare Clinical Users o Develop training materials o Educate users on DEA requirements o Train users on new workflows

Other Medical Practice/EHR Tips for Successful Rollout of EPCS

• Saves time with electronic renewals

• Supports safer medication decisions

• Reduces manual record keeping requirements

• Supports attainment of meaningful use

• Increases patient convenience and care

EPCS Contributes Value

Educate, Communicate, Collaborate to Realize the Full Value of EPCS

Post-test Question #1

1) How much of the CDC reported drug overdose deaths were related to dispensed prescriptions?

a) 5%

b) 10%

c) 35%

d) More than 50%

Post-test Answer #1

1) How much of the CDC reported drug overdose deaths were related to dispensed prescriptions?

a) 5%

b) 10%

c) 35%

d) More than 50%

2) How many states have legislation in support of EPCS? a) 5

b) 10 plus the District of Columbia

c) 46

d) 48 plus the District of Columbia

Post-test Question #2

2) How many states have legislation in support of EPCS? a) 5

b) 10 plus the District of Columbia

c) 46

d) 48 plus the District of Columbia

Post-test Answer #2

3) Nationally, what percent of prescribers have EHR systems enabled for EPCS?

a) 1-2%

b) 3-4%

c) 5-6%

d) 10%

Post-test Question #3

3) Nationally, what percent of prescribers have EHR systems enabled for EPCS?

a) 1-2%

b) 3-4%

c) 5-6%

d) 10%

Post-test Answer #3

4) What actions must be completed before a prescriber’s EHR system is set-up to legally send electronic prescriptions for controlled substances?

a) Electronic health records (EHR) software update and certification for EPCS b) Establish identity proofing and signing credentials with two-factor authentication c) Set-up access control to ensure system security d) All of the above

Post-test Question #4

4) What actions must be completed before a prescriber’s EHR system is set-up to legally send electronic prescriptions for controlled substances?

a) Electronic health records (EHR) software update and certification for EPCS b) Establish identity proofing and signing credentials with two-factor authentication c) Set-up access control to ensure system security d) All of the above

Post-test Answer #4

5) How can you determine who in your local community are enabled for EPCS and help provide guidance for getting EPCS established with medical practices?

a) Call or email local doctors

b) Share educational support found on www.getEPCS.com

c) Post educational information on your website

d) All of the above

Post-test Question #5

5) How can you determine who in your local community are enabled for EPCS and help provide guidance for getting EPCS established with medical practices?

a) Call or email local doctors

b) Share educational support found on www.getEPCS.com

c) Post educational information on your website

d) All of the above

Post-test Answer #5

Q&A

Save the Date – Future Town Halls

Pharmacy’s Role in Interoperability May 14, 2015 | 12:00 pm central Pharmacy, Leadership and the Optimization of ePrescribing Quality June 4, 2015 | 12:00 pm central Register Today! http://www.himss.org/library/pharmacy-informatics

See you at HIMSS15 | April 12-16

www.himssconference.org

Register Today | NCPDP 2015

http://ncpdp.org/ac/index.aspx