Prescribers can`t completely eliminate paper—yet

Behavioral healthcare providers constantly are being told that electronic systems will increase efficiency, improve patient care, and reduce errors. E-prescribing is part of this drive to eliminate paper-based systems, but there's a hitch that complicates provider organizations’ attempts to become paperless: Drug Enforcement Administration (DEA) regulations do not permit e-prescribing of controlled substances.

This restriction poses a problem for psychiatrists and other physicians, as some medications used to treat mental health and substance use disorders are controlled drugs, including:

• Alprazolam (Xanax)

• Amphetamine (Dexedrine)

• Buprenorphine (Suboxone, Subutex)

• Clonazepam (Klonopin)

• Lorazepam (Ativan)

• Methadone

• Methylphenidate (Ritalin)

The DEA requires providers to manually sign prescriptions for controlled drugs. The DEA says it would approve of only “certificate-based” technology to authenticate prescribers and, thus, prevent drug diversion. Yet no system currently meets the DEA's standard, and the technology is complicated and unlikely to be widely adopted, says David C. Miller, chief information security officer for Compuware Covisint, an information technology company.

Miller took this message to Capitol Hill in December, where he testified before the Senate Judiciary Committee. He reminded lawmakers of some of the problems associated with paper-based prescriptions, such as that they are hard to track and manage, involve manual processes vulnerable to human error, and are difficult to store and retrieve. He noted that existing technology his company developed for domestic automakers and the FBI could meet the need for authentication (identifying a prescriber), nonrepudiation (ensuring the pharmacist that the electronic signature is valid), and record integrity (ensuring that the prescription was not altered after being signed/authenticated).

After Miller's and others’ testimony, a bipartisan group of 19 senators asked Attorney General Michael Mukasey to review the DEA's position on e-prescribing of controlled substances (to read their letter, go to https://www.behavioral.net/Media/DocumentLibrary/US-Senate-Eprescribing.pdf). The senators noted that e-prescribing of controlled substances would help law enforcement by allowing them to:

• track and monitor prescriptions in real time;

• aggregate data to detect irregular patterns;

• create an audit trail of what is sent and by whom; and

• receive automatic alerts of abusive behavior.

In their letter, the senators cited Miller's testimony, and they concluded, “It is our belief that both the health care and law enforcement communities would benefit greatly from a secure [electronic prescribing of controlled substances] system, and that technological solutions are at hand.”

Miller suspects the DEA eventually will conduct a pilot of e-prescribing of controlled substances using technology already in use. He believes the DEA will quickly realize its benefits: “E-prescribing controlled substances is not only a good idea, but also imperative in an effort to solve many of the existing—yet unnecessary—frauds, abuses, inaccuracies, and errors in play for healthcare today.”