• January 2009 FEATURE ARTICLES •
Thought Leaders
ePrescribing: Ready for Prime Time. But is Your Government?
By David Miller
Ordering cheeseburgers at fast-food joints
triggers more technology than getting a prescription written for
Vicodin.
Crazy? It’s also true. That was part of the
U.S. Senate testimony offered by my colleague, Laura Adams,
president and CEO of Rhode Island Quality
Institute, during testimony to Congress on why ePrescribing’s
time had come. I also testified and said the technology to
handle such a need exists and has been proven for nearly a
decade. We argued that not only is ePrescribing of controlled
substances ready for prime time, it’s well past due. It can and
should be legal for all major classes of drugs, including
Schedule II narcotics; however, our government doesn’t think so
— at least not yet.
By replacing pen and paper with bytes and
bits, we argued, lives will be saved, inefficiencies and errors
will be wrought out of the system, disease trends will be
spotted, and bad docs and rogue pharmacists will go to jail — a
cost that is orders of magnitude less expensive than with paper.
Too Pollyannaish? Not necessarily.
Past Legal Hurdles
In spite of all the evidence that technology
brings to the table (e.g., reduced costs, decreased errors and
greater efficiencies) the U.S. Drug Enforcement Administration
(DEA) has only allowed hand-written prescriptions to dispense
Schedule II narcotics. This is the case even though, as Newt
Gingrich famously noted, "paper kills."
The DEA traditionally has maintained that, in
spite of the known advantages technology offers, there has
always been room for error, unscrupulous docs, lack of control
and a "wild west" mentality. These are the same fears that
previously blocked online retail purchasing some 15 years ago,
during the Internet’s infancy. Today, thousands of consumers
shop online, trusting their credit histories to bits and bytes
over the Web. They do this because the system now contains
enough built-in safeguards that protect identity and banking
information to invoke trust.
Healthcare, for all of its clinical advances,
has just taken the slow administrative road to technology
adoption, as witnessed by the 75 percent or so of physicians
that still use paper files for pretty much all patient records
and prescriptions. Some say the solution is to use both systems
(paper and electronic) side-by-side until there is enough trust
in ePrescribing. Yet, time after time, physicians have shown
that they just won’t use two systems. Redundancy of parallel
systems, they say, is just too cumbersome and too much of a
bother.
Present Legal Hurdles
I told Sen. Sheldon Whitehouse, who
championed this cause, that healthcare needs to look to other
industries that already have solved similar problems of security
and identity. These companies shared a common goal of safely and
securely exchanging vast amounts of sensitive data outside of
their organizational walls.
The automotive industry, for example, formed
a collaboration hub a decade ago (Covisint) that securely
enables the sharing of specific inventory, purchasing,
engineering and administrative data. Hundreds of thousands of
employees in this industry securely exchange large amounts of
sensitive information and access remote applications on a daily
basis.
With a four-digit code and a piece of
plastic, banking consumers trust that their identities will
remain intact whether they’re withdrawing ATM cash or making
impulse purchases on Paris’ Avenue des Champs-Élysées. Major
stock exchanges also have no problem electronically transacting
tens of billions of dollars daily.
Security is the lynch pin upon which all
success rests for both the automotive and banking industries.
Same goes for healthcare, which could literally transform itself
overnight by aggressively adopting technology and, in
ePrescribing’s case, save lives while also saving money.
What’s Next
A number of good signs have emerged since our
December 2007 testimony. Namely, Attorney
General Michael Mukasey penned a letter signed by 19
U.S. Senators, including President-elect Barack Obama, Ted
Kennedy, John Kerry, Lindsey Graham, Arlen Specter and Tom
Coburn, which urged the DEA to adopt the security technology
used by other industries to enable ePrescribing.
The DEA has finally begun to listen. Earlier this year, it
proposed a new set of rules regarding the electronic prescribing
of controlled substances. These new rules will allow electronic
prescribing of controlled substances under a set of security
controls, which are still being reviewed by the Office of
Management and Budget.
What You Need to Know and Do
Keep informed and stay active. Follow
the DEA’s actions, and keep in touch with your legislator or
your physician’s association. They value your input.
Take your time. Don’t be duped into
the first shiny new system that some sales person drops into
your lap with all of its electronic bells and whistles. Ask your
colleagues what they like, what has proven successful, and
tailor your questions based on your experience and the feedback
others give you.
Change is coming, so be prepared. You
likely will soon implement ePrescribing for controlled
substances. Train your key personnel on the new systems in
advance and adopt systems aggressively.
Brace for resistance. Contrarily,
leveraging technology is not second-nature to many in healthcare
— there will be detractors. Know that a cultural change is afoot
and deal with that before the technology enters your workplace.
Now is the time to start that process.
Final Thoughts
The DEA is currently in a review period for
the newly proposed rule on ePrescribing as it relates to
controlled substances. The public comment period is now over and
the DEA is determining what changes, if any will be made to the
rule. If no changes are made this rule will become part of the
DEA regulation.
I continue to consult with Sen. Whitehouse on
the security and identity intricacies involved in enabling such
legislation. There is hope that healthcare may finally catch up
to other industries and adopt secure technologies that make real
differences in people’s lives. Perhaps, soon, writing
prescriptions for controlled substances will actually trigger
more technology — and security — than does ordering a Big Mac.
David Miller is chief security officer for
Covisint. Contact him at dmiller@covisint.com.
