I-STOP, a 2012 law taking effect later this month in New York, will penalize doctors who fail to use e-prescriptions—a replacement for doctors’ handwritten notes that advocates believe can limit the abuse of controlled substances. But restrictions on those substances have caused issues around e-prescriptions, medical groups warn.
Electronic prescriptions, or e-prescriptions, could streamline the process of getting patients their medications, but should state law force doctors to throw away their paper Rx?
New York’s Internet System for Tracking Over-Prescribing Act (I-STOP), passed in 2012 and taking effect March 27, is designed to limit patients’ abuse of prescription drugs by requiring physicians to submit all prescriptions electronically directly to pharmacies. It will be the first law in the country that not only mandates the use of e-prescriptions but also issues penalties against doctors who fail to do so. (Minnesota requires e-prescriptions but does not penalize doctors who not using them.)
So far, the medical world has mixed opinions.
“When it works, it’s seamless,” New York County Medical Society President Michael T. Goldstein, M.D., told the Associated Press last week. “But there are circumstances where it doesn’t work, and patients suffer.”
An Issue of Control
The use of e-prescriptions is growing, but only in some parts of the country. Controlled substances like opioids, the abuse of which I-STOP is intended to curb, are the biggest problem, with just a small percentage of them nationwide being e-prescribed—in most states, at a rate of 1 percent or lower, according to MarketWatch.
The reason for the lackluster response to this Rx innovation, according to American Medical Association President Steven Stack, M.D., is that e-prescription technology hasn’t been perfected yet and is still difficult to use.
“E-prescribing in the right circumstances is fast, efficient, and liked by patients and pharmacists and physicians. But there are many circumstances where there are challenges,” Stack told MarketWatch.
Even so, trade groups in the pharmacy industry such as the American Pharmacists Association (APhA), the National Alliance of State Pharmacy Associations, and the National Association of Chain Drug Stores have worked over the past five years to make e-prescriptions for controlled substances legal. Physicians in every state can now electronically prescribe these drugs. Ken Whittemore, senior vice president of professional and regulatory affairs at health information network Surescripts, noted that his organization took a lead on making e-prescriptions possible.
“We certainly believe that, because of the enhanced security associated with e-prescribing of controlled substances, the opportunity for abuse, misuse, and fraudulent activity is going to be dramatically reduced,” Whittemore told APhA in January.
Even with the industry shift, other challenges persist. The Wall Street Journal reported in February that some doctors are concerned that patients won’t be able to comparison-shop for medications because they must select a pharmacy to receive their e-prescriptions.
And some patients simply like paper slips, Joseph Maldonado, M.D., president of the Medical Society of the State of New York, told the Journal. “The physician now has to deal with an angry patient, a belligerent patient, or a patient that insists they want this in writing.”
Making Room for Exceptions
New York has acknowledged some limitations to how far the law can go right now. Last week state health commissioner Howard Zucker released a set of blanket exceptions covering nursing homes and residential medical facilities without e-prescription software, as well as compound drugs with complex names that exceed the software’s character limit.
The exceptions, which last one year, were welcomed by the Healthcare Association of New York State.
“The commissioner made some practical judgments based on technical limitations,” Susan Van Meter, the association’s vice president of governmental affairs, told Politico New York. “We think it’s the right thing for patients and we appreciate it.”