What Does NY’s E-prescribing Mandate Mean for You?
Beginning March 27, 2015, all prescriptions written in New York State must be submitted electronically. It is a mandate that threatens to catch many dentists off guard and unprepared to comply—potentially leaving patients standing at the pharmacy with worthless paper prescriptions and consuming valuable office resources managing calls to replace them with electronic versions.
There are multiple reasons why our industry has been slow to embrace e-prescribing. Many dentists are unsure of how or why to approach e-prescribing, what to expect from the technology, or how best to integrate it into practice workflows. We write far fewer prescriptions than our physician counterparts, making the cost benefits of adopting the technology more difficult to identify.
Further, most dental practice management (PM) systems don’t provide medication data in a coded format that can be exchanged with pharmacy systems. This is true even with PM systems that offer stand-alone e-prescribing systems through a third-party vendor partner. The PM system may interface with the e-prescribing solution, but drug information is not coded to pass bi-directionally between them, resulting in two separate patient databases.
Not only are there few financial incentives for dentists to adopt e-prescribing, but until now there have been no requirements, nor have we been encouraged to do so. Minnesota passed legislation in 2008 requiring e-prescribing by 2011, but it is a mandate without enforcement.
That will change in March for New York State’s nearly 14,500 dentists, who will no longer be able to stand on the e-prescribing sidelines. According to guidance issued by the New York State Dental Association, the mandate covers both non-scheduled and controlled drugs, the latter of which requires practitioners to register their e-prescribing system with the New York State Department of Health Bureau of Narcotic Enforcement. Systems must also meet federal security requirements.
The e-prescribing mandate does not require dental practices to have in place electronic patient record systems. However, it does require the ability to access the Internet by computer, laptop, tablet, or smartphone to write and transmit prescriptions.
With little guidance on what e-prescribing systems to select, dentists are on their own to identify which work best for their practice needs. The first step is understanding exactly what e-prescribing is and why it is important enough to warrant government mandates.
E-prescribing is a technology framework that enables prescribers to write and send prescriptions to a participating pharmacy electronically, replacing handwritten or faxed notes and eliminating the need to call in prescriptions. In Electronic Prescription Standard for Dentistry, the American Dental Association (ADA) Council on Dental Practice identified a number of benefits from e-prescribing, in particular quality assurance, patient safety, and decision support.
Specifically, e-prescribing can significantly reduce medication errors, which occur in 3.3 million outpatient visits and claim an estimated 7,000 lives each year in the United States. The ADA Council on Dental Practices notes that these errors are caused primarily by illegible handwriting, unclear abbreviations, dose errors, unclear oral orders, ambiguous orders, and fax clarity—most of which are avoided with e-prescribing.
E-prescribing also delivers clinical decision support (CDS), which further reduces preventable errors by cross-referencing medication information to identify drug-drug interactions and drug-allergy reactions, and has the potential to “increase the communication between the dentist and the patient, thus increasing access to important reference and patient information, preserving the patient-dentist relationship in the delivery of health care.”
Despite these benefits, many in the dental industry are reluctant to invest in e-prescribing systems. One reason, as noted previously, is the lack of incentives to do so. Though dentists do qualify for financial incentives through the Electronic Prescribing (eRx) Incentive Program, few practices have patient populations that include the required minimum 30% Medicaid beneficiaries. Another issue is that most PM systems do not support e-prescribing, requiring an investment in a replacement or stand-alone system.
The intrepid few in the dental industry who have taken the leap into e-prescribing have discovered that these obstacles are far less significant than originally anticipated. The key is to identify a system that works well within the existing workflow and requires minimal upfront investment in hardware, software, and ongoing support.
The ADA identified core prescription capabilities of an effective e-prescribing system, including searchable medication lists with available dosage forms, strengths, route, frequency and duration, as well as directions to the patient, prescriber signature, and the number of authorized refills. Fields for dispense as written (DAW) or substitution permitted designations, comments, and PRN should also be included. Other fields include DEA schedule for controlled substances and DEA number for prescriber when issuing a controlled substance prescription, unique identifier for the prescriber (eg, NPI or TIN number), patient name and address, and date the prescription was issued.
As long as core capabilities are present, the most important aspect of an e-prescribing solution is its ability to interface with the practice’s existing PM system. This eliminates the need to manually enter key data such as patient demographics whenever a prescription is written. Also important is Electronic Prescribing of Controlled Substances (EPCS) certification, which is required to e-prescribe controlled substances in 49 states, as is SureScripts™ certification.
Other important features include access to extensive dental-specific drug databases such as those found in Lexicomp® Online™ for Dentistry and interactive diagnosis tools designed to augment patient care and optimize practice workflows (eg, enabling creation of differential diagnoses for oral lesions and generating lists of medications likely to be safe for your patient). Medication decision support further enhances quality and safety by providing an immediate response to questions.
The ability to access a patient’s prescription history data from pharmacies, insurance claims, and pharmacy benefits managers also increases quality and safety by enabling interaction screenings. Finally, the ability to request information on insurance eligibility and formulary at the time of prescription lets dentists identify which medications are covered and even suggest cheaper or alternative options.
A customizable favorites list is another important function, one that saves a tremendous amount of time by eliminating the need to sort through hundreds of medications when most practices prescribe just a small handful. Finally, seek out a web-based solution that enables faster, more streamlined implementation and that offers mobile access for maximum convenience.
E-prescribing has rapidly become the norm in healthcare, with more than half of all eligible prescriptions now being routed electronically. Though hard financial incentives to do so are few, the benefits of adopting e-prescribing are many for the dental industry. Doing so will help us evolve into a two-way data exchange with pharmacies that will enable us to treat our patients in the safest manner we can.
For dentists in New York, the clock is ticking. For dentists nationwide, New York’s status as a bellwether state signals that the time is now to prepare for what is likely to become a requirement in their own backyards.
Martin Jablow, DMD, is “America’s Dental Technology Coach.” He practices general dentistry in a group setting in Woodbridge, New Jersey, and promotes the use of technology in the dental office to improve efficiency and patient care through lectures and articles on the use of technology to enhance the practice of dentistry. Dr. Jablow can be reached by email at email@example.com.