BestPractice
October 2, 2018
Providers who prescribe controlled substances can now submit the prescriptions to pharmacies electronically.
The change in the Epic electronic medical record system means providers no longer have to print out and sign paper prescriptions for medications including opioids and amphetamines, and patients no longer have to pick up the prescriptions and bring them to pharmacies.
The new capability is expected to improve the security of prescriptions by eliminating printouts, save time for both providers and patients, and allow providers to prescribe fewer medications at a time, says Michelle Campbell, administrator for ambulatory operations for Johns Hopkins Medicine.
The health system has had an e-prescribing function for medications that are not controlled substances since 2013, when it began using Epic. E-prescribing for controlled substances began in April, and it is now available to all health system providers. Enrollment is not required, Campbell says, but it is encouraged.
“We jumped at the opportunity,” says internal medicine doctor Michael Fingerhood. “It’s more convenient for patients and for me. It’s a better practice to send the prescription directly to the pharmacies. It meets the goal of making Hopkins easy.”
So far, about 1,300 physicians, nurse practitioners and physician assistants have signed up, Campbell says. One is Sophie Lanzkron, director of the Sickle Cell Center for Adults at The Johns Hopkins Hospital. “We write a lot of opioid scrips,” says the hematologist. “This is so much more secure and efficient.”
Before signing on with e-prescribing, Lanzkron says, her clinic had prescription pick-up days three afternoons a week. “Patients would come through and we’d have to go get the scripts out of the safes,” she says.
The clinic sees patients from all over Maryland and from neighboring states, so some traveled considerable distances for the prescriptions. Then they had to take the piece of paper to their pharmacies and either wait for the request to be filled or come back for it.
Now, Lanzkron says, patients are notified by their pharmacies when the prescriptions are ready. “It eliminates a step in their lives,” she says.
As required by the federal Drug Enforcement Agency, the e-prescribing system relies on a double-authentication approval that prevents misuse, Campbell explains.
The first step for providers is to meet in person with the enrollment supervisor designated by the department, to authorize e-prescribing within Epic. (Providers who don’t know their enrollment supervisor can find out by emailing Campbell at mcampbe5@jhmi.edu.)
The providers then download the free Imprivata ID app to their own smartphones.
Once enrolled, when users prepare to write an e-prescription for a controlled substance, an additional window pops up in Epic. The provider then signs in with their JHED password and a six-digit code that the app sends to their phones, and the prescription goes right to the patient’s pharmacy of record. Campbell notes that about 90 percent of pharmacies in the region allow e-prescriptions.
“It does create some safety around not having a paper prescription with a doctor’s signature out there,” she says.
