The ONC Doctors’ Perspective: Electronic Prescribing of Controlled Substances (EPCS) Is on the Rise, and We Must Work Together to Address Barriers to Use

Andrew Gettinger, M.D. and Thomas A. Mason, M.D. | October 3, 2019

According to new findings, the percent of clinicians who electronically prescribe controlled substances (EPCS) has increased. Despite this increase, overall EPCS rates remain low. The use of EPCS technology can help healthcare providers directly integrate opioid prescription information into electronic health records (EHRs), which can enhance patient safety and help deter diversion and fraud. ECPS technology can also streamline clinician workflow and reduce patient burden.

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, enacted in 2018, requires Medicare Part D prescriptions of opioids and other controlled drugs be prescribed electronically beginning 2021. New data show that use of EPCS technology is on the rise, but varies across clinician characteristics. In 2017, over 80 percent of office-based physicians prescribed controlled substances. Understanding differences in clinicians’ use of EPCS technology is critical to identifying ways to address barriers to use such as costs and security requirements.

The Office of the National Coordinator for Health Information Technology (ONC) took two approaches to measure the current use of EPCS technology among the nation’s clinicians. First, ONC worked with Surescripts, the electronic prescribing network, to identify Medicare Part D prescribers who EPCS on the Surescripts Network in 2015 and 2016. Second, through the 2017 National Electronic Health Record Survey (NEHRS), fielded by the National Center for Health Statistics, we asked office-based physicians if they prescribe controlled substances and, if so, if they do so electronically.

ONC found that three percent of Medicare prescribers used EPCS technology in 2015. This number increased to 11 percent in 2016. NEHRS statistics show that 32 percent of physicians EPCS in 2017. Though the data are not directly comparable, the results from these analyses imply that while EPCS is low, use of the technology is on the rise. However, ONC analyses show variation across multiple characteristics, including provider specialty, technology use, clinical setting, and geography.

For example, on average pain management specialists made almost 1,400 Medicare Part D opioid prescription claims in 2016 with over 20 percent of these specialists transmitting the prescriptions electronically. This was nearly twice the EPCS average among all prescribers. On the other hand, on average, family practitioners made less than 250 opioid claims in 2016, and only 15 percent of these clinicians did so electronically.

EPCS also varies across practice size and practice ownership.  In 2017, 59 percent of physicians in practice groups of 100 or more physicians EPCS. In comparison, 23 percent of physicians in a solo practice EPCS. Physicians who practice in groups owned by a health plan, health maintenance organization, hospital, or other healthcare entity EPCS at higher rates than physicians in a private practice. Furthermore, physicians who participated in a Center for Medicare & Medicaid Services program, such as Accountable Care Organizations or Patient-Centered Medical Homes, were more likely to EPCS than non-participants.

Use of EPCS technology does not vary significantly between rural and urban areas; but it does vary between states. Some of this variation is explained by current state policies. The SUPPORT Act requires that all affected drugs covered by Medicare Part D be electronically prescribed starting in 2021. Some states, like New York, Maine, Minnesota, and Connecticut, have already mandated the use of EPCS technology while others are looking to implement similar plans.

The type of technology used by clinicians, and how it is used, also impacts rates of EPCS. Physicians that use an ONC-certified EHR electronically prescribe at higher rates than those whose EHRs are not certified. Physicians who are able to electronically send, receive, find, and integrate patient health information also electronically prescribe at higher rates. Half of these physicians EPCS, compared to 29 percent of physicians who cannot perform all four interoperability domains – a statistically significant difference.

The value of EPCS technology – streamlined prescriber workflow, improved medication safety, and reduced drug diversion and fraud – should be available to all clinicians.   We are also intrigued by the potential for EPCS technology to make prescriber identification both assured and easier. This can permit a single workflow for prescribing both controlled and non-controlled drugs, which can improve the usability of the current process. To that end, ONC will continue to work with our federal partners and clinical stakeholders to advance the adoption of EPCS technology.

Visit ONC’s data briefs for a complete listing of these and other findings.