New York's attempt to become the first state to penalize physicians who don't use e-prescription software has been pushed back a year and an old healthcare IT villain is being blamed—software that has yet to be certified for provider use.
New York's difficulties could serve as a cautionary tale to other states considering similar legislation. California, Missouri and Vermont have explored similar mandates. Minnesota passed an e-prescription mandate in 2011, but the bill in New York is the first to include jail or monetary penalties for violating the requirements.
The issue of software certification surfaces repeatedly in national discussions about federal meaningful-use requirements for electronic health-record software.
In New York, doctors weren't ready because many of them use EHR software that hasn't yet been certified by the Drug Enforcement Administration, said Dr. Andrew Kleinman, president of the Medical Society of the State of New York.
A spokeswoman for the Electronic Health Record Association, a vendor group, defended vendors, however. Many EHR vendors offer software that is ready for controlled substance e-prescribing, she said, but development is complicated because of the regulatory certification process and the necessary safeguards that must be put in place by physicians.
Gov. Andrew Cuomo signed a bill last week that postponed the previously set March 27 e-prescribing deadline to 2016, three years after the initial law was passed. The New York law includes prescribing for controlled substances, explaining the need for the DEA to certify software.
“The majority of physicians and prescribers do e-prescribing, but the requirements that the DEA has made for controlled substances are pretty significant,” said Ken Whittemore, senior vice president of professional and regulatory affairs for SureScripts, a network that acts as an intermediary between physicians and pharmacists.
The state medical society and some EHR vendors called for the delay. The medical society is educating its members, but hasn't taken a political position on the mandate, which could lead to similar legislation in other states.
“There are certainly a lot of people across the country who want this,” Kleinman said. “In all of the negotiations for the delay, basically everyone, (including) the senate and the assembly and the governor, made it clear that it's just a delay.”
Making the move to e-prescribing could be expensive for a doctor who is about to retire, said William Rosenblatt, president of the Independent Doctors of New York, an organization of private practice physicians who don't accept insurance plans.
“It's another unfunded mandate,” Rosenblatt said. “It's going to end up costing you money and you have no choice in the matter.”
Some patients just prefer to have a paper prescription, said Rosenblatt, a former president of the state medical society. Today's prescription pads are so tamper-proof that the state has little justification for using the technology to help avoid fraud, he argued.
The mandate doesn't require that pharmacists be able to receive e-prescriptions, but nearly all of the state's pharmacists can. All but 20 ambulatory pharmacists were ready to receive e-prescriptions as of the March 27 deadline, said Tracy Russell, executive director of the Pharmacists Society of the State of New York.
The software physicians use required more updating and certification than that of pharmacists, but “that's no excuse for the providers to have waited to the last minute to get their software in order,” Russell chided.
“Pharmacies had to update and transfer their software as well, but they were ready,” Russell said. “They've been incrementally more ready in the past few years.”
Even though pharmacists were prepared, their organization supported the delay because it was concerned that pharmacists would be at the receiving end of most problems if physicians' software was not yet in working order when the law went into effect.
“If there is confusion on the patient's part, the individual that will have to deal with that confusion will be the pharmacist,” Russell said. “We supported the delay because we foresaw that our members in the pharmacies would be catching the brunt of the problems.”
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