Physicians in the state of New York say they're mostly ready to begin prescribing drugs solely through electronic methods this week after being given an extra year to prepare. They'll be the first in the nation to face penalties if they fail to do so.
Enforcement will likely be tame in the beginning as long as physicians can show they're trying to comply, said Dr. Joseph Maldonado Jr., president of the Medical Society of the State of New York.
Maldonado said the extra year has helped, though some providers have been granted waivers.
Dr. Howard Zucker, the state's health commissioner, recently announced 12 circumstances (PDF) in which a provider would be exempt from the mandate. Those include prescribing products with complex directions or compounded drugs, which would be difficult to enter into an electronic system.
Zucker also acknowledged that e-prescribing isn't ideal for non-patient specific prescriptions and that nursing homes likely won't be ready for the mandate, for economic and technological reasons.
The health department will reevaluate next March whether software has improved to resolve the circumstances under which exemptions have been granted, and whether nursing homes are better prepared to comply with the law, according to the announcement.
The e-prescribing mandate is going into effect nearly four years after the law originally passed. Gov. Andrew Cuomo signed a bill last March extending the effective date by a year, after providers said they wouldn't be able to comply.
A December survey of 900 providers (PDF) conducted by the Medical Society of the State of New York and e-prescribing software developer DrFirst, showed 44% were not ready for the mandate. Thirty-seven percent of those doctors said their electronic medical record wasn't yet configured for full e-prescribing; 28% said they don't write many scripts; and 14% said they “resent the mandate.”
While statistics from the Office of National Coordinator for Health Information Technology show that 75% of providers are e-prescribing through an electronic health-record system (PDF), the challenge is whether they can prescribe controlled substances, which are much more heavily regulated by the Drug Enforcement Administration.
Last year, physicians blamed their software vendors for not being ready, even though surveys taken last January showed 80% of ambulatory EHRs and 85% of acute EHRs in New York state were prepared to e-prescribe controlled substances, said Stu Ballatt, vice president of marketing at DrFirst.
E-prescribing technology is now available from “well over 90%” of vendors, Ballatt estimated.
DrFirst powers the e-prescribing component in 330 EHR products and also provides standalone software that providers can use solely for e-prescribing. In some cases, the company has been called in to prepare providers for the mandate when it became clear their EHR wouldn't be ready in time.
Maldonado said the waivers will help those still having trouble.
However, “at this time we have not called for (further) delay, but we have made efforts to try to tweak the law in areas that are problematic for physicians,” he added.
The Medical Society of the State of New York is currently pushing for an exemption for physicians who write fewer than 20 prescriptions a year, Maldonado said, and hopes to secure that change by the end of the legislative session in June. “They shouldn't be subject (to the law), because it can be a financial burden,” he said. The penalty amounts have not yet been disclosed.
Minnesota passed an e-prescription mandate in 2011, though it lacks penalties for noncompliance. California, Missouri and Vermont continue to entertain similar legislation, and legislative discussions are also going on in Massachusetts, Texas and Ohio, Ballatt said. “It would be a lot easier for other states if they choose to (pass a mandate), because the EHRs and the pharmacy system software are much closer to ready now,” he said.
