For long term, post-acute care providers (LTPACs) working to enhance care delivery, the medication prescription process stands out as an area of opportunity and potential improvement.

LTPACs have historically relied on manual ordering methods for prescriptions, which are often cumbersome, inefficient, and sometimes inaccurate. While hospitals and physician practices have embraced electronic prescribing (e-prescribing) to promote greater reliability and safety, LTPACs have struggled to adopt technology, due, in large part, to a lack of financial incentives to onboard costly systems.
All this is changing, however, with the advent of new rules and regulations that require organizations, including LTPACs, to engage in e-prescribing.

New York state is embracing the transition toward automation head on, creating both an electronic repository for controlled substance prescription data and an e-prescribing mandate that demands that all organizations migrate to automated medication ordering.

New York State’s i-STOP Program

As a first step toward e-prescribing, New York created the i-STOP program for controlled substances. A main component of the initiative is a robust data repository that houses six months of information on all controlled substances dispensed in the state.

Effective since Aug. 27, 2013, New York pharmacies and other dispensing organizations must report controlled substance data to the repository. Prescribers are required to consult the program’s registry when writing orders for Schedule II, III, and IV controlled substances.

The advantage of the i-STOP program is that it gives practitioners direct, secure access to controlled substance prescription histories for their patients, which prevents overprescribing and allows providers to ascertain whether there is potential for abuse or nonmedicinal use.

Using i-STOP as a jumping off point, New York then created the e-prescribing mandate, which goes into effect as of March 2016—after New York legislators delayed the initiative a year to ensure smoother implementation.

The mandate takes i-STOP a step further, requiring all entities to e-prescribe both controlled and noncontrolled substances, whether prescriptions are internally or externally filled, during a patient’s care or after discharge.

To comply with this mandate, all prescribers will have to switch from paper-based processes to e-prescribing technology supporting controlled substances, noncontrolled substances, and discharge scripts for both.

The ruling also requires greater physician involvement in prescribing, demanding the prescriber submit an order directly, instead of delegating the work to a nurse or a physician’s assistant (PA). While a nurse or PA can still start the prescription process, the physician must personally review, edit, and approve the order before submitting it to the pharmacy. This distinction represents a substantial process change for many long term care organizations that have historically relied on nurses and PAs to handle the logistics involved with medication orders.

To be in compliance with the mandate, New York’s LTPACs will need to revisit their workflows and change their approach to generating prescriptions.

Implications For Other States’ Providers

Although New York is currently the only state with an e-prescribing mandate on the books, many other states are closely monitoring its progress. Florida, for example, has a program similar to i-STOP.

Given the current trajectory, it is understandable why other states are actively tracking the implementation of the mandate in New York and examining the global benefits of early e-prescribing preparations, including:
  • Effective reduction of rehospitalizations. By digitally routing discharge scripts to pharmacies and reconciling orders, e-prescribing technologies can ensure continuity of critical medications and improve overall care transitions by mitigating transcription errors and reducing breakdowns in communication.
  • Improved operational efficiencies. Automating the historically cumbersome transcription process allows for more top-of-license roles for staff, which in turn yields increased bedside time and improved patient experience and outcomes.
  • Increased preparation time for ICD-10 onboarding. With ICD-10 finalized (as of Oct. 1), early adoption of e-prescribing processes allows for improved medication management and resident safety, facilitating a more seamless transition to ICD-10 compliance when the time comes.

No Time Like The Present

While the aforementioned preparatory benefits are persuasive, the road to seamless e-prescribing implementation can be long. LTPACs should therefore not put off preparing for these efforts. Although e-prescribing is not yet mandated, organizations looking to be successful in the long term should adopt proactive strategies for implementing technology to ensure they are reaping the full benefits of e-prescribing.

Three specific reasons why organizations should get started right away include:
  • Compliance requires a complete workflow evaluation. For many LTPACs, e-prescribing will demand a whole new approach to medication ordering. As such, organizations must thoroughly assess current workflows and determine how they might change. This will involve pulling together a group of key stakeholders and walking through the various processes.
The group will then need to figure out how onboarding technology will alter existing policies and procedures and prepare to lay the groundwork for change. Organizations should not rush this exercise, as getting the workflows right is a foundational step in transitioning to automation.

  • Garnering physician support takes time. As mentioned before, physicians will play a role in prescribing that is different and more comprehensive than traditional processes have been in the past. Organizations therefore need to educate physicians on their responsibilities and gain buy-in. This may involve identifying a champion to guide the effort and/or bringing physicians into the workflow design process to ensure everyone is comfortable with the new normal.
Again, organizations should allow plenty of time for this transition, as rushing it can lead to frustration, lack of support, and even retention issues.

  • IT vendors may have limited bandwidth. While many New York state health care providers currently e-prescribe noncontrolled substances, most do not use technology for controlled substances.
This is because vendors must be certified to offer controlled substance e-prescribing. It is going to take vendors some time to obtain the necessary certification and get all their clients up to speed prior to compliance deadlines.

LTPACs shouldn’t delay implementing e-prescribing because as deadlines loom, vendors will likely become inundated and be unable to accommodate last-minute implementations.

Taking A Proactive Step Forward

Although e-prescribing is likely not top-of-mind within many LTPACs, the profession will experience this paradigm shift in procedure sooner than later. Those who delay will be at risk, both in regards to compliance and overall patient outcomes.

By allowing sufficient adoption time and taking a concerted approach to technological implementation, organizations can ensure they are in compliance while also keeping their residents safe and their employees satisfied.

Steve Pacicco is chief executive officer at SigmaCare. He can be reached at or (212) 268-4242.