The clinician’s prescription pad, rivaled only by the stethoscope as a time-honored symbol of health care, officially becomes a relic of a bygone era next month when mandatory electronic prescribing takes effect statewide.
Leaders in the medical and dental communities say all systems are go for a March 27 start date. Pharmacies won’t accept paper scripts any longer, nor will they honor faxes. Emailing doesn’t constitute e-prescribing, experts say, which is conducted only through secure, dedicated systems.
New York is the first state to mandate electronic prescribing for all medications, not just narcotics, such as opioid-class painkillers. State lawmakers voted e-prescribing into law four years ago and initially set a March 27, 2015, deadline, which was extended because too many clinicians had not yet begun digital prescribing.
Underlying the law is the need to blunt the flow of legal medications into illicit channels. Stolen prescription pads have played prominently in funneling narcotic medicines and certain psychiatric drugs into thriving black markets. A single pad with only 50 blanks could net as much as $150,000 in prescription-drug street sales, police sources say.
Now, the pads will soon hold little value for pushers, but leaders in the medical community say clinicians must get onboard with e-prescribing — and meet the deadline.
“There will be no more extensions and no excuses,” said Dr. Joseph Maldonado, president of the Medical Society of the State of New York.
Despite the pioneering status of the state’s e-prescribing law, practitioners have stumbled toward the start date. And even now, some still prefer their pads, bemoaning the death of paper prescriptions. “I have heard that there are still physicians who are not fully on board,” Maldonado said. “We are trying to get the word out.”
Last year, Gov. Andrew M. Cuomo announced an eleventh-hour reprieve that gave prescribers a year to introduce electronic prescribing systems in their practices.
A flurry of logistical issues had conspired against a mass move into digital prescribing in 2015, doctors and other experts said.
Several vendors’ systems were not yet certified for prescribing controlled substances and a substantial number of clinicians had not yet installed a system. Those problems — among others — drove calls for more time.
But paper prescription pads are now the exception, not the rule, Maldonado said, noting there are still a few instances when paper can come into play. Prescriptions that are to be dispensed out of state, he said, can be written on paper and veterinarians can still handwrite scripts for pets.
In Great Neck, Dr. Eric Gould, a pediatrician, said he isn’t eager about the prospects of electronic prescribing but acknowledges that he isn’t fond of his handwriting, either, which he describes as less than elegant. He and his colleagues are scrambling to meet the deadline.
“We’re just starting it,” Gould said last week of electronic prescribing. “We’ve done it a little bit. Eventually we’ll get used to doing it. I understand the reason for it, and of course, that’s the way it’s going to be.”
Even though paper prescription pads were targeted for extinction by state legislators in 2012, criminals on Long Island and elsewhere in the greater metropolitan area still saw them as valuable as cash.
In September, Cedric Moss was sentenced to 15 years in federal prison for his role as mastermind in a prescription drug ring that helped fuel Long Island’s growing addiction crisis. Moss relied on stolen prescription pads to obtain scores of narcotic pills direct from legitimate pharmacies.
New York’s mandatory electronic prescribing is part of a larger measure known as I-STOP, or Internet System for Tracking Over-Prescribing Act, which was passed by the State Legislature in 2012.
Among that law’s chief aims is reducing drug diversion and doctor shopping, two key problems underlying the number of prescription narcotics and addictive psych drugs, such as Adderall, that flourish as street drugs.
Drug diversion — the black market practice of redirecting pharmaceuticals into illicit channels — has grown exponentially in New York — and so had problematic doctor shopping.
The shoppers obtain multiple paper prescriptions for otherwise legal medications from a variety of doctors. Both Nassau and Suffolk county police report doctor shopping as a common practice among addicts and drug suppliers.
Ken Whittemore, a pharmacist and senior vice president with Surescripts in Arlington, Virginia, the nation’s largest e-prescribing enterprise, said New York’s crackdown is a model for other states considering a widespread reduction in paper prescriptions.
Even though all states as of September require prescriptions for controlled substances be written electronically, only Minnesota has a law requiring that prescriptions for any pharmaceutical-grade medication move from provider to pharmacy through secure, digital systems.
Minnesota’s law, however, comes nowhere near the strength of the New York measure, Whittemore said, because New York imposes penalties against clinicians who are not onboard with e-prescribing.
“We have heard that other states are watching very closely the mandate that New York has adopted,” Whittemore said.
State health officials estimate that 300 million to 350 million prescriptions are filled annually in New York based on orders by physicians, podiatrists, dentists and nurse practitioners, the professionals affected by the state’s e-prescribing law.
Many Long Island doctors and dental health specialists in private practice say they made the move to digital prescribing years ago.
Dr. Michele Reed, co-director of a family medicine practice with offices in Garden City and Rosedale, Queens, said her patients have become accustomed to the warp speed pace of e-prescribing.
“Our patients get upset if we write a [paper] prescription for them,” Reed said, “because they are used to the convenience of having the prescription ready by the time they reach the pharmacy.
“We have been prescribing electronically since 2008,” she added. “We also have electronic medical records, the whole system.”
Features of electronic systems help clinicians track medications and observe precisely when the prescription has been filled, Reed and other clinicians say.
Consumers, nevertheless, have complained, Maldonado added, noting that e-prescribing lessens their ability to take a prescription from one pharmacy to another in search of the best price.
But Whittemore said consumers can make calls before a prescription is electronically written and have the prescriber dispatch it to a preferred pharmacy. “There are rules in all states with language stating that a patient’s choice of pharmacy has to be respected. That’s their right to choose,” he said.
Few providers on Long Island are waxing nostalgic about the impending death of paper prescriptions. Many are asking how they ever got along without the electronic version.
“We are definitely onboard for that deadline,” said Dr. Valerie Goldburt, a Setauket dermatologist whose practice also has offices in Manhattan.
Goldburt said she and her colleagues — 27 other medical doctors and five physician’s assistants — have been e-prescribing for years.
“It definitely reduces medical errors and can reduce the misuse of paper prescriptions,” Goldburt said.
Prescribers who got rid of paper prescriptions years ago also say the day-to-day work flow in a busy practice runs smoother without the paper pads.
“It’s so much easier electronically,” said Dr. Ashish Sahasra, a Garden City endodontist who said his practice was up and running with an electronic system in time to meet the first deadline last year.
The prescribing system used by his office allows him to write prescriptions remotely from his mobile phone and electronic tablet. Sahasra, like other health care providers, is also impressed with e-prescribing’s speed.
He underscored that electronic prescriptions eliminate the introduction of handwriting errors into the prescribing process.
Illegible handwriting can result in the wrong dosage, or worse, the wrong medication altogether. Patients have died as a result of handwriting errors, court documents dating back decades have shown.
In 2000, aware of patients dying as a result of handwriting errors, the Institute for Safe Medication Practices in suburban Philadelphia had called for a nationwide end to paper prescriptions by 2003.
Yet, 13 years later 48 states have yet to adopt e-prescribing for all medications.
“This is the wave of the future,” Sahasra said. “It is difficult to think of prescribing any other way.”