Physicians, dentists and other clinicians start exclusively using electronic prescribing systems Sunday as New York begins sweeping paper pads out of day-to-day circulation.
Gov. Andrew M. Cuomo’s office estimates 60,000 prescribers are up and running with certified systems that allow them to generate and transmit prescriptions digitally. New York’s electronic prescribing law is widely considered the most extensive in the nation.
With the move to dedicated digital systems, paper prescriptions should come into play only in the event of a natural disaster or major technological failure, Cuomo said in a statement March 17.
As some last-minute stragglers scrambled earlier this month to meet the e-prescribing deadline, state Health Commissioner Howard Zucker sent letters to certain health care professionals with word of an eleventh-hour reprieve.
Doctors affiliated with nursing homes, compounding pharmacists who make customized medicines, and physicians involved in clinical trials were granted a blanket waiver allowing them to write or dispense medications using paper prescriptions.
Others not required to relinquish their pads include physicians and dentists who have received individual waivers. The state Health Department has not disclosed the number of clinicians receiving those reprieves. Most are older practitioners expected to retire in the next few years.
Several clinicians who have spoken to Newsday on background said converting to electronic prescribing and medical records systems is an expense they can ill afford in the closing years of their careers.
Although phoned, handwritten, faxed and emailed prescriptions are forbidden for a majority of practitioners under the law as of Sunday, practitioners affiliated with nursing homes can continue their customary prescribing methods until next year.
Dr. David Siskind, medical director of Gurwin Jewish Nursing & Rehabilitation Center in Commack, was among those welcoming the reprieve, saying it will give his facility and others like it time to acquire an electronic prescribing system.
“Most nursing homes would not have been ready by the deadline with an electronic system to send these prescriptions,” Siskind said.
Long-term care facilities have until March 27, 2017, to install a certified electronic prescribing system, according to Zucker’s letter.
The New York State Health Facilities Association estimates there are 635 nursing homes and other long-term care facilities statewide. About 37 of those facilities are in Nassau and 42 in Suffolk.
Siskind pointed out that nursing homes generally do not have a staff of on-site physicians around the clock.
Doctors who treat nursing home patients, he said, often work in practices elsewhere. Traditionally, nurses in the care facilities contact physicians when patients need a medication, and doctors fax or phone in a prescription to a pharmacy.
Registered pharmacist Howard Feirman, owner of B&H Compounding Pharmacy in East Meadow, is among another group that can continue working from paper prescriptions until next year. He said current electronic prescribing systems cannot yet accommodate his highly specialized field.
Compounding pharmacists, he explained, make customized medications for individuals based on doctors’ orders, and the medication may require multiple ingredients. That means paper prescriptions are necessary to list a drug’s components.
Zucker’s letter noted that any compounded medication containing two or more ingredients still can be prescribed on a paper form.
Current databases underlying e-prescribing systems do not contain complete ingredient information that compounding pharmacists require, Feirman said.
“When you have a regular drug, it has a specific number,” Feirman said of a categorical listing developed by the National Council for Prescription Drug Programs, an accredited organization that sets pharmacy standards. “With compounded drugs, there are multiple ingredients and they [state health officials] haven’t figured out how to list all of the ingredients in a way that they can track them at this point.”
Waivers for practitioners this year are reminiscent of the reprieve Cuomo granted a year ago, when electronic prescribing was supposed to start for all prescribers. Many doctors, dentists and podiatrists were unprepared as that deadline loomed, so the governor pushed the e-prescribing start date to March 27, 2016.
Electronic prescribing was mandated with the state legislature’s passage four years ago of the law called Internet System for Tracking Over Prescribing — I-STOP for short. Its aim is to stem the flow of legal drugs into illicit markets. One way to do that, lawmakers said, was to sweep as many prescription blanks as possible out of daily circulation.
Two other chief purposes were reducing drug diversion and doctor-shopping, key problems underlying the number of prescription narcotics and addictive psychiatric medications that flourish as street drugs.
Drug diversion — the practice of redirecting legal pharmaceuticals into street sales — had grown exponentially in New York, police sources have said.
Prescription forms had become valuable currency in the explosive opioid drug epidemic that has surged throughout Nassau and Suffolk counties — and beyond, state lawmakers and doctors said. Addictions have spawned violent crimes while causing a dramatic spike in overdose deaths and babies born craving the drugs themselves.
Crime rings stole millions of paper prescription pads and used them to reap tens of thousands of narcotic pills, dispensed directly from pharmacies. The leading drugs sought by dealers and addicts have included hydrocodone, oxycodone and methadone.
As many as 1.4 million prescription blanks were stolen between 2008 and 2011 from New York City hospitals, the state Health Department reported in 2011. Most of those blanks were taken from New York City Health and Hospitals Corp. facilities, an investigation by the Health Department’s Bureau of Narcotic Enforcement found.
Doctor shoppers, meanwhile, went from one physician to another seeking paper prescriptions to feed their addictions.
On Friday, Dr. Joseph Maldonado, president of the Medical Society of the State of New York, said it has been a challenge for many clinicians to adopt electronic prescribing, but a majority have done so.
Practitioners who are using the technology already have helped drive down the number of prescriptions for narcotic painkillers and other highly addictive drugs, he said.
“Inappropriate prescriptions due to doctor shopping are down by 90 percent” since late last year, Maldonado said. “And data shows that prescriptions for the most powerful opioid medications have been declining in New York and are far below most other states in the country.”
Surescripts, the largest e-prescribing enterprise in the country, reported Friday that the number of New York clinicians prescribing through its system increased 28 percent since March 1 as the state moved closer to its digital prescribing deadline.
Maldonado noted that electronic prescribing has drawbacks.
“There are many physicians across New York State who, by the nature of their patient care setting, write very few prescriptions,” he said. “Mandating these physicians to adopt costly and cumbersome technologies that so far have proven to be extremely challenging may cause many longtime physicians to give up patient care altogether.”