Enabling Electronic Prescribing for Controlled Medications: Perspectives of Physicians and Other Prescribers

Background: The government is developing regulations to allow for the first time electronic transmission of prescriptions for controlled substances (CS). However, adoption of electronic prescribing of CS requires that prescribers accept accompanying security measures such as electronic authentication of each prescription. Objective: Document prescribing patterns around controlled substances and prescription-related incidents; use of e-prescribing functionalities for non-controlled medications; and attitudes/expectations for the impact of e-prescribing of CS on office practice, patient safety, and public health. Methods: 246 prescribers affiliated with Berkshire Health System were surveyed in 2009 (64% response rate) to provide a baseline for assessing the impact of electonic precribing of CS, in terms of practice patterns and incidents. Multivariate analysis predicts indicators of likely adoption of electronic prescribing of CS. These data will be used to estimate its impact on national adoption rates when regulations are in place. Results: 43.1% of respondents currently use e-prescribing for non-controlled substances, with CS an average of 25.1% of prescriptions. The following occurred at least once during the past six months: written prescription lost (59.4%); incorrect medication prescribed (35.1%); medication interactions unknown at the time of prescribing (35.8%); incorrect dose was dispensed (22%). 25.3% of respondents expect e-prescribing to initially be disruptive to practice, and 65% expect it to improve quality; 44.9% said being required to use a signature authenticating token (a security measure) would be a large inconvenience; 25.8% reported the advantages of this requirement did not outweigh the burden. Factors associated with acceptance of electronic prescribing of CS and security measures were: experience with e-prescribing, greater use of computers for communicating with colleagues, and more interaction with colleagues outside the practice. Discussion: Prescribers expect electronic prescribing to decrease errors and diversion associated with controlled substances, but are concerned about the burden associated with safety features, which may slow adoption.