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ACEP Now: Vol 35 – No 09 – September 2016(click for larger image)
Figure 1. Each red mark represents the address of a different pharmacy in New York City.
PHOTO: NAYAN PATEL, MD
Many emergency physicians may be aware that electronic prescribing, where a prescription is sent via the Internet directly to a designated pharmacy, is an alternative to the traditional hard-copy prescriptions used in one form or another by almost all emergency departments. What may come as a surprise, however, is that mandatory electronic prescribing for all patients, including ED patients, is now the law in the state of New York and may well be adopted in other jurisdictions.
As of March 27, 2016, emergency physicians in New York are required to use only electronic prescriptions; paper, fax, and telephone prescriptions are all banned, with both civil penalties and imprisonment specified for noncompliance. Although the law apparently isn’t being enforced yet, it’s evident that the many pernicious effects, on emergency patients in particular, have received little consideration.
A Prescription for Confusion
Many ED patients may not know the specific pharmacy where they will get their prescription filled. For example, there are 140 pharmacies with the Duane Reade brand alone in Manhattan (which is just one of five boroughs in New York City) and another 47 with the CVS name. As Figure 1 indicates, there are multiple branches of each chain, often in proximity to one another—there are 24 Duane Reade pharmacies on Broadway alone! Moreover, there are 80 Duane Reade pharmacies on a street or avenue with at least one other pharmacy of the same chain. In all, there are a total of 33.6 pharmacies of all types for each square mile of Manhattan.
It’s estimated that there are 1.63 million nonresidents in Manhattan every day, including 848,000 visiting vacationers, day-trippers, and students from other countries and states. More than 500 languages are spoken in the city; the potential for confusion with our patients is evident.
Remarkably, the law doesn’t allow for the electronic prescription to be filled by any pharmacy except the geographic entity to which it was originally sent. For example, the CVS nearest Mount Sinai Beth Israel on First Avenue and 15th Street couldn’t send a patient to the Duane Reade right next door or even reroute a patient or prescription to another CVS a few blocks away. If the particular pharmacy is closed, doesn’t stock the formulation, or is simply out of the precise medicine prescribed, the only alternative for the patient is to return to the emergency department for another prescription.
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7 Responses to “Mandatory Electronic Prescribing Inconvenient, Confusing for Emergency Department Patients”
October 6, 2016
ED providerThis article clearly and accurately outlines the frustrations that ED providers face in everyday practice as a result of this mandate. E-prescribe is meant for office use and not designed for an acute setting. The questionis : What is ACEP doing to open a dialogue with legislators to educate them on the dissonance of their intended e-prescription use and everyday ED practice, and to hopefully change this requirement for EM providers?
October 9, 2016
NYC Emergency PhysicianE-prescribing makes sense and offers many benefits to patients, prescribers, regulators, insurers, and others. The issue is really about how the system has been implemented (very misguidedly). The current system (as noted) requires the patient to identify a specific pharmacy to which the prescriber directs the prescription.
Given modern cloud technology, submitting a prescription to a central server and having the patient go to any pharmacy that can then retrieve the prescription, would satisfy the majority of the concerns that we have as ED prescribers.
October 9, 2016
Marcia Pehr, DOmisguided health care policy is right. I work in Urgent care now, and occasionally cover a few doctors offices, and it is just as bad there.Bean-counters mandating something that they feel needs to be forced on the people who actually use it usually means it isn’t really such a good idea. By all means put the thing out there and encourage it, but leave the options open to use judgement when another method would be more efficient and appropriate. Trust me, if the technology really is better, it will be adopted- nobody had to force people to use cell phones.Also, on the subject of cost effective medicine, we previously got our official NYS prescriptions printed up and sent to us for free. Now we are required to get the software from one of a number of outside vendors who charge both for a license to use the software and a monthly or yearly use fee for every prescriber at every practice location. Why if electronic prescriptions are such a good idea doesn’t the state of NY come up with a single unified statewide software program to be issued to every prescriber and pharmacy?
October 10, 2016
Stephen GrantIt’s really quite simple. No one in a government position-regulatory or legislative-could possibly make a better decision on a consistent basis for the patient than I can as a caring an educated physician..who actually has interviewed and examined the patient…can’t be done…not possible!
October 10, 2016
SteveI work in Philadelphia and I have the similar concerns. I work the evening shift and quite often patients are uncertain as to where they will be filling a prescription the next day. These patients usually ask for a paper prescription and this remains an option for us.
Some of our patients are not able to name the street address of their desired pharmacy or they will give a street corner that is several blocks away or a vague description such as, “the one over there” while they point toward the wall. Time is wasted searching the web to determine the facility to which the prescription should be sent.
Our EHR (Allscripts Sunrise Clinical Manager) will not allow us to e-prescribe certain non-controlled medications, steroid tapers in particular.
This is a very frustrating situation that was enacted as a blanket cure-all without concern for local impediments.
October 10, 2016
AlanWhat about the general inconvenience of not being able to call in a prescription for a family member or a friend in need. I am not talking about a controlled substance either just a basic script. The sovereignty of physicians’ autonomy is slowing being regulated away by legislators. I really hope that NY ACEP in particular is listening and working on having some dialogue with the powers that be…
October 12, 2016
ED ProviderNYC Emergency Physician’s idea above is actually a good solution. Only if the legislators are reading this thread. ACEP needs to make this a top priority before this spreads to more states, as it eventually will.