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Thursday, 11 July 2013 08:14

The Slow Adoption of Electronic Prescribing in Dentistry Featured

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post 51 picAdoption of electronic prescribing has been extremely slow in dentistry.  I speak from experience because my company incorporated this capability into our practice management software about a year ago and we have been able to sell it to only a handful of clients. 

There is one primary reason for this slowness, the inability to prescribe controlled substances (narcotics).

I read a recent study that claimed that physicians prescribe narcotics about 12% of the time.  A similar study indicated that this percentage is over 40% in dentistry. 

Pain relief is a primary reason for a dentist to reach for their prescription pad and these drugs are often restricted.  Practices just aren’t interested in a feature that will only provide its full value only a little more than half the time.  


So, I’ve been closely watching the progress of e-prescribing narcotics and would like to provide you with an update.

The DEA approved e-prescribing of controlled substances almost two years ago.  This paved the way for software vendors to make the necessary changes in their products to comply with the government regulations. 

Almost all electronic prescriptions flow through a central hub operated by a company called Surescripts.  After DEA approval it was up to Surescripts to update their software to provide the appropriate changes to their prescribing capability. 

This was done in 2012, but Surescripts does not interface directly with practice management software.  This is left to other companies i.e. DrFirst, Dosespot, Emdeon…  These companies have to update their software and get certified with Surescripts.  This is not a simple process because it involves a third party audit to assure the software meets all DEA regulations.  Then these companies work with the practice management system vendors (Henry Schein, Patterson, DMC…) to put the functionality in the dental practice.  

Sounds like a line of falling dominos, but moving at a very slow pace.  These same dominos exists on the other end of the prescription transaction and that’s with the pharmacies.  They have the same string of software vendors, just a different set of companies. 

Add to this the fact that twelve states either prohibit or limit e-prescribing of narcotics.  They are:  Arkansas, Hawaii, Indiana, Maine, Mississippi, Montana, Nebraska, New Jersey, New York, Rhode Island and Utah.  These states will require that their legislatures change their prescribing statutes.  This is not always a speedy process.

I understand and agree with the need to be extremely cautious with this process.  Drug addiction is a major issue in the U.S. and prescription medications are a significant piece of this abuse.  The glacial pace of e-prescribing controlled substances is the result of this caution.  

If all the dominos fall, there are additional issues.  It will be incumbent on the prescriber to:  

  1. Make sure their e-prescribing software is certified with Surescripts.
  2. Get an audit report supplied by their e-prescribing software vendor indicating compliance with all applicable DEA regulations.
  3. Adhere to new ID authentication procedures.

I’ll admit to some confusion about item #3.  They use the term “identity proofing”.  Here’s a link that attempts to define this process. 

I’m searching for a little more specificity that can be applied to the dental office but have not found it, yet.  This should become clearer after the software dominos fall and broader implementation roles out.  Just expect a more involved process to identify yourself and your patient, if you wish to e-prescribe Vicodin.

Slow electronic prescription adoption in dentistry will continue throughout 2013.  Enough of the software certification dominos for controlled substances should have fallen by next year to see an increased use of this important tool. 

I believe that my company, investing in the partial solution (e-prescribing non-narcotics) over a year ago, was not a wrong click, just a right click that was a couple of years ahead of its time.


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