Implementing Electronic Prescription of Controlled Substances at a Tertiary Care Pediatric Hospital : Unanticipated Effects and Provider Perceptions

BACKGROUND AND OBJECTIVES There has been slow adoption of electronic prescribing of controlled substances (EPCS) due to cost concerns and cumbersome technological and security specifications required by the DEA. The objective of this study was to assess the effects of an EPCS implementation at a tertiary care pediatric hospital on prescribing patterns and providers' perceptions of this functionality pre and post implementation. METHODS The prescribing patterns of both the pilot group and the institution as a whole were analyzed before and after implementation. A survey was distributed to a multispecialty provider pilot group identified by a high baseline prescribing level of controlled substances (CS). A follow-up survey was then re-distributed eight months after this functionality went live to the pilot group (n=21) and institution as a whole (n=140). RESULTS The initial adoption of e-prescribing in 2010 was slow and peaked around 73% just prior to enabling EPCS in June 2017. EPCS had a strong effect on our institution's overall e-prescribing rate (91% as of April 2017), not just that of controlled substances. Over a near six month period, we noted 41,475 CS prescriptions that were e-prescribed. Of those CS prescriptions sent by EPCS-eligible providers, 86.3% were sent electronically. The top three specialties utilizing EPCS were psychiatry, primary care, and behavioral development pediatrics. This corresponds to our most frequently prescribed controlled substances: stimulants, opioids, and anti-epileptics. In regards to our pilot group's initial perceptions, over half (12/21) agreed that they thought EPCS would decrease the initial CS amount dispensed, which translated to 41% (7/17) reporting this actually happened within the pilot group and 25% (35/140) from those who completed the survey institutionally. Over half of the pilot group (12/21) also reported having a patient require an additional healthcare visit for the sole reason of obtaining a CS prescription that most thought could be avoided with EPCS (11/12). After implementation, most (14/17) reported avoiding additional healthcare visits for the reason of obtaining these prescriptions. Hospital-wide, 73% (102/140) reported the avoidance of an additional healthcare visit due to access to this functionality. Medication compliance was thought to be improved in 48% (68/140) and 84% (118/140) perceived improved patient satisfaction due to reducing delays in care. Improved workflow efficiency was report