ATLANTA -- Dr. David Hunt, the Office of the National Coordinator's chief medical officer, told a crowd of physicians here yesterday that as a practicing surgeon he does not use electronic prescribing.
The reason, he said at the Healthcare Information and Management Systems Society annual conference, is to avoid the impractical " and potentially unsafe " consequences of working around a federal ban on the e-prescribing of controlled substances.
The ban, imposed by the Justice Department, has had the effect of suppressing e-prescribing, widely considered a prime example of meaningful use and a potentially heavy driver of health IT adoption.
In complying with it, providers have been forced to create two workflows: one for e-prescribing conventional substances and a separate, paper-based, system for prescribing the controlled drugs.
For many, it has been simpler to maintain a manual system for all their pharmacy orders.
Hunt made his remarks in response to a physician in the audience who appealed to him for help.
"As a surgeon like you," the audience member said, "almost 50 percent of the prescriptions I write are for controlled substances " the others are antibiotics. The bottom line is that this will not work having two different workflows. We need your help."
Hunt responded that he faces the same problem in his surgery practice.
"As a surgeon I may or may not help you, but I'm going to leave a scar," he told the audience. "Everything that I do at least every one of my patients receives some form of analgesics " and typically narcotic analgesics."
"I don't have two workflows. It doesn't make any sense," Hunt said. "And that's a system that you know will break down in terms of safety and efficiency."
The Office of Management and Budget is now evaluating a two-year old proposal by the Justice Department for a tougher security protocol to facilitate controlled substance e-prescribing.
The plan calls for a multi-factor system that might include a password in addition to a key-card or other form of security.
Hunt said he understood the system might be a "workable solution" and that he would test the scheme in his practice if it was approved.
"Once it gets into place I have already committed that I would begin electronic prescribing," Hunt said.
"But I guarantee that if it doesn't work I'm gong to throw it out."
David Roberts, vice president of government relations at HIMSS, said the issue has implications for the success of the administration's plan to incentivize physicians to take up health IT.
"Once ARRA goes into effect and e-prescribing becomes one of the key components of getting the incentives, do people want to have two systems -- one for non-controlled and one for controlled substances?"
"That's a big issue," he said.
