EPCS solves the complex problem of prescribing, monitoring and use of potentially dangerous and frequently abused drugs.

Dr. Holly is a graduate of the University of Texas Medical School in San Antonio, where he is an Adjunct Professor of Family and Community Medicine. He is also an Associate Clinical Professor in the Department of Internal Medicine at Texas A&M College of Medicine.  In 2012, he was named a Distinguished Alumnus of the University. Dr. Holly was named the HIMSS’ Physician IT Leadership Award recipient for 2012. Dr Holly writes and lectures extensively on health policy, informatics and healthcare transformation.

Southeast Texas Medical Associates (SETMA, www.setma.com)
In 1998, Dr. Holly led SETMA to adopt electronic medical records. SETMA has become a leader in healthcare informatics winning many awards including the HIMSS Davies award and Stories of Success Level I, and the eHI Innovator of the Year in 2012. SETMA is an NCQA Tier III Patient-Centered Medical Home (2010-2016), is accredited by AAAHC as a medical home (2010-2017), URAC (2014-2017) and The Joint Commission (2014-2017).  AHRQ published SETMA’s LESS Initiative on their Innovation Exchange. Starting in 2009, SETMA has publicly reported by provider name on over 300 quality metrics at www.setma.com/public-reporting.

Challenges and Solutions
All SETMA physicians and nurse practitioners prescribe controlled substances electronically (ePCS).  This is a major step in the safe and effective use of controlled substances and places SETMA in the company of only 4% of healthcare providers nationally who are currently using this function.

The “conundrum” in the prescribing of controlled substances is created by the tension which exists between

  • patients who need pain medications and other medications which are subject to abuse,
  • providers who want to properly treat patients with these medications,
  • an increasing abuse of pain medications
  • increasing demands by the Texas Medical Board upon physicians who prescribe these medications.  

SETMA’s e-prescribing of controlled substances decreases the potential for abuse of pain medications and other potentially abused medications by:

  • Eliminating the ability for duplication of prescriptions, refills and or number of pills prescribed for controlled substances,
  • Creating an electronic record of all e-prescribed controlled substances,
  • Requiring a provider-specific, unique six-digit number which changes every thirty-seconds for ePCS,
  • Eliminating the ability for anyone but the prescribing physician from creating the e-prescription by requiring:
    • ​A HIPPA compliant, secure, access-controlled electronic device for producing the 6-digit code which changes every thirty seconds.  This device has a 12 digit access code which is specific to the provider and which is hard-wired into the electronic device which produces the six-digit security codes.
    • ​Two-factor authentication for access to EMR for ePCS, which is first the physician’s personal, secure password for accessing the EMR for prescribing the controlled substances and
    • ​The provider to have in their personal possession their smart card which is the second factor authentication for accessing SETMA’s EMR which is the platform ePCS.

Next Steps
Making e-prescribing of controlled substances (EPCS) legal nationwide, while a critical step, is only one part of solving the problem of controlled substance abuse. The next step is for physicians in every state to use the technology.