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E-scrips seen as a way to combat opioid abuse

The health care network that includes Cambridge Hospital plans to stop issuing paper prescriptions for addictive painkillers, an effort to combat opioid drug abuse, which killed more than 1,200 people in Massachusetts last year.

Cambridge Health Alliance will be among the first big hospital operators in the state to roll out new technology that allows doctors to electronically send prescriptions for controlled substances directly to pharmacies. Hospital officials say next month’s small but important software upgrade will improve monitoring of prescriptions and reduce fraud and counterfeiting.

Paper prescriptions, even when printed on tamper-proof material, can be copied and misused.

“It’s a major focus of ours, making sure we have a safe community and we’re not providing medications that end up on the streets and end up being abused,” said Dr. Brian Herrick, chief medical information officer of Cambridge Health Alliance, which also runs Somerville Hospital and Whidden Hospital in Everett.

Doctors already prescribe most drugs electronically, but federal regulations prevented them from doing the same with controlled substances such as OxyContin and Vicodin until 2010. The federal rules require providers to produce two forms of identification before ordering such a medication electronically — for example, a password and number code.


That so-called two-factor authentication requires a software upgrade that hospitals and doctors have been slow to adopt, given all the other technology upgrades they’ve been juggling, said Paul Uhrig, chief administrative and legal officer at Surescripts, an Arlington, Va., company that tracks electronic prescriptions. “This is another set of changes they needed to make to their software.”

About 67 percent of prescriptions nationally are ordered electronically, according to Surescripts. The rate for controlled substances is less than 1 percent. “We’re beginning to see that increase,” Uhrig said.

Uhrig and others say eliminating the paper trail for painkiller prescriptions is especially important given the nation’s severe ongoing opioid epidemic.


In Massachusetts, 1,256 people died from overdosing on prescription painkillers or heroin last year, according to state figures. That was 57 percent more deaths than in 2012.

State officials, public safety agencies, and health care organizations have been developing strategies to curb the opioid crisis, from improving the monitoring of prescriptions to expanding treatment services for addicts.

Addiction can start with pills legally prescribed to help patients cope with pain, such as after a surgery. Once people get addicted, many turn to heroin, which is cheaper.

To cut the paper out of opioid prescriptions, Cambridge Health Alliance will use software developed by Imprivata Inc., a Lexington health care technology company. The software tackles the earliest phase of the opioid crisis, said Dr. Sean Kelly, Imprivata’s chief medical officer, and an emergency physician at Beth Israel Deaconess Medical Center.

‘To my mind, one obvious piece that we’re missing is really getting at this problem upstream,” Kelly said. “Once those medicines get out there and get in someone else’s medicine cabinet and get passed around, then it’s a whole world of hurt and cost and death.”

Electronic prescriptions are “much cleaner and more transparent” than paper scrip, Kelly added, and they make it easier for hospital administrators to track prescription patterns and detect if any one clinician seems to be prescribing too many pills.

Imprivata’s technology will allow Cambridge Health Alliance doctors to order opioids by entering a password, then typing a temporary code that is sent to their cellphones. The hospital is also testing a hands-free feature that will relay the code through bluetooth technology, so that doctors don’t have to type the second passcode.


Cambridge Health Alliance will implement the technology over the next several months as it registers nearly 700 doctors, nurse practitioners, and other providers to participate. The software upgrade will cost about $100,000 to roll out, said Arthur F. Ream III,, director of the hospital’s IT applications.

Besides the potential to reduce fraud, the technology may also save patients a trip to the doctor to pick up a prescription for a refill. Instead, patients could go directly to their pharmacies, Ream noted.

Dr. Christopher Chiodo, an orthopedic surgeon at Brigham and Women’s Hospital, which still prescribes opioids on paper, agreed that e-prescribing could reduce forgery and improve prescription monitoring. But he added that the technology’s convenience could potentially make it too easy for patients to get prescriptions.

“Opioid addiction is complex,” said Chiodo, Brigham’s chief of foot and ankle surgery. “The original prescription is just one part of the equation. Anything we can do to tackle this epidemic would be helpful.”

Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.