J Am Med Inform Assoc 19:375-381 doi:10.1136/amiajnl-2011-000209
  • Research and applications
  • Focus on health information technology, electronic health records and their financial impact

Prescribers' expectations and barriers to electronic prescribing of controlled substances

  1. Grant M Carrow3
  1. 1Brandeis University Schneider Institutes for Health Policy, Brandeis University, Waltham, Massachusetts, USA
  2. 2Berkshire Health Systems, Pittsfield, Massachusetts, USA
  3. 3Massachusetts Department of Public Health, Boston, Massachusetts, USA
  4. 4McKesson Provider Technologies, Charlotte, North Carolina, USA
  5. 5DrFirst, Inc., Rockville, Maryland, USA
  1. Correspondence to Professor Cindy Parks Thomas, Brandeis University, Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, 415 South Street, MS035, Waltham, MA 02454, USA; cthomas{at}
  • Received 23 February 2011
  • Accepted 12 August 2011
  • Published Online First 21 September 2011


Objective To better understand barriers associated with the adoption and use of electronic prescribing of controlled substances (EPCS), a practice recently established by US Drug Enforcement Administration regulation.

Materials and methods Prescribers of controlled substances affiliated with a regional health system were surveyed regarding current electronic prescribing (e-prescribing) activities, current prescribing of controlled substances, and expectations and barriers to the adoption of EPCS.

Results 246 prescribers (response rate of 64%) represented a range of medical specialties, with 43.1% of these prescribers current users of e-prescribing for non-controlled substances. Reported issues with controlled substances included errors, pharmacy call-backs, and diversion; most prescribers expected EPCS to address many of these problems, specifically reduce medical errors, improve work flow and efficiency of practice, help identify prescription diversion or misuse, and improve patient treatment management. Prescribers expected, however, that it would be disruptive to practice, and over one-third of respondents reported that carrying a security authentication token at all times would be so burdensome as to discourage adoption.

Discussion Although adoption of e-prescribing has been shown to dramatically reduce medication errors, challenges to efficient processes and errors still persist from the perspective of the prescriber, that may interfere with the adoption of EPCS. Most prescribers regarded EPCS security measures as a small or moderate inconvenience (other than carrying a security token), with advantages outweighing the burden.

Conclusion Prescribers are optimistic about the potential for EPCS to improve practice, but view certain security measures as a burden and potential barrier.


  • Funding This study was funded by the Agency for Healthcare Research and Quality (grant number R18 HS17157).

  • Competing interests None.

  • Ethics approval This study was approved by the Institutional Review Boards of Brandeis University, Berkshire Medical Center, and Massachusetts Department of Public Health/Lemuel Shattuck Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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