"The second part," said Yakimischak, "is a two-factor authentication. It's no longer good enough for EPCS to just be using a password or just be using a biometric or a token or a key, you have to use two out of those three."

Yakimischak explains that there's some cost involved in the issuing of credentials and the software itself. Any time there's an upgrade now that has to happen in the field, that tends to be one of the slowest pieces, he adds, because with these upgrades vendors usually don't just bring out an upgrade for one thing.

"They put in a package of things, twice a year, that has a 100 different new features and the deployment of those," he said. "They have to go through a testing period and then the practice may have to go through some effort to migrate their data, so it's the deployment of this software that is usually the last leg of the puzzle."   

As more and more physicians opt for e-prescribing for controlled substances, Kelly is hopeful that this will make it more convenient for chronic pain patients to get the medication they need.

"EPCS makes it easier for physicians to write prescriptions for patients in need while at the same time creating a better security system with an audit trail to prevent over-prescribing of controlled substances for patients who may or may not need them," he said.

The DEA, along with other medical professionals, contends that e-prescribing, including for controlled substances, offers many benefits such as an authentication trail and features that check for drug-drug interactions, allergies and confirmation that the patient is getting the right medicine.

In addition, EPCS can have an impact from a monetary and regulatory standpoint. Kelly points out that there are a number of hospital systems right now that are interested in electronic prescription of controlled substances not just because of this issue around drug diversion and security, but also to help meet meaningful use goals.

"About 13 percent of prescriptions are for controlled substances, so enabling EPCS can help meet meaningful use targets for e-prescribing," he said.

"Stage 2 says that more than 50 percent of prescriptions need to be electronic, so EPCS can help meet these goals," said Kelly. Conversely, not having a system for EPCS in place can make it very hard to meet these numbers.

Physicians, he explains, typically don’t like having to go through two workflows, so they will often default to manually writing prescriptions, even if they have an e-prescribing solution for non-controlled substances. For example, if a patient is discharged with 10 prescriptions and even just one is for a controlled substance, a physician will likely manually prescribe all 10.

While many in the healthcare community applaud the schedule change, others believe that it will ultimately have a negative impact on patients.

John Norton, director of public relations for the National Community Pharmacists Association, said NCPA is not surprised but disappointed with the DEA’s final rule rescheduling hydrocodone combination products.

"While everyone agrees that the level of pain medication abuse is way too high, the challenge is finding remedies that don’t hinder access for patents with legitimate pain needs, especially in long term care settings," said Norton. "For example, a greater effort needs to be undertaken to crack down on the small percentage of prescribers who are driving the problem. We will continue to work constructively with the DEA to find the most effective policies possible."

Thomas E. Menighan, executive vice president and CEO of the American Pharmacists Association added that, while APhA "recognizes the significant public health threat posed by the abuse and misuse of prescription drugs," the group is "concerned that rescheduling hydrocodone-combination products will significantly impact access to pain medication for patients with legitimate medical needs and will ultimately increase health care costs at a time when policymakers are seeking ways to reduce costs."