What Happens If My E-Prescribing System Goes Down?

Electronic prescribing is now the normal way prescriptions are issued in California. For most prescriptions, California law requires an electronic data transmission prescription unless an applicable exemption applies.

But technology can fail.

A medical practice may lose internet service. An electronic health record system may become unavailable. An e-prescribing application may experience an outage. A computer or other device may stop working. A power failure may prevent the practice from accessing its electronic prescribing system.

When that happens, a common question is:

What am I supposed to do if I cannot electronically send a prescription?

California law provides an exemption when an electronic prescription is unavailable because of a temporary technological or electrical failure. The Medical Board of California specifically recommends that licensed prescribers keep compliant paper prescription forms available in case a technological or electrical failure prevents an electronic prescription from being issued.

Is E-Prescribing Required in California?

Yes. California generally requires prescriptions to be issued electronically, subject to specific exemptions.

Business and Professions Code Section 688 establishes California's electronic prescribing requirements and provides exceptions for certain circumstances.

One of those exceptions applies when an electronic data transmission prescription is temporarily unavailable because of a technological or electrical failure. The Medical Board describes this as including circumstances involving a failure of the computer system, application, device, electrical power, or other service interruption affecting the certified electronic prescription application.

This means the law recognizes that an electronic prescribing system cannot always be available.

A temporary outage does not necessarily mean a prescriber must wait until the electronic system comes back online before providing a prescription.

Instead, the applicable exemption may allow the prescription to be issued through another legally permitted method.

What Counts as a Technological or Electrical Failure?

A technological or electrical failure can involve more than the entire medical practice losing power.

Examples can include:

• The e-prescribing application is temporarily unavailable.
• The practice's computer system goes down.
• The internet connection is unavailable.
• A required electronic prescribing service experiences an outage.
• A device required to transmit the prescription stops working.
• Electrical power is lost.
• Another service interruption prevents the electronic prescription from being transmitted.

The California Medical Board has specifically described temporary technological or electrical failure as including failures involving a computer system, application, device, loss of electrical power, or another service interruption affecting the certified electronic transmission prescription application.

The important issue is whether the electronic prescription is temporarily unavailable because of a qualifying technological or electrical failure.

Can I Use a Paper Prescription If My E-Prescribing System Goes Down?

In circumstances covered by the technological or electrical failure exemption, a prescription may be issued through another legally permitted method.

The Medical Board has specifically recommended that prescribers have compliant paper prescription forms available for this situation.

California's Medical Board has also explained that the e-prescribing law does not require a pharmacist to reject a prescription simply because it was not issued electronically when an otherwise valid alternative format is permitted.

However, the fact that an e-prescribing system is unavailable does not mean that every prescription can automatically be written on any piece of paper.

The prescription still has to comply with the laws applicable to the particular medication and type of prescription.

This distinction is especially important for controlled substances.

What Happens If the Prescription Is for a Controlled Substance?

Controlled substances have additional requirements.

California requires controlled-substance prescriptions to comply with applicable state and federal controlled-substance requirements.

The Medical Board states that if a prescriber does not issue a controlled-substance prescription electronically because of a technological or electrical failure, the prescriber must document the reason in the patient's medical record as soon as possible and within 72 hours after the technological or electrical failure ends.

This documentation requirement is important because the prescriber is relying on an exception to the normal electronic-prescribing requirement.

The medical record should therefore explain why the electronic prescription could not be transmitted.

Do I Need a Special Paper Prescription Form for Controlled Substances?

For written prescriptions for controlled substances covered by California's security prescription requirements, the paper form must meet the applicable California requirements.

The Medical Board of California recommends that prescribers keep paper prescription forms available that meet Health and Safety Code Section 11162.1 in case a technological or electrical failure prevents an electronic prescription from being issued.

California Security Prescription Forms are specialized prescription documents rather than ordinary office stationery.

They contain required security features and identifying information designed for controlled-substance prescriptions.

The Medical Board notes that California Security Prescription Forms include required security features and must be produced by printers licensed through the California Department of Justice Security Prescription Printers Program.

Why Should I Keep Paper Prescription Pads in the Office?

An electronic prescribing outage is difficult to predict.

A practice may go months or years without needing a paper prescription form because its electronic system operates normally.

Then an unexpected outage can occur when a patient needs a prescription.

The Medical Board specifically recommends that licensed prescribers maintain compliant paper prescription forms for this type of situation.

Keeping an appropriate supply available can give the practice an alternative when electronic transmission is temporarily unavailable.

For controlled substances, having compliant California Security Prescription Forms available is particularly important because an ordinary sheet of paper may not satisfy the requirements applicable to a written controlled-substance prescription.

What If the Outage Only Lasts a Few Minutes?

The law addresses a temporary technological or electrical failure, but practices should not assume that every brief inconvenience automatically qualifies for an exemption.

If the electronic prescribing system is functioning and the prescription can be transmitted electronically, the normal electronic-prescribing requirement generally remains applicable.

The technological-failure exemption is intended for circumstances in which the electronic prescription is unavailable because of the qualifying failure.

If your system comes back online quickly, the appropriate course may be to resume normal electronic prescribing rather than automatically relying on paper.

Practices should also follow their electronic prescribing vendor's procedures for determining whether a prescription was successfully transmitted before attempting to issue another prescription.

This can help prevent duplicate prescriptions.

What If the Prescription Was Sent but the Pharmacy Did Not Receive It?

This situation is different from an e-prescribing system being completely unavailable.

Before issuing another prescription, the practice should determine whether the original prescription was actually transmitted and whether the pharmacy received it.

For example, a system may show that a prescription was submitted while the pharmacy has not yet processed it.

Issuing a second prescription without determining what happened to the first could potentially create duplicate prescriptions.

The appropriate response can depend on the medication, pharmacy, prescribing system, and circumstances.

When possible, the practice should communicate with the pharmacy and confirm the status of the original prescription before issuing another one.

What If the Entire Office Loses Power?

A power outage can qualify as a technological or electrical failure when it prevents electronic prescribing.

California's Medical Board specifically identifies loss of electrical power as an example of a temporary technological or electrical failure.

If the practice cannot access its electronic prescribing system because of the outage, the applicable exemption may allow another legally permitted method of issuing the prescription.

For controlled substances, the additional documentation requirements still apply.

This is one reason a practice's downtime plan should account for both technology and paper prescription forms.

What If My E-Prescribing Vendor Has an Outage?

A vendor outage can also prevent a prescription from being transmitted electronically.

California's Medical Board has explained that the technological-failure exemption can apply when the service relied upon to transmit the prescription experiences an interruption.

If the outage prevents the electronic prescription from being issued, the practice should follow its downtime procedures and determine which alternative prescribing method is permitted for the particular prescription.

For controlled substances, the prescriber should also document the technological failure in the patient's medical record as required.

Do I Need to Document the E-Prescribing Failure?

For controlled-substance prescriptions, yes.

If a controlled-substance prescription is not issued electronically because of a technological or electrical failure, California requires the prescriber to document the reason in the patient's medical record.

The Medical Board states that the documentation must be made as soon as possible and within 72 hours after the end of the technological or electrical failure.

A practice should therefore have a process for documenting downtime events.

The documentation can identify the basic reason electronic prescribing was unavailable, such as:

• E-prescribing application outage.
• Computer system failure.
• Internet service failure.
• Electrical outage.
• Other technological service interruption.

The precise documentation should accurately reflect what occurred.

What About CURES If My System Goes Down?

CURES is separate from the electronic prescription transmission system.

CURES is California's prescription drug monitoring database, and California requires certain prescribers to consult CURES before prescribing, ordering, administering, or furnishing controlled substances, subject to statutory exemptions.

The Medical Board states that there are separate exemptions when CURES cannot be accessed because of temporary technological or electrical failure or because the CURES system is unavailable.

If CURES itself is unavailable, the rules concerning CURES access are different from the rules governing the electronic transmission of the prescription.

The practice should therefore avoid treating an e-prescribing outage and a CURES outage as exactly the same situation.

If CURES cannot be accessed because of a qualifying technical problem, California law provides specific exceptions. The Medical Board also advises prescribers to seek to correct a technological or electrical failure within their control without undue delay.

What If I Cannot Access CURES and Need to Prescribe a Controlled Substance?

California provides specific exceptions to the CURES consultation requirement.

For example, if it is not reasonably possible to access CURES in a timely manner, another authorized individual with CURES access is not reasonably available, and the prescription does not exceed a nonrefillable five-day supply, an applicable statutory exemption may permit the controlled substance to be prescribed without consulting CURES.

The prescriber must document the reason for not consulting CURES in the patient's medical record.

There is also a separate exemption when CURES is not operational or cannot be accessed because of a temporary technological or electrical failure.

Because CURES requirements and electronic-prescribing requirements are separate legal issues, practices should document each applicable circumstance accurately.

Can Schedule III, IV, and V Prescriptions Be Issued Another Way?

California provides additional flexibility for certain controlled substances.

The Medical Board notes that written prescriptions for controlled substances must comply with applicable requirements, but Schedule III, IV, and V controlled substances may also be prescribed through oral or electronically transmitted prescriptions when authorized by Health and Safety Code Section 11164.

The precise requirements depend on the schedule, medication, prescribing circumstances, and applicable state and federal law.

For this reason, a practice should not assume that the procedure for a Schedule II prescription is identical to the procedure for a Schedule III, IV, or V prescription.

Are Schedule II Prescriptions Different?

Schedule II controlled substances have additional restrictions.

When a paper prescription is required or used under an applicable exception, the prescription must comply with the requirements governing Schedule II controlled substances.

California's controlled-substance prescription requirements include specific rules concerning the form, information included on the prescription, signature, and circumstances under which oral or electronic prescribing may be permitted.

The Medical Board recommends that prescribers maintain compliant California Security Prescription Forms for circumstances in which technology prevents electronic prescribing.

What Security Features Are Required on California Paper Prescription Forms?

California Security Prescription Forms contain specific security features designed to help prevent alteration, copying, and misuse.

The Medical Board identifies required features that include:

• A unique serialized number.
• A corresponding barcode.
• Security features required by California law.
• Required prescriber information.
• Required prescription information.
• Features designed to prevent alteration or duplication.
• Other security elements established under Health and Safety Code Section 11162.1.

Beginning January 1, 2021, California required controlled-substance prescription forms to contain a 12-character serial number, a corresponding barcode, and other required security features.

This is why practices should keep properly produced California Security Prescription Forms available rather than relying on generic blank prescription paper.

Can I Print a Prescription From My EHR During an Outage?

The fact that an electronic health record system can generate a document does not automatically mean that the resulting document satisfies California's requirements for a controlled-substance prescription form.

California Security Prescription Forms have specific security requirements and must be obtained through the applicable security-printer system.

If a practice plans to use paper prescriptions as part of its downtime procedures, it should have compliant forms available in advance.

The Medical Board specifically recommends that prescribers maintain paper prescription forms meeting Health and Safety Code Section 11162.1 for technological or electrical failures.

What Should My Practice Do During an E-Prescribing Outage?

A practice can prepare a written downtime procedure before an outage occurs.

A practical process may include:

1. Confirm the problem

Determine whether the failure is with:

• The practice's computer.
• Internet service.
• The EHR.
• The e-prescribing application.
• A third-party electronic transmission service.
• Electrical power.

2. Determine whether electronic prescribing is actually unavailable

If the system is functioning, continue using electronic prescribing as required.

If a qualifying technological or electrical failure prevents electronic transmission, determine which exception applies.

3. Identify the prescription type

Determine whether the prescription is:

• Non-controlled.
• Schedule II.
• Schedule III.
• Schedule IV.
• Schedule V.

Different requirements can apply.

4. Use an appropriate alternative

If an exemption applies, use the legally permitted alternative method for that prescription.

For controlled substances requiring a compliant paper form, use the practice's California Security Prescription Forms.

5. Document the failure when required

For controlled-substance prescriptions issued without electronic transmission because of technological or electrical failure, document the reason in the patient's medical record as required by California law.

6. Check CURES requirements separately

If CURES cannot be accessed, determine whether a CURES-specific exception applies and document the circumstances when required.

7. Resume electronic prescribing when the system is restored

Once the technological failure has been corrected, return to the normal electronic-prescribing process.

What Should I Keep in My Office for an E-Prescribing Downtime?

A practice should consider maintaining a small emergency supply of compliant paper prescription forms.

For controlled-substance prescriptions, the forms should meet California Security Prescription Form requirements.

The Medical Board specifically recommends that licensed prescribers have compliant paper prescription forms available for technological or electrical failures.

Practices should also establish internal procedures for securely storing and accounting for paper prescription forms.

This can be particularly important for multi-doctor practices where several prescribers may need access to prescription pads during an electronic outage.

Why Are California Security Prescription Pads Important During an Outage?

Electronic prescribing reduces the routine need for paper prescription forms, but it does not eliminate the possibility that a practice will need them.

A technological failure can occur unexpectedly.

When it does, having compliant paper forms already available can give a practice an alternative method for prescriptions when California law permits one.

For controlled substances, the paper form must meet the applicable security requirements.

California's Medical Board recommends maintaining these forms specifically because a technological or electrical failure can prevent electronic prescribing.

What Prescription Pad Options Does Castle Press Offer?

Castle Press provides California Security Prescription Pads designed for healthcare providers who need compliant paper prescription forms.

Available options include:

• 4" x 5" pocket-size prescription pads
• 8" x 3.3" desk-size prescription pads
• Options for one through ten prescribers
• Two-part prescription forms
• 50 prescription sets per pad
• Custom name and address layouts
• Black-and-white logo options
• Serialized numbering and corresponding barcode
• Multiple security features designed for California requirements

For a practice preparing for possible electronic-system downtime, these forms can be maintained as part of the office's prescription contingency plan.

Castle Press and E-Prescribing Downtime

Castle Press is a California Department of Justice-approved security printer for controlled-substance prescription forms.

California's security prescription system requires controlled-substance prescription forms to be produced through approved security printers and to contain the applicable security features.

The Medical Board recommends that prescribers maintain compliant paper forms in case a technological or electrical failure prevents an electronic prescription from being issued.

Castle Press provides California Security Prescription Pads with the security features, serialization, barcode support, and prescriber configurations applicable to California security prescription forms.

Having an appropriate supply available before an outage occurs can help a medical practice avoid having to figure out its paper-prescription process after the electronic system has already failed.

What Should I Have Ready Before My E-Prescribing System Goes Down?

Preparing before an outage can make the process much easier.

A practice should consider having:

• Compliant California Security Prescription Forms
• Current prescriber information
• Current professional license information
• Applicable DEA registration information
• A secure location for paper prescription pads
• A procedure for distributing paper forms to prescribers
• A procedure for documenting technological failures
• A process for determining when electronic prescribing has been restored
• A process for checking CURES availability
• Contact information for the practice's EHR/e-prescribing vendor
• Procedures for communicating with pharmacies when necessary

Practices should periodically review their downtime procedures to make sure they remain current.

Frequently Asked Questions

What happens if my e-prescribing system goes down?

California provides an exemption to the general electronic-prescribing requirement when an electronic prescription is temporarily unavailable because of a technological or electrical failure. Another legally permitted method may then be used, depending on the prescription and circumstances.

Can I use a paper prescription during an e-prescribing outage?

When a qualifying technological or electrical failure prevents electronic prescribing, paper prescribing may be available as an alternative when permitted by the applicable requirements.

For controlled substances, the paper prescription must comply with the applicable California and federal requirements.

Do I need to document the outage?

For controlled-substance prescriptions that are not issued electronically because of a technological or electrical failure, California requires documentation of the reason in the patient's medical record as soon as possible and within 72 hours after the failure ends.

How long do I have to document a controlled-substance e-prescribing failure?

The Medical Board states that the reason must be documented as soon as possible and within 72 hours of the end of the technological or electrical failure.

Should my practice keep paper prescription pads even though we use e-prescribing?

Yes. The Medical Board of California recommends that licensed prescribers have compliant paper prescription forms available if a technological or electrical failure prevents an electronic prescription from being issued.

Can I use ordinary blank paper for a controlled-substance prescription?

Controlled-substance prescriptions that require a California Security Prescription Form must be issued on a compliant form. Ordinary blank paper is not a substitute for the required security prescription form.

What if my EHR is working but the pharmacy is having a problem?

That situation may be different from a technological failure affecting the prescriber's electronic prescribing capability. The practice should determine whether the prescription was successfully transmitted and communicate with the pharmacy as appropriate before issuing a duplicate prescription.

What if CURES is also unavailable?

California has separate statutory exemptions for certain circumstances in which CURES is unavailable or cannot be accessed because of a temporary technological or electrical failure.

Does an e-prescribing outage automatically allow me to prescribe every medication on paper?

No. The applicable exemption and requirements depend on the prescription and circumstances. Controlled substances have additional state and federal requirements.

Do I need special prescription pads for downtime?

For controlled-substance prescriptions requiring California Security Prescription Forms, the paper forms must meet California's applicable security requirements. The Medical Board recommends maintaining compliant forms specifically for technological or electrical failures.

What happens when the e-prescribing system comes back online?

Once the technological failure has been corrected, the practice should return to its normal electronic-prescribing procedures when electronic prescribing is required.

Order California Security Prescription Pads for Your Downtime Plan

Electronic prescribing is an important part of modern medical practice, but no technology system is immune from outages.

A computer can fail. An internet connection can go down. An EHR or e-prescribing vendor can experience an interruption. A power outage can temporarily prevent an entire office from accessing its electronic systems.

California law recognizes these circumstances by providing an exemption when electronic prescribing is temporarily unavailable because of a technological or electrical failure. For controlled-substance prescriptions, additional documentation requirements apply.

The Medical Board of California recommends that prescribers maintain compliant paper prescription forms for precisely this type of situation.

Having California Security Prescription Pads available before an outage occurs can help your practice maintain a prepared downtime procedure rather than trying to obtain compliant forms after an emergency has already begun.

Castle Press provides California Security Prescription Pads in pocket-size and desk-size formats, with options for one through ten prescribers, two-part forms, custom layouts, serialized numbering, corresponding barcodes, and other required security features.

Need California Security Prescription Pads for your practice?

Castle Press California Security Prescription Pads

Official sources

• Medical Board of California — E-Prescriptions
• Medical Board of California — CURES Mandatory Use
• Medical Board of California — Prescribing Rules for Controlled Substances
• California Department of Justice — CURES
• California Health and Safety Code §11165.4
• Medical Board of California — Prescription Pad Security Requirements

Important: This article provides general information and is not legal or regulatory advice. Requirements can change. Confirm current requirements with the appropriate authority.