Home Forums Discussions Problems error with e-prescribing

Oh, you missed the codified days. There were times a long, long time ago; long before the dinosaurs roamed the land and HIPAA and MIPS were even thought of, we had databases that were, to say, horrifying. They had amoxicillin 250 mg/5mLs written three times and the 500 mg version wasn't even there. Meds were left out, etc. So, all of these drugs looked italicized, because you may have even freehanded some. None of the medications were tied universal and, therefore, could not be tied to an NCD code. Therefore, they needed to be codified. They could be faxed from the prescription writer but not sent electronically. Of course, this soon needed to be changed. And, SureScripts, the medication transporter in the sky provided and made all this happen.

So you may have a script like the following. All I did was put the oral tablet in front of the 1 mg. Pretty much all the meds put the form of the drug in front of the amount. More and more of them aren't even faxable due to no way to give an NDC code to it.



Before being codified, you will note it is in the active medication list, but it is intalicized. This was not good. Prior to having the ability to codify meds, ALL of the meds looked like that. It was rather exciting to codify the meds. One of the frustrations was if you had a codified med and a non-codified med, they would both go to the pharmacy but one would go to the computer and one would be faxed. So, you had to tell the patient. Make sure the pharmacist gives you TWO drugs. And, tell them one was faxed.




So, when you were ready to prescribe, you could codify meds or you could do it at your leisure. This was something only the doctors in our practice were allowed to do. As you can see here, you can select for this patient only in which case if you make an error, you only kill one patient or you can go for it and select all. As you got braver and braver and more and more tired, you would select all. Most benign meds we were OK with. I mean once codified, always codified. Even meds like Concerta, if you really took your time and clicked on the same strength, you were fine. I tended not to do so with drugs you could overdose on such as oxycodone, etc.




Here is where you needed to be careful. You have a patient with clonazepam 0.25 mg chewable which is not written in the codified manner. So, you right click on it, and select codify. Now, in error, you select 1 mg. So, if you codify only this patient, you only have one patient sleep for a day. But, if you apply it to all patients, then EVERY patient in your practice on 0.25 mg of a chewable clonazepam was now suddenly on 1 mg. Just a four-fold mistake.

For those of us who were savvy with SSMS, and eventually realized the error, we could query the drug and using date and drug, change them all back. I am sure some got by us. And, I am sure that those four-year-olds whose RLS was doing a little better got a lot better.



Now, I must say that before there was SQL, I don't know, version 4, maybe, the drug database was horrible. Ungodly. Unusable. Then two people came along. One with nothing to do for two months from 7 pm until 11 pm and another who was much better with Google and finding databases. The latter was Jon Schreiber. The former, well I will tell later. But that person was very proud of his achievement. Everything came together. A crappy database. A lot of complaints, nothing about codification in the works, I don't even think ePrescribe was here yet. But, the most important component was Microsoft Access.

And, I can be prone to hyperbole, but this WAS two months, every evening, after work. EVERY night, save the weekend. This person was very excited to finally show the fruit of his works. This person still has this database years later. Drugs were added, drugs were deleted. A few errors here and there pointed out. But, there weren't very many errors, I can tell you. It was rather funny though. Out of ten doctors, five would remove the Meds Databases from their AC folders immediately and loved it. Four would sort of put their toes into the water and change. And, they all loved it. How could you not. The other was so bad I can't explain. And, alas, the one doctor would just not change. To each his or her own, I guess.