Home Forums Discussions General Discussion Workaround so physician signature on all scripts

This workaround works best for solo practitioners although it's possible to use in a group practice.

We fax most of our scripts and even when my staff printed a script, I would scratch out his/her name and sign mine. We generally felt uncomfortable faxing a prescription with an MAs digital signature, although we didn't test the waters much to find out. We were using an electronic digital stamp, but it was rather clumsy.

So, I made this change in the user's section. I went into all users who can fax and print scripts and substituted my name for theirs at the top. They could still keep their username and password, which is key. If I set up a new employee, I simply insert their name and password and give them nursing rights.

Now, when they bring up a script or print a letter, etc., my digital signature is at the bottom. Each user still sends messages, etc. by using the dropdown box -- the only downside is that instead of appearing like: [Mary], it will appear like: Smith, B [Mary].

I guess in a group practice, one provider would have to be used for all scripts or one MA could be associated with a certain provider. I haven't thought through that much since I am solo.

Bert,

I wrote to Jon a long time ago about this. My suggestion was that most or all staff should be allowed to start an Rx since so many are just re-fills or the doc looking at some middle leveling saying, "give them 10 days of this, twice daily, 50 mgs", or what have you. In the Rx section there should be a drop down that we support staff could then choose the provider this is being written for. Then we staff would forward the Rx via the email system, off to the doc for final approval and/or editing which really is key. The Doc may want to flush the Rx completely, change any number of things on it like quantity, dose and so on. Then they could either check off on it to print themselves or send it back off again via the inter-office email to the staff member of their choice, like the MA, with or without a small note attached, like "mail to patient", "fax to Pharm" and so on. Staff that creates Rx's for docs should be able to attach a small note too just in case it is needed to help the doc in their duties, "migraines returing" and the like.

Jon said he was sort of into this suggestion, especially the provider drop down so as to be able to choose the provider that will eventually need sign off on the Rx and recieve it. So as always, if you like this idea or something like it, send it off to him so he knows that it is something that a number of folks want.

Paul

Paul,

I agree. I like your idea. We fax scripts (probably the number one topic on the message boards, don't you agee?), which certainly applies here. But, even going back to less secure methods, I many times will ask my MA to call in Amoxicillin 250/5 bid times 10 after she/he tells me that so and so has a sore throat after his brother had it documented the day before. And, even though I can fax right from my PC, I may receive a message from my MA that says an 18 year old patient has a yeast infection. I may not have time, so I do the script and send it back. She should be able to call/fax it in.

I have let Jon know many times. I agree there should be a drop down box similar to the orders window.

By the way, liked your post on the physician unions. I definitely agree. You should try being across the street from a FQHC.

Have any other solo practitioners tried this?

Still wondering if anyone else has tried this and what their experience has been.

Nancy suggested that we could just log in as her and create her letters and Rx's as she instructs us. But I don't like that. The system should be flexible enough to allow a real "paper" feel to all of this. And more importantly, it should be properly tracking the chain of custody of these sort of things to prove that we did handle it in just such a fashion. From me taking a message and setting it up, to my provider with her approving and or adjusting it (number of refills or what have you), and back to me or the MA (or who ever else on staff) to complete the task be it fax, phone, mail, pick-up and so on. AC has always prided itself on behaving in a way that is in tune with the way we really work and chart, well here is a place it needs to finally tweak itself to do such. But to date our providers are the bottleneck in our offices. I've been saying it long enough.

The problem with logging in as the physician is that all messages would go to her inbox and all messages would appear as thogh they came from her.

Oh, I just meant for the few minutes now and again that I or someone else would be writing an Rx as instructed by the provider, not as an all day sort of thing. log-in as provider, write Rx, log back in as yourself. But again, the chain of custody thing is paramount here. I took the message, set up the Rx, sent to the provider, she liked and appoved it, now she either finishes it herself or sends it back to us. She could print it too and then send the messaage back to us that the Rx, the orders or the letter are in the printer and ready for whatever...pick-up, call-in, faxing, mailing and so on...

Quite a few users viewed this post. I thought I would put a poll on here to see if anyone has actually found it helpful.

Physician signatures multiple choice

I am solo and am using the workaround (20%, 1 Votes)

We are a group and are still using the workaround (0%, 0 Votes)

We are a group so it didn\'t help us (0%, 0 Votes)

Didn\'t use it because didn\'t like the doctor\'s name in the dropdown box for messages, etc. (40%, 2 Votes)

We just didn\'t find it useful for our practice (40%, 2 Votes)

Total Votes: 5 Voting on this poll ends: 10/09/2007 6:42 PM

I must caution people to be careful with this. I just had to fire an office worker for calling in narcotics for an ex office worker. I had to call the DEA and police department as well as talk to my lawyer about it. It was a significant hassle and expense and the liability is significant. In my state, Texas, the medical board is trigger happy to take your license away for stuff like this. Last thing you need is to have your name in the "wall of shame" bulletin from your local state board. The bottom line is that there should be a way for amazing chart to allow medical assistants and ancilliary staff to start a prescription and let the doctor sign off on it. However, the physician should hold final say on prescriptions. Please do not institute work arounds that leave you exposed liability wise. BTW the office worker whom I had to let go was the LAST person I would have suspected... You just never know.

I appreciate your concern over employees faxing in scripts for narcotics or other controlled substances. However, I do not share your viewpoint. While if I read between the lines, you may be implying that calling in a prescription for narcotics is less likely; I am not so sure this is true. Yes, the MA, nurse or other staff member may be less likely to phone in a script due to the fact that he or she may be asked for his or her name, but the only time we had an event it was a called in prescription and the pharmacy didn't ask for the name. At least a fax leaves a paper trail.

Maybe I have not been in the business long enough to get "burned," but I am not going to let the one or two employees in my career who take advantage of his or her position to commit crimes from using practices that help my staff and me be more efficient. I reported my MA to the police, DEA, DA and the attorney general as well as my attorney and nothing became of it. I feel bad for those under the Texas rules, because in Maine we do not get listed or exposed for something we had little or no control over.

This is just my view. I completely understand yours.

Guys,
Actually I agree with both of you. We should be able to use work arounds that help us, but here in NY they are quite strick too. They seem to love to have one or two people to "make examples of". Makes you feel like you're back in grade school or something. Some silly doc here really messed up bad recently, he pretty much deserved to get caught. He was writing Rx's for patients that may or may not have needed the stuff and had them sharing part of their pills back with him and his wife who were actually using the stuff. Seems he was busted at the same thing back about 8-9 years ago, but was only "sactioned" then. Unreal. You better believe he was the lead story around here for a few nights. Busting Doctors is cool, didn't you know that? But here controlled substances must be on NYS official hardcopy, not called or faxed in.

But again, the real point is that this is a "wish" and a commumication back to the mothership that we need our program to function in a "paper office" fashion to allow us to work in the way that works best for us; Not us conforming to the program. Isn't that the knock against "other" non-doctor designed EMR's? We should all want the program to record the chain of custody so it does protect us, that we took a message, sent it to the doc, she responded to it and then one of her staff finished the job for her, right?

Bert, you forgot the most important choice in your poll..."would you like AC to build or design something similar to what was discussed in this thread?" As you said yourself the idea of the wish list and your starting the polling thing was to convey back to AC what we out here in the working world were doing, seeing and needing since we seem to NOT have as easy and open a conduit back to AC as we once did, right? The culture back in RI is changing and we users out here who at least used to beta still feel a need to try and communicate our needs and "wishes" back to the homebase some how.

hockeyref,

I don't always agree with you, but you are right on the money. And, I don't want anyone to think I don't agree with gcarcamo. He is right on as well. I had menant to post that it would be best if the program worked as he and you have said.

By the way, we have to use controlled scripts as well for oxycodone and stimulants. We can call in T3s and Vicodin. Below oxys, the rule is it has to have Tylenol in it. The users then won't abuse it due to the Tylenol effects. Huh?

Regarding writing narcotics...anything that is schedule II around here cannot be called in, it has to be a hard copy. Other than that...no special scripts. Here is where we had a problem.

I had a patient, who took my prescriptions that were printed out from AC and photocopied the prescriptions. He then took copies of those prescriptions to several pharmacies. This way, he was able to get his hands on, several hundred Vicodin per month, which unfortunately he was taking. This went on for about three months, before at astute pharmacist called me one Saturday morning. This is a patient I never would have suspected. He is now in treatment.

At the moment, I now write in purple on each prescription the pharmacy it is going to, as well the signing my name and purple. My next step will most likely be some sort of safety paper. I had not thought to purchase a network fax when we opened - so am looking at that as well.

Narcotic abuse is alive and well -- it doesn't matter if it's office staff, clinical staff or patients. Sadly, even providers are not immune. We all need to be ever vigilant to protect ourselves, and our communities.

Barbara

Wow. This thread has begun to generate quite a few comments.

That was incredible that your patient did that. I guess with chronic patients we tend to write the name of the pharmacy on the script. We use controlled substance scripts for all CII meds, I just don't know them all. I know we can call in Darvocet and Vicodin but not hydrocodone and Darvon.

I fax all scripts through a networked fax machine. I don't see why you couldn't connect a computer to a fax machine and share it out but that's for another day. The only issue is when I get a call for something that needs a few Vicodin, and I am home, but I guess again it would be the chronic user where you wouldn't want to do that.

In Maine, we have a website for all CII scripts. Very helpful. It should link to the pharmacists, but it doesn't. They can use it however. Unfortunately, it is only for certain insurance companies.

The employee of mine called it in, when we ONLY fax from the office or write controlled scripts. So far all attempts to do anything about it have failed. What have others experienced with this.

Finally, I guess I don't want to go into detail since maybe anyone can read these, but all I will say is that the website address is at the bottom of the prescription page. That may not be a good idea. I mean our DEA# and license number are there as well. I wonder if like some trial software, one should fill out a form first and then Jon should send a link for the download. At least show you are in healthcare at a clinic or somewhere. After, you could download with your registration number or username and password.

Thoughts?

Bert,

I'm not following what you are asking. What is at the bottom of the prescription page? In AC?

I do not print my DEA# on the scripts. The pharmacies all have the number. A former pt of mine tired to call in a script for Vicodin from another provider, but could not provide them with a DEA number. Silly woman used her own name and thus was caught.

I know there is a new free service for scripts that you can do online. I have no idea if our pharmacies are hooked into it. And it still would require hard copies for schedule II's. Plus double entry (that software and AC) for medicaitons.

Yes...a networked fax is on my list...

Barbara,

When you print a script from Amazing Charts, it puts the URL at the bottom, I guess for advertising. This makes it one step easier to finding the site and downloading the program. IMHO, there should be a proof that one is a provider before being able to download the program.

We don't put DEA numbers on it either, although we do have them on CII scripts. They aren't really needed. But, there are many sites out there where anyone can look up DEA numbers. Faxing is still the way to go.

I don't like the online services because 1) they are not easy to navigate (at least they weren't), 2) double entries and, thus, time consuming and error producing, and 3) fairly costly.