Home Forums AC and Allscripts

We are looking at using Allscripts for e-prescribing. There is supposed to be an interface b/w the two. Does anyone have any experience with this product?

Thanks,

Frank J. Paiano, DO

Frank,
I tried Allscripts and didn't like the fact there are so many extra steps to print a rx. The program is free and the costs to download and convert you patient demographic profile I found to be exorbitant. It should cost us nothing. If I had to pay $0.01 it would be too much.

I realize I'm missing out on the Medicare 2% incentive, but given the added time involved on my part to report to Medicare everytime w/ E-Rx and the time of my biller to enter those codes, I'm not seeing the benefit. Based upon our limited Medicare numbers, and looking at the time involved just to get the incentive, I've decided it's not going to pay off for us to e-Rx. If/when it becomes mandatory, then we won't have a choice. For now I do have a choice and will not e-Rx.

If anyone has a better idea or can explain the Medicare reimbursement so it would be more time effective (i.e. earn more money without costing more time/money) then pleae add to this thread and help us all out.

Thanks for the information Adam.

I have not generated an e-Rx yet.

It may just be helpful to look up Rx history of the pt.

Frank J. Paiano, DO
Internal Medicine
Leesburg, FL

Adam, have you tried Rcopia? Did you think it any better?

What do you all do when you see possible forgeries come in? Do you move to faxing everything? I've been thinking that it would be pretty easy for me to copy a printed script. I think one of our patients is going to try it eventually.

Ben,
No I haven't tried Rcopia.
Have you? Do you like it?

About forgering prescriptions, it would be simple for any 10 year old with a scanner and Photoshop to manipulate our scripts. I am not really worred so much about that because I don't see myself as the prescription police. AC keeps very nice records for us everytime we use it to prescribe. So if the REAL prescription police come knocking on my door, I can easily show them I did or did not write a certain prescription.

In the days before AC someone could have forged my scripts, and my paper records were ATROCIOUS. Therefore I would have had a VERY difficult time proving or disproving the reality of a prescription. Now it's basically 100% guaranteed I will know if I wrote one or not.

AC is truly.....well......AMAZING!

The dilemma with e-prescribing is that currently you can't use Surescripts to send any scheduled meds, even Schedule IV or V. This ironically means that I can print these or in my state fax any of them except Schedule II. I use e prescribing for my Medicare patients unless they have a scheduled med - the rest I fax. If I have a schedule II for medicaid I have to put it on special paper and being cheap I continue to use handwritten scrips for those, otherwise I print Schedule II and hand sign them.

Forgeries are much more likely to occur using phone in scrips - anyone with the basic information on one of my written scrips can call in a scrip for Schedule III narcotics. I live in a small town so the 3 pharmacies know all my employees and I really only call in one rarely as I usually just fax them.

Until the DEA makes a final ruling allowing e prescribing for Scheduled Medications this will continue to be a problem.

Unless you have already started e-prescribing for the year it serves you no advantage to start now. Just wait and see what Jon and AC are going to do once Version 5 is buttoned up - he was working on improving e-prescribing until he diverted his resources to get the CCHIT version done.

Hi Steven:

>>> Forgeries are much more likely to occur using phone in scrips - anyone with the basic information on one of my written scrips can call in a scrip for Schedule III narcotics. I live in a small town so the 3 pharmacies know all my employees and I really only call in one rarely as I usually just fax them.

Actually, that's not really true. Most software answering systems can post the initiating call's phone number, so if it is not coming from a physician's office, the pharmacist should call to verify. Also, at least in my state, the pharmacist can call a centralized database number to get a listing of all prior narcotic prescriptions made for the patient in the past.

Al

That's interesting Al, about the phone numbers.
In Maine, or atleast in Bangor, I'm pretty certain our pharmacists dont care. I call from my cell phone pretty frequently or other random phone numbers. In 9 years, (including residency)I've never been called back by a pharmacist to confirm the number that I was calling from.

In fact, in the past 3 years we had two confirmed cases of people calling pharmacies illegally for narcotics. The pharmacists only questioned the call-ins because they did not recognize the voice of the callers (who used the name of our M.A.'s). The pharmacies called out office to confirm and we identified the issue.

However we never identified the callers, presumably they were patients of ours, or former patients.

Thank you Adam, I'll take on your perspective about it.

I think I'll speak to NPs about faxing our prescriptions and wait on e-prescribing. I'll have to find a good way tomorrow. We have a neighborhood pharmacy next door that we can send most of our patients to.

So thank you Steven for your input on e-prescribing.

Until I got around to hooking up a network fax machine - I simply printed them to a printer, walked out with the pt. picked up the scrips and dropped them in the fax with programmed numbers for 5 of my most common pharmacies. You can even put a period and the name of the pharmacy they use as a med and it will print first (mult. scrips per page) to make it easier to remember. In my community the pharmacies have no issues with the e signatures - when it used to say just e signature they usually took it since I called each of them and told them, now they never push back (except rare mail order) with the scanned in signature on the default scrips.

I currently either print the Schedule II's on the printer or handwrite for medicaid - sign and copy. Our Board of Pharmacy advised me that they wanted a copy of the actual scrip with my signature on it if they came to audit scrips - they actually said that my scanned were okay, but the law is old and actually they want a carbon copy or photocopy (did not argue any further).

Ben,

the time you will spend on faxing the scripts and also speaking with the pharmacy over the phone is extremely inconvenient. I will have to say that the feedback I get from practices is they save anywhere from 3-4 hours a day from being on the phone. Which allows them to not only get other things done but also to set up more patients which equals more money for the Doctor! E-Prescribing is the way to go...

Jeff Kirkorian
DrFirst Rcopia

Well, most of the time that 3-4 hours on the phone is by Medical Assistants, so it does not really save the doctor much time. I think that learning a new system cuts down on productivity for a while, and if you factor in the price of systems like Rcopia it seems to be a less than favorable route for many offices. If e-prescribing is to make a solid footing and actually become the standard, cheaper systems need to be implemented.

I have not found any real time savings - my fax is networked and I fax directly from the computers. The current e prescribing formularies do not reduce callbacks as they are not right - many medicare d will say something is covered and it will require step edits (other scrips first) or prior authorization. Even when I jump through e prescribing I am still pulling out my hair. This is coming from someone who does the e prescribing just to test it and am pushing through anyway.....ironic is that the pharmacy has to pay their software provider for every scrip they receive -- can be as high as 10-25 cents per scrip.....I guess we shouldn't complain

Jeff,

It would be fun to see a real time demonstration of just exactly how many seconds it takes to log into Rxcopia and E-prescribe and compare to a computer-fax script from start to finish in AC.

Who would win? and by how many seconds?
1 seconds? 3 second? 25 seconds? or 32 seconds?

It took me exactly 32 seconds, from start to finish to computer-fax a test script to Bert today. This wasn't a script that was already in the patient's profile either, it was a brand new Rx. The single longest time bottleneck was waiting for my fax interface to pop up, 9 seconds. The rest of the time was typing in the Rx, sig, quanity, then finding the recipient's fax number in my address book (8 seconds).

If RxCopia can substantially beat 32 seconds, I'm willing to give it a try. Until then...........oh well.

Steven,
I'm quite certain the E-Prescribing Lobby is pushing the Congresspeople and Senator's VERY hard to make E-rxing the standard. Think how many BILLIONS of dollars they stand to make, at no effort to themselves, at the complete effort of YOU AND I, by charging pharmacies (and soon to follow US) 10-25 cents per script. At least the pharmacy passes the cost to the patient, but do you think Medicare will allow us to pass the cost? NO WAY! Like everything else we do for free, they consider that "bundled" with the services of doctoring.

In my office, we easily reply to 25-100 faxed or called in requests for Rx refills per day. $2.50 to 10.00 per day sucking out of my office results in hundreds to a few thousand dollars per year.....gone. Not in my kids college fund but someone else's so they can drive a Porche.

These people have every interest in doing this under the guise of "Patient Safety" however, we know the real reason like every other reason this stuff happen. Money.

"10-25 cents per script" That's the dumbest things I've heard in a week. It would be too much at a penny.

Why isn't there a standard that the open source community can write a free implementation of? And why is it set up to go to certain Pharmacies instead of a central repository? I assume so larger pharmacies can rope patients into using them for convenience. :| It sounds like a good idea.

Maybe I'm overlooking something.

Edit: I've decided my above comment is unacceptably ignorant. I looked for the standard, but couldn't find it. I'll look again this evening.

Oh, and thanks Jeff for giving me your take on a public forum, I appreciate being able to see the doctors responses since I form many of my perspectives from their reactions.

Edit2: Looks like I found it. http://www.ncpdp.org/eprescribing.asp It is $650 to become a member. ...I think I have a different idea of what a standard is for.

OK, four things.

1. Adam, you forget it would be even more time consuming because the bottleneck isn't the PC to fax, it's the writing of the script. If you do 5 scripts, that will be MUCH faster than any drill down method such as Rxcopia.

2. There is no logic in being able to call in Vicodin but not being able to fax it in from the PC if no signature. Calling in scripts is the easiest way to get medication illegally.

I hate to say it, but personally I think we should be able to write scripts on coffee filters. Sorry but I couldn't care less about drug diversion. Sorry. I hate that 99% of the good patients have to pay for the 1% of drug dealers out there by having to come to the office to get their Concerta.

That is the most exaggerated, outrageous thing I have heard in a long time. You must mean three hours per week. This is a rhetorical question, but what practice takes 3 to 4 hours on the phone with pharmacists? They must have been using cell phones with no nearby cell tower and terrible batteries and dropping calls left and right. They can't be getting more than one bar. I think I would recommend Verizon. Even if we tried by faxing in 100 scripts without the sig, amount or # dispensed; I don't think we could spend four hours on the phone.

And, spare me the "I will see more patients" and "time is money" routine. Time is money for lawyers. Time is time for doctors. The amount of patients I see each day = well child + follow-ups + acutes + walk-ins period. It has noting to do with my scripts.

I remember when all the EMR companies would tell me their program wold "pay for itself" due to no dictation. Well, we didn't use dictation so forget that. And, then it was for every chart your receptionist had to get or put away cost a dollar.

Well, I will take that job. $200 per day, no stress and no e-scripts.

E scrips currently cost us a fee per year just to sign up and then the fee the pharmacy is paying. One more thing - the pharmacies can't pass on the fee either. There fees are set by the insurance company and some scrips counting the meds are only reimbursed 4-6 dollars - do you think that covers the bottle, the labor to fill and thei inventory ?

I know this because one of my friends and neighbors is a small town pharmacist and we compare prices and fees a lot.

I agree the hours are exaggerated - I get back 1 or 2 pushbacks every day or two and deal with them. My staff almost never gets calls and the worst client is mail order pharmacies who routinely do not accept e prescribing.

Amen, Bert. I refuse to go to E-prescribing until it is proven it saves me time, is secure, is cost-effective, and benefits the patients. And those physicians who are being led to slaughter without even dragging one toe in the dirt are making it tough on the whole profession. 2% is just that...2%. And soon it will be 2% of nothing. Standing up for what is right is for a lifetime and the lifetimes of those that follow us.

Leslie

I am doing eRx, but to use the technology, not for the money, which I never expect to see.

My partner and I did the Medicare quality initiative last year for diabetes, still have never received any payment. No one at First Coast (Medicare's fiscal intermediary in Florida) knows anything about it. Not a word on payment on the Medicare provider website. Screwed again!

Who among us ever expects to receive the "stimulus fund" payments for EMR use? Don't spend it yet.

Dr. Lauer,

Honestly we would not win for writing the first script oever. However our system keeps track of the script written in memory. Regardless of it being a favorite med or not, meaning that we keep the sig info for everytime you write that script so yes it takes about 8 seconds to write a brand new script but after that its just a click and were into miliseconds!

Steven,

We are connected with all Mail Orders and they do take our scripts. We also inform you on the patients insurance for Prior Auths which i believe is convenient, also we have all Diagnosis codes in real time in our system so no more looking up codes! I would really stress you all to take a look at it. I have many doctor's that are using AC that have interfaced with Rcopia!

Also, All docs viewing I am sure you use Medicaid Tampur Proof Paper, which i believe costs about $90 a tab. If you didnt have to buy that paper anymore I think that would save you almost $400 a month. Wouldnt you agree?

In my state I only use tamperproof paper for Medicaid hand carry - Schedule II and my e scrips says I can't send any scheduled meds (even vicoden which my staff can call in - much more secure).

Regardless though it is an excess fee. Which can be avoided!

When e-prescribing is universally accepted (truly universal, any drug, any pharmacy) it stands a chance of mass adoption. As it is, it is too expensive, does not save much time (for most), and is simply one more set of companies trying to make business by selling the "future of health IT" and "the future is now, just look at the government trying to help pay for it and giving you incentives!" Honestly, if the systems weren't only half-usable and over-priced people would not have to be "baited" into using them.

I hope they ditch New Crop (take away the o and put in an a) and go with somthing useful with customer support that is not an oxymoron.
PS Can you tell I'm having a bad day. Sorry, somedays Pollyanna just can't be found.

Paul,

I see where you are coming from but also want to state that we do work with the DEA and are able to send all drugs in certain locations as far as a pilot program with the DEA. As far as been the future i believe our structure and being Partnered with 65+ EMR's is great because it allows you to go in the direction of electronic without putting that large amount of capital down on an EMR but to start off cheap with an E-Prescribing system.

I use Allscripts and I find it very easy to use and extremely convenient, especially, when I need to renew patient meds while at home or working in the hospital.

The only downside is that there is no FREE interface with Amazing Charts.

I wonder if you have acctually gotten a chance to sit down and look at other systems, you are the first that has not come and give me feedback in regards to Allscripts being Cumbersome.Also the other key quote they use is "you get what you pay for". But if your happy that is what matters, i just want to state to take a look because what you think might be easy because your use to it might be even easier with another system!

[quote=.}Who among us ever expects to receive the "stimulus fund" payments for EMR use? Don't spend it yet.[/quote]
I know what you mean John. Adam and I and others probably won't get the stimulus for the EMR. But, is anyone. Oh, yes. The FQHCs. Adam and I are paying for our EMR while the big FQHC across the river just got 1.8 million dollars for theirs. I think you're on the wrong board Jeff. 1.8 million buys a lot of RxCopias. So, Washington just sent over $10,000,000 to Maine for infrastructure and EMRs. http://newsmanager.commpartners.com/mainemed/issues/2009-07-06.html
Now, for those who think they need the money for what they do, keep in mind, they get more money for Medicaid than we do for BC/BS. They get over $650,000 tax free money each year. They get free liability insurance because you can't sue the government. And, they pay no taxes. Those four things are supposed to be so they are able to take care of those who are less fortunate. Why do they need $1.8 million more? Maybe it's to help them pay for sending records. Oh wait, they don't send records. They only send the five or six or maybe 20 notes they generated. Of course, that's quite a bit with Logician given it takes five sheets of paper to document conjunctivitis. Sorry. Can you tell I'm a little bitter about FQHCs?

1. Jeff, do you think AmazingCharts forgets the script and the sig when we go to the next patient? We can push one button and send all the scripts.

2. I don't understand when you just turn around and say that mail orders do take your scripts. So, it is either that they do or Steven is lying. I have never known Steve to lie. So, why don't you believe what we are experiencing?

3. See, here we go again with the savings. First, on January 1, 2008, due to the infinite wisdom of our legislators, it was decided that all those with Aetna, Cigna, BC/BS etc. were trustworthy enough to hand carry regular scripts to the pharmacies. But, they decided that Medicaid patients weren't so we would have to write on tamper-proof paper. You know, in case they wanted to change Amoxicillin from 10 days to 14 days. There has been a great deal of diversion my Mainecare patients of Amoxicillin and MiraLax. Or is that Glycolax. No MiraLax, wait Glycolax. Sorry, only Adam and I will get that joke from out Mainecare Preferred Drug List. But, we DON'T use tamper-proof paper. We fax. Yes, fax. And, if it's Ritalin we do use the tamper proof paper. Now, I can't speak for everyone else, but I have spent less than $300 on tamper proof paper in 2 1/2 years, hardly $400 per month.

4. But, we don't put a lot of capital down for an EMR. That's the point. See, those doctors who can afford to pay $50,000 to $75,000 for an EMR can afford e-Prescribing.

5. When the drug and insurance companies start paying for this, maybe I will use it. Actually, I won't, because it is far too slow, but at least it would make sense.

6. See, the interesting thing I have found about AC is this. In general, when you look at the offices where one person pulled ten other providers kicking and screaming down the road to NextGen, maybe two or three of those doctors liked or love technology. The small practices and solo practitioners who had to look through literally tens of EMRs to find one he or she could afford, tend to like technology. Some of us LOVE technology. And, even so, I have no interest at this time of using e-Prescribing.

In a way, I think it's great you are giving the positives from your perspective and handling all the somewhat constructive criticism. But, in a way, you remind me of that annoying (I don't mean that to be mean, seriously) drug rep who waits until you come out of a room, tells you they only need one minutes, then pitches their spiel for five minutes AND THEN DENIES THAT ANY OTHER DOCTOR HAS SEEN THE SIDE EFFECTS I HAVE EXPERIENCED.

The drug reps we or I love are the ones who come in with DD coffee and donuts, talk Patriots football, keep the Maxair in the closet and answer questions if we have them. So, it would seem if you started a thread and said, "Hey this is Jeff, and if anyone has any questions, I would be glad to answer them," it would go over better.

And, oh yes, you could send us a Dunkin' Donut card as well.

I am currently using NewCrop through AC - I find the formulary to be inaccurate (I assume all e prescribing use the same one as I can't see each developing and maintaining their own for every company).

I know that the DEA is in the public comment period on sending electronic schedule scrips, but I also know how long the government takes to do anything.

The large mail order pharmacies I am sure take e scrips they just make it difficult to find them and figure out how to do it.

As far as faxing - I think Adam was being very fair - I can type new scrips using my own terms much faster than a drill down. I also know that wil have to change as in order to do e scrips and make it work we will have to standardize our med names, forms, scrips, etc otherwise the computer can't check interactions, formularies, allergies, etc. Since I can't do it all I look forward to some help with this although I also hate that everytime I send a scrip for keflex to the pharmacy their database flags their penicillin allergy....

I am also not sure about stimulus money, but I love to play with new technology and that is why I am experimenting with e prescribing, Phreesia pads, lab interfaces, etc.

I just want to reiterate unless you really feel you need to do e prescribing you should wait to make sure it is cheap, fully integrated and stable. There is a reason only some of choose to be a beta tester.....

We are set up with: Caremark, ESI, Medco, Wellmark,prime mail,prescription solutions, and next rx......

As far as different systems and functionality Steven, I would really suggest you take a look at ours I have doctor's that look at all systems and look at DrFirst and say there is no comparison.


Unfortunatley Bert, I am a Giants fan and I dont believe DD needs to be distributed for something that has been proven for patient safety.

I am actually a Braves fan, and I hope you know I was kidding about the Dunkin Donuts.

Yes of course.... But you never know all doc's have different personalities!

I have been so busy that I didn't realize that a great number of the posts here are from a vendor. While I would like to try Dr.First if I win the lottery, I do not like vendors in the middle of our conversations. I still think there should be a members only area and a separate area that we can interact with vendors.

I would like to agree, Vicki, but I think if we had such an area (a forum only for interaction with vendors) it would not be very useful, and instead would be similar to posting forum rules stating that only AC users could access the members forum and that no person should endorse or condemn any product/software/etc. That might end up being more helpful for people wishing to speak about AC but I think that the way things work now is better and easier for discussions about all things AC, including related programs, software, law, etc. I am willing to put up with posts from vendors as long as they are not slamming their competitors or just blatantly trying to sell. This forum should be about information, not about some statistics that pretend to show truth.

Vicki,

My soul purpose is not to push/sell in this forum it is to be here for support if there are any question's. I have read the term's of this forum and do not plan on bad mouthing any competitors or trying to sell on this forum. I am here for informational purposes only! Sorry for the misunderstanding and am looking forward to answering any questions you might have!

I am torn on the subject, although I may lean toward allowing vendors within the discussions only because of the confusion it would cause otherwise.

However, I would think it would be better if the interest of fair trade, etc. if the vendor STARTED the thread and gave some type of disclaimer and then followed up with if you have questions, etc.

Then, no matter where one is in the thread, you can always go back to the top and say, "Well at least he/she was up front about it.

Jeff came in after the 11th post and began to advertise his product. I think he has been fair as far as not bashing other companies, but it is definitely advertising.

I have often felt a bit weird talking about F.A.P and VIPER along with other medical software products my company has produced.