Home Forums Discussions Problems All caps in med names on prescription meds list

Why do several meds repeatedly show up with irrational partial capitalization of the name, when searching in the drop-down menus or search boxes in the prescription writer/allergy list?

Examples: acetazolAMIDE, diphenhyrAMINE, predisoLONE, (there are many others).

It looks unprofessional when added to an encounter note or prescription.

I spoke with AC's programmer - the scripting format is a standardized one that is supposed to draw attention to certain letters, syllables, etc that is supposed to differentiate from similar ones, so that you are less likely to mistake prednisolone for prednisone. I also discussed that this makes it look funny in the letter writer and they had no great solution. The formatting is there for safety (I know it looks funny) and I asked if there was some way they could make it be in all caps in the letter writer for instance.

I agree that these CAPS make preSCRIPtions took funny. AC should drop this prACTice.

Now that medications are discrete data, and have to be reentered into the prescribing module for e-prescribing and med-interaction checking, how are folks doing this? It takes time to re-enter every one, and erase the prior entry.

Instead of re-entering - choose the med in the list - right click and hit CODIFY. This brings up a pop-up list of suggested codified alternatives which are usually very close - depending on how you enter drugs like Lortab, amoxicillin, etc. You can codify only that pt's med or if you have been consistent, eg always put AMOXICILLIN 500 mg then you can codify for all pt. - after you do this for a while you will find most of your patients converted over. It actually only takes a minute or two for a patient with a very long list.

Thanks Steven. How did you learn about the CODIFY option? Is there a tutorial on the latest beta version?

I am not sure where I learned it - have been using beta since day 1. I have also talked with Jon and other AC team members at conventions when version 5 was first coming out and looked at some demos. There is a demo video at www.amazingcharts.com/5beta but I am not sure if it shows codifying meds.

There are lots of new features that taking getting used to - allergies are not autocodified and you will have to manually enter allergies and code them - they will pull over ones you have put in the past, but they are italicized and not truly coded for allergy checking. That will take you a few seconds on most patients and after you manually put in those from the past you will want to remove the old italicized ones (a pain, but useful in the future when comparing scrips to allergies).

Yes, that is pretty standard in the commercial medical world. That is how our hospital writes them.

I am not worried about the letter. I am worried about the scripts. I haven't used V5 yet. Do the prescriptions actually have them spelled out like that?

If so, another reason not to upgrade. That will be horrible.

Yes that is the way scrips look - again due to their desire to use some type of standard - I think the only way it will change is if all users send in request to change to all caps or something.

Or not all caps. Like maybe like amoxicillin. Wouldn't we have to actually get New Crop to do that? Doesn't it come from their database?

Seriously, I will have to do a lot of thinking if my scripts are going to have that on them. Of course, if it's ePrescribing, I guess it doesn't matter. I guess I will have to play with it some more. I still haven't looked at the vaccines and VIPER. If VIPER doesn't work (and I am sure Ed will make it work), I won't change anyway.

I think its sad that whoever developed this curious capitalization, didn't think that anyone would object to spelling prednisone as predniSONE. This epitomizes what is wrong with the whole EMR industry -- shoehorn the user into whatever bizarre standard the vendor comes up with.

Is this drUG thing at the EMR level? I think it goes higher than that. I remember the first time I saw it about three years ago. I was like, what the hell? Then I realized why. Then, I thought I hoped it would go away.

HElp, i THInk it MAY be beginNING to AFFect me STRANgly!

Yes, but don't you see how STRANgly kept you from prescribing Stringy and, thus, avoiding a horrible medical error, lol.

I spoke with AC - they said that they cannot change the scrips as it is in a format called "Tall Man" and apparently this is a requirement. They are working on changing it in notes - I had spoken to them about changing it at least in the letter writer.

Thanks for getting us that explanation.

"Tall Man lettering (or Tallman lettering) is the practice of writing part of a drug's name in upper case letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors. For example, in Tall Man lettering, "prednisone" and "prednisolone" should be written "predniSONE" and "prednisoLONE", respectively. The Office of Generic Drugs of the Food and Drug Administration encourages manufacturers to use Tall Man lettering labels to visually differentiate their drugs' names, and a number of hospitals, clinics, and health care systems use Tall Man lettering in their computerized order entry, automated dispensing machines, medication admission records, prescription labels, and drug product labels." From Wikipedia.

Looks like AC is drinking this particular flavor of Kool Aid.

I don't think AC has a choice.

Why don't they just call it Orapred (prednisolone) or prednisolone164gy287.

I really don't care much about how it looks in the letter writer, but I do care about it in general.

I am about to write a very provocative and professional statement about what I think about it and how it should be handled:





It's STUPID!

I think unfortunately it does make scrips look silly, but I think it is one of those things that has been mandated by "somebody" or is it "someBODY" ? He did say he would look into making it look better in the letter writer and maybe the note itself, but the scrips had to stay that way.

I would like it changed for the letter writer as that is how I often do hospital admits and med lists for patients.

I find it extremely ironic that Jon is going to try to make the meds look better on the letter writer yet we have been asking for changes on it for years with no effect.

Don't me wrong. I am glad for you, though.

Maybe we need Google: Did you mean "Prednisone"

As a sidenote - the lead programmer and I talked a lot about the letter writer and he has it on his list to work on the letter writer as well as the format it saves in. I know that the letter writer can probably never be a full fledged word processor and once notes are typed and saved they need to be locked so that changes are not made and that makes it difficult - it would be great if we could make some font/typestyle/letterhead changes.

Steven,

Thanks for the update. I may be in the minority, but I don't see such a big deal about its being locked. It could easily be opened in Word. I have software that allows me to convert a PDF to a Word document, and I can open the HTML document in Word, change it and then save it to HTML.

Ironically, the only issue with saving it to PDF will be the extra steps invovled in naming it and saving it somewhere and importing it unless it can all be done at one time.

Confirmation of the Law of Unintended Consequences:

Since the drugs began being printed in the "Tall Man" script (ie: predniSONE), the AC spell checker has been flagging these drug names as misspellings. A bug in AC spell checker won't memorize "mixed case" spelling exceptions, so the same drug names keep getting flagged again & again.

That is a bug. I don't think you could create that bug if you tried. Good pickup.

I actually reported this bug about a year ago.