Home Forums Discussions General Discussion What is the best way to handle refills with E-Rx

I am using AC v5, and just started using E-Rx. I like it so far, very simple to use.
(I love that it is seemless with v5. I had tried an earlier
version with NewCrop on v4 and gave up.)

I'm trying to figure out the easiest way to handle refill requests.

For example, right now most of our refill requests come over the fax from pharmacies and over the phone from patients.

One way would be for a nurse to do it all, (as they now call in refills without me being there), but it appears that I can not authorize anyone to do the refills for me.

I would love it if the nurse could prepare the prescription (medication, amount, pharmacy, refills, etc) and send it to me to verify and sign off. It does not appear it works this way though.

So is the best way for a nurse to type in a note attached to the chart for the requested medication / pharmacy, and send it to me? Perhaps entereing the preferred pharmacy in the demographics section before sending it to me to save me that step?

Has anyone come up with a process that works well for handling refill requests?

Thanks,

-Lee

Lee, once again, I propose Paperport. With it and a fax machine with fax-to-pc capabilities, your refill requests arrive in Paperport on any computer networked. From there either you or your designated staffer can mark up the faxed request, fax it right back and then update in AC (if that is important information for you to keep). I personally review every fax and I personally do all the refills.

That is how I do it as well, a lesson learned from Leslie.

It does not take long but is almost faster to mark up in paperport than e prescribe. I will sometimes just shift back and forth between paperport and AC and eprescribe as well. Nice to have 2 options. I want to document that the refill was given though.

Thanks Leslie and DoctorWAW. That does make sense. I will look into Paperport. Since it is a reocurring theme, I should look into it.

The problem I was having was how to document refills while E-Prescribing without duplicating work.

On my paper charts, we just have a sheet on each chart with all refills listed for each time we refill something. Very easy to tell on a patient what you have done.

It would be nice if Amazing Charts had a "Prescription History" section that would just list out everything you have prescribed / refilled in chronoligical order. Since it does not, I guess it does not matter if I E-Prescribe or fax in the refill, either way I will need to duplicate the work to document what I've done somewhere else.

I will look into Paperport.

Does anyone know if in AC, you can give an MA permission to E-Prescribe refills?

The only way I can see to have someone else do refills for you is to have them log in as you, and that does not seem like a good idea.

-Lee

I do refills by selecting the patient's name from the list and attaching it to a message. I write refill in the message line.
I then do the eprescribe and it plops a "transmitted to the pharmacy" in the message. I save it to the chart. It the patient calls, the front desk or ma can look and see if it is there.
Is working great for us.

Thanks Vicki. Putting "refill" in the message line is something I have not been doing, but makes a lot of sense. I will start doing that.

It looks like there is no way getting around the fact that I am the one who has to do the refills, is this correct?

I tried giving my RN the highest privelages, and she was still not able to E-Prescribe.

Right now, our nurses have protocols where they can refill certain medications without talking to me. They also write up scripts and have me sign them.

I would like to mimic this in AC. I would like for a nurse to be able to prepare a refill that I can sign off on. Or I would like a nurse to be able to refill certain medications without me.

Perhaps this is not the best way to practice medicine, and perhaps I should be doing all refills myself anyway.

It appears with AC, there is no option but to do all refills myself. Does anyone know otherwise?

-Lee

Yes there is another way for the staff to do the refills.
They must go thru the new crops screens and they are permitted to do refills there. I give them instructions and they can now go thru the new crop screens and function. Up until we learned this fact this week, they would print and fax (I know it defeats the purpose of having an EMR) to the local pharmacies.

What new-crops screens must the staff go through? Is this something outside of AC? Can't we somehow enable staff to use AC's e-prescribing just as a physician would?

Currently in V5 we are still using New Crop screens for refills that have come via Surescripts as only they have been officially certified to allow this.

We are currently working (for v5.1) to obtain Surescripts certification (required for us to do refills via our window), as well as add the ability to rapidly and approve or deny refill requests coming from the pharmacies. So hang in there...

Jon

When I tried e-prescribing in V4, my office manager could not send prescriptions--being logged in as herself. Only I could. If I sign up for e-prescribing again, can I somehow designate that she can also do e-prescribing? It looks like the SureScripts sign up only allows for the MD to be specified. Under SureScripts account management now--I think my account has expired--when I click on mid-level providers or staff, no names show up on the drop down menus. Is there a way for me to authorize my office manager to use e-prescribing when I renew?

Using the NewCrop screens, someone other than the physician can prescribe and refill patient meds in version 5. Doing this via NewCrop does synchronize the meds with AC. However, no one but the physician can prescribe using AC's own prescription writer window.

John, Thanks for the info. I see that the prescribing window in AC allows one to choose New Crop screens. If one does not choose New Crop screens, and uses AC only, can one still submit prescriptions to pharmacies by hitting "transmit"? Does that your Sure Scripts without the New Crop interface? When I do that the sending screen disappears, but the pharmacy is not receiving the prescription. Is the "transmit" button in AC supposed to work without going through the New Crop screens? Any idea what I need to do to get it to work?

Yes, you are correct, the pharmacy should receive the eRx when you click "Transmit to Pharmacy". First write the prescription on the AC "Medications & ePrescribing" window for that patient. Click "1. Prepare Script", and then "2. Prescribe". In the "Print/Transmit" window that opens, choose the correct pharmacy, and click "Transmit to Pharmacy". When the window disappears, then AC has transmitted the Rx to SureScripts via NewCrop. Your only confirmation is that the window disappears.

You can confirm that SureScripts has received the eRx by doing the following:
1. Send the patient's eRx as described above.
2. With the AC "Medications & ePrescribing" window open, choose "Manage via NewCrop screens" from the "ePrescribing" drop-down menu at the upper left.
3. Click the "Admin" tab at the top right of the NewCrop window that opens.
4. Under "Reports" on the upper left, just under the patient's name, choose "Prescriber Report".
5. The window changes to show two calendars. If you are checking on the same day that you sent the eRx, don't change anything, and click the "Printer Friendly" link under the calendars. Otherwise, choose the start and end dates, and then click the "Printer Friendly" link.
6. A table opens in a new window, showing all the patients for which eRx was done that day. The far right column, "Route", is blank if you filled an eRx or approved an eRx from a pharmacy, using the NewCrop screens (not AC). If you used the "Medications & ePrescribing" window in AC, the column says "Electronic".

You can't confirm that the pharmacy has received the eRx from SureScripts. In my experience with eRx, a minority of pharmacies are still learning the system, and some pharmacy personnel don't have a clue how to check for an eRx. So try several pharmacies before calling Tech Support.

However, if you can't even access the NewCrop windows that I described above, then you aren't credentialed yet for eRx by NewCrop. Send an email to joe@amazingcharts.com -- he seems to me to know how to fix the eRx bugs.

Is there any way to keep the New Crop Status Page open or minimized all the time? I have tried to do this but it always needs to be closed before moving on in AC. Also, if there is a way to keep it open, does it automatically refresh as new scripts come in to be acted upon?
Thanks.

Apparently not. I wasn't able to go to another window in AC with the NewCrop window open.

I hear that once you start E-Prescribing, pharmacies will start sending refill requests electronically.

I only do E-Rx through AC. I have never gone to the New Crop page.

As far as I understand, AC does not yet handle refill requests. So, do this mean I need to log onto the New-Crop page every day to see if I have refill requests?

Is there a way I can E-prescribe, without having to check for refill requests by going to the New Crop page?

Thanks,

-Lee

I am doing the e-prescribe but am still receiving refill requests by fax. I think it is too cumbersome to go to the New Crop page. I do check the eprescribe page that opens from the drop down "on line services" from the task bar in AC. With some regularity a few e-prescribes did not go through, generally this has been to Caremark. I am not getting any irritated pharmacies or patients because I am not using electronic refills so this seems to be working really well for me.

Unrelated question about eprescribing but 1) I was wondering if anyone has been paid the 2% for eprescribing for 2009 but more importantly as many of us will now be elgible in 2010- I believe do we truly qualify for the medicare payment- from the medicare website in the faqs about eprescribing reimbursement http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=dmKNvfuj&p_lva=8253&p_li=&p_accessibility=0&p_redirect=&p_page=1&p_cv=&p_pv=3.1056&p_prods=8%2C61%2C1056&p_cats=&p_hidden_prods=&prod_lvl1=8&prod_lvl2=61&prod_lvl3=1056&p_search_text=&srch_btn_submit=%C2%A0%C2%A0%C2%A0Search%C2%A0%C2%A0%C2%A0&p_new_search=1&p_search_type=answers.search_nl

the following criteria are listed as needed to code for the eprescribing - so my question is do we qualify??? look at what they post below- look forward to your thoughts thanks tim


What type of electronic prescribing system must I have
in order to participate on the Electronic Prescribing (eprescribing)
Incentive Program?
Feedback
What type of electronic prescribing system must I have in order to
participate on the Electronic Prescribing (e-prescribing) Incentive
Program?
Answer
Eligible professionals must have adopted a "qualified" e-prescribing
system. There are two types of systems: a system for e-prescribing only
(stand-alone) or an electronic health record (EHR system) with eprescribing
functionality. Regardless of the type of system used, to be
considered "qualified" it must be based on ALL of the following
capabilities:
• Generating a complete active medication list incorporating
electronic data received from applicable pharmacies and
benefit managers (PBMs) if available
• Selecting medications, printing prescriptions, electronically
transmitting prescriptions, and conducting all alerts (defined
below)
• Providing information related to lower cost, therapeutically
appropriate alternatives (if any) (the availability of an eprescribing
system to receive tiered formulary information, if
available, would meet this requirement for 2009)
• Providing information on formulary or tiered formulary
medications, patient eligibility, and authorization
requirements received electronically from the patient's drug
plan, if available

Yes we do qualify - the tiered formularies are the weakest, but can be used in newcrop screens. You can download from pharmacies, but only some pharmacies participate and I would not count on it.

The EMR allows good management of scrips and easily generates great lists for the patient. The electronic scrips work great - have used since June of last year with newcrop when the system was really clunky - new version is leaps and bounds above newcrop.

From what I have read the 2% bonus won't be paid until around October of this year for last year.

so the last two points about cheaper alternatives and other options and formularies in my note those do qualify for medicare how do we do this is this somewhere in the newcrop screens when you go out of v5?

When you bring up newcrop screens they will give you TIERS, but it only really works for medicare. You can also sign up for free epocrates and the epocrates screen will bring up formularies and allow you to choose insurance (esp. for non-medicare).

thanks tim