Home Forums Discussions General Discussion Writing a prescription and eprescribing

Some questions I need cleared up for me and I would appreciate your input. I am using v5.026.
1.When I go to the medicine list by hitting "Write Scripts" a patient's med list comes up. The fonts on some of the meds are different...some are italicized, some are bold, some are italicized in a different font. What do they mean?
2.What does Newcrop Screen do that the AC prescription page doesn't do?
3.So I enter a prescription and am given a choice of printing or transmitting to the pharmacy. I hit transmit and away goes the med. Am I really transmitting electronically or am I sending it by a fax via Surescripts? The reason I ask is that I got a call from a pharmacist I know and he said that he had gotten some faxes from me that did not have our fax number on it so techinically he couldn't take them. I am confused about the options for eprescribing. Help and thanks
Dave

Italicized meds need to be codified - click on that scrip on the left and right click - pick CODIFY AND THEN associate it with the proper med (can then choose for all patients or just that pt - only takes a minute or so to do all the pt meds once you get used to it).

Newcrop screen allows you to receive electronic refill requests (AC is developing better way to do this). Also currently is the only way you can check formularies on Medicare Part D (required for meaningful use), but this is very poorly done and is not always accurate (I have found some say covered level 8 and they are really not covered). Hopefully formulary checking will also get better.

When you transmit to the pharmacy it sends electronically - if the pharmacy does not have e prescribing set up properly they will receive a fax from surescrips- it also takes a few days after you first start for Surescrips to fully get up and running. I am not sure about the lack of a fax number - go under admin options, e-rx, account administration and then choose your default location - that will let you enter phone, fax numbers, etc.

Hopefully that will fix your issues.

If the patient demographics are correct, the NewCropScreens will show a link on the first page to "Rx history/Rx hub" and if all is well you can see all prescriptions written by anybody for some period of time and import them if desired.

Thanks David and Steven for the info. One more point of clarification. The script writer with AC uses Surescripts and may be transmitted by fax but is designed to just be sent electronically, right? And Newcrop is really for receiving electronic requests? thanks Dave

That is pretty much my understanding also. It reverts to fax if the receiving pharmacy is not online. Sadly it is not smart enough to revert to fax for schedule III-V drugs. I have not used the pharmacy refill request much as our policy is to prescribe the number of refills we think a patient needs and prefer to hear from the patient why refills are needed before a scheduled visit. All inall I do like e-prescribing but will say that after two years it has become ALMOST as quick as writing them by hand.

David:
Good to hear from my esteemed colleague in Fairbanks. When I was a resident I had a standard whereby I did not refill pharmacy requests. Rather, I preferred to give enough refills until the next visit, or call personally in the case of an early refill. If the pharmacy was sending a request, the patient was not taking the pills as indicated or was overdue for an appointment. Since being in practice, I have gotten used to refilling faxed pharm refill requests, but thinking about going back the other way. Some patients have no clue what they are on, and say "oh, the pharmacy will send it". Your post intrigues me. Do you think it would be doable to completely work with just the patient on this? I have been to some offices where a sign says to bring all pill bottles to every visit and that pills will not be refilled after hours or over the phone.
BTW, we should consider an AK AC get together this summer.

We do tell the patient to bring all pill bottles to each visit, and really push to make this happen. It is astounding how many ways there are to have it go wrong between how I think the patient is taking a medication and what is actually passing their lips. The MA checks the pill bottles against the chart every time.

We are not absolutely rigid about our policy, but I want to hear directly from the patient why he/she needs a refill. Sometimes the pharmacy only gave part of the Rx I had written, for example, or their insurance only paid for 30 days instead of 90. If the patient just could not get an appointment and the prescription had run out, we refill until the appointment that we then make sure is scheduled. Our after hours calls get handled by the Providence triage service, and they don't refill prescriptions.

I previously was in a coverage schedule with another busy doctor who encouraged pharmacies to call him nights and weekends for refills. It was a nightmare. When I got out of that schedule and we got firm with our policy, it was surprising how quickly everyone adjusted, and with very little pushback. I get my personal meds from a mail order pharmacy, and it is just not that tough to see when the bottle is getting empty to arrange to get more, nor is it hard to read the label and see "0 refills" and know I need to be making an appointment.

I think that putting the pharmacy between us and the patient is as much a mistake as putting the insurance companies between us and the patient. Patients need to take responsibility for themselves sometimes ("I can't have a flu shot because my insurance won't pay for it"). Sometime those automatic refill requests come in on meds that have been discontinued, changed, etc. If we are willing to address these automatic requests then we wind up chasing our tails and validating/invalidating info that the pharmacies have all in the interest of making things "look" seamless to the patient and making the pharmacy/insurance look good. Not MY agenda.

That's a very good point.

Agree with AKbeth. We don't plan on responding to anything from a pharmacy. We have had an ongoing policy in our office that we only respond to patients, not pharmacies. If a patient needs meds or diabetic supplies or nebulizer supplies, then they need to call us....not the supplier. Gosh, if we responded to all the requests we get from 3rd parties to supply stuff to patients, I'm sure the government would have been broke even sooner.

I have to respectfully disagree. I and my staff can handle faxed requests for refills much more easily than phone calls from patients. In fact, when a patient calls in and says they need a refill we tell them to call their pharmacy and have them fax it to us. The faxes can be handled at our convenience. Tied up phone lines are just that...tied up, making other patients angry that they can never get through. Also, when a patient calls for a refill it is very common for them to not really know what it is they need refilled, "I need my bp medicine refilled, you know, the little green one, I can't pronounce it." My staff replies, "What pharmacy?" Patient replies, "Hang on a minute and let me check with Dad and see where he wants it...DAAAAAAAAAAAAAAAAAAD!!!!!!! WHAT PHARMACY??. He says he doesn't care. Send it to Walgreen's on___, no, now he says send it to Rite Aide".

When my patients are running out of meds, it is time that they have an appointment with me. I don't provide more than a 30 day supply when patients "run out of meds". No narcotics. After doing this for years, they kind of have the whole idea now. That is, if they are running out of their prescription meds, it means that they should have set up the appointment they were supposed to have. Others may have a different type of patient but for me, it has been a real fight with patients gaming me for prescription meds without ever being seen. The behavior may in fact be due to this being a rural shortage area and I was the first doc to stay more than a couple years. Initially there were patients who hadn't been in in years who would just call and routinely order any med they wanted to just be called or faxed in. We are not going back to those days. If they didn't need to see a physician, why do they need a prescription? Some physicians may book the next appt when the patient leaves the current one but when we book an appt further than a month away, it is a no show.

I have a pretty good idea if a patient has not been in for a while and will not refill their meds for more than a month. I can check this easily enough in AC when the fax comes in if I am in doubt. Also, once a month I do a database search for all patients not seen in over one year. We then recall them if it is appropriate. We try always to book their next appointment when they leave from their current. I have also learned over the last 22 years that calling patients 24-48 hours prior to their appointment to confirm it has almost eliminated No Shows. Those that are confirmed but then fail to show are charged a No Show fee.

It's fascinating reading these posts. It reminds me that a lot of practicing medicine is like parenting, and that there are "permissive" and "strict" practitioners in both fields. Also, both fields have "experts" who are uninvolved in the actual process who write erudite books and who judge our actions as negligent or not after the fact.

Fortunately, our kids eventually grow up. Sometimes our patients don't.