Home Forums Discussions Problems eRx and nursing privileges

O.K. Maybe I'm missing something. My M.A. is set up as "nursing privileges" under her name on AC. This is set this way because when she imports documents, it requires that I sign off of them, which I want to do. Unfortunately with eRx, the "Transmit to Pharmacy" button is grayed out when she only has nursing privileges. If I move her to mid-level provider status/medical student, it allows her to eRx but then there are no prompts to have me sign off the imported items.

Is there a way to set her as a nurse who can send the eRx? This sucks.

Well, you only have one choice. You will have to make her two different people. Melissa as the MA who imports, and eMelissa as the MA who prescribes.

She would either have to log in and out to each alter ego or have another computer set up specifically for each or use a virtual machine.

Ahhh...the pleasantries of F.A.P.

Unfortunately that's what I was afraid of. Frustrating. So much for the wonderfulness of eRx. Having her log in and out is just too tedious and silly during a busy clinic. So now, I have essentially made upgrading to v5 completely worthless for me.

We'll just go back to faxing all the prescriptions as it will still let her do that. Completely silly. I should be able to set my nurse up to eRx since she can call the pharmacy or fax a prescription without my direct guidance.

I'm wishing I had v4 back. Is that bad? Surgeons hate change and I especially don't like it if it doesn't make my life easier or more efficient.

Travis,

I would never give up ePrescribe. I have faxed scripts for years now, and it is not even close.

I have to admit I am not even CLOSE to being an expert on ImportedItems. Why not let her send them to a fake provider, and you can sign them at the end of the day?

Is she in one triage area when she does both of these things? Just get a cheap computer and keep another nurse signed in. Or use VM. That is a rather simple and easy solution.

Again, I don't know how important the work flow is with Imported Items, but I wouldn't be sitting her imploring you to stay with ePrescribe if I didn't think it was best for you.

Here I go again. How do I know what is best for you?

For me, eRx is simply a hoop for the HiTech stuff. I prescribe less than 10 meds/week out of my office. That's just not what I do commonly. I rarely do recurring meds either. So the imported items/workflow is much more crucial to what I do. This is where pathology and radiology come through to me so I can review them, call the patients if needed, and proceed with further treatment.

Faxing the meds isn't a big deal.

In the short term, I will have my other front office person be the "eRx girl" and set her privileges as such. She's really my insurance person and scheduler but we'll have to adjust to make this work. We'll just do this when it's convenient and continue to use the fax function for my normal M.A. to use.

Is it just me, but it seems that prescribing meds is only allowed to be done by physicians. No matter how trust-worthy your MA any mistakes will be your responsibility. If you write the scripts, sign them and then have someone fax to the pharmacy there would be no problem.

MAs and nurses call in prescriptions all the time. These are basically done under the authority of the physician. If my MA tells me that so and so has a UTI, and I ask her to prescribe Bactrim DS tablets po bid for 5 days, I have no problem with that.

I also think I have as much chance of an error as she does. And, I wouldn't use the word "allowed" as almost all pharmacies will accept a telephone order from an MA.

I just read an article yesterday entitled, "Physicians need to work to the level of their license." meaning to delegate other tasks.

My MA will refill meds like Mycolog II and Zyrtec, Zantac, etc. I can't be bothered worring about that. I do check them, and I will change it if necessary or say, "We need to see that patient." She doesn't just prescribe meds on her own or call in Vicodin.

Exactly Bert. No meds are to be called in or eRx without my direct knowledge. Not even Zantac. Actually, in my clinic, I've worked so hard at keeping the flow the same as pre-EMR, that I write down the prescription exactly how I want on the superbill and hand it to my M.A. She then has the f/u appt, the meds, the CPT and ICD-9 code all on one sheet.

You actually write a prescription on the Superbill so it can be ePrescribed, faxed or written out as a script? I can see that calling it in wouldn't be redundant.

Just asking.

I have always written the Rx on a script pad. Now, I like the idea of eRx because it records the Rx in the chart. I don't like my staff calling in Rx because they inevitable "forget" to document that they called it in and I have no record of it. My most common Rx is by far and away, narcotics. I like good documentation of those. I like the computer in that it documents the date it was prescribed and the exact medication so I can look it up at any time, any place.

During clinic, I write on the superbill because that's all I have in the room with me and the patient. Works for me.

In your state are you to the point where you can ePrescribe narcotics?

As long as it's not Schedule 2, I have not had a problem. We can call in Lortab or fax Lortab. Not Percocet, Dilaudid, etc although there are instances where Schedule 2s can be faxed (hospice, long term acute care facility, home infusion)

This is faxing. I have yet to actually eRx a narcotic yet to see if it works.

Addendum: I just looked it up and all narcotics can be sent by eRx as of June 2010 in Arkansas. The DEA actually encourages it to cut down on forgery of written prescriptions. Interesting

What I may do is set-up a laptop/computer at the area I usually just grabbed the script pad. Maybe, just maybe, I'll acutally eRx myself if I can set it up adequately. God forbid I have to do it. But I'll only be doing it in clinic. My M.A. will have to do it at other times.

Hmmmm....where did I hear that before.

That's cool if you can ePrescribe narcs. I thought we had to do the two of three thing: Something you know, something you own, something that's you. How stupid. Doesn't that sound like a wedding thing? Something borrowed, something blue, something old, something new.

The rule went into effect but he actual implementation will take a bit longer. From the DEA website:

Q. Why is DEA requiring the use of two-factor authentication credentials?

A. Two-factor authentication (two of the following – something you know, something you have, something you are) protects the practitioner from misuse of his/her credential by insiders as well as protecting him/her from external threats because the practitioner can retain control of a biometric or hard token. Authentication based only on knowledge factors is easily subverted because they can be observed, guessed, or hacked and used without the practitioner’s knowledge.

Q. What two-factor credentials will be acceptable?

A. Under the interim final rule, DEA is allowing the use of two of the following – something you know (a knowledge factor), something you have (a hard token stored separately from the computer being accessed), and something you are (biometric information). The hard token, if used, must be a cryptographic device or a one-time password device that meets Federal Information Processing Standard 140-2 Security Level 1.

Q. What is a hard token?

A. A hard token is a cryptographic key stored on a hardware device (e.g., a PDA, cell phone, smart card, USB drive, one-time password device) rather than on a general purpose computer. A hard token is a tangible, physical object possessed by an individual practitioner.


Greg

That's what I thought. So, those two statements seem to contradict each other.

Personally, I really wish we would get over this diversion thing. It would make it cheaper to practice medicine.

No clue honestly. I call in Lortab all the time. Never tried to prescribe schedule 2s by any other means than a written script

You can put whatever med in ePrescribe you want. So far, it tells us when it can't send it.e.g. error message.

I'm running Beta version of 6. How can I have my MA do refills or update the medication area?

I am not using v6, so I am probably the worse one to answer. But I will try. The place we always made these changes was in Administrative Options --> User Account (Configuration). Edit users from there.

Let me know.

Bert is right. The great thing about v6 is the ability to give your MAs prescribing privileges. v5 doesn't have this ability without making the user a Admin->user config->edit existing user->towards bottom right of screen it allows you to check a box to allow the user to prescribe under your name.

BTW, eRX has always let me send off Lortab through the eRx without yelling at me but we then usually get a call from the pharmacy saying it's a no-no

Yeah, because calling it in or handing a piece of paper to a patient is SO much safer than using a HIPAA compliant ePrescribe.

Exactly. Writing my DEA number on a piece of paper and giving it to the patient has always been a beautiful idea. This whole "sending electronically" is way more corrupt.

And, don't forget accidentally leaving the tamper-proof prescription pad on the desk in the exam room. Studies show that greater than 99% of all patients, when seeing the script pad with DEA#, License number and imprint of the doctor's signature from the last prescription, will return it to the front desk.