Home Forums Discussions General Discussion ePrescribe tutorial via Print Instructions (Plan)

I would like to do three things with this post:

• Show an idea I am using currently
• Ask what users think about it in general
• Critique my idea and the writing of it

I have considered signs on the wall to do pretty much the same thing. I have considered just having my receptionist hand them a piece of paper. But, I am trying to incorporate it into my patient handout.

It has been effective. Last week I had no issues while the week before I had five calls about scripts not being there, and two of these were after hours, times I really do not want to be talking to a patient about a medication that should be there soon.

And, as you will see in my verbiage, it does allude to the pharmacist's calling the office. I have had a pharmacist tell me part of the reason they don't call is they don't want to bother me when the ePrescription should arrive soon, but at the same time they are telling the patient it simply is not there. Logistically, when that occurs, (when the ePrescribe gets there in 15 minutes and the patient in 10 minutes), we get a cell phone call back with the patient's telling us we didn't "call" in the script. We then have to call the patient back (given the pharmacy won't take the cell phone from them). Then we are told they are at Rite-Aid in Mexico and we need to look up the number. We then have to call the pharmacy to give the script who then tells us the ePrescribe just arrived. The system is ridiculous as the pharmacist could easily make it a one call does all. I realize they likely get 25 patients saying they should have a script many of them that actually weren't called, faxed or eRxd by the associated physician's office, but still I think this should be part of their job as it gets the job done efficiently: the script gets called in.

The problem is if it is something simple like an ear infection I am adding paper to a paperless office.
____________________________________________________
The actual handout: (note to patient is fictitious as is the patient, Bill)

Bill,

Here is a summary of the plan discussed. Please contact us if you have any further questions or concerns:

You have been diagnosed with pneumonia. This is an infection of the lungs which can be either viral or bacterial. Your doctor has prescribed the antibiotic below to treat your pneumonia. If your fever continues more than a couple of days or you find yourself short of breath, please call the office or go to the emergency department.

PRESCRIBE: Ceftin 500 mg oral tablet, 1 po bid for 10 days, # 20

Your doctor sent your medications to your pharmacy electronically known as ePrescribe. They will likely arrive at your pharmacy within 15 minutes, however it can take 30 minutes or longer.

Make sure to inform your pharmacy your doctor electronically prescribed your medications. Your pharmacist can then let you know if they have arrived.

If you feel you are waiting too long for your prescriptions, please ask your pharmacist to call us. It is more efficient if they call us.
____________________________________
The other huge benefit to this is that the patient actually has documentation of what was prescribed. So, they don't have to say it was an antibiotic and some type of med for cough.

Any suggestions or accolades or thumbs down would be appreciated. Remember, I am sensitive.
_____________________________________
Finally, the most important line is this entire post is:

Make sure you tell your pharmacist your doctor ePrescribed the prescription

I also suppose I could just tell the patient, and, to be honest, I end up talking about it anyway when the patient gives me a blank stare as to why I have just given them a piece of paper. It does, however, force me to explain their plan better so documentation is improved. Now, how do I keep track of who has already received this or do I do it everytime. If I put it in a message or some place it is in the computer's memory, I can search it at some point.

Bert,

This is an excellent idea, since we often have the eRx multiple call issue.

This is still occurring at times, even with our present procedure. After asking the patient for their preferred pharmacy, I have the patient stand at the desk while my MA eRx's the prescription in front of them. The patient is then told, "your prescription was just electronically transmitted to your pharmacy". I guess that there is some sort of delay at SureScripts at times (assuming the speed of light is not different for eRxs), since the patient will call us if the pharmacy gives the "duh" look when they arrive.

One question: do you have templates for multiple conditions & meds, or are you a lightening fast typist of these notes?

Great post. We have the same experience. Whether it is ePrescribe or fax, it is the same thing. Prior to ePrescribe, we faxed everything from the computer. I would ask for the pharmacy, and then spent about 15 seconds faxing it right in front of them and then tell them, "I have faxed your meds to the pharmacy." Forget the pharmacy. 25% of them would still stand at the front desk and tell the receptionist, "Don't I need a script? He told me he was going to use an antibiotic." I feel like saying to them, "Yes, you do, sorry. I just ask you what pharmacy you use for the hell of it."

I have a few templates, but I mostly type. The meds are fortunately automatically inserted. It is nice because it says "transmitted to pharmacy." I am a lightning fast typist, though, especially since I am so confident in the AC spell checker.

A lot of probelms arise because of the fourth principle of thermodynamics.

I call it the Power of Last Authority.

I don't know how many times I have told a patient who is getting an x-ray with an urgent read, "I want you to wait at radiology after the film until I speak with you on the phone. The radiologist will give me the reading of the film. Do NOT leave UNTIL you talk to me.

Then I get the urgent read and ask to speak with the patient, and the tech tells me, "Oh, they went home." This is because the tech told them it was negative.

Same thing with pharmacy. I can tell them over and over I have just sent the prescription to your pharmacy. It will get there. But, when the pharmacy tech tells them it isn't there, they believe him or her and just assume I/We never sent it.

So, the last person they talk to is the one with the right information according to them.

Exactly. I always realized this, but now you've given that phenomenon a name. I have days when getting something done for a patient is like hitting a difficult bank shot in pool. Just hit those bumpers a tiny bit off, and the shot goes wide.

Good analogy. I suppose the acronym would be PLA or POLA.

I like the idea of your template. Currently, we manually type in the pharmacy name, address, and time of transmission after the auto-generated (transmitted to pharmacy). We keep a Notepad window open, type the pharmacy info listed in the TRANSMIT window, and then copy and paste that into the plan.

For example:

PRESCRIBE: Azithromycin 250mg tablets, Take 2 Tablets STAT, then one daily (days 2-5) (transmitted to pharmacy) (Walgreen's Pharmacy, 1234 Anywhere St., Orlando, Fl at 2:34 PM).

If you don't mind, I think we'd like to borrow your template for the printed plans.

Of course. Borrow away.

Depending on the number of pharmacies or at least your most used, you could likely use Shortkeys which would allow you to choose a pharmacy with a key combination, and you could configure it to automatically insert the date and time.

http://www.shortkeys.com/screen.htm

You could add each pharmacy name on the notes section and you're done.

Of course, Leslie is the resident expert.

Is it possible to print a prescription that is a 'copy' and not a valid prescription.
I could then have a cover letter to staple to the copy of the 'copy' script that would have the information about e-rx on it that they could take to the pharmacy.

Then why wouldn't you just print the prescription and forget the e-prescribe? I must be missing something here.

ePrescribe has many advantages, but the main reason is:


MEDICAID

I am with you, Deborah. The only reason really I moved to Eprescribe is because I want to be paid what I have already earned from Medicare. I simply tell patients as I am prescribing that their script should be at the pharmacy within the hour. If not, have the pharmacist call us.

But Deborah was insinuating understandably so that, if you are going to print out the paper, why not print out the script.

A lot of people do not have the dilemma of Mainecare (Medicaid) where it is illegal to print out a script on regular paper, plus it will not be filled.

Unfortunately, the pharmacists here will not call us.

Let me edit this to even show even how stupider the government is. You can have Aetna and I am not allowed to print out a script if they have Mainecare secondary.

We all know how Medicaid patients will change a 10-day course of Pen-VK to 14 days.

I could not survive without e-prescribing!!!!!

I have e-prescribed for 8 yrs on 3 different systems and despite the glitches of some missing rx, it is by far preferable to paper. Our pts are well-versed in the potential electronic delays and will call us themselves if a rx needs to be re-sent.
They understand how to go on-line or by phone to check with their mail order pharmacies to check if e-scripts are received or being processed.

I never print RX. It is easier to hand-write the few controlled substances that still need to be written. I don't understand what the problem is. I just wish Newcrops would record which pharmacy the rx was sent to. I am hoping for that in future upgrades since my prior 2 systems both provided that.

Hi Solodocmom,

Thanks for your post, and I am glad to get feedback from someone with so much experience. I agree that ePrescribing is extremely helpful and will be incredible once controlled substances can be prescibed "without having to go through airport security" to do so.

The two areas I would disagree on are the following:

One is printing controlled scripts. Printing to our TSP800 printer has many advantages over writing scripts FOR US. First, it is legible. Second, each doctor has their own group. My guess is family practitioners have many patients on chronic pain meds while pediatricians have many patient on ADHD meds. It is so much more accurate for us to be able to simply click on Concerta 54 mg as it is written and print it knowing everything will be the same, and we will likely not forget to write ADHD and the actual written number. I generally walk patients up to the front desk and my receptionist always has these scripts off the printer and in between the sliding glass doors backwards after she has looked them over to insure accuracy. 99% of the time I can grab them, check them for accuracy, and sign them and hand them to the patient.

The other advantage is that given the 24 hour rule (which is broken at times), the MA has printed every script and they are waiting to be signed in the morning.

The second one is the "What is the problem?" The problem is my patients have been exposed to ePrescribing for six months and not eight years. Our pharmacists not much longer. Our patients aren't well versed in telling the pharmacies their scripts were eRxd. And, if they call us back, the same script could take just as long if not longer.

So, all I am doing is what you probably need eight years ago. Educating my patients.

Yes , it was definitely an adventure in the beginning. We even had CVS go in and re-educate their pharmacists. We would call the pharmacy and say, "Do you have a computer screen? Now go to your in-box and click it." Then the pharmacist would generally reply, "I see you sent it 7 times!" Our e-prescribing company at the time was IScribe and they took care of the pharmacy education.
The patients were educated by the staff. I would think that in the age of the IPhone that this would be an easier explanation than 8 yrs ago. Remind the patient to give the pharmacy a half hour to receive and prepare rx. Then recommend that the pt call you directly if the rx is not at the pharmacy. Then simply resend it. It is not usually worth the argument with the pharmacist that you already did it, so sending 2 or 3 times may be necessary the first few months your area gets started.

As to controlled substances, we have chronic pain specialists in this area who do a great job of taking care of those patients. I probably only go through 2 paper script pads in an entire year.

Hang in there! It is so worth the initial education of the practice. Every script given is documented, interactions are prevented, patient satisfaction is HIGH!

I would like to second Solodocmom's enthusiasm, as well as one of her wishes. We generally have been very happy with the time saved by erx, and the patients like it. They are impressed by the technology and happy that they can just go by and pick up the prescription without dropping it off first. To me one of the best aspects is reduced duplication; no more writing all the prescriptions and then re-writing to document them in the chart. That is why we do the same as solodocmom and use the program for printing controlled prescriptions.
One of the appropriate goals of EMR's was to reduce errors. This is clearly an area where they achieve that goal.

I do share the wish that the program would document where the prescription went. To do like MMC and re-type that info seems an annoying waste of time, given the technology (though I understand why you do it). Is there really no way to look up this information when we need it? Is it hidden somewhere in those labyrinthian New Crops screens that I am afraid to explore?

You can find out where the Rx went in the NewCrop screens:
1. Open the AC prescription writer window (it doesn't matter which patient).
2. Go to "ePrescribing" (top left), click on "Manage via NewCrop screens".
3. When the NewCrop window opens, choose the "Admin" tab (far right at top).
4. In the next window that opens, click on "Prescriber Reports" (left side of the window).
5. Choose the date range to review for eRxed prescriptions, then click on "Printer Friendly" under the calendars.
6. A report displays with all the eRxs sent on those dates, including the destination pharmacy.

That seems like an easy process. But, thanks John.

I do use the Newcrops screens, mostly to send the mail order refills (MEDCO, Express, Aetna, Caremark). For whatever reason, those mail orders will not work through just the AC. I have also explored the ADMIN section of Newcrops and it will show that I sent a rx but not where I sent it to. This is a great deficit, esp because my prior Pocketscripts (may it rest in peace) did have this ability. In fact, when they stopped providing e-prescribing, we printed out the prior 4-5 yrs of records for the active patients and placed them in the chart. It continues to be an excellent reference.

Catherine
FP
NJ

I hope no one is taking me wrong. WE LOVE EPRESCRIBE. Probably more than most. All I am trying to accomplish and ask for other's opinions is how to handle the situation when patients arrive before the ePrescribe. More and more, given that my best friend is a family practitioner right down the road, I see the differences between FP and Pediatrics. Adam tells me if his patients (average age of 55 or so) get there and there is no script waiting, they just leave and come back the next day. If one of my parents get to the pharmacy with no script and one kid in the car, one on the DS and the 9 month old crying, they aren't happy. And, they are on their cell phone.

There is almost nothing worse during the day than a patient already seen and treated calling back and having to represcribe the medication. And, if the first one didn't get their in 15 minutes, what's to say the second one will. The pharmacy tech SHOULD call the office. But, if not, I think you are better off explaining it should be there in 15 minutes and they should let the pharmacy know this.

I don't understand how writing a controlled script is quicker and more efficient than printing it. Printing is not only faster, it is legible and more accurate, since the med is either be represcribed from the active med list or taken from Surescript's list. And, it is recorded in the chart and script writer and the History. We have yet to finish a script pad in almost five years. The only thing we use a script for is head lice or scabies.

@Jon Catherine doesn't print controlled substances. She states that she hand writes them.

I know the ePrescribe process is different than email. I realize it has to go up to the clouds and to another cloud and back down to the pharmacy. But, is that the best technology can get. We've had email now for over 20 years and even with modems, they got where they were going in a hurry. And, they are extremely consistent. If I send an email to someone, they get it within 30 seconds and usually sooner.

ePrescribe has got to get to that level. The script should be at the pharmacy by the time the patient gets to the parking lot.

Catherine:

See my directions a few posts above. NewCrop does show the Rx, patient, time & date sent, and pharmacy.

Post back if it doesn't work for you.

That is the exact way I pulled it up in admin. When the page comes up it does not show the pharmacy. I shows my name as the destination. Thoughts?

John,

May I recommend using the free version of Camstudio and video your process. It makes a large file but has a good compression ratio when zipped. If you can upload it to a website, then many could benefit from it. If you have no site to upload to, send it to me and I can upload it.

I understand the process. It is just that the report that comes up does not show the pharmacies. It shows my name under the destination. I will contact Newcrops directly to see if they can reset it or direct me otherwise.

Unexpected. I am using 5.029 version of AC, which doesn't allow refill requests within AC, as with the 5.1x versions. Could this be the reason?

I am using 5.0.28. I get the following in column format:

Date
Entered by
Patient
Phone
Drug/SG
Notes (where you could type the pharmacy name {not optimal})
Location (my office, completely useless, pharmacy should be)
Route (fax) (uh....wrong)

Bert,
I suspect that you have described the reason why pediatricians might have more of an issue with unreceived erx's. We have not had much of that.

You are right; I read Catherine's post wrong. Catherine, why would you hand-write the controlled prescriptions when you can use the script writer and then print them (which documents the prescription at the same time)?

Guess it depends on whether your state accepts his format to be OK for tamper-proof paper. We print to special paper, but it is still cheaper or as cheap than an 8 1/2 sheet of paper. When you can print, it is always better, especially from within the program where you have documentation and a history.

John,
Thanks for posting the process; it really is not as onerous as it looks, especially since it is not something we would need to do often.

But...it doesn't work for me either. As Catherine said, the report does not include the pharmacy. I am using 5.028, so I doubt that is the issue. Any ideas? Are you holding out on us (some secret ingredient to the recipe)?

Bert,
Maryland gave up long ago on special forms for medical assistance, and for controlled substances. Not sure how it impacts the trade in illicit prescription drugs, but it sure makes our life easier!

It doesn't seem like a version thing. Once you get into "the worst website I have ever seen" it would be the same for all. All is does have a comments section, it would be useful if you put the name of the pharmacy there.

Jon,

I agree with that. Personally, ssshhh!!! I really don't care much about drug diversion. It's not my problem. I diagnose and treat. After that. I don't have time for it.

It's the old "Those who are doing it right get punished for those who sell the Adderall."

But, then there's the "Can't print a script for Medicaid patients." Now there's a lawsuit waiting to happen. Except you can't sue the government.

That is the silliest law ever devised. Like a Medicaid patient is going to change Triamcinolone from a 15 gram tube to a 30 gram tube.

Now, you tell me. What is going to cause drug diversion more. Not being able to print amoxicillin to non tamper-proof paper or forcing a physician to walk around with a 250 sheet tamper-proof pad. I can guarantee you that the physician is bound to leave that pad behind in a room or a table just like I leave my pens, clipboards, Superbills, etc.

I write the contolled substances because I DO NOT want another printer, nor do I want to buy the special RX paper that fits in the printer. I have done that before and it has been of no benefit. The 3 rx I may have to write in 1 wk does not inconvenience me. I save space in the reception area and rx paper is not left unsupervised, sitting in a printer. The pad remains in my pocket only. Can you tell that I have had staff steal rx and write illegal narcotics? (The police arrested her but the DEA did little and I believe she did no jail time!)No one touches the rx pad in my office but me!

So lets add another layer. Now the patients want me to hand write all of their otc's on rx so that their HSA (health spending accounts) will cover the cost of their allergy pills, etc. So now I pay to have an emr and eprescribe and am forced to hand write baloney. What fun!

This is really spooky...have I suddenly discovered a secret tunnel into the inner workings of NewCrop? I can't explain why we are not seeing the same report.

There is another report that might help in some cases. On the same NewCrop Admin window, you can click on "Pharmacy Communications Log". You will get a long list of prescriptions that were processed as refill requests, sent to you by various pharmacies. This does have the initiating pharmacy's info. However, this doesn't help if your office initiated the eRx, those won't appear.

Sorry everyone.

I have tried everything to change the setting in the ADMIN section but it will not show the destination pharmacy. I am using AC 5.0.29.

One last thing, the hand written rx are scanned into the patients chart and I do input them into the script writer, even though it won't send, so I can see it in the rx record. It used to be simpler, but oh well.

[quote=Bert=Now, you tell me. What is going to cause drug diversion more. Not being able to print amoxicillin to non tamper-proof paper or forcing a physician to walk around with a 250 sheet tamper-proof pad. I can guarantee you that the physician is bound to leave that pad behind in a room or a table just like I leave my pens, clipboards, Superbills, etc.[/quote]

@ SOLODOCMOM I hope you didn't read this as having anything to do with whether you print or handwrite scripts. Sorry if you did. If so, please reread it.

As an aside, we use the locked version of the TSP800, and only I have the key.

OK. Here is what I came up with. Maybe it's right, maybe not. Doesn't completely go along with John.

If you go in any way such as from a patient chart or the main program CTRL + P, you will get to New Crop. Click on Admin and you get to the screen with Reports on the left top corner of the black box.

If you click on Prescriber report, you get a report of every prescription you have ePrescribed WITHOUT the pharmacy name (at least on mine).

If you click on Pharmacy Communications Log, you will get a report WITH the pharmacy, but these scrips are only those that were printed FROM the New Crop site (refills, etc.).

Is that anyone else's experience?

I find that the pharmacy communications log only refers to electronic refill requests that the pharmacy has sent me and what my response was.