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I just recently found out about eRx, which is a FREE online prescribing program from ALLSCRIPTS
It is supposed to be permanently free, subsidized by various companies to improve QUALITY.
Sounds to good to be true
Supposedly they can have a custom interface for Amazing Charts. (How much, to be determined).
I did sign up, no risk there. Seems straightforward.
Anyone have any experience with it? Comments?
Potentially could make a nice add on to AC.

I have signed on to eRx from its implementation. Since that time, I am recieving a barrage of e-mail and phone calls asking if I am interested in integrating the eRx component with Allscript's EMR. To me, it seems like a fancy sales gimmick with the stated purpose of "improving patient safety", but with the underlying motive to sell their EMR system.

Also, in our state (Washington), electronic Rx is extremely limited as every vendor, prescriber, and pharmacy must individually and personally present their system to the Board of Pharmacy (which meets quarterly, I believe) and get their approval before implementation. At the rate they are going, it may well be into the next century before we can have electronic billing.

As far as I know, SureScripts with e Crop or somethint like that is the only electronic online prescription service which works or is at least recommended by AmazingCharts. Its cost is $35 monthly which, frankly, is about $25 too much in my opinion.

I could be wrong, but I have not seen any electronic prescription service which fully integrates with AC, i.e. write a script there and have it documented in AC or use a script from AC and send it electronically.

When I looked at many of these admittedly over three years, none of them were very intuitive. My guess is the fastest online script writer is ten times slower than using AC.

The best way, again IMHO, is to have a network fax machine which you can fax to from each desktop. Then you can send 1,000 scripts a month for free.

What is everybody's experience with the large mailorder pharmacies, especially the ones that are contracted with the big carriers to do there Rx's in bulk. We are just sick of these bozos.

I swear that they have a shredder right under the fax machine so as soon as the fax comes in, it can simply slip right into the shreddder. I can't count the number of times we get call from patients who call to complain that the mailorder place never got their Rx, and we know we sent it. We log each and ever fax we send in a good hand written log because these guys and the specialists around here lose our faxes all the time. "Gee that's strange because we sent it to you two days ago. You better go back and check your fax machine and desk again..." I love being able to say that. Frequently we have sent these 3 or 4 times!!! No Joke here. What a waste of our staff time and resources.

I'm just not sure that using a direct digital fax will help much because all these other folks are still so piss poor about controlling their end of the food chain. Unbelievable. I'd love to hear how these places are treating other offices around the country.... Have a good night.
Paul

I haven't had any issues with the local pharmacies and digital faxes. On the one occasion per twenty days or so, they can't find it. The only think that irks me is that they tell the patient, "they never sent anything," rather than, "We don't have the fax, but maybe we lost it. I'll call them right now." I can't count how many times a patient has gone home to call us or come by the office, and I am like, "Why the hell didn't you have the pharmacist call?" Sometimes they will say the pharmacist told them that isn't his or her job. Then, I have to tell the patient well tell them they are out of a job on your prescriptions, go to another pharmacy and write a letter to the owner of the pharmacy telling them why. Or stand write in the front of the HIPAA line and refuse to leave until they call us.

But, I always print out the mail order scripts.

Hi Folks,

No matter how well integrated a web prescribing system is to Amazing Charts, it's STILL a system with a bag on the side (tech speak for a kludgy design). ANY e-prescribing system has to SAVE YOU TIME AND HEADACHES or it's not worth talking about. I've yet to find one that lets me write a prescription either faster than I can write it, or faster than I can bang one out from within Amazing Charts. The fact that they're giving us this mess for FREE doesn't make it a bargain.

The mail order places drive me NUTS - and I won't talk to them. They have clerks call, ask for the doctor, then after they're SURE that the doctor isn't wasting THEIR time (ie, right doc, right patient, etc) they then put the DOCTOR on hold - often for up to ten minutes - to wait for a pharmacist. Both times this happened, once I got a pharmacist on the phone I RIPPED HIS THROAT OUT (verbally, of course). I no longer hold for mail order pharmacists.

Have a great weekend, folks.

V.

Hockey, don't get me started on the specialist's staff and faxes of referrals. I've had it with the lazy people. The want us to do our job and theirs too--2-4 times! Patients call them and ask if the PCP sent their referral. The staff says "no, not here" but of course we did. Sometimes they throw it away because the patient isnt established with them yet so there isnt a chart (duh). Usually, they are to lazy to look. The patient calls us back claiming the referral wasnt sent. They want us to send it again. One patient went through this and actually appologized to us when she finnally saw the specialist because he thought she had been repeatedly not showing up for her first appointment. Had 4 referrals in her new chart-- all the same one!

If the referral is electronically done online, I refuse to fax it. I insist that if the patient didn't want to wait for the referral to be processed or lost it, then the specialist needs to go online at the insurance company's website and print it out. I will give the the "referral number". I've had them tell me they dont have internet access. I say 'how about the IVR--voice system. Just call and get the automated voice referral system."

We've had the same problem with referral specialists. The one I love the most is when we fax records - frequently more than once for the same visit - and get a call from their office saysing "Mr. Jones is here for his appointment and we haven't received his records yet. If we don't have them in the next five minutes we're going to send him away unseen". So the girls drop everything, fax them AGAIN - only to get a phone call saying "No, the OTHER records.. we HAVE these". Um WHAT OTHER RECORDS????? Then I get a really SNOTTY consult letter basically saying "I saw your patient for his elevated liver enzymes and elevated bilirubin.. not sure what you wanted me to do for him.. call me if he doesn't get better"

It's getting out of hand.

V.

Vinny,
Our specialty community is mostly without any competition. Only 1 urology group, 1 cardiology group, 1 nephrology group, 1 endocrinology group, 1 gastroenterology group, most of it owned by the hospital. As such, the attitude appears to be "take it our leave it." Each group has this poorly drafted "referral intake form" that must be filled out. So my staff has to get information from AC and HANDWRITE it on the the referral form. If I don't do this, my patients will not get specialty consultation. The AC generated referral form (which has all the fields required) gets thrown away! Now if they do get an appointment, the initial visit is with a physician's assistant who would send back a referral letter with something profoundly inane that adds nothing to the patient's care.
As a consequence, many of my patient prefer to get better service and are willing to drive 150 miles to Seattle.

I don't understand how hospitals can be exempt from anti-trust (as they have "integrated" our medical community with the exception of the FQHCs).

We do have the advantage of having lots of specialists in NYC so we do have the option of sending them elsewhere.

My worst story on this-- a dermatologist. We'd sent several other patients to him, and he seemed pretty good. Patients loved him anyway. Well, one of our patients had a new "strange mole" on her face and wanted it checked out. Did the electronic referral and gave it to her. Now, she forgot to take it with her to her appointment. Her appointment happened to be on a minor holiday and we were closed (one of those 3-day weekends though). They refused to see her. Would not log onto the insurance website and download the referral. Would not call the insurance company's Interactive Voice System to confirm the referral.

When we spoke w/ her the next day, we sent her someone further away but who saw her immediatley once I explained the situation. TURNED OUT SHE ACTUALLY HAD A SKIN CANCER!!!!!! At least it was caught early and she's ok now.

CAREMARK, EXPRESS SCRIPTS, and MEDCO apparently use the same sixth graders to process their incoming mail and faxes. I will get multiple faxes regarding "clarification" of prescriptions. They fax a copy of my prescription which is still completely legible and accurate after being RE-faxed. Now, I print out the prescription and give to the patient to mail. I have gotten less questions from these mail order companies when I leave it to the patient to complete. They also see how frustrating it is. I only write for 3 months with no refills.

Most of these patients require regular evaluation, but if they get a years worth of prescriptions, they MIGHT return in a year. I tell all that RENEWALS will only be done at follow up office visit. If they call for renewals, they will get seven days sent to the pharmacy of their choosing. Once they pay full copays for a weeks worth of medication, they are usually more compliant with the evaluation and treatment plan we agree upon at their office visit.

Practically all other prescriptions are sent through the network fax while I am with the patient. I have the dialing sound set high so we both can hear the fax dial from the exam rooms. Local pharmacies can no longer tell them "Go home and call your doctor, he didn't send a prescription, again."

I love the patients who call for medications, haven't been seen in years, but tell my staff that "The doctor always calls this in for me." I did not spend years training and countless thousands of dollars of debt to be their free prescription refill service. You know that if they had a medication reaction, they'd be "calling my lawyer."

Besides, very often these patients require medication adjustments, and if they just received a 3 month refill I catch hell for changing dosage or medication and wasting their money. (My time apparently has no value). My staff has better things to do than babysit non-compliant patients.

Today I am looking into iScribe, mostly because MY prescription plan uses it.

How many out there like to "Call my lawyer."? At $350 per hour from the time they pick up the phone....

Wow, someone must have touched a nerve.....

Gee Bill, are we exchanging patients? I could have sworn those same folks are with us in NYC.

We've been working with a service called RelayHealth for basic website/secure messaging/online office visit capability. They have an eRx package that is really quick and easy to use. I've read comments about the Surescripts inteface not being user friendly + you still have to input the Rx into AC separately. Well, with the RelayHealh one, you'd still have to input it into AC separately, but it is VERY user friendly. I think Jon should look into a robust interface with the RelayHealth service.

We have a few asthma patients that just want their resue inhaller refills without visits or proper control. Got one right now as a matter of fact. Nancy wants this guy to get in and give us a visit and a spirometry but he hasn't returned our calls. Yeah, now we're your mother too, right? "Honey have you called your doctor about your asthma issues???" So we are trying to hold the refill "hostage" to get this guy to come in, but with asthma you're always a bit concerned to hold out because they might actually need it one night... People are just so messed up and manipulative. It just blows my mind sometimes the behavior I see in this office.

Paul:

Those folks get one more refill and a speech: either they come by the clinic and get the test, etc, or they need to find another doctor 'cuz they're obviously not interested in the kind of medicine I practice. I document that, and stick to it.

Hey Paul,

This guy is a problem waiting to happen. If his use of his rescue inhaler is increasing, and he's not taking his preventive meds as prescribed, he's a liability waiting to happen. If he IS taking his other meds, they need adjusting. We would hold his rescue inhaler hostage, and if he's not in good control we'd adjust his medication. If he's not compliant, after attempting to educate him on the nature of asthma, dismiss him.

Regards,

V.

... and heck, there's always Primatine Mist in the OTC section of the local pharmacy.

V

Yeah,
Our MA has two calls into this guy and we are trying to hold out on the Rx to "assist" with compliance with the docs wishes. Unbelievable how some people behave. Please treat me my way, not your more appropriate clinical way. In a way I can avoid co-pays, office visits and time off from work no less the tests you need to monitor me and take good care of me. He did try and get out of it even more, in an attempt to cut the doc off at the pass so to speak because he "reported" that the new treatment seems to helping. Yeah sure, that is why you are still needing so much of your rescue inhaller, right?

But this type of non-compliance is our fault right? I think that our fees should be cut by 20% across the board for every patient we see under his carrier because we are failing him so badly. This is our fault, didn't you know that. I just love P4P. It puts the responsibility for such things squarely where it belongs. Oh and we were trying to get generic Welbutrin 150 XL filled for a smoking patient to assist her in quitting. Not Chantex or even Name brand Welbutrin. Our all caring and easy on the doctors Excellus BC/BS denied that and wanted a prior auth on it!!! This is our fault too I would guess. Simply AMAZING!

See this weeks JAMA.. according to them, it's OUR fault because we don't apply "evidence based medicine" at EVERY visit with EVERY patient. Um.. yeah.. THAT's why he won't come in.. Oh, that and if we just have more computers... yeah, that's the ticket.

Two years ago I would have wasted three hours writing a long rebuttal to this BS article.. but I'm now that I'm old and tired, I just threw the thing away.

<sigh> Nice to know that no matter what our patients do, it's OUR fault. Heck, JAMA says so, right? Someday, hopefully someday soon, can we take back our profession? Pretty please?

V.

Sorry Vinny,
You and our friends lost control of your profession a long time ago between the f'ing gov't (especially here in NYS) and the carriers with their managed care, HMO's and P4P. If you don't believe me if and when this nice guy Michael from some downstate law firm (yeah a lawyer who cares about doctors, works with MSSNY) comes thru your part of town you've got to hear him talk about the new office based surgery center laws that are coming. He speaks to local county medical societies on request or something. I gather he hits the Albany area as much if not more than Syracuse. Thank goodness we don't go past locals here in our office. This thing is unreal.

Now granted as always there were a few really bad cases that then lead to the gov't doing what as he put, it does best..."Over reacts", right? This is another form of they have the right to come on in and look at anything and anywhere any time they darn well please. What I really found most disturbing was that the law actually has set "standards of care" in it. So like if you did something different, like because the newest research shows that what you did should now be common standard, TOUGH CHITT, you still have to do what is in the f'ing law!!! I kid you not. So now our state legislature is practicing medicine without a license! Isn't that a crime that we should all sue them for??? How about I go out as a college grad with a BA in Pysch and just start practicing medicine, just as they do, without a license, a degree (MD or DO that is) and a ACGME approved residency. What's good for the goose, right?

I could be the next great 1 800-MD1 Tush. You think I joke. This un-licenced hack was advertising in plain site all over NYC, in the papers, on TV, and on the subways especially. He was 1 800 MD1 Tush. He butchered people with plastic surgury for years. Got caught (sort of) ran off and then opened another practice across the river in NJ for a while until someone over there got wise. Then and only then did he finally get busted for real.

But if you think that you are ever getting back control over your profession or practice in these days of Vaccine registries and CHITT certified spy portals for the the gov't and the carriers to have un-controled access to yours and your patients medical records, you are sadly mistaken. Perhaps only if you go completely off the grid...No insurance what so ever so nobody has those god awful contracts and conditions over you. Stay off the HIPAA and the Insurance carriers radar completely and you might stand half a chance.

So did you ever figure out if the patients can request to not have their children's data submitted to the registry. I certainly don't want my two kids in there. My kids doc is one of the finest and most respected docs in our area. She is awesome and I know that my kids are up to date and she can tell the school such if and when they need to know from time to time. How long until school nurses, principles and other staff will have access to this database so they can "confirm that the children are all up on their shots". And don't tell me this is not a way for the gov't to spy on each and every doc who see kids in this state. Perhaps as many of us who can should stop taking new pediatric patients, families established or not, so we don't have to comply with this stupid invassive law. Leave Bert with all the paperwork, right Bert??? There are already FP's in our area who limit kids by age or amount. Less expensive vaccines to stock that we get ripped off on anyway. Just ties up thousands of dollars of working capital that we are at risk of loosing in a power outage anyway. Let the stupid carriers put the stuff in my fridge and let them try and get it at the prices they claim.

We haven't gotten JAMA in awhile now because we haven't paid Nancy's local, state or AMA dues with the county country club. What a rip, the dues for a $10 an hour starving PCP in solo practice should be the same as some $300K and above specialist that requires referals even when the patients have PPO and other go where they want type plans so they can make a lousy extra $10-$20 bucks on the office visit because now it's a consult instead of a standard OV! What bullCHITT. We just lost just about the same amount of money doing their lousy "consult referal" so these rich disresectful SOB's can then pocket the same. Go Fish!!!

Anyway, I'm still fighting a cold and feeling pretty low. let me back-up and pack-up my friend. Thanks for all you do.
Paul