Home Forums Discussions General Discussion electronic prescribing problem and EHR incentives

1. Over the last couple of months, I have been unable to e-prescribe certain items that used to go through fine. A couple of examples are Triamcinolone cream, even through it appears on the drop-down menu. And manually-typed items like Aerochamber Spacer get bounced. Why? How can I manually add them to the Surescripts database? Why do I need to?
2. When I look to the prescription history, apparently sometimes the prescription is sent electronically, sometimes by fax, even to the same pharmacy from the same patient for the same drug. Why?
3. Many eRx seem to be arriving at the pharmacy HOURS after they are sent, even when the tracking page says "confirmed". Why?
4. Because of #3 above, I'm getting a lot of calls from patients standing at the prescription counter. AC says I sent the prescription to the right pharmacy, and SureScripts appears to confirm this. When I print it out to fax it, the Meaningful Use counter in AC thinks this is a non-electronic prescription, and I get dinged against my incentive-compliance standards.
5. We will use a fake-patient as a placeholder when I have to leave the office for a meeting ("drwolffeoutofoffice" is the name). But each of these is an 'encounter' without vital signs, smoking history, etc. It will count against me. Any suggestions?
Thanks!!

Regarding #3, I generally have found that it's the pharmacy who really hasn't looked at their faxes and not that it takes AC "hours" to send something (although many times patients have given me the wrong pharmacy).

The few times I had problems, I've told the pharmacies that everyone else doesn't seem to have that problem and that I'll send my patients elsewhere. It's amazing how quickly the prescriptions arrive once you tell them this.

drwolffe,

I am rather raw about eprescribing as I just got my wonderful letter from the department of health and human services informing me of the 1% reduction in the fee schedule. I had not decided to e-prescribe until choosing an electronic health record as it made no sense in my mind and even somewhat dangerous in my opinion to start escribing without and electronic record. With over 300+ choices out there, I was finally able to start escribing in November 2011 after choosing AC.
But it took alot of research and effort to choose the right one, its like getting married, you have to do it right the first time.
I think it is illogical and backwards--if the government wants to penalize do it logically, make the first penalty for not having electronic records, then if a provider chooses not to escribe or do the quality metrics, then penalize them. but to penalize escribing first is just another taxation that is labelled as a penalty.
Furthermore there is a base pharmacy that won't even let me escribe, but yet if I don't get my 40% of escripts, then I will suffer another penalty for this year. So I have a governmental run agency not allowing me to escribe but yet I am the one to suffer the penalty--
So, I don't have any good solutions for you other than to escribe at the time of the encounter and make sure you are coding out your G8553 on every patient you can. I have not had any problem with triamcinolone cream not going through, but have had problems with CVS/caremark from time to time not accepting escripts and then when I fax through updox, i then get a fax from CVS/caremark wanting me to fill out there faxed script--I have chosen only to escribe to CVS/caremark, and if they choose not to accept it I then print up a script and give to patient and tell them they are on their own, but if they want their med I will be happy to deal with another pharmacy that accepts escripts if they can't get their med through CVS/caremark. jimmie

Jimmie, I'm not clear if you are now using Amazing Charts, or if you are using a standalone eprecribing program. Before we got AC I was using Allscripts free (at that time) eprescribing program, and have to say I liked it a lot better than the AC module. Switching over was a non event.. we just stopped using it one day and started using AC. Im guessing by your presence on this board that you are an AC user, but maybe not. If that is the case, I would not worry about the ramifications of using some other eprescribing program if you can get your 1% . I believe this is the easy, non-intrusive, and actually useful part of Meaningful use. Even [b]I[/b] am willing to do it.

David,

Yes I am an AC user, and looked at options of escribing while still with paper charts, and whether right or wrong thought it would be best to adopt the electronic health record before escribing--I had two partners use quest, but after a period of time quest wanted 500 dollars to continue utilizing their format for escribing, and figured I would get the electronic records going then start escribing and soon realized I had run out of time (thinking I had the entire year to escribe and not just till june 30)and realized the penalty is now a reality and no longer theoretical--So I already have above 40% escribing since starting AC--so should hopefully not suffer another penalty. I love escribing I just wish I could escribe without printing scripts of faxing now--I guess the better way to look at it is that I was able to make the right choice with my electronic records, and taking the penalty is a small price to pay in the long run. Its the "penalty" that grovels me. jimmie
jimmie

RE: #5... I don't think the placeholder patient in the schedule counts against anything... unless the chart is for some reason opened and signed each time as an encounter. So, you can leave anything in the schedule, it's just the signed encounters that count. If you aren't sure about the truth of this, another solution is to just delete the holder from the schedule at the end of the day.

My gripes with Erx:
WHY can Walmart send me an electronic refill request for AndroGel... but I can't reply electronically.
This is B.S.

WHY do I have to codify all my meds to send them correctly via ERx, but a pharm asking for a refill doesn't (or at least the codifying isn't standardized)... and I have to be the one to "match" the rx. If it were codified to the same standard on EACH end, this matching BS wouldn't be needed. Such a waste of my time, especially with the slow "reloading" of the refill screen with each "adjustment".

Wow this is all very helpful.

I have not been keeping track of the pharmacies that claim not to have received the prescriptions. I will keep a list and see if there's a pattern. Thanks, Jimmie.

And Jimmie, I too am suspicious about what actually goes on in the pharmacy. I used to fax prescriptions. Despite my fax machine insisting that the fax went through, at least 75%--mysteriously--were claimed by the pharmacy not to have appeared when my patient got there. They explicitly told my patients that I had not done what I said I would do, making me look careless or bad. So I embraced eRx because of its auditable trail. This worked great for a while, but I have gradually experienced pharmacists now claiming that I never sent these, despite the confirmation. I believe that it's just a lie, to shift blame from them to me, and to help them manage their workflow, even if they screw up mine.

There is a middle man, the hub. You are not sending directly to the pharmacy, and your confirmation is not to the pharmacy, but to the hub. I get this same problem with a non-AC e-Rx.

Getting it to the pharmacy it the hub's job. You would like to think of it as instantaneous, but I guess they have bottlenecks as well.

Most of the time my texts on my phone go thru quickly, sometimes not.

Patients might need to be trained to call their pharmacy to verify receipt and filled before going there and wasting an hour sometimes.

Have you talked to support about the matter? I know other users with similar issues that required a fix on AC's end.