Home Forums Discussions Problems Electronic Prescribing Regulation Issues

We are in Oregon and we have recently been informed by first, our local Walgreens and secondly the Oregon Board of Pharmacy that we may no longer prescribe narcotics of any kind electronically. We have been using Surescsripts since it became available through AC and have never had a problem with things such as Darvocet, Vicodan and Tylenol 3 being ordered through the system but now we are being required to submit handwritten signatures only. Since we see a great number of injury patients this is becoming a burden and surely a huge disappointment. Walgreens is claiming the DEA came out with new regulations in November and the Pharmacy Board backs this statement. Our local medical association is dumbfounded as to why they were never notified and the alleged notification remains a rumor at this point as we have yet to receive a copy from anyone. What happened to electronics being the "wave of the future" in the healthcare industry! We use electronic prescribing exclusively and we are very disappointed in this seeming setback. I am interested in hearing from anyone else that may have come up against this.

Christy,

The only thing that I'm aware of is that we are to use tamper proof paper for all scheduled medications UNLESS they are sent electronically or faxed (except Schedule II). It's my understanding that this goes into effect April (delayed from October 1).

Jumpin' Jehosophat! I can't believe it! The government gets involved and contradictions happen, plus things become more cumbersome and costly instead of more streamlined and less expensive. And messed up a good thing! Who'd a' thunk?

What's incredibly stupid about these rules is that it's a lot easier to produce a forged handwritten narcotic script compared to electronic prescription. I can't tell you how many time I have caught people redhanded trying to forge hardcopy prescriptions.... just think how many that have not been caught.

With electronic prescription, there is a electronic trail of where the scripts originate.

In the state of Washington, electronic prescriptions have not taken off because of the rate at which the Board of Pharmacy is approving prescribers, EMR vendors, and pharmacy for e-scripting. At the current rate, it would take hundreds of years to get everyone in Washington approved for e-scripts.

What's even more stupid is that you can (in Indiana at least) call in a script for a narcotic. Providing the DEA number IF it is asked for is easy. It is plainly printed on any old script of mine. This is something I wish we could legislate out. it would also give me further ammunition as to why I will not refill narcotics in the middle of the night or on weekends.

Leslie

OK, Passive-Aggressive comments ahead:

I agree this is ridiculous. There are basically three ways to do a script. Handwritten/printed and signed; faxed/electronic; and called in. I would think that in order the least safest scripts would be:

Called in: I had a nurse call in Vicodin for her kid who seven years old for 90 tablets. The pharmacist never asked her name. No DEA number or anything. Anyone with any bal... could call in a script under my name from a phone booth or cell phone or whereever.

A written script. Please. If I print out a script on AC, how difficult is it to forget my signature when one sees it a hundred times.

Fax/Electronic: Sure, someone could download AC (much too easily if you ask me), enter the demographics from the script they got last week and print out a script and forge my name. Then, they have to send a fax with my fax number on it. Seems a bit difficult to me. I would guess ePrescription is even harder if you have a username and password. And, how hard would it be to give the pharmacies a 16 digit code or something which would be like a Certificate of Authenticity and this same number would print out on the cover sheet or on the script. Change it every three months or so.

So, we have been faxing scripts including Vicodin and Tylenol with codeine with no issues. But, some pharmacies won't even take Lomotil or the above. Do you know why I can fax/write/call in Vicodin and Tylenol with codeine and not hydrocodone and codeine? Because the Tylenol will affect the user's liver so they won't abuse it. Right.

Now, the stupid thing is (here comes the passive-aggressive) thing, we have this incredible family pharmacy which is super progressive and will do things like take Ritalin without a diagnosis on it or a number written out, but will ask you to send it in later. So, they have no problem with Lomotil, or T3s or Vicodins. But, other pharmacies will force me to physically sign them. I just refuse and ask the pharmacist to tell the patient to go to Miller Drug. I know...maybe I am acting childish.

Of course, now you CAN'T write scripts for Medicaid patients. You have to either fax them or write them on tamper proof scripts. It's just stupider and stupider. Don't they realize that requiring providers to carry tamper proof scripts around will increase the chances significantly that the pad will be left on a table or desk?

OK, PLEASE DON'T GET ANGRY WITH ME:

The way I see it, I couldn't care less who gets the narcotics and amphetamines on the street. Why should all of the legal patients be penalized and have to drive twenty miles to the office to pick up Concerta or oxycodone. I say call the stuff in or fax it or send it by carrier pigeon. If the users want to use, they will. I know it probably costs society in the long run, but what does it cost the extra phone calls and patient travel.

Hi Christy,

One other thing about Oregon, and it is a beautiful state. Lived in Tacoma for awhile. But, Oregon is the only state where I nearly got thrown over the hood of my car and beaten for simply trying to pump my own gas. What is the deal with that?

The only thing Oregonians hate more than people who try to fill their own tanks, is Californians. Just be thankful you weren't driving with Calif plates!!

BTW, guess who just hit the top poster list! Anyone want to kiss MY [censored]??

Congratulations, Donna!

(Now you can reply with thanks, and cement your lead; can't remember who I learned that trick from).

Yeah, but who'd you knock off. I can't see from way up here.

Again, thanks Brian, I was wondering where you were today!. And Bert, if Paul wasn't so long-winded and broke up his posts into bunches of little posts, you'd lose your lofty perch! Paul, take notice of this advice, break up into paragraphs pal, you could be Bert, Jr.

Hey, Paul got ahead of me when I took the Not-So-Voluntary-Hiatus from my other job to open up here. After I passed him I never looked back.

Besides, it works both ways. If you are busy reading Paul's long, but very well written and intelligen posts, you can't quite be posting now can you? <G>

My goal is to do what no one else has ever done. More posts than members. LOL

See, you did exactly what I advised Paul to do! I understand your wily ways...

Ahh! A little friendly competition! Let's see who really wants the title! I wonder who will respond first to my useless post on this thread. Anybody placing bets on who it will be?

Well, I'm never one to turn down a bet and a chance to post at the same time.

David, I keep trying to tell everyone:

This is not a race! (286)

Bert,
Congrats on being the first to respond. Does this mean I must share my winnings with you?

No. Probably not. I am too good at responding to "useless posts."



I lived in Tacoma for awhile. How far away are you. Went to PLU then worked at Seattle Children's Hospital for a bit. I absolutely loved Seattle.

Orcas is one of the San Juan Islands. Go 1 1/2 hrs north of Seattle and hang a left onto the ferry. It's an hour ride on the boat to our rock. One of those "work where other people vacation" spots. A bit dark and rainy this time of year but the good days make it all worth it. I have become quite accustomed to island life. No stop lights, no traffic. Makes Seattle look really bad by comparison, even though as far as cities go it is very nice.

Hey,
I used to do Audio work as both a stagehand and as a private contractor. My old Audio company was "Sound Advice" because more than anything else, that's what I had to offer, sound advice. I thought it was kind of catchy. There are others now who I think have hijacked the name. I never did incorporate it or anything.

Now with our weather here, we are very gray for a good part of the year especially the colder months, but that gray comes with a good deal of snow, Lake Effect Snow. How about Nancy and I move out your way and Hook up with you. I can assist with running your place and re-open Sound Advice at the same time...lol. Oh to be out of the rust belt... my poor rioting '98 Grand Cherokee. She was so pretty once, now she looks like Godzilla has been chewing on her rocker panels for lunch.

What any of this has to do with E-Rx's is beyond me, but hey, "is this a uselss enough kind of post to get my post count up like Bert???" Actually I have him just where I want him. He thinks he is kicking my butt, but this leaves me free to not just rush in everytime there is a new thread or reply. Bert does it for me... See, I've got him perfectly trained now.

Here is another cheap post just for the numbers.

Bert= Wayne Greztki; Top Scorer ever (twice as many as Mess), 4 Stanley Cups all with Mess on one team, The Edmonton Oilers. He is Loved and Respected by all. Great Leader and Captain, and now Coach.

Paul= Mark Messier, 2nd Top Scorer ever, with 6 Stanley Cups with Two different teams, 5 w/ Edmonton (1st 4 with Wayne, 1 as Captain after Wayne left for LA), and 1 w/ the NY Rangers, Only man to ever Captain two separate teams to the Stanley Cup...He is loved, Respected or feared by all. Loved by his friends, teammates, and fans, feared by all who had to face him, Respected by all for all the previous reasons just mentioned. Refered to as "the greatest leader of men since Spartacus" (No Joke)

Both played together since the juniors and are best of friends for life. Two great leaders who constantly give back to the communities that they live in. I'm quite content to play Mess to Bert's Wayne.....

Paul

But, we still need a goalie.

I'm quite defensive.
And I think I do a pretty good job guarding between my posts.
Can I join the team?

Don't puck with me.

Well, I WOULD be more defensive than you, except that I am quite OFFENSIVE. And, how did puck make it through the censors.

Bert,
Wayne and Mess were both center icemen, which is a forward position, which is perfect for us because, yes, we are both pretty "offensive". Well put my friend.

Roy,
If you are "really good between the posts" then sure we could certainly use a good goalie.

Perhaps some of our female posters could play on the backline and point as the defensemen, since the ladies seem to be best at "defending the slot". I kid you not, that is what we call that juicy scoring area right infront of the net between the face-off circles.

At the risk of offending everyone now (if I haven't already) here's a little hockey christmas humor:
"Jesus saves, but Moses picks up the rebound in the slot, he shoots and scores!!!

Cheap Post Addition: Sing to the tune of the 12 days of christmas.

On the first day of hockey Glenn Sather gave to me; a chance to play with Wayne Greztky....
On the second day of hockey Bill Friday gave to me, Two Minor Minutes and a chance to play with Wayne Greztky....

One more post to cheaply crank the numbers:

Our dog who is about 50 lbs, and is a mix between a Golden Retriever and a Boarder Collie is named "Greztky". I didn't really want a dog, so I told Nancy if he is going to stay he is going to have to be "The Great One". And he is a strawberry blond, with a pointy nose, a great sense of positioning, and a good personality. It fits... And it was a good addition after "Happy Gilmore" and his dog named "Gordie" after Gordie Howe. Turns our there is another family who's kid goes to the same school mine do and their dog is also named "Greztky". And I thought for a CNY'er I was being so original....

Wow Paul, almost filled in the whole page! Impressive.

We'd love to have you come out, but there is no hockey happening on the island and no public places to go jeeping. You could cross the border and root for the Canucks I suppose.

And just to keep us on track with the thread, you can't do electronic prescribing here because there is only one pharmacy and they won't do it( too expensive for them).

David:

We can't do pure electronic prescribing in my part of Arkansas, either. Too few places have that capability, in my neck of the woods.

I had considered faxing my prescriptions to the pharmacy, as some have suggested, but I think of the times (all too often) when I hand people their prescription, and there is something wrong with it (my fault or their fault). If I faxed the prescription, the error would not be discovered until it was too late.

I like printing off a nice legible prescription from Amazing Charts, handing it to people and allowing them to review the prescription before they leave. This gives them plenty of time to remember an allergy that they forgot about, or some nuance of their prescription plan.

Also, people often tell me they want their prescription sent to one pharmacy, and then go to another. I then get an angry phone call from the patient, wondering where their prescription is! I tell them I faxed it to ABC pharmacy, and they tell me they want it sent to XYZ pharmacy.

I would rather just hand them the prescription, and let them carry it where ever they want.

In summation, I feel like sending people out the door with a printed prescription is actually safer in many ways, and it saves me calls from the pharmacy.

Damn it Brian, sometimes we are as different as President Bush and Hilary Clinton: (these are just my experiences -- not any criticism -- just interesting)

That seems to happen with Concerta but rarely with the others. I almsot never hear back from patients on faxed scripts.

OK, well maybe. I have already done the quote on this one.

OK, I have been faxing scripts directly from the PC for three years now. And, not ONCE has anyone gone to the wrong drug store. Now, the only thing that DOES happen is the pharmacy will call to say I need to do an ACTUAL REAL LIFE signature for Vicodin or T3, and I will get on the phone with the patient and ask them to trek over to a real drug store like Miller Drug. Again, just my experience. The more the better, right?

I would rather just hand them the prescription, and let them carry it where ever they want.

In summation, I feel like sending people out the door with a printed prescription is actually safer in many ways, and it saves me calls from the pharmacy.

I have been faxing scripts for about 2 years and it has worked well up until recently. Apparently when I first started, I was one of the only ones in town doing so. Now every doc in town has gotten onto it and the pharmacy fax machines are usually busy. My fax machine will redial a finite number of times but not indefinitely. So, more and more, my patients get to the pharmacy and the script never made it there. I have discussed this dilema with some of the pharmacy managers but they do not really seem to care.

Leslie

Well, I guess I deserved that. The end of my post made NO sense. I forgot to do the quotes.

I had come on this AM to apologize to Brian. I wasn't intending to say he is wrong. Experiences are experiences. Just giving mine so all the info is out there. Things are different in Maine than in Arkansas.

Leslie,

Here are some ideas:

I am not sure about where you are, but it was Federal law so it should be the same. We HAVE to fax Medicaid scripts, so I fax them. I am certainly not going to call them in or print them on expensive tamper-resistant paper.

You may want to consider sending a letter to the OWNER of the pharmacy and telling her that you are required to fax most scripts and, since you her pharmacy cannot guarantee them to go through, I will have to advise my patients to go elsewhere.

I tell the patients right in the room that the pharmacy they chose will not accept Vicodin or T3 scripts or Lomotil for that matter, and they will need to go to another pharmacy. Eventually, economics will prevail. And, it gives business to the pharmacies which are willing to work with you.

Just some thoughts.

Well, the Oregon Board of Pharmacy finally released the information on their website so we can see the official order. Apparently, the DEA needs to consider the idea of Schedule II narcotics being permissible before they can approve. Never mind it has been done all along. What does this have to do with quality health care! What idiot is thinking an electronic signature is possibly less secure than a handwritten version! I can’t even rant and rave anymore. All the pharmacists are on board now and we remain in hell over this bureaucratic nonsense.

http://www.oregon.gov/Pharmacy/Imports/Memos/DEA_TransmissionSchIII-V.pdf

PS: I live in WA and I buy my gas there. I hate waiting for someone to pump my gas but sometimes it is nice since it does indeed rain almost constantly! I'm sorry to hear that you were accosted over such a small incident. Lord knows what they might of done had you checked your own tire pressure! =D

Basically, the government will just never get it.

And, oh yes, I waited to get back to at least Olympia before checking my tires.

Brian, handwritten Rx have issues too. Alot of patients here in NYC seem to call back and say "I lost my prescription, can you call it in?" After we got tired of this, we began assuming that they had not lost it, but just didn't want to wait at the pharmacy (or make 2 trips). Kind of cynical, but its NYC.

Now, if they lose their Rx, they must come by and pick up a new one--even if its just for ibuprofen. We had some angry patients, and lost a few, but now its been 3-6 months since anyone called in claiming that they lost the Rx. All the get-over artists are pulling this trick on other doctors now.