Home Forums Discussions General Discussion How long does an erx take?

Hi everyone,

How long does an erx take to get to a pharmacy? I thought that it was close to instantaneous.

A pharmacist at a small rural pharmacy just reported that it regularly takes "at least 45 minutes" to get an erx (from anyone, not just us.)

Other experiences?

Thanks.

Gene

From my experience, it's instantaneous. But we deal with mostly large chain pharmacies. (Although we get the "my pharmacy didn't the prescription" all the time.)

I called our pharmacies in the past about this and we are told that sometimes the eRx queues up on the internet and does not download instantaneously. In some cases when the patient reached the pharmacy they were told the rx was not there and then when we called a little later they did have it . Of course one never knows if the person checking for the E Rx is doing a good job !
Bala

Bingo! on your last sentence. We haven't called around to see, but our sense is it is rather quick. In the two to three minute range. Partly is how it is set up. Our most popular pharmacy is a subsidiary of the hospital so the packets go all over the place before hitting the pharmacy.

The biggest issue is what I call the "Power of last authority." I can tell my patient a million times to wait at x-ray until I get on the phone with them and give them the result, but if the tech tells them to go home, 90% of the time they will.

I don't know, but it seems as though the pharmacies just say to them, "your doctor didn't send it," and that is the page I get back even though the patient watched me ePrescribe it. All they have to do is tell the patient some times it takes 15 minutes or so and to take a seat or maybe it got lost in cyberspace.

Of course, if the pharmacist would call us directly instead of making the patient page us, it would be a rather seamless operation.

Yup. One minute for it to get to the pharmacy and 44 for them to find it.
Ok, maybe a little harsh, but how long does it take for you to get an email?

Well, looking at the time of your post (and subtracting my reply time), I would say about 45 seconds.

Several of our most used pharmacies are in large grocery stores. I know from personal experience that invariably she I go to pick up a medication, I am told " It is not here yet; do you have any shopping you need to do while we check on this?" I don't think this coincidental.

This spring I went on-site with a large rural clinic that was implementing AC in the mid-west, and in the process of validating their eRX, validated some suspicions I have about the pharmacy network.

Like so many other things having to do with networks, it is the "last mile" that makes all the difference. Pharmacies like Wally World have solid connectivity, and can see the eRX within seconds. How long it takes to get processed is another variable - YMMV.

Some local pharmacies are still using *gasp* dial-up, and thus the time delay. Local pharmacies are loved for many reasons, but their refills come over non-matching and have to be refused - new script written because they know Robert Jones as 'Bobby', and similar.

My frustrations exactly. Patient are amazed at the eprescribing, that I already sent it while talking with them about the problem, but they are also distrustful of the technology. My last patient today asked if I was going to send it. I said, "I just did while we were talking about your hypertension." They said, "but last time the pharmacist (Walmart)says they didn't get it." I told them that if it isn't there, then have the pharmacist call immediately and I will authorize it.*

Like any low performing flunky, I think employees at these big chains just find it easier to blame the doctor for not sending it, rather than looking on the computer or explaining it may take 15 minutes. I have gotten this from the local hospital: "The doctor never faxed it." Patient says, "But I stood there and watched him fax the order." Then then somehow find it on a machine.


*Incidentally, the patient then asked if is is 'filled' already, have joking as he implied the real delay is with the pharmacist. I told him the technology exists in some offices to send it to a machine and the vending-like apparatus dispenses the pills in a bottle and labels with the information. He commented that then we wouldn't need pharmacists. At this point, I explained the vital functions the pharmacists fulfill, like explaining his BP medication will keep him up all night urinating if he takes in the evening.

My favorite is when a patient asked for us to CALL the pharmacy after we've sent an eRx to make sure they got it because last time the pharm "never received it"... Um, no.

I wonder what the reliability with eRx compared to email. Because email ALWAYS gets there.

We have a 47 inch flat screens that run slides that we constantly change. You know the ideas that come up in a meeting and someone says, let's put that on a sign. NO ONE looks at those 8 1/2 by 11 pieces of paper taped all over the waiting room. But, when they can sit there reading slides or watch Cars, it sinks in more.

The most slides pertain to pharmacies. I sent out over 40 faxes to pharmacies last year with my pager number and cell phone. I nicely tried to get across to them that asking the patient to page me, having me call back the patient, having the patient describe the little green pill and whatever dosage because I forgot, then telling me he is not sure of the number and the pharmacist is busy so I have to look up the number. Finally, I make the call, and the pharmacist picks up the phone.

GUESS WHAT! You had to talk to me by phone anyway! Why not just call my cell phone in the beginning. Same amount of work. In fact if there is a tech, the pharmacist could just say can you get Dr. Arrogant on the phone.

About 8 pharmacists use it.

Do you know what would be cool on the eRx instead of having their number and fax (which is helpful), would be a place where all NewCrop users would put in whatever phone information they wanted. And, in big bold letters, every scrip would say,

"For questions on this script, please call my cell at 555-5555."

I generally find the e-prescribed meds arrive rather quickly at large retail chains. On more than one occasion, I've sent an e-script only to have the pharmacy call the patient's cell phone while I'm still in the room with them.

I have instructed our staff that if a patient calls with some problem at the pharmacy, to have the pharmacy staff call us.

The main issue I usually have is when I ask a patient what pharmacy they want their meds sent to they usually go to the wrong pharmacy to pick it up.

That happened to me for the first time the other day. I was wrapping up the visit and the patient got a call or text from the pharmacy and said they had a refill. I asked, "You need a refill on something else?" And they said, "No, the pharmacy just got the one you sent!"

That is pretty funny. I agree with the staff thing and having the pharmacist call. Unfortunately, after hours is tough.

Here's what kills me that I forgot in my last post. We can't really tell patients what pharmacy to go to or refuse to send a med there. I do tell them stay away from Wal-Mart and Rite Aid.

BUT...I tell them all the time and it is on our slides....You wouldn't go to a supermarket that didn't allow carts or take Mastercard, etc. Why do you allow the pharmacy to push you around. Just tell them, "It isn't my job to call my doctor. You and he/she can work it out. Either you call her or I will walk right out of here and never come back. How many of those do you need before you start losing business? And, I would walk right up to the store manager. Tell her you want to show her something. Point to the pharmacist and tell the manager you would like a picture. Because you want to remember what she looks like and you sure as hell ain't coming back to this store to see him.

I find it interesting that many practices describe delegating tasks to staff that I would never dream of doing (like calling patients to discuss lab results) but then several of you would give your cell phone number to a pharmacy which seems like a guarantee of needless interruption. I go at the prescription thing backwards from you. I never take calls from the pharmacy nor do I respond to refill requests from the pharmacy, but instead have the patient call a staff member to request a refill. The staff member can then determine from the chart if the patient needs to be seen or if it is a legitimate need, then pass it on to me. We have a few pharmacists who like to play doctor, and "suggest" medication substitutions or additions. These have been snuck in as "refill requests" from the pharmacy.

Well, I have to take the other side. Since giving out my cell phone number over a year ago, I have received about 15 calls from the pharmacy. I would much rather take a cell phone call and tell them I meant 400 mg/5mL and not 200. One call, done. It is much more intrusive than having a patient call, then I many times have to call them, then I have to call the pharmacist who doesn't know what the call is for. Just me.

I delegate many things. If a patient have a pregnancy test or an H/H for anemia, and they are normal, I review them and my CMA calls them. The patient will understand quickly that she is not pregnant or that the HB of 14 means she is not anemic. If it is an abnormal lab, then I call them, as there is always that question, "Then what do we do next or how bad is 10.5.

I see your points though.

I have sent a prescription while the patient is in the room, and walked out to the front desk to find the pharmacy on the phone with my staff with a question about that same prescription.
However I find that it is often the same pharmacies that say "we never got the prescription". I once had a pharmacy tell a patient that, and when I called them the employee that picked up the phone happened to be a patient. She looked and told me that the script had actually already been filled and was waiting to be picked up.....

Many times when a pt calls to say the pharmacy doesn't have the Rx, they say "Dr. said she would call it in but the pharmacy doesn't have it." I wonder if they tell the pharm that we "called it in" and the pharmacist didn't see the message in their VM & didn't bother to check eRx. I've asked our doctor to say "sent electronically" and "e-script" and have put up some posters. Maybe this will lessen these types of calls.

Serene,

Often times I will move my wonderfully designed laptop stand and have the patient watch as I e-prescribe their med to the respective pharmacy. I will then tell my patient it may take 45 minutes or more, to allow the pharmacy a chance to do their thing, so if there is a delay, it ain't my fault.

I need make some signs that say this.

@Serene,

We have had that happen especially since pharmacists are used to eRx. Nothing against your post, but the pharmacists really ought to check all three possibilities.


I also think a lot of pharmacies won't fill the script until the patient arrives. I think it depends on the format of the script. Even putting a label on a box of Triamcinolone 0.1% means tearing it off. And, if they don't show up, they have done the extra work.

I think it would be helpful to meet with the pharmacists quarterly to exchange ideas. I am sure they have very similar complaints about us. I have asked my pharmacy friends why all pharmacists won't call my cell phone. Of course, I would never think that some doctors wouldn't like that. In fact, David posted he wouldn't want to give out his cell phone.

I am a firm believer in the "buffer zone". I pay a certain amount for an answering service, to handle after hour calls, and make it abundantly clear when patients use the portal, that it is only for non-emergent messages. The patients are also made aware that the portal will only be utilized by my nurse or myself during working hours.
This goes along with pharmacists, especially the local ones. They have been educated that I will respond immediately if they call the business phone during working hours. But they are not or will ever get my smart phone number, unless I choose to call them from my smart phone.
I think it is just a matter of education and maintaining one's sanity. For me having a "buffer zone" allows the business and personal to stay as separate as possible, and I am of the opinion the telephone portion of my smart phone is personal and the business phone is business, but as I have said before there is more than one way to skin a cat.

We also call back immediately (seconds) if they call the office. That is what we are here for.

My question is if the telephone portion of your smart phone is personal, how do you answer your pages from your patients pertaining to the prescription that didn't get called in?

Bert,

Forgive me if I do not understand your question, but during office hours my nurse would take care of via Updox or business phone..

After hours, I cannot even remember when this came up, but we have 6 physicians that take telephone call after hours, as we are all outpatient FPs or internists. We take telephone call a week at a time and would handle that type of issue either by way of home phone, smart or cell phone or business phone if we are at the office after hours.
Often I will use either my home phone or smart phone, call the answering service and take care of the call this way to avoid having my patients get access to my home or smart phone #. It is an extra step but well worth it to protect my "buffer zone".

Oh my goodness. I'm personally convinced that some pharmacists have an excuse list lined up for any/all questions, the top two being: 1. We never received it & 2. Your doctor won't get back to us. To me, it doesn't matter if it was e-rx'd or faxed, certain pharmacies will always do this (especially mail orders). We ask our pts to tell the pharmacists to contact us directly. End of story. Nine times out ten staff can handle it.

For e-rx it works instantaneously for us, but most people use chains. Usually we get a call immediately if Dr. rx'd something strange (like the directions don't fit the product as the e-rx writer will sometimes glitch when it sends).

We just got our e-rx receiver up a few months ago (it had been down and we had no idea). That actually has made life easier and faster in most instances, though we still sometimes get calls from patients stating that the pharmacist said that our office told them the patient doesn't exist. That seems to be some e-rx error...very annoying. Patients don't like being told they don't exist!

But they are not or will ever get my smart phone number, unless I choose to call them from my smart phone.

You are correct, there is more than one way to skin a cat. I am also confused as my phone shows private number to everyone unless they are programmed into the phone.

So, I guess if I am on call, which is everyday, every hour, every month and I go to a restaurant, I would much rather that a pharmacist (professional) call me and ask about the number of pills, then for a patient to call the service, the service to page me, which is just as much an interruption and then I have to call the pharmacy. So, I don't know why calling the pharmacy is any better than their calling me but it adds the call from the service and then finding and calling the pharmacy.

Generally, when a pharmacist calls me, the pharmacist is the one who needs to speak with me, "Hi Dr. Adams, did you want 30 tablets or 90 tablets on the Klonopin?" I say 90 and it's done. Takes literally 15 seconds. With Blue Tooth in the car, it is also much safer than fumbling around for my pager, looking down illegally at a very small number, and remembering it so I can dial it through the Blue Tooth phone.

I used to do it just this way, but I think the ease of e-script refills is winning me over. It is some extra work for the staff to do a refill request with looking at last date filled, last visit, and so on. I guess it just comes down to preference. Thankfully, either way should catch a pharmacist trying to sneak one in. (This is illegal, right?) The e-script request will say it cannot match to an existing prescription, in which case I would call the patient.

The area of refinement I want to work on most, is making sure patients have a follow up when their scripts are set to run out, and making sure all their scripts are renewing simultaneously for chronic meds. I spend way to much time filling refills. The holy grail for me would be, as described, not having to do any refills because they are all done at a revenue generating appointment.

My bet would be that it is because your office number is in the pharmacy computer, and unless they specifically remember to look elsewhere, they just don't remember to call the cell.

I love this...not ALL pharmacists, but it does fit some to a tee. I think it also explains a lot of the delayed or "we never got it" e-rx's.

If pharmacists are going to be problematic with giving excuses, and you detect a pattern, don't forget you can always stear your patients to a different pharmacy.

In my experience, when the prescriptions don't match, I don't need to call the patient. It's when I write for Zyrtec and the pharmacy correctly changes it to cetirizine. When it is sent for refill, it says Cetirizine 10 mg. Take one daily. #30. And, it is matched against my record of Zyrtec 10 mg.....Since it is always going to be their version unless I change it to Dispense As Written, I click on the med and change them so they match. They will then match each time. Or it can be how they write the sig.

If I call from my home phone directly to a patient, I get the invariable star 82 command in order to complete the call, but then the patient will have my home #, which is what I am trying to avoid.

I recently upgraded from a Droid Bionic to the Samsung Galaxy 4S, which I highly recommend, and do not have call blocking on my plan.

1. I almost never call a patient if they have call anonymous rejection
2. I usually call the service and ask them to ask the caller to turn that off
3. Having said that, I have never had a direct call to my house from a patient
4. The Galaxy S4 is in my opinion the BEST Android phone on the market
5. You should be able to find a free app to block your number
6. It shouldn't take very long to activate that feature, in fact nearly all if not all carriers allow features to be turned on and off from their site unless you don't plan to get it, which then defeats the purpose of using your cell to call patients

A lot has changed with phones. We had rotary dial phones, but even bigger there was no Caller ID, Call Anonymous Rejection, Call Blocking, etc. You just picked up the phone, said hello, and the called identified themselves. Now, I would have to say up to 75% of the population won't answer his or her cell phone unless they recognize the number.

Saw a post on another BB. He used google voice to place a call, but never took s call to that google number ( eg, did not toward the. Google number anywhere),

I admire Bert and others. We could never call a patient from any of Dr.'s personal numbers and not have them blocked. They would call him at all hours for questions that could wait until office hours. They just would. Even though he is the only doctor in the practice. Many of our patients are incredibly demanding and just don't care or respect the doctor's time. Doctor will bend over backwards for patients. It's really frustrating to see.

Then add the pharmacy nonsense on top...*shudder*

I don't know how you guys do it. You couldn't pay me enough money to do this job. I just like being tech support!

Reminds me of a saying from residency:

Two words: Dis--Charge (we were in the South)

Thanks Jill,

Everyone should have a smart phone (which they likely do) and go to the Google Store. The number of apps for Android phones passed iPhone about a week ago. Of course, iPhones are fine as well.

You could get an app that would detect the phone number, and give an auto-message. "Thank you for calling my PERSONAL cell phone instead of my pager. If this is an emergency, please call 911. They don't mind if you have their number. Otherwise, I will answer your non-urgent question at 3 am."

Gosh, How many apps do you need? Once you get over 800,000... maybe a million apps will be enough. The other questions is quality!

Maybe one more. Actually, it allows the programmers to put their apps on the store for free and allow thousands of beta testers and ideas for improving their product.

Once they get extremely popular, they can sell their product for anywhere from 99 cents to $14.99 and likely make quite a bit of money.

The other issue is that it isn't really 800,000 as much as 80,000 if each type of a certain type of app has ten listed. If you want an email app for Exchange, there are about 15, of which only one meets my needs. Touch screen keyboards allow the user about 25 to 30 choices, and you will need all of them to find one that you like.

I am in the same building with the surescripts based local pharmacy that I use most often. Min of 15-20 min, sometimes 45 or more minutes. There are days that they don't get them at all. Cyber Space can take a while. I do't know how this compares to other ERx programs.