Home Forums Discussions General Discussion Features for AC

So, I have some ideas, but I thought I would see what people thought. Generally, I am the only one who wants it.

When you write a script, there are five check boxes that one can check. DEA, NPI, License, DAW and Omit digital signature. One of the main reasons I upgrades was hoping that when you write a new script, you have to check them each time. I was hoping that was a bug. But now, since it continues to be the case, I think it is supposed to be that way. Personally, I would think you would either want the first three to always be checked or not to be checked. Checking them each time, not only takes time, but means at least five patinets coming back to the office on CIIs since the DEA wasn't checked. Once a script is done, they pop up on refills but for most new scripts they don't. We rarely use the last two.

I suppose having a preference would be good.

Next feature. (Please answer the first one also).

Do people use the dropdown for documenting Medical Decision Making?

I was wondering what people thought of the check boxes having to be rechecked each time while writing a script? Is this just a bug? By design?



I was also wondering what people thought about documenting level of complexity.

I don't understand. This thread has over 300 views. There is no right answer. Of the 300, you either don't care if the check boxes stay checked or you do care.

You either do want to put complexity or you don't.

1. Boxes in eRx: I am pretty sure they are remembered from one prescription to the next for me. So of the five, I have "Include DEA on script" checked. It is remembered so I never have to re-check it (except perhaps every few months it somehow is unchecked).

2. The only value that I can see for the "medical decision making" box is to then use the "E and M helper" to help you determine what level of CPT to use for your office visit. I don't use the helper so I do not choose a level of complexity.

I hate those boxes that I seem to have to check on the RX writer every time...I wish that they would stay checked, except for DAW..that would save 3 clicks a script and tenosynovitis and ICD 10 code is.....

Thanks guys. I agree completely with Todd. Jon you are correct, they stay remembered for a particular medication. But, with a new med, you have to check them. I can't see why anyone would want the first three not checked.

Or at least if they want them checked for some scripts, why not all. I can see that some would not want the DEA on there. But, if we don't put it, we get a call on every CII and CIII med.

It's not even the clicks. I never miss them, because ironically, your mouse pointer has to go directly over them. But, my MA (who is 99% perfect) (once she does something wrong) it is every time. All of her methlphenidates, etc. (which I sign off) have no DEA on it.

Don't understand, my prescription DEA and NPI always remain checked, regardless of medication or even before a medication is selected (I am using 8.2.4, build 123). I looked for, but could not find, a place to set these as defaults. I'm not seeing those settings as options in "Administrator Settings" nor under the "Settings" button in the right upper corner of the prescription writer, which opens a "Prescription Preferences" window.

Is there a vote box somewhere that I am missing? Not sure what kind of response you are wanting, Bert. I definitely want those boxes in the prescription writer to remain checked once I set them, except DAW and that one does not seem to hold its setting now.

Regarding level of complexity, is the question "Do I set it?" in which case the answer is yes. I don't have linked billing software. My coding and billing person looks here, although I'm not sure it would show up anywhere other than during an audit(?). I don't think there is any place in the billing software to indicate this setting. I rarely use the Medical Decision Making helper.

Do I want it (level of complexity) to hold its previous setting? In my system, it currently does remember the last setting until the program is closed and re-opened, and I would prefer that it did not.

Don, what I want is for Todd to say it is happening to him and that it affects his work. I am wanting for you to say we are crazy and that it does stick AND that you want them to stick. It is good that for all three of us DAW does not hold its setting.

The complexity does show up in the note if you choose for it to under preferences:



If you forget this setting is on, it will show in all of your notes making them fraudulent if those particular notes are used. It is hard to print the MREs.

The problem, as I have stated for 11 years, is that if you do want to check it off, the location of it coupled with the fact that it is not required like checking off the CPT code, makes it simple to forget it. Worse, once set for one note to High Complexity means the chance of leaving it as the default rather high. Having to check it off would make you have to make a decision.

This would create a problem as many users would not wish to have to check it, just as now you could select not to. My feeling is it should have to be checked or not be there, because there is just no way you are going to select it each time.

As you stated in your last paragraph, you do not want it to stay. But, chances are if it did, it would stay on the wrong setting.

The best way (in my opinion) would be to have it default to low complexity, but be in a position where you have to see it. Then you could choose medium or high and let it default back to the minimum complexity each time. To be honest, I am not really sure the best way to do it, but the way it is now, it is not ideal. I have had multiple acute otitis medias show up as medium complexity because I forgot to change it.

This is why I have these two questions. To discuss a topic that has never been discussed.

If I check "high complexity" on one chart, then go onto another and forget to turn off "high complexity" the program pops up a warning.

It seems like in audits, you have to have the magical words written down. If you say it was complex, they believe you. If you take detailed history and detailed exam, with multiple co-morbidities and have to juggle several possibly dangerous therapeutic options, and you document all that -- but forget to check "high complexity -- you might not pass muster because the complexity is not self-evident to auditors. At least, that's what I have been told.

Hi Tom,

I actually didn't know that. Very cool. However, it doesn't do that with medium complexity, which for something cough conjunctivitis would not be good. Maybe it should say, your last note's complexity was higher than low complexity.

The problem, which would certainly not be looked at the same by everyone, is that it is not only located in a place which I overlook, therefore coding everything low complexity, one is not forced to choose one. Herein lies the problem. As many would not want one more step to sign off a note, it would have to be a preference.

I guess it also depends as you alluded to how much having the code on the note. I know there is a preference as to whether you want the complexity on the printed note.

I know that it has been stated here by one that they don't use the E & M coding chart to help decide a CPT code. However if one did and the higher complexity gave the 99214 or 5, it may be good to document it.

Whoa, Tom... "that is what I have been told" by WHOM?

Personally if you don't use the AC "medical decision maker", I see NO value to checking the complexity box. If you get audited, they want to look at the chart and yes, the level of complexity is part of assessing your level of coding. Why would you think that they would care about a stamp on each note that says "high complexity" when they make that determination? (As opposed to making their own assessment?)

I look at it more like this. First, it is interesting, because our emergency department about a year ago started putting down CPT codes and level of complexities in their notes. Not sure why.

For me, it just reminds me that I can use it in coding. I know this sounds crazy, but maybe the one sign off button could be split into three. For those who don't care, selecting any wouldn't matter and you could have it turned off anyway. But, that would be one way to select one of the three. At least it would make you aware.

One of the things I loved about Logician Internet (and I am sure a bunch of them) was it would code for you. And, if you have a note (like today's viral meningitis) and it coded 99213, you could go back and change it until you got the proper 99214. I don't mean cheat. I mean you know that it should have been 99214. Maybe you should have done more ROS or your PE wasn't 12 things or whatever.

OK, here is another one. And, I KNOW this is stupid. I just want to see if it happens to anyone else. I realize I should figure it out after a while but, so far, I haven't. It used to be that I would put the zip code in ePrescribe as my first filter. It just worked well that way. Most of our area starts with 044, so I would put that in very quickly. Now, the fax number and phone number take up that spot. So, the zip code must go in the box three over. Now, I know that is no big deal, but so far it has been.

For me, if that are were highlighted or you could choose where the cursor defaulted to, it would help me tremendously. I am fully prepared to be shot down, told to suck it up and remember where it goes.

We don't use the medical decision maker - didn't know we have one.

I too wish we could set the Rx boxes the way we want and only change when needed.

The ordering/printing module could use some click reduction work as well

John
FP
Anchorage

Thanks John. I am feeling a lot better about the check boxes. I thought for sure there would be a ton of users who didn't want the DEA on each script. I guess you could go into admin and set three the script the way you want, then have the three buttons unchecked, and you could check to removed the numbers.

You are correct about the ordering. It's funny. I never use the actual tabs. I always use the free-style. Before, I could use the free-style and just print. Now, I have to add. One mre step.

I think the default (when no preferred pharmacy is entered) is for it to bring up a list of pharmacies based on the patient's home zip.
So you should not need to put in the zip code at all.

We have patients include their pharmacy as part of their registration demographics so when I see them, the front desk staff has already entered it.

But my patients do not want to always use their zip code. Many of them prefer the R/A or CVS down the street. What they put in as their registration pharmacy many times does not stay as their pharmacy. Especially if it is Wal-Mart. Once again, we just practice differently. I tend to see 25 patients a day. If one is not chosen, many will choose pharmacies out of the zip code.

So, for me, it is helpful to put the zip code in fast. And, I like being able to put it in quickly.

I have a different problem. I leave the box checked that says Omit Digital Signature (I want to hand sign) but it ONLY uses my digital signature when I occasionally print a narcotic. It does it at just the WRONG time, even though I have it checked to omit that. Of course the patient is waiting, I uncheck the box, recheck it, then print again and it's fine. Any help?

What is wrong with doing both?

I have never checked any of the boxes so I tried it today. I checked the first 3 boxes and sent an Rx on a pt. Then I went into another pt and sent in an Rx for them. The 3 boxes remained checked.

I have never used the medical decision maker.

Bill, please do it twice, three times, ten times. It stays checked for me sometimes as well.

While we are on this topic, it is not only just annoying but mad medicine when you put a note to the pharmacist in the note section. This actually stays for that script. Not just for that patient but for another patient with the same script.

I had one the other day who needed Augmentin, but didn't need to start it until three days later. Worked great. Then I had a patient with pneumonia, and wrote the exact same script, and it showed up. Got a call from the pharmacist.

I've never seen this happen for a different patient. I'll have to try this out and see if it works that way for me.

Well if you can't make it work, you don't know what you're missing.

I can make it happen over and over and over again. I can't make it not happen.

And, make it happen on any computer.

It happens if you use one of the "saved" prescriptions from the pull down list, it defaults to the last one written, including notes to the pharmacist.
It would be much nicer if AC would allow us to save prescription templates with our preferred info.

Greg

This is exactly right.

The note to the pharmacist should NEVER be saved. You can go in the admin section and write a default note if you wish. I don't really mind having the last script saved, because it is obvious if I need to change it or not. But, it is easy to overlook.

Now, I say NEVER. But, it is good for it to keep ADHD written there. So, I guess I can't have both. But, I could write it in the sig or the medication line.

Still checked after turning off the computer for the night and multiple Rxs written today

That's good. I would be happy.

Probably none of my business, but do you really turn off your computers at the end off the day. I think it's a 50/50 thing.

A hyperlink that shows map location of pharmacy Still not the doctors job!! (Corner of "X" and near "Y")

Does anyone know their pharmacy store number even though we stare at this number daily?

Imagine my 80 year old patient knowing this store number

Next to pharmacy name the location (Corner of "X" and near "Y")

Too funny. It is interesting to hear how patients describe their pharmacies. We have two Rite-Aids. They always say, the one across the street from the porn store. Fortunately, one is near and one is farther.

We were just talking yesterday about how many people still ask at the window where their script is; has it been sent over, etc. I'm thinking, yes, I just ask what your pharmacy is in the room because I am fascinated by it.