Home Forums Discussions General Discussion narcotic e-prescribing

So apparently there is a new law in Florida which says docs must e-prescribe schedule II and III meds such as Adderall, Concerta etc. Does anyone know how I can start doing this on Amazing Charts?

Hi Greg,

We went through this last fall. Maryland is not yet requiring electronic prescribing of controlled substances, Pennsylvania is, and several pharmacies including Walmart and I believe Optum Rx are. So clearly it is necessary.

Set up is something of a nuisance. First, to even get to the right screen is a bit of a challenge. I found 2 ways to do this. There may be a more direct approach, but here is what I know:

1. From Amazing Charts, select View, administrator options, sign in, set eRx, account administration, admin, then finally EPC set up and user guide

2. From any of your patients, or a test patient, open the prescription writer. At the top of the window select e prescribing, then manage via New Crop, then admin, then EPCS set up and user guide.


I found the process tedious and ambiguous. Eventually you have to pay some money, and they will send you a "token" in the mail. I found a could not proceed further immediately,, it took a couple of days for the token to come, then I resumed and the rest of the process went pretty smoothly.

You will have to download the Exostar Authy app to your phone, every time you send EPCS your phone will chirp, you have authorize to allow the prescription to be sent. The window of time to authorize is very short, I am guessing about 15 seconds.

Post again if you have other questions or concerns.

Good luck!

Gene

If you have a smart watch, you can put the token on your watch, and it is quicker to generate a code.

That sounds like so much hassle. Is this really any better than printing, for those of us who still can?

No, it is not.

Thanks! Hopefully this will help with our opioid epidemic.

The initial setup for EPCS via NC can be a bit tedious. NC will walk you through it via remote. I am not sure if this has been answered but once the medication is in AC, you simply use the ePrescribing drop down from the script writer.

I will have to disagree with the above.

Using EPCS, for me at least, is FAR BETTER than using paper. It is quick. It is easy. You know where the patient is getting the medications. You know they can't lose the scripts. You can see that the medication made it to the pharmacy. Just to be clear, you don't need a token and a phone, you can use one or the other. The first token is free so it is good to have that backup and leave it in your office. The meds that you send are clearly displayed on your smartphone.

It is around $125 a year, a small fee for a process that is 10 to 100 times better than printing to a Star Printer.

While we do have a policy that these must be done during office hours, there will be times that the script gets sent to the wrong pharmacy. Or it was the wrong script. When you are home, you can remote in and send it. Otherwise, the patient must wait until Monday.

Just so you know, I have been using EPCS for years now. I wouldn't go back. It is one of the best five improvemetns in ePrescribing.

Not to brag, but I am on the NewCrop advisory board and have direct access to the EPCS brass. If you have questions, please ask. Unfortunately, and I don't mean this as a knock on AC or AC support, but many things that NC could do directly has to go through AC.

I also like EPCS, once you get use to doing it, a few extra steps than regular e-prescribing but I think better for the patient too. They don't have to swing by to pick up the script and I can send it if they are here at the office and by the time they pick it up at the pharmacy, it saves time for them, not having to wait around after showing up with a paper script. Also if I am on vacation I can keep all of the scheduled drugs filled without bothering my partners to write out on paper. All round better from my point of view.

Bert, jimmie - Would you care to share any tips/tricks you've learned since you started e-scribing? My providers are not fans, but it sounds like there are things I can show them to make it a better (or at least less bad) experience.

Among their issues:
- having to go through the motions of sending the RX through AC so it will show up in the patient's med history (in addition to actually sending the RX via NewCrop)
- unable to change the pharmacy via NewCrop
- when replying to an electronic refill request, the patient and medication show up as "unknown" in AC's RX Transaction Log
- having to resend RXs because the pharmacy claims they don't have it. Is there a place I can go to confirm a script was sent and received by the pharmacy?

The med should already be in AC. You always prescribe it in AC as usual. Say oxycodone 5 mg tablets, 1 po q4 hours prn pain. Unfortunately, you would have to close the script writer and open it back up (if you typed it into AC). Chris Conrad is changing that in the next version, so you can save and keep open or close. EVERYTHING in your AC inbox will be in EPCS and anything in current meds in EPCS will be in AC.

So, let's say you prescribed Concerta 54 mg 1 po daily. You would type that in AC prescription writer and get to the point of sending it, but you can't because AC and SureScripts and NewCrop won't let you. It will tell you that.

So, you close to save the med. (Remember once the med is in AC, you won't have to do that). You open AC and select ePrescribing and then Manage Via NC Screens. So instead of clicking on AC to send, you simply click on the top left icon. That will open NewCrop. You will now see a list of meds. They will be the SAME meds as in AC. I have never in three years written a med directly from NC.

Now you choose the oxycodone and click on it. That puts it into the field above (Pending) to be ready to send. You can edit it by clicking on the tab EDIT. You then click on Transmit/Prescirbe. (All this is done by my MA so I don't have to do it). You then click on Push to subscribe and it wants you to use your phone with Authy or your token. This is two-factor identification. You HAVE to have that in any EPCS to send. First is your password into AC, then the 15 second Authy. You simply click on Authy.

It records where it went, what time, what pharmacy, who sent, etc. You don't need to look at that, but it is there if you need it.

Changing the pharmacy for MAs is different than for you. The pharmacies will be listed below the Push to subscribe. There is a pharmacy listed in bold green bar. You can change it several ways. For us if we choose 04412, it will give us all the pharmacies in Bangor. Other ways to search.

Number three is nothing I worry about. The recording of what you sent is in EPCS. It is gold. It is the "bible" Where it says is where it goes. If they say they didn't get it you can send that to NC and they will research it. I just click on send again.

If you send a med it will be in current meds. On the right side of the current meds table there is a magnifying glass. Clicking on that will show you ALL the scripts you sent. It will show the exact scripts. It will show you they received it. It will say it was verified and successful. IF IT SAYS VERIFIED it means the pharmacy received it and clicked on verified.

I AM HAPPY TO GO THROUGH THIS WITH YOU BY REMOTING IN ANY NIGHT OF THE WEEK. WE ARE IN THE SAME TIME ZONE.

If I have to send three scripts of Concerta, which we are allowed to do, 90% of the time the staff sets it up so it is in pending meds. It takes me three clicks to send. I can do a med check in under three minutes.

BY THE WAY, NC HAS THREE TEST PHARMACIES YOU CAN PRACTICE ON. TRUST ME ONCE YOU DO FOUR OR FIVE, YOU WILL LOVE IT. IT IS VERY SIMPLE. THE FIRST TIME YOU DO SOMETHING BY FOLLOWING STEPS, IT SEEMS CRAZY.

Anne-Marie,
If it is a routine refill, say hydrocodone/acetaminophen #60 every month without refills, the med is in the New Crop section by clicking on eprescribing tab upper left portion of script writer, then click the drop down Manage via New Crop Screens, and the medication should be there if not, you are correct you have to use the script writer in AC then after doing will be present in New Crop

You have to add pharmacy by clicking on add pharmacy then search tab and fill in the pharmacy and town (that is usually the quickest) which you then can tap on the pharmacy you choose

After sending the script I print the prescription to updox inbox and my nurse knows I did it and when and where it went for future reference

Hi Anne-Marie,

All of the above advice is right on the nose. Here is the way I look at it:

Go through all the steps to prescribe the controlled medication, through Amazing Charts, as if it were a non controlled prescription. Pick the medicine, quantity, refills if appropriate, and so forth. Then when you actually come to the transmit page, if the pharmacy is listed, just exit and go to New Crop.

If the pharmacy is not listed, then select from the Amazing Charts screen, as you would a non controlled medication. Hit transmit, which of course will fail. Then go to New Crop.

It sounds very cumbersome, but with experience it's really not so bad.

Hope this helps!

Gene

I agree with all of the above. After some practice and a learning curve pretty straightforward. Like Jimmie I also print the confirmation to Updox then import it into the chart under pharmacy just to be sure. The main problem I have is that it does not always record it in AC when hovering over the medication to check the last refill date. Have to use more clicks to go to the New Crops screen.
Just started doing this in December. So far every script I have sent this way has been received by the pharmacy.
I also find this a major problem solver with no longer having to write a "Do not fill until..." prescription when going on vacation. Can easily log in and do them electronically.

As an FYI. I used to print them, but we see 25 ADHD kids a week.

Just want to make sure that everyone knows how to do the same thing within NewCrop. It shows if it is electronic and verified meaning they got it. They have to verify it on their end. If you send them at a future date, you can't do this.

But, it is helpful, because you can see everything. All the meds. When they went. Where they went. Did it get there (right then).

Paper is great too. Just sayin' in case you don't know how to do it.

The other good thing is if the pharmacy says they didn't get and it shows they did, with one click you can write a message like Pharmacy says they didn't get. NC will research it. They will even call the pharmacy and tell them they are idiots. Well, not quite idiots.

Thanks for all the replies... Got my fob from Exostar and will hopefully get EPCS set up today.
For the last week there has been a 15 second lag time pulling up the script writer/ e-prescribing in Amazing Charts. Anyone else having this issue?
Also how difficult is it to set up remote access to AC (for e-prescribing while on vacation)? Currently I can only access AC by going to the office. I used to have a better router with VPN so that I could access from home. Is that the usual method? or is there a cloud option through AC?
Dr Mo

Greg,

I use AC in the Cloud and as long as I have 4g access and a hotspot on my phone, I can access AC in the Cloud with my application Microsoft Remote Desktop for Android. Several of my partners all use AC on local servers at the office and if we lose electricity or internet at the office their remote access applications won't work. But they use team viewer or go to my pc.

Thanks Jimmie. I am on a local server. I will look into the "team viewer" and/or "go to my pc". Thanks for the info

I also use a local server. Used to use "free" Team Viewer to log into my office desktop but they were asking me to pay and it is costly. I now use Google Remote Desktop. Works well for me. The best part - free. I still have Team Viewer installed as a backup access system. I use the fob in the office and the phone app at home for authorizing controlled e-scripts. Less chance of losing the fob.

Thanks for all the tips! I gave them to both providers and it helped tremendously. I think it's like everything else - once you've done it for awhile you get used to it. I do still hope they'll eventually be able to write these through AC though.

Two things: First there is an easy way to go to a database and add a gazillion pharmacies. I believe it is where the nurses get them.

For the narcotics or benzodiazepines, it is only one script, so rather easy for the doctor to do it. For us, we do many, many (like 25 ADHD med checks) a week. We do three of each. If they are on three ADHD meds that is nine. Each one needs to be edited a bit.

During triage, my CMA sets up ALL the controlled substances. Since she has already done BP, HR and weight and taken a quick history, it takes me LITERALLY about 30 seconds to do a med check. Of course, I stay in the room and ask a few questions, but it is simple and easy if the MA preps it. I couldn't do it without that. I check them, but I don't have to click on them from current meds and edit anything and change the pharmacy, etc.

Hi
I am late in Eprescribing narcotics.
I am in Houston ,Texas and now it is mandatory to Eprescribe all scheduled meds.
Can anyone please guide me how to start it in Amazing Charts ?
Thanks

Hi Naila,

NewCrop, the middle-man-woman is kinda clunky but with lucky you can navigate it.

1. Bring up any chart
2. Right click on patient and bring up medications
3. Open ePrescribing (top left)
4. Manage NC screens
5. Click on Admin at top right
6. EPCS Setup and User Guide


or (easier)

1. At main page click CTRL + A
2. Log in to admin
3. Select Set e-Rx
4. Select Account Administration (bottom left)
5. Click on Admin top right
6. Select EPCS Setup and User Guide

It looks clunky, because it is but it works. If you have issues, message back and I can help and talk to NewCrop to hopefully help.

So this is another hassle and another $250.00 or more per year.
This doesn't benefit doctors or patients, doesn't improve safety or security or save time.
I am so over this electronic revolution.
It is time to go back to 4x6 file cards
Medicine really was better in the "old" days, and people's useful life was for the most part just as long.
Of course, people live a little longer than they did in 1975, but most of the gain in time is spent in nursing homes and going to countless specialists and procedures.

Grumpy.

Just two different sides. Been doing medicine for 25 years. This is the single greatest thing they ever came up with. Love it.

Well Bert, I'm glad it works for you.
I'm happy with printing paper Rx's -- we use quarter-sheet 8.5 x 11 prescription paper.
So far Oregon doesn't mandate EPCS.
Sounds like NewCrop might, though -- and some of the big internet pharmacies already do.
We are Borg.

If I had to hear one more person tell me they lost it from the highest row at a football game, then lost another one on the way to get it.... Yes, I said no. But, just hated that call. We printed from a Star Printer, and was all cool, but sending it electronically...

I don't mind telling people I won't replace their "lost" prescriptions.
It helps me assess the seriousness of the patient's commitment to their treatment.
They don't "lose" very many $20 bills.

Newcrop makes sense for practices writing 25 Adderall Rxs per week, but we average about 3 Rx in this category per month. Does Newcrop have an option for practices that rarely use these medicines -- a pay-per-prescription model?

Bump

I am in Dallas and found out at the beginning of the year about the mandate. I did not see any communication from the Texas Medical or Pharmacy Board. Had unhappy patients who could not fill prescriptions. Had to figure out how to apply for a waiver that is good for one year. Tried to subscribe to NC, paid $500 for 2 providers, it has been 4 weeks and no token received. They would not refund the fee even though no token sent and I don't need it for at least a year. The process to get the service started is overly complex and tedious. One of those headaches of practicing these days.

If you send your name in PM, I can talk to a higher up and see if I can help. The process can be a little confusing but by following the NC site and asking them to walk you through it. You don't need the token. Just your smartphone.