Home Forums Discussions Problems Prescribing problems

Hi everyone,

The shout box has a few posts, ACZ and Chris, alluding to problems with prescribing. I been noticing a few very unusual things, very intermittent, for the last month or so. No pattern at all.

Medications which should be active will occasionally appear as inactivated.

When using NewCrop to eprescribe a single controlled substance, one or more noncontrolled prescriptions are listed as having been prescribed at the same time.

When responding to electronic refill requests, occasionally the proper prescription is sent to the pharmacy, but Amazing Charts records that as a different prescription.

All of the above are infrequent, but obviously have the potential for problems.

As mentioned, absolutely no pattern that I am able to detect.

Anyone else?

Thanks

Gene

Gene, I have posted in other threads about the problems with AC prescribing. I wish ACZ would comment as well. I have had all of the same problems you have. My suspicion is that most on the boards or using AC do not do their own refills and med reconciliation. This would mean that an MA or Nurse in the office is doing the refills and med rec so that the provider never knows there is a problem. I do ally own refills and most med recs.

One issue that you did list is that ecrop doesn't seem to keep the UOM from AC or itself. I am constantly having to go back in and put Tablet, cpsule whatever, it overly time consuming but I hate having to do something over that I know I have done before. opefully Mark or someone from AC can schime in on this thread.

The codify issue s one of the worst problems I have found.

The making a med inactive seems to happen after an electronic refill has been sent. These used to be very rare but seems to be happening more often in the recent version of AC. We are on 11.1.4

AC tech support (Matt) has spent a long time trying to correct the PMP issue. He has been working with me and Bamboo Health (they apparently run the PMP stuff for the state). Bamboo Health emailed us stating they had fixed the issue but it isn't. The problem is when I look up the prescription monitoring from AC all I get is the first page and the statement about using google analytics. I just tried it today and did get a little more but still not the same report as if I go to the actual state site. Goign to the state site is doable but more time consuming.

Will try to post more as I find them in hopes other chime in and we can get these issues fixed.

I haven't had any of those problems. I do think AC needs one full time coder to work only on the ePrescribe. It generally works well but there are some workflow issues (obviously everyone has their own workflow) but options would be good.

I wonder if the inactive meds have to be brought over when you first open the script writer.

_________

I just know that I would up my support fee $1,000 gram if one thing could be added besides PMP doesn't seem to work. If AC, unlike NewCrop, (which changed its rules a year ago) allows sending multiple ADHD scripts at one time, I will up my support payment myself or make a donation. No single change in AC or NC or SureScripts has affected the number of hours per week and errors per month than NC only allowing one script of a particular script at a time.

I have had the same intermittent problem with prescriptions that I did not plan to send being listed as sent along with controlled drugs. I than have to go back and modify that they were not actually sent so that when patients call for refills they are not told that refill were sent last month, for example.
A pain and time consuming.
No particular pattern.
It is a pain having to recodify medications that were already codified.
I have been wondering why some drugs suddenly appeared to be inactive. Thought I (or a nurse) was doing something wrong. After reading this thread I see the problem lies somewhere else in the system.
Frustrating, like I have extra time to spend after trying to meet all of these charting requirements in order to get paid...
Theo

"I have been wondering why some drugs suddenly appeared to be inactive. Thought I (or a nurse) was doing something wrong. After reading this thread I see the problem lies somewhere else in the system." This has happened for years, used to happen to the other provider in the office more than me so I always joked about it with her because she will hit buttons over and over until she locks something up. NOW it is happening to me more.

Went to do refills this morning and a pt I prescribed Farxiga for on 3/7/22, did not put in "Days Supply" or "Course" days but the med is inactivated. NO ONE HAS TOUCHED THIS CHART IN A MONTH!!!! I had to open the chart and review and reactive the med before I was able to send.

This is an aside, but I am glad you brought it up. I think I forgot about this.

If you write "Days supply" or "course" (which seems redudant -- tell me if I am wrong), is that what it uses to automatically move a med such as amoxicillin for 10 days over to inactive?

Thanks.

Hi Everyone.

I have checked with our support lead and they are aware of some of these issues. The "prescribe a controlled and other prescriptions look like they are being sent as well" issue is one they are very aware of and are actively working with NewCrop to fix.

For medications being uncodified, we would need specific examples of medications you have seen do this.

For the drugs becoming inactive, I have seen this happen when someone uses the "Course" field when writing a prescription. This field is designed to inactivate a medication after the number of days entered into that field. So if you enter 30 in the course field, then on the 31st day the medication will automatically be inactivated. It was designed to use for limited run, non-refillable medications like Amoxicillin. Now, this may not be the case with you (which in that case we would need examples again), but it seems to be the likely candidate in that scenario.

The "Course" field will inactivate a medication automatically after X days (whatever you put in that field). "Days Supply" just lists a days supply on the script and has no other functionality (I believe this was one of those required functions for the ERX certification).

Hi Mark,

Thanks for the update. Is this beta ready to be used. I guess that is a stupid question. Is it on the portal now. If I can prescribe three ADHD meds of the same strength and amount, I would gladly put up with ten other bugs.

Thanks Mark for chiming in and letting tech support know.

I promise you I am not putting a number a space or anything else in the "course" or "days supply" blocks. I gave an example medication above. The Farxiga was prescribed 32 days ago and nothing was marked. Electronic refill request came in and the medication was no longer active in the chart.

Alprazolam is a medication that routinely goes from being active to needs to be codified.

All of the controlled meds are missing the UOM even after resetting them several times.

I have some VERY good news for you, Bert. I just had Anthony test this in the new V11.2 Beta and you CAN do this. The only thing is the fill date for each med needs to be different. So if you prescribe Adderall on 4/8/2022, the next prescription needs to have an"earliest fill date" of 5/7/2022 (30 days out).

Oh, and you will no longer be doing it from the NewCrop screens. It will all be done from within Amazing Charts.

So does version 11.2 get rid of NewCrop for all controlled meds?

Sorry Bert but I don't want 10 more bugs just for the prescribing of ADD meds! I don't want any more bugs period. The CODIFY thing is enough to drive a person mad.........

Yes, you will no longer have to go to NewCrop to prescribe any controlled substances. It will all be done from within the Amazing Charts script writer. There is still a 2 factor authentication that needs to be done (that is a requirement), but it is all on one screen now.

Also, they reordered the UOM to have the common ones on the top of the list. I believe that was a feature request that came directly from the userboard.

THANK YOU!!! Hopefully this will help.

Found another med with the codify problem, Lorazepam.

This is a great thread. First, Mark you are the best. So helpful to have you on here.

It's funny, because I have noticed a few codify problems, but not enough for me to even complain about it, and I have won the Top Complainer award nine years in a row now, lol.

I do see where number of days could be helpful, because MaineCare (Medicaid) requires 90 days of every script. So, if the amount of millimliters is 1200 for the month, you specify 3600. It's just the opposite with new ADHD scripts. There you can ONLY do 15 days of any new script. So, that makes sense. Because with so many different ADHD meds, there is a somewhat decent chance that the drug and strength will be wrong. But, man if I write for 90 days of Zyrtec and switch to Claritin in a week, they are out 11 weeks and not 3 weeks.

I work with NC. Not for but with them. I give them feedback on certain things. One was when they stopped the ability of three months at a time. I was livid. Couldn't talk with the developers. The person I work directly with said "I knew you were going to be pissed." I told her right up that if we have a chance to change to Allscripts or whatever, I was out of there. Stupid!

Sorry guys. I just brought on 10 more bugs. But, hey Mark, that ability alone if I see six med checks in a day saves me 45 minutes and at least two errors.

It's funny you bring up the don't fill before a certain date thing. A LOT of pharmacies will let you write 1 of 3, 2 of 3, and 3 of 3. The only one that doesn't is Hannaford, and they lost around 25 patients right off the bat.

Another stupid thing. And, I don't mind things that make sense, but why is it you can write 5 refills of benzos (we do two), no refills and only one month at a time on opioids but can send three (or more actually) if they fill them all within 90 days, but I can't write for 2 refills which would make WAY more sense.

I love when you send a 30 days supply of Concerta to Pharmacy A. They have only 10 pills. Why in god's name they cannot write in the computer that they owe the patient 20 pills (since it was their fault to begin with) is beyond me. No, we have to spend another five minutes or whatever sending in another script.

This is good. I am well on my way to winning the "Most Complaining" award.

Oh, and Mark. Listening to us and moving -- I am guessing tablet -- or letting us select it to the top makes complete sense. But, it should have some AI feature where if it is a liquid or suspension, it enters milliliters and if it is Prozac capsules, it enters capsules.

@ChrisFNP -- I have never lost a UOM on any script. Strange how it can be different. But, I would rather that bug than the log into AC and "pooofff!!" gone. Just gone. And, you have to do a full repair.

Another interesting thing that I hope AC doesn't do with the new script writer. Don't have AI for the Pharmacy note. You have to click on DAW for Brand Name Medically Necessary and not in the note to the pharmacist. If you write Brand Nam.... it immediately scolds you and won't allow the script. So people write BND name instead because NC hasn't gotten that good yet.

I think Chris Conrad is looking into this option. We had a short discussion about it. It all has to do with the information we get on the back end. If the UOM information is there in some form, then it is possible to come up with a mapping for it. The big problem comes if it is not there, Then it is almost impossible to do a mapping.

Add Tramadol to the need to RECODIFY list. Here is what happened, electronic refill received on Friday, sent in prescription, pharmacy says they never got it, pt called this morning to ask us to refill, go to resend and this medication is now in italics. Did the CODIFY thing, and resent. I checked it after re-sending through Ecrop and it did not go back to italics.

The only pattern see is that when we do electronic EPCS that comes in as an electronic refill request from the pharmacy then some meds are going to italics and have the recodify issue.

HERE's a fun one:

Qsymia 3.75mg put in via Amazing charts, QTY15 UOM: Tablet, precribe

Qsymia 7.5mg QTY 30 UOM: Tablet, prescribe

this is a controlled so won't go through with just AC; Move to EPCS

Highlight Qsymia 3.75mg tablet which is now showing to be not specified but the Quantity is correct,

Qsymia 7.5mg tablet has been changed to milliliter but the quantity is still 30!

HOW IN THE HECK DOES THIS HAPPEN??????????

OK, let me explain how it happens, lol:

I write a sig:

1 tablet po bid for 10 days
I then tab to the next field and the sig looks like the following:

Yes, blank. So, I type it again:
1 tablet po bid for 10 days, and it looks like the following:

So, I type it again. This time I barely move the mouse, sneaking up on the sig field (literally) and highlight it and and hit CTRL + C. You know it has never disappeared after I have copied it.

Move forward: I open AC. I type in my username and password and hit enter. Gone. Just not there.

These are things that do not happen to anyone else. Especially the disappearing sig.
_________________________

Now move on to Chris. You have these issues with codify becoming nod-codified and other strange things. These things never happen to me. Maybe a codify thing once every two months. So, everyone has these ghosts. Ghost bugs.

Ghosts and Gremlins in the system, I have only had the sign in disappear a couple of times over the years but can't think of a time where I have ever had the SIG disappear as you describe.

Are you using the Quick Script Writer? I never use those boxes.

No, I never use the boxes.

Had a patient come in today to discuss the refill of his pain medication. I show in the PMP it was filled by OptumRX and in the process of shipping. That isn't the problem! The problem is he states he didn't call Optum for the refill but I show it was an electronic refill request. I also show that the med was inactivated by NewCrop and then I got another refill request on the 15th which I sent in again to try and get the pt the med. I took a screen shot of the log.

As a doctor you have to know your interactions. Pharmacies = bad. NewCrop = bad. Pharmacies + NewCrop = (well fill in the blank)

I'm just confused on how and why these gremlins got into the system. I hope 11.2 and getting rid of New Crap will fix these.

I think I know. The reason why I say I work as an advisor for NewCrop is because I emailed this woman who was fairly high up in management. So, I would complain to her (yes I won complainer of the year there three times in a row), and she would write back and vent about why they do it this way and not that way. So got kind of comfortable saying what I and the AC crew thought. After about three months I find out that every single email I sent has to go through her boss. Man, that was embarrassing.

Anyway, when they came up with the stupid "You can't send three of the same medications at one time," she was the first to email and say, "Man, you aren't going to like this."

Here is a fun one today, saw pt, refilled his sildenafil, he goes to the pharmacy and they tell him I canceled it, not refilled it. How does that happen?

Sorry for not adding earlier, but I will now, since my gremlin seems a little different than what is being described.
I am also sharing this to vent my disappointment in AC for their lack of transparency on this issue.

I am on version 11.1.1, installed may 2021. Never liked the upgraded version of prescribing, but didn't notice any problems with it. Also never really familiarized myself with some of the features such as "codify" (I am a bit of a low tech user of AC). Beginning 2022, New Hampshire started to implement enforcement of EPCS, so I started to pay attention to my NewCrop more, and then enrolled a couple of months ago.
I started to notice some odd inconsistencies, which seemed to pre-date my "upgrade" to EPCS. These were along the lines of those already described by others, which I originally attributed to key stroke errors.
The one I have found most consistently:

An electronic request for refill (for an Rx previously prescribed) will arrive, with a request for #30 or #90 with 0 refills.
I will check it against my previous prescription in my med list (by hovering over the drug) and checking date of last or next visit.
I will renew the request for the medication WITH ADDITIONAL REFILLS (more than zero) and send it.

The medication then is recorded in the transaction log as having been transmitted with only zero refills AND
on the med list it will appear ITALICIZED and prescribed as only zero refills AND
the original prescription is automatically inactivated AND
the previous Rx date and amount is erased from the prescribing history!

When I check with the pharmacy, they confirm the number of refills I have authorized.
When I check the transaction log for the previous Rx (maybe a year prior), it still shows, though no longer in the med list history.

The other bug that I think I have seen (but haven't yet proved) involves the "codify" function which I have only used a few times:
I very carefully pick the drug to codify, and it still substitutes with I drug I did not intend.
Most recent example is omeprazole changes to esomeprazole.

The above two examples, in addition to the issue of meds changing to italicized are frustrating to me, as I take pride in maintaining an accurate med list (not to mention that it is a medico-legal issue), and this has greatly reduced my confidence in the med list and prescribing history.

The other disappointment is with AC/harris as a company. Mark from AC (and on this forum) reached out to me and was very attentive, concerned and helpful. I was left with the impression that these were random problems being actively researched and documented so as to fix them. He asked me to keep track and provide him with specific examples, which I did for several weeks. I finally saved some up, and when I found the time, contacted AC again. In my recent contact with another AC support person dedicated to this problem, he seemed quite aware of this problem, and said "we need to get you upgraded to 11.1.4".
If I had known that, I would have done it months ago, even before adding EPCS!

I feel like a fool, and am very disappointed in AC/harris.
Also, this is the kind of issue that could sink a small solo practice such as mine. I do not have the energy to fix a prescribing problem or switch EMR's so my next step if this is not fixed is to close my practice.
ACZ in Exeter NH

Hi ACZ,

Let me try to track some of these issues with you since you are new and don't know all of the history.


First, let me tackle this one. Amazing Charts has improved dramatically with an increase in support and by the hiring of the main program developer Chris Conrad. But, the issue AC has always had and kept if from far outdistancing the category of EMRs for small and medium business models has been in communication and support. Support has IMPROVED dramatically over the past three years as you can tell by people like Mark@AC and others who frequent the board. Always keep in mind that if you don't take your improvement or suggestion or bug report to Help >> Recommended improvements >> and then your comments -- they will not be seen by the person who needs to see it: Chris Conrad and development. Case in point: I am the number one C & B (complainer and bitcher, lol) on the board (please not comment from Chris C.) but I have as yet to ever ask for or report anything through the proper channels. So while Mark@AC can give instant feedback and help and I know they will address some concerns with the development team, that is not in their job description.


I am not a big fair on how the ePrescriber worked in the upgrade but I have gotten used to it. For me, the big change is when you change the pharmacy and not being able to see the complete pharmacist once you load the script. But, answering this from the perspective of your being new, the script writer has improved dramatically in the past six to seven years. The main thing is it consistently works. Yes, the choosing of a med in your med list and starting its refill changes it to zero which makes matters difficult, i.e. it shouldn't even begin to change until you send it. It would be nice to have on it: First prescribed, last prescribed and date of new prescription. I have learned to inactive it and write the script over.

I HATE TO WRITE IN ALL CAPS, BUT A LOT OF YOUIR OBSERVATIONS ARE BASED ON THE DIRECITON OF AC TO NC TO SURESCRIPTS WHEN IT IS THE OTHER WAY AROUND. If you take nothing away from any of this is is SURESCRIPTS[color:#990000][/color] THAT IS THE GOD!! OF EVERYTHING PRESCRIPTIONS. They are the onles making us write milliliters or, in general, give a UOM. Not AC. Then AC has to scramble to catch up with this. The new mandate coming down the pipeline one I predicted years ago is that tsp and tablespoon will no longer be accepted and AC, once again, will have to change their coding. It is SureScripts that mandated codified scripts over non-codified non-NDC rated scripts. Keep in mind that when codified first came out users had hundreds of patients with thousands of meds ALL of which were uncodified. Each time we have to choose codify just this drug vs codify all drugs. You can see how codifying amoxicillin to amoxicillin all of the amoxicillins was helpful but if you screwed up and did all and entered the wrong codify, then all Seroquels were changed to Abilify. It took roughly two to four months to get them all codified. This was a SureScripts mandate, not AC.


The frustrating yet different things people face seem to be things that pop up for certain users. No doubt the script writer could be better, but it is the single most difficult part of the program that AC has to continually code. One thing you didn't have to live through was THE INFAMOUS 15 to 20 second lag time in sending a script. Trust me, it was bad, but fixed.


This is why we say gremlins. Because certain things happen to certain people. I haven't seen this huge codify problem and certainly not the one you just described. One thing developers will always say, "It is difficult to fix something that is not reproducible. I have an issue that 8,000 doctors don't have: the immediate disappearance of certain sigs which seems to be directly proportional to the complexity of the sig. So, I will write, "Intuniv 1 mg capsules, Sig: 1 po for seven days, then call for refill." Because Intunive is dosed in seven-day increments of 1 mg to 2 mg etc. but only after seven days. Well when I go to write 7 in the dispense field, the sign disappears. Once this gremlin infiltrated that prescription I realize it has enough gremlin power to do it three times so I fool it by write ths sig, and slowly (I do not wish to wake up the gremlin) and copy to the clipboard the sig. Interestingly it seems to send the gremlin away. To this day, support and development can't reproduce it.


I have to give some background here as well as pat myself on the back once and Ruben 10 times. AC decided to move a lot of their infrastructure of the code to new servers. In doing so, the ACUB Amazing Charts User Board was not going to be carried over, and one of the great things about AC was/is its user board. Posts from years and years were going to be destroyed. I instantly started the new board providing the financing and time to set up the host and domain and sending out emails to all current users. I need a support tech to do the logistics and fine-tuning of the board, make sure it was up to date, and give it the polished shine it has today. Since then the Amazing Charts User Forum ACUF has an annual ACUF-boardathon with users donating toward the cost. You will see the coin next to their avatar.

At the top you can read about the board and how AC does not have anything to do with it at all. It is completely separate. I will admit that the old board had moved a bit from mostly positive comments to AC bashing. We have tried to change that narrative here and I think we have been successful. We invited AC to take part on the board as before. Mark@AC is sort of the default support engineer who follows the board ON TOP OF HIS DUTIES AT AC. He gets to compensation for this. He can help you on the board. He can take back ideas. But, the best way to do this is with the method described at the top.

There was a time and maybe still is when people were very disappointed with AC/Harris and still are. A lot of things were different when Jon Bertman (an amazing person who wrote the code for the original AC) when it went to PriMed. A lot of us were nervous about the change ot Harris as they do look at the bottom line. But, I think AC has made significant changes for the better.

You should have seen the pace and lack of forward development in the company when Chris Conrad was named the head of the development team. One thing you will find and what you are experiencing right now is that Chris' philosophy on new developments and features are based solely on the number of those asked for and not the acuity of the problem. So, if 100 users ask for a different color skin and one person mentions a horrible logistical problem with the script writer. I don't agree with this at all, but that is the way it is not to say that your ideas don't count.

Remember SureScripts is the huge company that is the Internet backbone and company that decided UOM, codification and change of tsps to 5 mLs MUST happen. NewCrop, like a small ISP that takes your prescriptions from AC to SureScripts can f...k things up as well. But with version 4.2, NC will be gone. I expect some issues with the new script writer without NC and Chris expects some whining from me. He has earphones with noise cancelling and Bert whine cancelling features.

So, don't give up on AC. The forum, while pointing out issues and being downright anti-AC at times has become much more positive. Whether AC recognizes how many users they get from the board is something I don't know. But, I hope some of this helps.

CAVEAT: Then general gist of this reply is correct. Some details are wrong, and I hope to be corrected.

PS: I have taken the liberty to make two changes in your preferences that will be very helpful. Please change back and scold me for doing so if you did not want it this way:

1. I changed your preferences so that when you get an private message, you get an email.
2. HUGE I changed your preferences so that when someone comments on a new post or forum you are in you will get an email.

As it is now, you will have no way of knowing about this post (well now you will).

Mark@AC may see your comment about NC in the Shout box, but he is likely following this thread and would see that there was a post and read it.

Also, in your profile in signature if you put your real first name at the top and save it we can call you by that name and not call you ACZ.

Finally, I friended you and followed you so I will know of any posts you make so I can see your viewpoint and maybe help.

@ chrisFNP:

I agree and hope so too.
Am now planning to upgrade from 11.1.1 to 11.1.4 asap, in the hopes that it is an improvement.
Had previously been reluctant to upgrade based on conversation had with support a few months back (unrelated to prescribing problem), but now feel it is probably necessary, while awaiting 11.2
ACZ

The other possibility is to wait and see how the beta goes. There are improvements in the script writer that, if there are few bugs, may be worth the wait. The way the betas are done small bugs end up getting reported, but generally aren't enough to keep you from changing. It is the "showstoppers" that you worry about, like many times when you sign off, it just crashes. Just an example. I am trialing it now, but I am on 11.1.4 now and am not in a big hurry. I will try to keep you posted.

@Bert:

By way of clarification:
I am a 61 y/o solo practitioner (x18 years), AC user for about 10 years or more, and have followed the user group during that time.
I mainly use the "imported items" and prescribing module in AC, so am fairly familiar with that module over the years.
Have also very much appreciated AC support over the years, and continue to appreciate the support personnel.

However:
This prescribing problem is a BIG DEAL!
Aside from being an inconvenience on the mild end, it is potentially a serious risk to patients on the other extreme.
Somewhere in between is my concern about losing an accurate med list and prescribing history.
I know of one practice that closed due to an issue like this, involving another EMR, but due to prescribing problems.
It doesn't matter if it is AC, newcrop or surescripts.
The issue here in my opinion is the need for transparency.
"You don't know what you don't know", and in this case, AC/Harris knows!
I would have appreciated some guidance as to whether to upgrade from 11.1.1 at least.

Regarding AC/Harris support: love the individuals, they have all been uniformly great.
However, I have noticed that:
When I call, it has sometimes take DAYS to get a response.
When I look for a chat (which it appears they have historically preferred, but I have historically avoided), I have noticed that they have recently been unavailable.
So now I have gone to e-mail, which appears to be their currently preferred way to be contacted, but still has a delay in reponse.
So, I don't know what I would do if I had a catastrophic problem in need of immediate assistance.

That's not a criticism of the support staff.
But, combined with my concern about the prescribing gremlins, it is a concern that I have about AC/harris.
That said, I am sympathetic to their challenges, as we are all dealing with the fallout and disruption of Covid19.

Would love to drop by your practice some day, as you seem quite tech-savvy and surely are doing good and needed work up there.

Best,
Ton Zwaan

Certainly, you are welcome anytime. I didn't notice if you were a family practitioner or other specialty. While I have my very sick patients with lots of medications, most have a med list that includes amoxicillin, Pepcid and melatonin. Just from reading what a few others are experiencing, it seems like most are experiencing different issues.

Not knowing the effect of multiple medications targeting hypercholesterolemia, hypertension, other heart problems, etc. where most visits make you attend to each, I must admit I am not knowledgeable on how much a poor med list is.

I hate to say it, because as already said, I try not to make major statements that are hugely negative against AC. And, like you said, the individual support engineers like Mark and others are super. It is just in general, support has always been the poor spot with AC. I have often suggested that there should be someone who answers all calls and triages them and directs them to the right support department. Having levels of issues would be great too. Take Veeam for instance a backup company. Well, if you server crashed and you need to restore, this would be something you needed help with within three to four hours, so your support request would be a Level I, and you would be contacted by then. Same token Level II may be 24 hours and so on. I have gone on sites that rate different EMRs and found many where there are five different areas regarding the program. Invariably the categories of Ease of Use, Cost, etc. get five stars where support is less. I will leave it at that except to say as you noted once you have support they are tremendous, it is just getting support on the phone or chat.

I hope you don't leave AC or have huge issues with your practice because of the script writer. You may want to email AC and ask for the trial and bang on it pretty hard and see how the script writer works with it. I can give you the email address of the person to contact.

This is a description that is very similar to what I have seen with the italicized meds/ CODIFY Issue. I have not had the issue of the CODIFY feature changing to a different medication.

I am hoping that the newest version fixes some of these issues.

Never thought about the difference in med lists relative to your pediatric practice.
Mine is Fam Med, skewed towards adults, many on up to 10 meds, managed by various specialists that I keep track of.
Best,
Ton Zwaan

ACZ, same here Family Practice with a few pedis among the mix.

So here is a problem I found today, get a refill request from the pharmacy, not able to match, look in inactive and shows medication (Eliquis) inactive, pull chart, history of med shows it was deactivated 2/15/2022 at 3:43pm "deactivated from New Crop" Last touched by myself and Type: Renewal, look in the chart and the Eliquis is in the med list for that day, no refill or discontinuation noted in the chart the others we did stop and prescribe are noted (I don't remember stopping it.), next visit the Eliquis is not on the med list and was not caught by myself or the MA, I signed off that chart at 3:42 PM and the history of the medication showsit was discontinued 3:43PM.

This is a major med that I need to make sure she is taking. This is the frustration ACZ and I are facing with some of these meds and this population of patients.

Yes, I feel your pain.
My work flow is quite different than yours I suspect, as I actually still use a paper chart for my visit notes (I know, crazy), but use AC mainly for prescribing and filing reports in Imported Items.
But the paper chart does create a fairly reliable record.
I just upgraded to 11.1.4 last night.

This morning, I received a pharmacy request for atorvastatin #90 with 3 refills.
Knowing that my previous problem revolved around the amount of refills in pharmacy requests, for fun I approved #90 with 0 refills.
That seemed to work OK, as the prescription was indeed transmitted with 0 refills, as I had transmitted it (confirmed by pharmacy).
However,
In double checking the prescription in the transaction logs I found:
1) That the transaction log in the PRESCRIBING module reflected the transmission to the specified pharmacy, but the transaction log in the PATIENT MED LIST was missing the pharmacy info.
2) ALSO, somehow, the transaction log in both the prescribing module and the med list showed a renewal of a 2nd medicaton (Tadalafil) that we had not authorized! We called the pharmacy, and they confirmed receipt of the atorvastatin and that there was no Rx received for Tadalafil eventhough the transaction logs and med list show it as being prescribed.....

My plan going forward is to review the automated pharmacy request, then prescribe them from the med list, then "deny" them with "prescribed by other means" until a future fix.

I sent an e-mail to AC to provide them with this info, but my contact acknowledges ongoing bugs, and did not reach out for details.
So, I am posting this as a public service to anyone who may not be aware, and hope that Mark will see this post also.

I'm off to Ireland for 2 weeks, and may not come back (insert smiley face here, but don't know how to do that).

Best,
Ton Zwaan,
Fam Med,
Exeter, NH

Ton,
I can't imagine trying to keep up with paper charts and AC!

I find the note system in AC is the reason to stay with the program. It is simple and straight forward SOAP note format. I have some templates that help with efficiency of seeing the pts but mostly type in what I want the chart to say.

I remember when I started (20 years ago) I worked with a doctor that had years of "charts" in the trunk of his car. He had just semi-retired and was starting to work a clinic for the local hospital. The charts were nothing more than a box of index cards with one line visit note and what medication he prescribed. Simpler times, pt's loved him and he new them all by name.

Being careful not to second guess someone else's work flow, it seems like a lot of money for the license just to prescript with it. I am with Chris on this one. There are so many advantages with using AC. Not sure if it is a typing thing. But, you can dictate directly into AC as well.

I have thought about dictation, just never have took the time and spent the money. I quickly hunt and peck and use templates. The visit template is nice but I often forget to use it, creature of habit.

We used Dragon before using AC to dictate chart notes, no Dragon Medical back then.

I have always found that dictation makes the most accurate note. It may not give all the reminders and fields so you code and get MIPS, etc. but while there are macros most of the time the dictation describes exactly what happened. I would much rather get a dictated note from a consultant, and I would much rather get it in SOAP format instead of APSO. I was using DNS and loved it, but I didn't feel comfortable doing it in front of the patient, therefore, I would need to wait until the end of the day. I suppose I could ask walk the patient to the door, then go back and dictate.

The huge frustration of dictating in AC is that there is no way to use the dictation to jump between fields. That's the whole idea, to never have to use the mouse. But, I do find that when I dictated the note was much more thorough.

There was one person on here, I forget whom, he will comment if he sees this, but he would type in short sentences that would remind him of the note, then come in early when fresh and do them. I do think that dictation fits better with FP as you generally have to address the different problems at the end.

The other thing is I tend to not get behind when typing a note in the room. Since you have to dictate after it is easy to save it for later. I suppose this is out of place, but the other advantage of dictating at the end of the day is the ability to be organized and look things up as you finished you A/P.

The thing that is catching on more and more are scribes. But, I see them mostly in the ED and specialists. It just seems like it has to add to the cost. More money going to the specialists and less for the lowly PCPs. Jon may want to comment on that.