Home Forums Discussions Problems Prescribing problems

I was able to get AC Support, Matt, on chat this morning to see a really weird problem with prescribing. I was doing the electronic refills this morning and saw that a medication was wrong. I opened the chart and found 2 testosterone's in the chart, but when you click on the first one it changed to Atorvastatin........how I don't know, was able to get it to repeat this problem so tried chat and Matt answered......he is now looking at it remotely and saw the name change, the Atorvastatin that the pt should be taking was moved to inactive by the computer, not me.

Things like this will make you think you're crazy.....

Every few weeks there will be an inactive med that I don't remember inactivating (should be active). My suspicion is this rare event happens when refill request screen directions don't match up, but I've never been able to prove it.

You guys keep looking for explanations for this stuff.
Time to realize that AC has become self-aware. The eRx module in particular is sick of all our complaining and is now toying with us by creating random inexplicable events. Chris Conrad probably knows this but does not want us to be afraid so he is keeping it under wraps.

I got an error message today in AC: "I know I've made some very poor decisions recently, but I can give you my complete assurance that my work will be back to normal. I've still got the greatest enthusiasm and confidence in the mission. And I want to help you".

Priceless

In AC's defense, keep in mind that eRx and EPCs depend on AC, SureScripts (the nationwide network who decides when to put in the new meds) and NC (like a local internet provider). If they are all not on the same page, there are problems. Maybe find out SureScripts phone or email and ask them why certain meds aren't on there.

My guess is they add them quarterly or every four months.

@Chris

Forgot about The Twilight Zone in between SureScripts and NewCrop.

@beagle: "Every few weeks there will be an inactive med that I don't remember inactivating (should be active)", find this all the time and it does have something to do with the electronic refill but it is not due to a mismatch, I have caught it but can't figure out why........

@JBS: that is the most sarcastic AI on the market, no wonder AC is increasing prices they are trying to add on comedy but it AIN'T funny any more

@Bert: yesterday was definitely the TWILIGHT ZONE, interestingly I was able to reproduce for AC Tech support, they want to look at the main computer as well and run some tests, I can not be the only one that this is happening to as it is similar the problem beagle posted about and I have complained about for months, the inactive/codify problems is horrendous but seems to better recently, not sure why; I understand that AC is dependent on New Crop and Surescripts but AC should be contacting them for the latest updates if not daily at least weekly, there are other EMRs using the Surescripts program so wonder if everyone is that far behind

You do know that was satire.

as is mine, I don't doubt Artificial Intelligence AI will one day be able to be sarcastic but I do now AC isn't there yet

reminds of when your car breaks down after you said you might want to get a new one.......or am I the only one that has had that happen.........

[quote=ChrisFNP] @beagle: "Every few weeks there will be an inactive med that I don't remember inactivating (should be active)", find this all the time and it does have something to do with the electronic refill but it is not due to a mismatch, I have caught it but can't figure out why........

The way to figure it out is have a few examples inappropriate inactive meds. Ask AC to look at the logs and figure out when/ how they were inactivated. You wanna runs this by the same tech support guy on current issue?

And NewCrap.

Which AC chooses to use.

Beagle, it is always a time issue. Have you discussed the inactive issue with AC tech an they found anything?

I am going out of town today, no pts, so logged AC tech (Matt) into the main computer so they could look around at things. The issue yesterday of meds "magically" changing names has happened before but I was never able to reproduce. Yesterday, I could get i to reproduce the problem and Matt was able to log in to see it but could not explain the problem.

Sarcastic AI or Twilight Zone, not sure..........

Problem solved! Not sure it's an 11.2 issue but after the upgrade, we ran into a problem with C-II stimulants. Now you are required to enter the number of days the Rx is for. If you try to prescribe a new Rx before that 30 day Rx, up pops a dialog box that says it's too soon. Then along comes the nationwide Adderall shortage (which took the FDA over a month to announce) and pharmacies and patients are calling saying this or that pharmacy doesn't have that dose or anything but 10mg. Then when you try to switch the unfilled but sent EPCS script to another pharmacy it's denied because it's too soon even though it was never filled at the first pharmacy. You can try a different dose (2-27mg Concerta tabs for 1-54mg tab) and can work. My NP Carolyn discovered the workaround by using the Quick Script Writer I have never used. After entering new or clicking on existing med, click the Quick Script Writer button and go through "death by 7 clicks" and change the default from 1 to 0 refills it will pop up in the Pending Medication window and no more denial due to too soon.
I am copying this workaround to AC tech support along with this suggestion: I find tech support difficult to access and several times unable to solve the problem, sometimes as serious as the inability to prescribe. The update to 11.2 should have been more thoroughly done rather than our practice becoming an unknowing beta tester. In addition, you should bring back the AC Users Forum and post it on your website to help users find solutions and you should monitor it daily or at least weekly. You should also send out emails or texts like Updox does if something goes down, there's a serious error, etc. It's frustrating to connect to tech support, hear that several other practices have had an issue with something I'm having without that being sent out to the users.
I sent this via email and in the Recommended Improvements tab under Help and will set my sundial and stone calendar to see if and when I get a response.

I agree with everything you say, but I am confused as to your wanting AC to bring back the AC Users Forum. AC made the conscience decision to close the users' forum.

This forum was then started. It includes everything on the old forum along with everything from that date and in a much better format and more secure. This board is not affiliated with AC and, thus, allows more open discussion.

AS it states in the introduction at the top, AC is more than welcome to respond to anything on the board and many support staff have.

Well I lost the link for this a long time ago. Didn't realize you can now (maybe then) just Google Amazing Charts forum. I will bet 90% of AC users don't know it's here. The forum is fine, just wish it was known to all AC users.

When Ruben and I (Ruben = tech support for the board), we sent many emails to anyone who had posted in the past five years. There is a link on the site but it doesn't go here. When AC was making some switches with their servers, they decided to NOT continue the board. The board is a fantastic commercial for them because not all EMRs have such a board you can frequent and ask questions and get both sides of the question.

AC, though, didn't like some of the negative press it was getting from the board. And, to be honest, it was getting some negative comments. But, that is usually not overall, it is something like this thread that goes on and on about how it is not working.

We wish that AC would like to here. It would be to their benefit. One is going to trust real users who have no reason to lie about things than the one or two people, say Athena, has you talk to who will say only positive yet biased points of view. We also (Jon Schreiber) and others don't have the rapport and direct communication to the higher ups like we need with Jon Bertman and Prime... (I can't think of the whole word -- pretty stupid of me.) Used to be we could email John Squire, the CEO and president of AC and talk directly to him. Or Chris. Or others. And, we had a group of doctors (Clinicians Advisory Board) that met weekly.

As to the issue with EPCS automatically going out 30 days is something that some pharmacies like, i.e. "Do not fill before such and such a date." Here it is only Hannaford who won't accept our usual 1 of 3, 2 of 3 and 3 of 3, which is actually better. Ironically, if you write it that way, NewCrop will let you load something like Concerta 54 mg, 1 po daily, dispense 30 three times although if you just do it with the 1 of 3 and 2 of 3....way they won't which is NewCrop being absolutely frigging stupid. The three are going there anyway.

This is NOT a bash AC thing. It is a SureScripts thing. I realize that they cannot have every UOM, but you would think they would check every month for "unspecified" and when it is used 500,000 times maybe look at what it is used for:

For instance:

Nebulizer treatments such as 0.83% would come in boxes or vials. But, not there, so unspecified, then typing in the bottom.
Proventil or Flovent, etc. They are inhalers or MDIs. Please dispense 1 unspecified is purely stupid.

See my POST #78463

This whole UOM fiasco is not an AC or Surescripts thing but higher up and probably more people away from actually seeing the patients!

Hi Chris,

Here's the link to the post #78463 that you mention:

https://acusersforum.com/ub/ubbthreads.php/topics/78463/re-prescribing-problems#Post78463

While nerds like me enjoy groveling through threads to locate such things, physicians with real lives and notoriously short attention spans prefer direct links.

Cheers,

Carl Fogel

I sent a communication to the center below. Below my email is the response I received. I would love feedback. While they didn't quite understand the intent of the email, the center did take notice and wrote back asking for clarification. I find this to be a very good sign as there is now a chance to have an open dialogue with the one group that seems as though they are in a position to make changes.

Email to the pharmacy at the Division of Drug Information at the Center for Drug Evaluation and Research:

Do you have anything to do with what UOM we are allowed to designate for medications. For instance, amoxicillin tablets has an option for TABLETS. Or Doxycycline capsules has an option for CAPSULES. Unfortunately, many of the common Units of Measure are no longer a choice in our Electronic Medical Record. Medications such as an inhaler has no option listed for MDI (metered dose inhaler) or simply inhaler. Albuterol 0.083% comes in boxes. That is its UOIM. BOXES used to be one of the choices for UOM.

So few are left and very few of those that are specific to the medications we normally use it forces physicians to select UNSPECIFIED for the medication and write the actual UOM in the comment section. This defeats the purpose of having concise and specific UOMs that cover nearly 95% of the medications used.


Reply:

Dear Bert,

Thank you for writing to the Division of Drug Information in the FDA's Center for Drug Evaluation and Research.

To better assist you, please clarify if you are referring to the dosage form/unit of measure of drug products designated in the pharmacy's computer system or are you referring to the dosage form that's provided in the drug product labeling.

Best regards,

TNC
Pharmacist
Division of Drug Information
Center for Drug Evaluation and Research
Tel: 855-543-DRUG (855-543-3784)
druginfo@fda.hhs.gov

_______________________________________________________________

When I reply to them to clarify, it may be a good idea to suggest or recommend commonly use UOMs that could be considered to be added back to the list. Would it be helpful for everyone to list some of these such as:

Boxes
Inhalers
MDIs
Chewables
etc.

Bert, I might reply like this:

Dear TNC,
Thanks for your reply. It is encouraging to know that someone is listening to my concerns and paying attention. I assure you that the opinions I express here are not just my own; they are shared by many, many physicians.

In answer to your question, I am a physician and I use an electronic medical record. I do not know about pharmacy computers or product labeling (though I suppose I could look that up). I do know what form the product comes in. I know that when I use my EMR, the dosage form/UOM's are now very restricted and limited. This creates confusion and errors.
For example, if I want to prescribe an albuterol inhaler, I should be able to prescribe an inhaler. Not make a guess of a box or a kit or a powder.

The EMR will no longer permit "inhaler" or many other UOM's. I have been told that your organization is responsible for creating the permitted list. Is that true? Is there some way to petition that the accepted list of UOM's be expanded to more accurately reflect the medications we are prescribing?

Once again, Jon's ability to write succinctly and coherently right on message is brilliant. I have replied pretty much verbatim. Thanks Jon!

OK, in contacting the FDA TNC this morning, I found out they have little to do with this. I then contacted SureScripts who has nothing to do with this either. But, she was able to direct me to the organization that does this. I will be contacting them today.

Oh, I forgot to put the name of the organization and the website. I can't make much out of it, but they seem to be the overseer of everything like Cover My Meds, etc.

So, it is the National Counsel Prescription Drug Program (NCPDP). Website: https://www.ncpdp.org

So Chris, in all your free time I am assigning you the task of breaking down the website. There is supposed to be a list of UOMs and ones you are supposed to use for things such as albuterol nebulization.

Oh, and their motto is Problem Solving and Innovation.

I was thinking of assigning James the job of taking down the website.

I'm thinking this is the same group of people who decided to come up with ICD-10

Bert,
Just getting caught up reading this thread!!!!

Here is the link Carl put for you of the screen shot I put in here:

UOM

As you can see that was page 147, I don't remember how long the actual list was but I do remember it was 147pages worth of acceptable UOM's.

I will try to find that info again and post a link, but it wasn't very helpful just said, you can't use these anymore!

HAPPY READING ON A MONDAY!!!!

Guess what? There is a new list, that last screen shot was from the list made in February 2021, now there is an "***Official Release***" as of August 2022.

Here is the link to the PDF:

List from NCPDP

The DO's start on page 126 and the Don't start on page 129, seems to be a lot more DON'Ts than Do's or in their words , UOM that were SUNSET. I also have included a screen shot of properly worded instructions, the one I highlighted I find interesting........

Thank you for your inquiry. Back in 2017 the membership of NCPDP harmonized the prescribing and pharmacy billing requirements resulting in the sunsetting of 32 quantity unit of measure values. In the Script Implementation Recommendations document there is information about these changes. If you look in Section 13 of the document, there is some background information and section 13.1 contains a table showing how the sunset code values are to be reported.

If you have any additional questions do not hesitate to ask.


Thanks

Teresa Strickland
Technical Advisor, Model Facilitator, Standards Development
NCPDP
9240 East Raintree Drive | Scottsdale, AZ 85260
(W) 480-477-1000 ext. 152 | (C) 480-296-4051
tstrickland@ncpdp.org | www.ncpdp.org

WHERE THEY STATE THAT TABLESPOONS SHOULD BE MULTIPLIED BY 15, SHOULDN'T IT BE ACTUALLY BE MULTIPLIED BY 14.7868

That is a Thanks but no thanks kind of answer, we are not changing a thing.........

Yeah, they have been working on it since 2017. It is really a joke. I mean "Take one pill by mouth each day," is different from "Take one pill po daily?" It's like making the patients use the same words doctors use in their HPIs to keep errors from being made. Of course, I say this, but I may be forced to, but no way am I going to change, "1 tablet po bid for 10 days," to 1 tablet by mouth twice a day for 10 days." And pharmacies here have been getting all over us for not putting in the number of days, now it says we can't. Well that is a win for me.

Wrote moxifloxacin ophthalmic suspension today and the dispense used to be 1 bottle and let the pharmacist figure it out. Now I had to write Dispense 3 mLs. Of course, we all know it is 0.5%.

What is an eaches?

Well this is like an 11.2 problem: I can get prescription transactions from the main landing page of all patients but when I open the script writer on an individual patient, go under Eprescribing to Transaction Status Page I get an error XML message. I got tech support on it and Dustin Lariviere was perplexed and said he was going to reach out to the development team. Anyone else dumb enough to be an involuntary beta tester for 11.2?

NO 11.2 because of the issues I read about here.......

@Bert......... Amazing Charts spells it "eachs" maybe the eaches is the correct spelling????

I think you are talking about peaches.... lol

I keep looking into this more and it seems the basic idea is that everything will eventually be dispensed in some form of mg, mL or grams, i.e.

So, when you write for albuterol 0.083%, take on neb treatment q3 to q4 hours prn cough/S.O.B. -- Dispense ____________

I used to just put two boxes. But the albuterol packets comes 20 to a box and 25 to a box, etc. So, they will give you the small box. But, what will happen and I am already doing it (worried the pharmacist won't figure it out) is the the box of 25 contains 25 packets of albuterol 2.5 mg/3mL. So you would order in mLs. So say you want two boxes of 25, it would be. 50 times 3 mLs or 150 mLs.

You can put tablespoon because that unit is looked at as 15 mLs (although it is lower). An ounce would be 30 mLs so 4 ounces would be 120 milliliters. MiraLax would be 527 grams. Proair comes in 6.7 grams and 8.5 grams so dispense 8.5 grams or you get the small one which would be unspecified. Pharmacy comments. Ventolin can come in an 18 mg. If you wrote Proair dispense 18 mg you would get a phone call or less mgs.

A gallon, because it is equal to 3785.411784 milliliters, you just multiple the number of gallons you wish to prescribe and multiply by 3840 mLs. It is all very simple.

Got a question - any controlled Rx'es coming from Pharmacy requests always gives me the "Lane is not authorized to prescribe." I have clicked deny and reason is Rx has already been sent by other means." Is anyone allowed to use the pharmacy request to refill controlled Rx'es?

I use the erx for controlled substances and do not have a problem. Not sure what is happening in your case. Have you tried to get tech support to look at this problem with you? I would get them to log in remotely and watch what is happening.

I have EPCS and e-prescribe controls easily, just not from the pharmacy request page. Can you do that?

So I posted this in the ShoutChat but bottom line is EPCS is down. I could prescribe a C-IV but not a C-II. Spent 2 hours on chat waiting to be told, surprise, suprise, it's a NewCrop issue and they are working on it. Told them they need a shout box on their website and Marc said, "That's a good suggestion." I wondered if another EMR didn't use NewCrap but on their website they say that 200 EMR's use their services. We're screwed. I've really considered dumping AC but if NewCrap is the primary cause of my prescribing woes, it won't do any good.

Got the message today that there is a problem and then right behind it that the problem is fixed. Shouldn't that have been sent out yesterday...........

Impressive rapid fix time. /s
In the future wtih AI, the fix will be applied before the problem is identified.