e-script

[nextyearrx]

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I heard at many retail pharmacies, E-scripts are major part of delivering prescriptions from Dr.'s offices.

It is very easy in typing as well as verifying for pharmacists. Is it becoming more common everywhere in US?

 

[owlegrad]

Yes and I love it compared to taking voicemail or typing handwritten scripts.

 

[Wheresmyaricept]

Lipitor 20mg Dispense 30: Take 1 capsule by mouth once a day twice daily to the affected area. Dispense 90 day supply. Misc: 10mg 2 tabs po qd.

 

[StellargalS]

Second the yes, and I love it for cutting me loose from all the telephone calls for "new ones", 75% of w/c were really just refills and 15% of the remainder required my coaching the dim wit entrusted to call the order in to me. Makes "volume" way less palpable.

 

[Old Timer]

E-Scripts don't reduce errors they just introduce different errors..... The idea is seductive until there are 30 e-scripts that appear in your inbox all at once when MD offices close down at 4 or 5 in the afternoon and pump out all of their crap....

 

[StellargalS]

E-Scripts don't reduce errors they just introduce different errors..... The idea is seductive until there are 30 e-scripts that appear in your inbox all at once when MD offices close down at 4 or 5 in the afternoon and pump out all of their crap....

I bet that would suck in the "right" setting but it also has a lot to do with the pharmacist preference. I can't stand getting jerked around (i.e. 28 random phone calls) but I dig getting slammed when I know it is coming. Although I hate getting slammed unexpectedly when the techs rule the roost.


"What if this is as good as it gets?"

 

[BlknOrange]

yes i saw these today... ortho-tri-cyclen dispense: 3 puffs; sig: 1 puff po qd; then i got: losartan 50mg tablets, dispense: 30 puffs sig: 1 puff once daily.

 

[farmadiazepine]

maxitrol eye drops. apply ointment to eyes. misc: apply qid buel for 7 days.

what this actually was was tobradex eye drops in both eyes 4 times a day and maxitrol ointment applied once at night.

e-rx's don't reduce errors.. like the poster said above, they just introduce new errors.

 

[StellargalS]

Have they created an interface that allows the pharmacist to easily address the more ridiculous errors like ortho tri cyclen puff packs? I ask because I am not in a position to go meddling into the workflow where I am currently. Further it seems to me that offices that regularly employ e-scripting would be less efficient in handling calls for script clarification than they were prior to it's implementation.

We do predominantly HIV and there is a wide range of drugs dispensed but the prescriptions all conform with my expectations as far as ARV combos go and interaction related dose adjustments. I just wonder what is the contemporary approach to handling clarifications is. Being a per Diem on egg shells sucks.

 

[Wheresmyaricept]

Have they created an interface that allows the pharmacist to easily address the more ridiculous errors like ortho tri cyclen puff packs? I ask because I am not in a position to go meddling into the workflow where I am currently. Further it seems to me that offices that regularly employ e-scripting would be less efficient in handling calls for script clarification than they were prior to it's implementation.

We do predominantly HIV and there is a wide range of drugs dispensed but the prescriptions all conform with my expectations as far as ARV combos go and interaction related dose adjustments. I just wonder what is the contemporary approach to handling clarifications is. Being a per Diem on egg shells sucks.

I didn't realize that "puff packs" were something that needed to be clarified. The only thing it cuts down on is illegibility problems. However, it introduces many other issues such as conflicting directions and quantities and refills. And then you can get 7 e-Rx's for the same thing over the course of the day, wasting our time. It's not even like they change something on it, like add refills. Literally the same thing.

And the contemporary approach to clarifying a prescription is to do what you've always done and call the office, talk to the secretary who has no clinical knowledge or prescribing authority, and get the correct prescription information.

 

[sosoo]

has the law on escript changed for control meds? i believe docs can send in control escripts now. what about C-II ? are they allow to escribe C-II as well? i saw Focalin in the escript and was shocked. : )

 

[npage148]

E-scripts are great becase I can instantly send a fax to the doctor asking them to fix they stupid typo and when they g

Have they created an interface that allows the pharmacist to easily address the more ridiculous errors like ortho tri cyclen puff packs? I ask because I am not in a position to go meddling into the workflow where I am currently. Further it seems to me that offices that regularly employ e-scripting would be less efficient in handling calls for script clarification than they were prior to it's implementation.

Yep, two office around us will send 10+ e-rx for a single patient multiple times a day and about 1/4 will have typos and 1/4 will be DDI/formualary problems. It's so hard to actually speak to someone at the offices all we do fax them back to the office (when their fax is working) and throw them out. We tell patients of these offices that typically the only way the issue will be resolved is if the patient goes down there with the notated e-rx and get a new one sent and maybe it will be correct

 

[StellargalS]

I didn't realize that "puff packs" were something that needed to be clarified. The only thing it cuts down on is illegibility problems. However, it introduces many other issues such as conflicting directions and quantities and refills. And then you can get 7 e-Rx's for the same thing over the course of the day, wasting our time. It's not even like they change something on it, like add refills. Literally the same thing.

And the contemporary approach to clarifying a prescription is to do what you've always done and call the office, talk to the secretary who has no clinical knowledge or prescribing authority, and get the correct prescription information.

Thanks! I figured as much. I am licensed x 17 years. The past five years I have been "taught" to overlook a majority of my "nit picks" but the remainder keep me from getting settled anywhere for very long. Nomads don't get bitten in the ass so to speak and I have always relied on that to help shape my practice. Thanks again for your assistance with this remedial stuff.

 

[StellargalS]

E-scripts are great becase I can instantly send a fax to the doctor asking them to fix they stupid typo and when they g


Yep, two office around us will send 10+ e-rx for a single patient multiple times a day and about 1/4 will have typos and 1/4 will be DDI/formualary problems. It's so hard to actually speak to someone at the offices all we do fax them back to the office (when their fax is working) and throw them out. We tell patients of these offices that typically the only way the issue will be resolved is if the patient goes down there with the notated e-rx and get a new one sent and maybe it will be correct

Thanks. On the bench a simple question like this gets the side eyes going😒 and it is all down hill from there. WTF? The internal struggles are just redonkulous.

 

[pezdispenser]

has the law on escript changed for control meds? i believe docs can send in control escripts now. what about C-II ? are they allow to escribe C-II as well? i saw Focalin in the escript and was shocked. : )

Yes, the DEA has allowed electronic prescriptions for controls since 2010, but it has taken a few years for states to put in place corresponding laws, and also for pharmacies and prescribers to get their software compliant and certified to do this.

http://www.deadiversion.usdoj.gov/ecomm/e_rx/

Some states allow all controls including C-IIs to be electronically prescribed, and some states only allow C-III-V, so you need to check your own state's laws.

 

[zelman]

Yes, the DEA has allowed electronic prescriptions for controls since 2010, but it has taken a few years for states to put in place corresponding laws, and also for pharmacies and prescribers to get their software compliant and certified to do this.

http://www.deadiversion.usdoj.gov/ecomm/e_rx/

Some states allow all controls including C-IIs to be electronically prescribed, and some states only allow C-III-V, so you need to check your own state's laws.

In fact, there was a bill (that unfortunately didn't pass) in NY that was to require all controlled substances to be electronically prescribed.

 

[sosoo]

http://www.deadiversion.usdoj.gov/ecomm/e_rx/
Some states allow all controls including C-IIs to be electronically prescribed, and some states only allow C-III-V, so you need to check your own state's laws.

the link does not have any comment on C-II. it vaguely mentions controlled substances only.. also the DEA is an agency, and state laws are just state laws.. until federal law has changed, we cannot follow the DEA recommendations? and state laws are invalid if federal laws are stricter?


also, how will they manually sign an e-prescription??

 

[genesis09]

the link does not have any comment on C-II. it vaguely mentions controlled substances only.. also the DEA is an agency, and state laws are just state laws.. until federal law has changed, we cannot follow the DEA recommendations? and state laws are invalid if federal laws are stricter?


also, how will they manually sign an e-prescription??

DEA allows for electronic signature. They came out with a bunch of guidelines about e-scribing of controls a few years ago. The general rules are that controlled e-scribes cannot be automatically signed. The prescriber must actually type his or her name on it or something like that. That will generate a unique code which will be interpreted by the pharmacy that there is an electronic signature attached to it. At Walgreens, an annotation box shows up on the rx say electronic signature accepted. My state just changed the laws to allow for e-scribing of all controlled medications. Even though, the law was changed a while ago, I rarely see e-scripts of controlled medications. I have received e-scripts of C-2s. The annoying aspect of it is if you don't have the medication, you can't just return the rx to the patient. You have to call the prescriber and have them send it to another pharmacy. You also can't store electronic C-2s.

 

[pezdispenser]

the link does not have any comment on C-II. it vaguely mentions controlled substances only.. also the DEA is an agency, and state laws are just state laws.. until federal law has changed, we cannot follow the DEA recommendations? and state laws are invalid if federal laws are stricter?


also, how will they manually sign an e-prescription??

The federal laws have already been changed. See Title 21 Code of Federal Regulations http://www.deadiversion.usdoj.gov/21cfr/cfr/index.html , particularly Sections 1300, 1306 and 1311.

The definition in Section 1311.100 specifically states that a prescriber may issue an electronic prescription for C-IIs (and C-III-V).

Now in the period of time after the federal laws were made but before the states made their own laws to allow electronic prescriptions for controls, the state laws would actually be stricter (by not allowing e-rx controls, for example by requiring a manual signature). But I believe by now most states should have made new laws to allow e-rx controls. However, some states are stricter than federal laws by not allowing C-II e-rx, or whatever they choose.

 

[Ackj]

In fact, there was a bill (that unfortunately didn't pass) in NY that was to require all controlled substances to be electronically prescribed.

I thought it passed, but wasn't going into effect just yet. Something like it would finally be allowed in '14 and mandatory in '16. Haven't heard any details on it in a while though.

 

[Old Timer]

the link does not have any comment on C-II. it vaguely mentions controlled substances only.. also the DEA is an agency, and state laws are just state laws.. until federal law has changed, we cannot follow the DEA recommendations? and state laws are invalid if federal laws are stricter?


also, how will they manually sign an e-prescription??

If their software is approved, there is a dual stage verification that only the prescriber can complete. The electronic signature is all that is required as per Federal Law.
Google is your friend.
https://www.google.com/#q=electronic prescribing schedule ii

 

[zelman]

I thought it passed, but wasn't going into effect just yet. Something like it would finally be allowed in '14 and mandatory in '16. Haven't heard any details on it in a while though.

Didn't pass. Already allowed, I believe.

edit: not allowed. my bad.

 

[sosoo]

The definition in Section 1311.100 specifically states that a prescriber may issue an electronic prescription for C-IIs (and C-III-V).

thanks for this. if not i couldnt possibly find it on their website. : )