Why does medication from the Right chart panel populate under “other” in the progress note when refilled?

Let me explain exactly my process and hopefully someone can tell me at what step I’m messing up on.

1.    Pt comes in with list of meds currently taking from previous provider and nurse’s types in those meds under the current medication section on the progress note.
2.  Pt wants refill that day.  Provider goes into the treatment window and pulls up current meds and associates a dx code with the meds and refills
3.  The next month pt comes in wanting refill of same meds and provider refills from the Right chart panel pushing that information into the progress note except instead of going under the dx code that he associated it with the month previous, it populates under “other”
Why? What am I doing wrong?

We were wondering if anyone knew of a warning message that could appear if an RX Refill was entered into a Telephone Encounter and not sent prior to the provider addressing the note.

Some of our providers would like to use EPCS, but would like to continue to prescribe 3 months of medication at a time, notating the fill dates of one each month, to avoid having the patient either call in every month or return to clinic each month.  We did turn on an item key to allow the same (NOT CONTROLLED) medication to be prescribed (started) under a diagnosis, and have created a work around for refilling those meds. 
Can our docs use the EPCS token to eRX controlled meds refills for 3 months at a time? Is there a separate item key that needs to be enabled.  Either way, can someone tell me the workflow for this.  I’d really appreciate it.
Thanks,
Karen

So Concerta has worked fine all through January until today and I have gotten 3 diff errors on three diff doses at three diff pharmacies.  Will put in a ticket, but didn’t know if there was a new database launched or what the prob can be. 

Put in a ticket for the unavailable -noncustom- RX ndc report item key to be turned on…will see if this gives any light.

However, quillivant always comes over as afax instead of a regular ndc error.  Has anyone found a fix for this kind of error?  A ticket on this never resolved anything

I am working on a little newsletter article that talks about the finer points of ePrescribing for my eCW clinics. I scrounged about until I found a Surescripts ePrescribing Guideline document that laid out the basic formatting of ePrescriptions and used it as the basis of the article. I believe that the information here is pretty solid, but if someone knows something to the contrary, please let me know. I thought I would share it in case it’s helpful to anyone else….

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Understanding ePrescribing

ePrescribing is quickly becoming the standard method for transmitting prescriptions to pharmacies. Many users may be confused about the precise requirements and structure of ePrescriptions.

When a medication is sent electronically to the pharmacy, eClinicalWorks converts the prescription information into an electronic message which is then transmitted to the patient’s pharmacy. The message is designed to contain the following information:

•  Patient’s full name and street address
•  Prescribing provider’s full name and clinic address
•  Date of the prescription
•  Name, strength, dosage form, and quantity of drug prescribed
•  Directions for use
•  Number of refills
•  Provider’s electronic signature

While the patient and provider information is pulled automatically from eClinicalWorks, the remaining elements of the message come from the information entered into Rx section of the treatment window. The first part of the eprescription message is comprised of the medication name, strength, and formulation. Together, these three fields cannot exceed 105 characters.

The second segment of the message is designed to convey the Take, Route, Frequency, and Duration information. Information in these fields cannot exceed 140 characters cumulatively. The third segment of the message conveys the amount to dispense and the number of refills. Lastly, ePrescribing requires each prescription message to include the medication’s NDC; custom medications that are not linked to an NDC code cannot be eprescribed.

In order for a prescription to be eprescribed, information in each field must be entered in a specific format.
•  Medication name: free text (alpha and numerical allowed) information, primarily selected from the drug dictionary
•  Strength: a number space unit format, example 50 MG or 100 mg-25 mg
•  Formulation: free text, either an entry selected from the “formulation” pick list or typed into the field, example: tablet or capsule.
•  Take: free text, either an entry selected from the “take” pick list or an entry typed into the field, example: one capsule.
•  Route: free text, example: orally
•  Frequency: free text, example: once a day or in the morning
•  Duration (optional) number space unit, example 30 days (any information added after the unit will be truncated)
•  Dispense Number space unit code*, example: 30 U2 (any information added after the unit will be truncated)
•  Refill: a single number only (any information added after the number will be truncated)

*The dispense field sends the unit type as a code to the pharmacy. If no unit code is entered into the “Dispense” field of the prescription window, eCW looks to the Formulation field for a unit description and converts that unit into a unit code with a matching description. (I will attach the table of unit codes and definitions.)

We would like to eprescribe test strips and lancets but I believe in order to do so, they need to have NDC codes.  I tried researching how I would find the codes for each brand and size but an not having much luck.  Can anyone help with this?

I just activated my first physician and it was smooth however within minutes I get emails from other physicians telling me they have received a message that contained a report of all of their sent prescriptions and the LOCK on the sent prescriptions is now there.

I have been trying to find documentation on this process however I have not read about this happening.

Nothing is easy! Things change or appear without the user knowing that this is going to happen. I feel so unprepared every time I activate a feature because there is no documentation.

Our office has Multum DB and are noticing our Tramadol, Ultram, etc are failing for incorrect DEA schedule.  I created a ticket and was shown where to add them for NY to the correct schedule.  Again they failed.  Then I was told to “remap the NDC code” even though that wasn’t the issue.  I did anyways, and it failed again.  The script attempts to send automatically and you do not receive the pop up window to enter the token OTP, and then it fails.  It is almost like ecw/multum does not recognize that tramadol was added to schedule iv awhile ago.  Any other NY offices experiencing this?

Hello everyone. I was hoping to get other eCW users feedback on a workflow issue we are experiencing, and am wondering how eCW may be used to assist with this.
We would like to find a way to restrict/limit the number of controlled substances that some of our providers are prescribing. I reached out to eCW and they confirmed that there is not a way to set-up limits or restrictions by provider on controlled substance prescriptions. There is also not a way to set-up an automatic alert or pop-up warning message for the specific provider.
My initial thought was that this will need to be a manual process (i.e. running the Prescription Log Report by provider to keep track of how many controlled substances they are prescribing on a daily basis) then provide a verbal warning and/or suspend their EPCS privileges to make it less convenient for them to prescribe the controlled substances.
How have other practices handled this situation?

ECW has added a report called NDC Mismatch report to the report console.  This report will display the medication orders that were faxed “behind the scenes” when sending electronically due to NDC issues.

I haven’t been successful in finding out what to do with the meds on the report to correct the issues.

I look and it appears the same NDC number is there, I don’t find anything different to use.  On some lists, the medication is reported as having an Obsolete NDC number, but Medispan is still displaying it.

Has anyone had any luck in managing the information on this report? 

Thanks for any ideas anyone might have.

For the past 3-4 weeks ePrescribing controlled substances has failed to every pharmacy, for every patient, by every provider in our practice. It spontaneously started intermittently working this week, but only for about an hour per day (time of day that it works seems to be random). Another issue we are having is our eLab orders not going out, nor eLab results coming in. May or may not be related to the same problem. Has any one else had this issue? What was your solution at that time? Any advice we should try? We have already put in a ticket with ECW and they have been working on it for about 3 weeks with no real answers.

Our practice is a PCP practice that is currently being audited/monitored by both BCBS and UHC for healthcare spending dollars. We are not “penalized” yet however they offer a bonus incentive if we meet their metrics this year (they’re a challenge and requiring some hefty changes on our part). Their metrics are likely going to directly affect our reimbursement in 2015 when their fiscal 2014 year closes or their reporting period closes. They’ve gathered our data for their last fiscal year and are currently monitoring us to make sure we are meeting their specifications.

One of the areas I have a major challenge with is prescribing within a patient’s formulary. They want the lowest drug tier written (obviously). This would seem to be an easy concept with V10/RX eligibility however it does not work correctly in my office or perhaps this could possibly be an entire ECW problem? If you go to add an rx with formulary after setting the formulary all drugs typed in/looked up come up as “covered” (green highlighted) - side note does anyone know why it says “3-99” and what those numbers could mean? I know this is incorrect as I’ve tried it on not only myself but other patients for non covered drugs on their plan from previous knowledge and it will report back covered. Further, when you look at where the information should populate for what Tier the drug is on their formulary, it is usually wrong or has two different tiers and the copay or co-ins reads: $9,999,999.99. Nothing populates under the “payer formulary alternatives”, only therapeutic alternatives which I assume is an algorithm put in place by ECW to pull drugs by class. 

Does anyone have any information on how to make this information more accurate? It is impossible for us to know patients’ drug formulary and making sure we are following protocol with them/prescribing. This would increase our office efficiency dramatically in cutting down on prior auths/rx filling delays as well - we do SO MANY PAs it slows down production quite significantly.

In the last month or so, we have seen many scripts E prescribed not make it to pharmacies even though E clinical shows successful. We have found out that some pharmacies have strict regulations which are rejecting E clinical custom meds due to NDC linking issues. How are practices handling it when a med has multiple dosages that you are trying to custom. Let’s say for example you have 5 custom amoxicillin dosages, and you want to label these so when you pull up the custom list, you can tell which amoxicillin dosage you want to choose—what i’m seeing is that if the custom meds are changed in any way in the name or strength or formulation field, many pharmacies will not get the med even though the escript will say successful. This is a recent change and E clinical has verified this is happening. So this makes it impossible to work with custom meds when there is more than one custom dosage. The other issue is that the NDC’s numbers have changed due to hippa now requiring 11 digits, so custom meds done a year ago no longer are recognized by certain pharmacies unless the ndc’s have been “updated.”

Using favorites is hard because each staff member would have to add the favorite correctly, so now its hard to use either custom meds or favorites.

Has anyone come up with an elegant way to keep Suboxone off the med list? Federal law (42 U.S.C. § 290dd-2) and regulations (42 CFR Part 2) cover how and when these medications can be made visible. They are not permitted to be visible in the EHR without written patient consent. PSAC on the encounter level does not block the med list and PSAC on the patient level does not have a break glass option.

Hi All,

Can anyone tell me the difference between “Discontinued” and “Not Taking” in the medication reconcillation in Version 10?

Thanks!

I recently enabled eRx for controlled substances. eCW told me this only works if the medication is directly pulled from the multum database as opposed to from the customized medication list. Anybody else having this issue and does that make any sense.? I have literally all my commonly prescribed meds in custom lists so it is a royal pain….to pull meds from 2 lists.

eCW say the NDC doesn’t match when you pull from the custom list but that doesn’t make any sense, it shouldn’t match non-controlled substances either. Also, all of my custom meds are pulled from Multum and the majority unaltered (except that I change most to 90 day supply, 6 refills for chronic meds).

Are these just teething problems for EPCS and they will eventually fix it? Anybody else having that problem. We are hardly using EPCS because of that issue.

We have a list of 8 popular pharmacies that we cannot eprescribe or fax medications. We have placed a ticket with eCW and they said that we have to call these pharmacies and tell them.  The pharmacies are telling us that they cannot eRx refills to us since their computers tell them that eRx is not listed for our practice.  We did move our practice from another address and maybe this has something to do with this.  Can we get some help from ecwusers as to what may be the problem? This is not for scheduled medications and even though we asked to have Surescripts involved so far eCW has not complied to place a case with Surescripts. Please assist.

Please just let us type it in, or make the list easier to use.
The drop down list in its current form is CLUMSY.
You can enter a first letter of the topic, but there is not a good way to get to other topics.

In a Telephone Encounter I can go to the Rx tab, click on Current Meds, click the “S” icon to Stop a particular med and this stop action will then appear as a row within the Rx tab of the TE.  However, when I then go to “Fax Script”, that stopped medication is not part of the fax.  In fact, I have never seen anything appear in the, “Existing Prescriptions not requiring Refills” section of the script fax preview.  Is there any way to communicate a cancellation or stopping of a medication to a pharmacy other than calling the pharmacy?  It’s a long story, but I’m asking this due to an ongoing problem we are having of not getting enough eRefill requests but instead large amounts of fax refill requests.  Thank you!

Looking through our CustomRx entries, we have some that contain a single medication name entry and then clicking on that medication will show you multiple rows containing different doses and or forms for that med selection. This is how our Medispan medications are organized. However, most of our custom medications, when selected from the search results, only contain one row with a single dose/form.  So instead of searching for, “medication x”, finding it, clicking on it and then being presented with many options, you instead search for medication x and find a bunch of different medication x’s showing up in the search results where clicking on any of these just provides you with one variant dose/form option.

I was told by another clinical site we are currently visiting that the entries in our CustomRx database that have a single medication name entry with multiple available doses/forms were build in an eCW version 9 or earlier.  They said that in version 9 you could create multiple dose/form entries for a single medication, but in version 10 that ability was removed and that you have to create a separate, searchable medication entry for EACH available form or dose.  I’m traveling and my SAM is out of the office but this information just seems strange to me.  If this is indeed what happened with the version 10 upgrade, it just seems like a huge step backward in user-friendly searching through CustomRx (not counting having to build each CustomRx medication entry with the dose and form as a part of the medication name so providers know which one of the many provided to click on within the search results).  Could anybody confirm or deny this understanding of how CustomRx builds work?  We essentially want our custom meds organized and searchable in the same way the Medispan or Multum medications are organized.  Can anyone confirm this information?  Thank you so much