Review Session - Medication Management/Electronic Prescribing
Covered by this topic
- Medication Management/Electronic Prescribing Demonstration
- Medication Management
- First DataBank Integration
- Meds Manager
- Medication Libraries & Remembered Entries
- System Configuration
- Paper Prescriptions
- SureScripts Prescriber Verification Process
- Enrolling Providers in Surescripts
- Electronically Prescribe Controlled Substances (ECPS) Option
- Receive E-Refill Requests
- Terminated E-Prescriber
- Surescripts Advanced/Drug Eligibility Option
- First DataBank Quarterly Report
- System Settings
- Security Role Permissions
- My Settings Preferences
Medication management is a simple process for the provider and support staff when using
. Medications can be entered quickly and easily using an autocomplete feature, which provides coded data input that is standardized and accurate. Furthermore, when the medication dosing and form information is entered, any potential contraindications can be set up to trigger alerts, prior to the prescribing, to assist clinicians in always providing safe, quality care.
Also intended to assist in better patient care, the WebChart system offers electronic prescribing (E-Prescribing) of medications. E-Prescribing is a necessity in today’s connected world. By submitting electronic prescriptions, it is not only less likely that prescriptions will be lost en route, but significant time is saved during the dispense process, thanks to the fast transmission of easily-readable information to and from pharmacies.
Standard WC functionality includes:
- First DataBank Integration
Within the WC system, any medication may be entered as discrete coded data, using First Databank to ensure accuracy. This provides an accurate historical record of the medications a patient presents with, as well as those being prescribed. Overall, features include viewing a patient’s complete medication summary and history, adding or deleting patient drug plans, adding preferred pharmacy information, using medication order templates, providing refill alerts when a prescription is about to expire, and refilling all prescriptions at one time, instead of individually.
First DataBank Integration
With a First DataBank integration, drug interactions can easily be checked and monitored during the charting process. Physicians are warned of potential drug interactions, and are prompted for drug therapies and/or tests that are indicated by diagnoses, and can note intolerances or other adverse reactions to complete the documentation required, supporting adherence to standard guidelines. Along these same lines, drug interaction checking will alert staff to preventable adverse medication events that may be caused from an allergy. If a user tries to add an allergy that is not recognized by the database, a warning will appear to alert the user that this is an unrecognized allergy. If a user adds a new allergy, and the patient is currently on medication that would cause an adverse reaction, a warning will display in the chart. The user can choose to override these warnings, but it may prevent automated alerts (such as drug interaction or contraindication alerts) from triggering.
To view and manage all saved or common prescriptions, utilize the Meds Manager menu , found in the Control Panel. This menu allows users to view, edit, or delete remembered prescriptions. The Meds Manager allows searching of specific (or all) libraries, and once the prescription has been located, it can be edited or deleted, if necessary. To find a saved prescription, verify the Current Library, in the upper-left corner. Set this to the library the remembered prescription was saved to. The full list of saved prescriptions for that library will display. Use the search and available filters to narrow down the results of the library’s saved prescriptions, if necessary.
Medication Libraries & Remembered Entries
Thanks to the expertise and weekly updates from the First Databank database of medications, the WebChart solution has an extensive library of medications, set to autocomplete where appropriate and trigger drug/allergy interactions/warnings, as needed. To edit or manage the number of libraries being maintained in the WC system, see the Library tab of the Control Panel. One excellent feature associated with the medication libraries is the ability to save common prescriptions. To help save time for clinical staff and physicians, WebChart has made it possible to remember common, or regularly occurring prescriptions, which are saved in non-default libraries.
Create a Remembered Prescription
When creating or accessing remembered prescriptions, the correct medication library needs to be set as the Current Library in the chart’s Allergies/Medications chart tab.
- Once all fields have been entered, click the Prescribe button to submit the prescription. When the medication is finished being prescribed, that medication will be available for reuse. It will populate all all of the same data entered, originally.
Use a Remembered Prescription
To prescribe that same medication with all of the associated details, navigate back to the Prescription Details page by clicking the Prescribe link in the patient’s chart. As long as the library the medication was saved to is set as the Current Library, the medication and its remembered name and associated details will populate when selected from the Medication autocomplete.
Update a Remembered Prescription
Updating or changing a remembered prescription is just as easy, if not easier. To begin, load the remembered prescription, as shown above. Once all of the fields populate as expected, make any and all changes necessary. With the changes made, ensure the Remember As keyword is set accordingly, and click the Update button. This is used to change previously saved scripts anytime after the initial save.
Before beginning any enrollments or system configurations, consider the following:
- Ensure proper permissions have been granted for the Manage Settings setting, View Users setting, and Manage Users setting. Control settings must be set to allow modifications to system users. Verify the Access Control settings of the user account being used for enrolling the provider(s).
- The prescribing user(s) being enrolled must be in the appropriate department. Verify the name of the Prescriber Department by navigating to the Control Panel and selecting the System Settings tab . Perform a Contains search for Prescribers Department. The listed Value is the department needed for prescribing users.
- SureScripts E-Prescribing must be enabled for the functionality to work. To verify, perform a Contains search for E-Prescribing in the System Settings tab of the Control Panel. The setting with Enable in the Item column will need to be turned on, or set to 1, in order for the module to be enabled.
- System Setting E-Chart | Meds | SureScripts Staging must be disabled (value 0) when e-prescribing is live on the production database.
WebChart comes configured with two versions of paper prescriptions, Script and Script-with Supervisor, which can be printed or faxed, as needed. These prescription options are programmed to pull in the appropriate prescriber and medication details.
SureScripts Prescriber Verification Process
As a means to maintain best practices, prior to submitting any requests to SureScripts, an internal verification must be performed for each prescribing clinician. The Deployment Consultant will initiate the internal validation by following these steps:
- Navigate to the DMS, locate the client, and Add Task of New Prescriber Verified.
Once the request is processed, a reply to the task will be provided, and a SureScripts Prescriber ID (SPI) will be assigned to the provider. Always check the provider prior to notifying the client.
Enroll Providers in SureScripts
The first step in being able to fully utilize the medication management and SureScripts features is to have the prescribing users properly set up in the WebChart system. Security rights must be enabled to allow the editing or setting up of users in WebChart . Once the prescribing clinician is set to become an electronic prescriber, SureScripts goes through a verification process. After verification, prescriptions will be eligible for electronic transmission. Assuming the user has already been created in the system and the initial setup and verifications have been completed, begin enrolling the prescriber, as follows:
- Navigate to the Access Control tab of the Control Panel.
- Search for and find the prescribing clinician needing e-prescribing privileges.
- Simply click the Edit link in the Options column.
Nurse Practitioners (NPs) and Physician Assistants (PAs) may be signed up to use SureScripts; however, a blank space must be entered into the DEA Number field using the space bar key. Upon submission, a reminder will be triggered about the required field. Simply acknowledge the reminder and continue to submit the page. <strong>A valid NPI Number is still required for NPs and PAs to be certified with SureScripts</strong>.
Electronically Prescribe Controlled Substances (EPCS) Option
The WebChart solution is certified through SureScripts to allow qualified providers to electronically prescribe controlled substances (EPCS). An additional expense will be incurred for the permit and Identrist fob, which are exclusive to only licensed providers with a DEA number. Additional steps are required for both setting up the provider, as well as prescribing the medication.
- The EPCS option must be selected in the user setup. Only System Administrators have access to this option.
- The E-Token Signature App needs installed on the workstation(s) being used by the provider.
- Two-factor authentication, with a token (e.g., USB thumb drive) and token password, is needed in order to prescribe medications.
An EPCS Prescription will not transmit without a Prescriber’s Token AND Passcode. Failure to provide both will place the medication(s) in an unsigned prescription queue.
Even though providers are capable of electronically prescribing controlled substances, not all pharmacies are capable of receiving these electronic requests. WebChart displays which pharmacies are EPCS-enabled when a pharmacy is selected for a patient.
WebChart limits or does not allow EPCS transmission for the following Medication Classifications:
- Detoxification/Maintenance Treatment
- Schedule II - Prescription cannot exceed a 90-day supply, in a single session, for a medication with the same Name, Form, and Strength.
- Schedule III & IV – Prescription refills cannot exceed five (5) refills. Refill requests older than 6 months cannot be processed. Prescription Start Date must be Today, therefore cannot be written for future dispense.
Receive E-Refill Requests
SureScripts allows authorization for refill requests to be handled electronically. There is a SureScripts requirement when using the Receive Refill Requests feature. When a refill request is received electronically, SureScripts requires a timely response, or that the request be worked within 48 hours. If responses continue to go unaddressed across a 48-hour timeframe, and there is a regular delinquency with processing/working the refill requests, SureScripts will disable the e-refill request functionality.
When a SureScripts-verified prescribing physician terminates from a practice, there are a series of steps that a SuperUser needs to follow to ensure prescribing and refilling capabilities are effectively discontinued.
Surescripts Advanced/Drug Eligibility Option
The Surescripts Advanced functionality includes access to Prescription Benefits (i.e., insurance eligibility and prescription formulary benefit information), as well as access to an individual’s Medication History and the ability to perform Prescription Routing to Mail Order Pharmacies using specified formularies. The System Setting (i.e., “Drug Lookup”, “Formulary”, “Show Surescripts”) must be enabled (Value = 1) in order to use these features.
Accessing an individual’s Prescription Benefits (both eligibility and formulary) allows prescribers to choose medications that are on formulary and covered by the patient’s drug benefit plan. Prescribers can also choose lower-cost alternatives such as generic drugs. An added benefit comes in the way of dispensing pharmacies, which are less likely to receive prescriptions that require changes based on drug benefit plans, which, in turn, reduces unnecessary phone calls from pharmacy staff to practices regarding drug coverage. Dose/Formulary In order to use the Dose/Formulary functionality and see the in-system button, the Dose Range Calculator system setting must be enabled. The button will be available when prescribing medications.
To see the Dosing and Formulary screen in its entirety when prescribing a med, the Form of the medication must be selected. Before selecting the appropriate formulary, an eligibility check must be run. An eligibility check cannot be run more than once every 72 hours, per individual. Once it has been run and obtained, then the available formularies associated with the individual’s drug benefit plan are loaded into the chart. The WebChart solution will maintain records of coverage eligibility in the Patient Benefit table. This eligibility status shows in the Allergies/Medications tab and the encounter Meds Plan section. Here, the last date/time an eligibility check was run will also display; however, if there is no listed date/time, no eligibility check has been run, meaning only dosing information will be available, with no formulary information. For more information on eligibility checking, see the Prescription and Insurance Eligibility Requests – Surescripts Advanced documentation.
First DataBank Quarterly Report
First DataBank is a national drug database that is integrated within the WebChart solution. This interface allows for searching medications by brand name, as well as generic and over-the-counter medication names. First Databank also provides drug formulary information, drug guides, dosage guidelines, drug interaction alerts, contraindication alerts, and drug diagnosis alerts. Client should note that all providers with either a DO or MD degree who prescribe medications out of WebChart , and send those medications electronically to pharmacies, will incur First Databank fees. These fees will be reflected in the annual license fee for Enterprise Health customers, or for WebChart customers, these fees may be included in either the monthly invoice statement or bundled into the system fee.
There are a large number of system settings available regarding the Medications module. In the System Settings of the Control Panel, permitted users can search for any settings pertaining to the E-Chart Module and Meds Section. These settings may need enabled, disabled, edited or set, to align with business needs and prescribed workflows. It is important to also search for the keyword Surescripts, so systems enabled for SureScripts functionality have the necessary settings established, as appropriate.
Security Role Permissions
In additional to system settings, it is important to review the security settings for each user or security role needing access to the medication management functions. Review the settings and give permission, as appropriate. There is also information available within the Security Role Settings online help documentation.
My Settings Preferences
Review the My Settings preferences of security roles and individuals, and ensure access and restrictions are established, as needed. Set each restriction or permission, accordingly. This information is also detailed within the My Settings online help documentation.
- Encounters Plan Section-Meds
- Allergies and Intolerances
- Discontinue Meds
- Drug Guide Search
- Drug Interaction-Allergy Warnings
- Drug Plan and Formularies
- E-Refills-ALL E-REFILLS tab
- E-Refills-E-SCRIPTS tab
- E-Refills-MY E-RX ERRORS tab
- E-Refills-MY PENDING REFILLS tab
- Edit or Change Meds
- Flow-Pat Ed-Meds Sheets
- Formulary and Dosing-SureScripts Advanced
- Medication History Reconciliation-SureScripts Advanced
- Meds Library-Remembered Scripts
- Meds Tab Summary View
- Preferred Pharmacy-Supply-Verification-Current Library
- Prescribing and Adding Meds
- Prescription and Insurance Eligibility Requests-SureScripts Advanced
- Print-Fax-Transmit Prescriptions
- Refill All Meds
- Setting up E-Prescribers
- Unknown Allergy or Medication Add Email Notifications
- E-Meds Report of Printed-Faxed-ESent
- Med Report
- Uncoded Meds Report
- Travel Kits
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