Review Session - Medication Management/Electronic Prescribing

Agenda

• Medication Management/Electronic Prescribing Demonstration
• Overview
• 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

Overview

Medication management is a simple process for the provider and support staff when using Enterprise Health . 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 Enterprise Health 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 EH functionality includes:

• First DataBank Integration * EH partners with First Databank, a comprehensive U.S. FDA-approved drug database and drug decision report tool, to check for drug?drug and drug?food interactions, as well as drug allergies, at the time a prescription is written or filled. The database is updated every 7 days.
• SureScripts e-Prescribing Integration
  • Through the SureScripts network, providers can securely transmit prescriptions to, and receive refill requests from, pharmacies across the nation, eliminating the need for paper scripts, faxing, and phone calls. The SureScripts network includes all of the nation’s leading chain pharmacies, many of the nation’s leading payers and pharmacy benefit managers, as well as over 10,000 independent pharmacies, nationwide. The EH system allows for sending prescriptions to pharmacies that are not part of the SureScripts network, as well.
• Electronic Prescribing of Controlled Substances (EPCS)
  • Custom configuration of EPCS and SureScripts Advanced functionality is available as an add-on service. This will be scoped and billed separately, as needed.
• Eligibility and Medicare Formulary
  • SureScripts-certified electronic prescription management provides real-time access to eligibility and drug formulary information of a patient’s Medicare insurance and/or pharmacy benefit plan, if available.
• Reporting
  • Several reports are available within the Enterprise Health system, designed to assist with providing quality care and tracking of managing prescriptions, medications, and drug utilization reviews. Some of these reports include:
    • Allergy Report
    • Controlled Substances Report
    • EPCS Incidents Report
    • Meds Report
    • Meds Report - Custom Report
    • Meds Report - Duplicates Report
    • Prescriptions Report
    • Prescriptions Printed / Faxed / E-Sent Report
    • Unsent Prescriptions Report
    • Uncoded Meds Report
    • Unrecognized Patient Allergies Report

Medication Management

Within the EH 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.

Additionally, duplicate therapies can be easily detected and avoided with the First DataBank integration. EH checks the current prescription(s) against the prescription history (both filled and prescribed), and a duplicate therapy alert will be sent out if the newest drug being prescribed is within the same therapeutic class of those medications already filled or prescribed.

Meds Manager

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 Enterprise Health 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 EH 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, Enterprise Health 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.

To change the library from Default, click the Current Library hyperlink, and select the preferred library from the dropdown options. Once the selection has been made, click the Set button to save the setting.

To create a remembered prescription:

1. First, set the Current Library to the appropriate alternative that will be the library the prescription will be associated with and remembered under.
2. Click the Prescribe link, to begin adding a prescription.
3. In the Medication autocomplete field, begin typing and select the medication name. It is important not to overwrite a saved or remembered prescription. To avoid overwriting a saved prescription, use medications notated with (New). Selecting a (New) choice will prompt users to fill out each field.
4. Fill out all of the remaining fields, as appropriate. The next field, Form, will display the most common option, with a list of alternatives below it. The Form will save with the remembered prescription, if an autocomplete option is chosen; however, if the Form is free-texted, it will not be remembered.
5. Use the Remember As field to enter the keyword being used to recall the remembered prescription. Generally, a physician last name, medical condition abbreviation, or what the medication is being used for, are all types of keywords often used. Enter the keyword in this field.

1. 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.

System Configuration

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.

Paper Prescriptions

Enterprise Health 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:

1. Navigate to the DMS, locate the client, and Add Task of New Prescriber Verified.

1. 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 Enterprise Health system. Security rights must be enabled to allow the editing or setting up of users in Enterprise Health . 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:

1. Navigate to the Access Control tab of the Control Panel.
2. Search for and find the prescribing clinician needing e-prescribing privileges.
3. Simply click the Edit link in the Options column.

If the prescribing clinician is new to