RE: [Bulk] RE: E-prescribing hassles

[Guest guest]

I know Colorado has a similar bill being considered – keeping my

fingers crossed!

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Ramona G.

Seidel

Sent: Monday, January 23, 2012 9:30 PM

To:

Subject: [bulk] RE: E-prescribing hassles

Regarding Walter’s “policy

approaches”. Initiatives to standardize PA format occurring in various

states. Here is link to the current land proposal:

MedChi

is proposing that the land Health Care Commission be granted the authority

to require carriers to conform to the standards and timeframes it outlined in

its recent report Recommendations

for Implementing Electronic Prior Authorization.

I do not suggest anyone read the entire

document (BORING!!), but for those interested in policy approaches, may be

worth pushing such efforts at state level. (and perhaps some good ideas

in this document from states that have already worked toward this goal.

Why re-invent the wheel?)

Cheers!

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Arnold, MD

410 518-9808

From:

[mailto: ] On Behalf Of Graham Chiu

Sent: Monday, January 23, 2012 10:59 PM

To:

Subject: Re: E-prescribing hassles

Your prescribing software generates a unique message id ( much like the

unique message id on email ) that is used to track the passage of the

script. So, if you know what it is, you can get Surescripts to trace it

for you to see whether it arrived or not. Ask your vendor how to look it

up.

On

Tue, Jan 24, 2012 at 4:05 PM, Pratt wrote:

I

have found that many times when the pharmacy says they don't have the rx, it is

because they are looking for the rx based on what the patient says (called,

faxed, or e-rx'd). 99% of the time, the pharmacy miraculously finds the

rx that they call us to tell us they never got -while i am on the phine with

them. Apparently, the phone vs. Fax vs. E-rx systems don't all jive in

all pharmacies. Let your patients know how it is being sent so that they

can tell the pharmacy the right info.

If

it is really bogging you down time-wise to make changes based on patient

preferences or patient error (or even the patient's new formulary), then it's

probably time to institute some " lost rx " and " change in

rx " fees. I would suggest making the new fees effective as of

1/1/12, with a 90 day grace period (but you don't have to tell the patient

about the grace period). Your staff can gently tell patients over the

phone that " this time " there won't be a fee, but that going forward

there will be if they lose/change/forget an rx.

My

$0.05,

Pratt

On Jan 23, 2012, at 6:29 PM, " Walter V. Kowtoniuk "

wrote:

I

hear you on the free options. I really doubt the problems are as

much inherent to Surescripts as they are to the participant pharmacies and

otherwise to the technology of huge central clearing houses for zillions of

silly prescriptions. Like I said, I’m a believer that

eventually the system will work reasonably well, at least enough to rely on it

plus the occasional call back. Even then, it doesn’t

solve the human element of lost prescriptions, formulary moving targets,

insurance changes, patient quantity changes, etc.

If all one is dealing with is Accupril and Amlodipine, it’s no big deal,

especially if the patient has a smart phone. How about the patient

on

Amlodipine/Lopressor/plavix/aricept/namenda/metformin/glipizide/simvastin/protonix/amitiza...,

using a rotory phone, you get it plus a bunch more. How about

half your schedule with this profile. It’s an enormous human

problem. Of course technology can solve it, within

limitations, and over time. No one can do this for

free. That’s why I keep pounding for policy

approaches.

-Walter V. Kowtoniuk

From: Seto

Sent: Monday, January 23, 2012 9:12 PM

To:

Subject: Re: E-prescribing hassles

Walter,

You

have my sympathies in trying to bring medicine in Western Pennsylvania into the

21st Century. Did you pay for SureScripts as an add-on to your EMR? It may be

worth it to you for the integration. However, I know of 3 free options for

e-prescribing:

AllScripts

ePrescribe

http://www.nationalerx.com/

Allscripts

ePrescribe for iPhone

http://itunes.apple.com/us/app/allscripts-eprescribe-for/id393019025?mt=8

Practice

Fusion EMR. This is the EMR I use, but you can use it just for e-prescribing

and not as an EMR.

http://www..practicefusion.com/pages/ePrescribing.html

I

have no financial interests in any of the mentioned products or services.

Seto

South

Pasadena, CA

On

Jan 23, 2012, at 5:36 PM, Walter V. Kowtoniuk wrote:

,

imagine multipying what you’ve just noted times a bit in rural western

Pennsylvania. You might give hard copies along with e-rx-ing

also. I do the e-rx-ing because I’ve paid for

Surescripts, I’m trying to comply with MU, and I’m a

believer that eventually, even in medieval PA, it will work.

None the less, it’s the human side of “refills because I lost my

prescription,” or “can you change my prescription from 30 days X 5 to 90

days X 3” or “I just changed insurance compainies and...”, or “my

insurance co just changed it’s formulary again as it did 5 days earlier”,

etc., which is the incessant challenge. And,

yes, I am trying to plug the holes moving

forward. As I have said, the necessity is the

environment of decreasing reimbursement and increasing costs along with all

these CNN and Fortune articles noting all these doctors going bankrupt or

otherwise going into administrative positions supervising the worker

bee’s. Personally, I’d rather go into

construction before succumbing to an administrative “authorizing” the “prior

auth’s” job.

-WK

From: Seto

Sent: Monday, January 23, 2012 7:37 PM

To:

Subject: Re: E-prescribing hassles

Sharon,

I

jumped on the e-prescribing bandwagon as soon as I could and have been doing it

for at least the past 5 years. It has gotten better, as more and more physicians

and pharmacies participate, but for some reason there are still a few

pharmacies which can't seem to " get " e-prescriptions. For example, I

get an electronic refill request through my EMR, and I approve it. Sent, done.

Then the next day, I get a faxed request asking for a refill of the same

medication. I figure it's just a duplicate and they haven't had time to process

the electronic refill yet, so I ignore the fax. 2-3 days later, I get another

faxed request for the same medication. I then call the pharmacy and ask if they

ever got my original electronic refill order. It used to be that half the time

they did receive it but their automated fax refill process doesn't sync with

their actual prescribing data, so they will keep sending the fax request until

someone cancels it. Annoying.

But

not as annoying as what's been happening lately, which is that the clerk will

just say " we never received it " . The last time I asked, I had only

given the patient's last name and she said " we never got it " . And I

said, " how do you know which patient I am talking about? I only gave you

the patient's last name (which was not an uncommon name). " So now I don't

know if they really didn't get it, or if they are just being lazy. I have taken

to reporting all problem e-prescriptions to SureScripts, the vendor used by my

EMR. They have a website that accepts reports of problem e-prescriptions.

However, after typing in all the pertinent data, I get an e-mail back from

SureScripts saying " We can't investigate further without the message

ID. " So far I've tried 3 times to get the message ID from my EMR vendor,

but for some reason they won't tell me how to find it. I haven't gotten

anywhere except for them to suggest that I try using Google Chrome instead of

Safari as the web browser.

So

fortunately the vast majority of e-prescriptions go through successfully, but I

keep thinking that if I make a big enough deal about these few problem

pharmacies, then they will also get their act together and all my

e-prescriptions will go smoothly. And if I don't do anything, they'll remain

thorns in my e-prescribing side. Anyways, e-prescribing is still not as

trouble-free as they make them out to be.

Seto

South

Pasadena, CA

On

Jan 23, 2012, at 3:56 PM, Sharon McCoy wrote:

Walter,

Are you doing e-fax or

true e-prescribing?

I found MUCH less was

lost after I switched to e-prescribing.

Just a thought.

Sharon McCoy

www.sharongeorgemd.com

www.impcenter.org

=======

Email scanned by PC Tools - No viruses or spyware found.

(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19110)

http://www.pctools.com

=======

=======

Email scanned by PC Tools - No viruses or spyware found.

(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19110)

http://www.pctools.com

=======

=======

Email scanned by PC Tools - No viruses or spyware found.

(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19110)

http://www.pctools.com

=======

=======

Email scanned by PC Tools - No viruses or spyware found.

(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19110)

http://www.pctools.com

=======

--

Graham Chiu

http://www.compkarori.co.nz:8090/

Synapse - the use from anywhere EMR.