PRESCRIBEIT®: Provider Workflow and Feature Management in Profile

article overview this article is intended for clinical users of prescribeit® and outlines the provider workflow and feature management, covering the following topics prescribeit® docid\ tmudow7kgoybenhhlf4dye prescribing docid\ tmudow7kgoybenhhlf4dyprovider workflow docid\ tmudow7kgoybenhhlf4dyprescribeit® logon docid\ tmudow7kgoybenhhlf4dyprescribeit® logout docid\ tmudow7kgoybenhhlf4dyeprescriptions with prescribeit® docid\ tmudow7kgoybenhhlf4dymanagement docid\ tmudow7kgoybenhhlf4dypast orders docid\ tmudow7kgoybenhhlf4dyeprescription cancellation docid\ tmudow7kgoybenhhlf4dyeprescription renewal docid\ tmudow7kgoybenhhlf4dy prescribeit® canada health infoway is working with health canada along with provinces and territories, and industry stakeholders like intrahealth to create, operate and maintain a financially self sustaining, e prescribing service, known as prescribeit® this will be a single service that can be scaled for use across the country, enabling prescribers to electronically transmit a prescription to a patient’s pharmacy of choice the service will provide safer and more effective medication management by connecting community based prescribers (such as physicians and nurse practitioners) through their existing electronic medical records (emr), to community retail pharmacies to enable the electronic transmission of prescriptions prescribeit® will reduce the use of paper prescriptions, enhance patient safety, reduce fraud, improve continuity of care, optimize jurisdictional drug information system investments, and facilitate better health outcomes for canadians e prescribing e prescribing is the secure electronic creation and transmission of a prescription between an authorized prescriber and a patient’s pharmacy of choice, using clinical electronic medical record (emr) and pharmacy management software provider workflow prescribeit® logon as part of the registration process, prescribeit® users were asked to provide a cell phone number to be used for the two factor authentication (two step login) process press the logon icon on the main toolbar menu to login with prescribeit® this logon requires the cell phone number you provided to receive an sms code in the prescribeit logon window that opens, click the request sms button to request the sms code once you receive the sms code, enter it in the sms answer field click connect to login the prescribeit® session lasts for a maximum of 12 hours, after which you will need to use the two factor authentication to login again logging out of profile does not log you out of prescribeit® the session is attached to you, as the provider, so if you log back into profile within the 12 hours, your existing prescribeit® session will be used prescribeit® logout click the logon icon on the main toolbar menu click disconnect to log out of prescribeit® eprescriptions with prescribeit® prescribe a usual medication by dragging and dropping the prescription from the usual scripts tab into the current order area prescribe a new medication by entering all or part of the name in the rx field of the current order area and clicking the ellipses to open the formulary window the number of prescriptions that can be sent electronically has increased from 25 to 50 double click to select an existing instruction or a new instruction fill in the required fields of dose, frequency, and quantity also add duration to ensure a complete prescription is sent to the pharmacy in the order items toolbar, click the print icon to e sign and send the prescription electronically using prescribeit®, with no printout alternatively, you can click the print dropdown arrow and select send and print to electronically send the prescription to prescribeit® and print a paper copy for the patient if the patient does not know which pharmacy they want to visit a non authoritative electronic prescription will be sent to prescribeit® the printed authoritative copy that is given to the patient will have a prescribeit® rx id and one time barcode for a prescribeit® pharmacy to use this paper copy must be signed by the prescriber and cannot be used at a second pharmacy print to only print a normal paper copy for the patient, i e , it does not have a prescribeit® rx id and barcode printed this option is used when the patient chooses to go to a pharmacy that is not prescribeit®enabled or the patient has opted out of prescribeit® the patient’s preferred pharmacy is denoted in the supplier field management past orders in the past orders view of the medical record, you can view the erx status of the patient’s prescriptions, which will change as it goes through the dispensing cycle to see more details, you can select an order and click the geterx details button in the toolbar, which becomes enabled this opens the prescribeit details window here, you can see the patient information, the created date of the order, the prescriber’s name and their pos, the pharmacy information, and the order(s) for the patient if any changes have been made to the order(s)by the pharmacy, these will be seen here as well possible erx status options sent the prescription has been sent sent fax the prescription has been faxed dispensing complete the dispensing of the medication has been completed repeats remaining there are repeats remaining in the order printed the prescription was printed if a prescription was printed, and the patient did not take it to a prescribeit® pharmacy or opted out of using a prescribeit® pharmacy, the erx status will stay as printed cancel sent a cancellation request for the prescription has been sent cancelled the prescription has been cancelled cancelled fax a cancellation request for the prescription has been faxed cancel error a cancellation request delivery has failed error an error has occurred no erx status there is no status applicable to get more electronic activity details on an individual eprescription, select it and press activity log to open the electronic activity log window here, you can see the message type, and when you select the item, you can see any notes from the pharmacy, if any splits were done for the prescription and what was actually dispensed if there was a prescription split, the split icon at the end of medication name field can be hovered over to display the split reason if available, the rx number will also be displayed at the bottom of the panel in the rx # field the field will not display if there is no rx number information eprescription cancellation an eprescription sent in error may be cancelled from the past orders view in the medical record in the past orders view of the medical record , select the eprescription to be cancelled, where its erx status is not dispensing complete press the geterx details button in the toolbar to open the prescribeit details window in the cancel? column, select the radio button click send cancel request from the cancellation reason dropdown field, select the appropriate reason click yes in the confirmation dialog box to cancel the eprescription note for a printed prescription that was dispensed, you will have to contact the patient directly in order to tell them to stop taking the medication eprescription renewal providers will receive eprescription renewal requests from prescribeit® enabled pharmacies for prescription refills in the prescribeit management view of the work centre and also as tasks clinical staff can also respond to eprescription renewal requests when the response is deny or under review split prescription renewal requests eprescription renewal requests could include single split and full split renewal requests, which can include between 2 and 5 requested prescriptions a single split is when the pharmacy does not have a dosage or part of the prescription in stock in this case, the eprescription renewal request will show the original prescription order, the requested split prescription (denoted by a blue dot) with the medication/dosage in stock, the informational split prescription(s) (denoted by a grey dot) for the item not in stock (between 1 and 4), and the split reason once that medication/dosage is in stock, a separate eprescription renewal will be sent a full split can happen when the prescribed strength of medication is not manufactured, or a combination medication needs to be split, for example in this case, the eprescription renewal request will show the original prescription order, the split prescription(s) (between 2 and 5), and the split reason if the prescription has been split, you will see a in the split column for the prescription and the prescription will be expanded to display the related prescriptions the split reason can be seen when the split icon is hovered upon a decision will only be able to apply to the prescription as a whole, not the individual splits for a single split renewal request, an (informational only) tag will display underneath the informational prescription medication matching logic selecting the most appropriate match for the renewal request medication is not always obvious and can impact the integrity of the patient medication list therefore, a prescription matching logic has been implemented to assist prescribers and locate the best possible matches for replacement for each pharmacy requested medication received in the renewal request, matches are found from the patient’s prior scripts to keep the patient’s medication list clean and consistent the search for these matches is done in the following order first, the system attempts to match based on the eprescription identifier (prescribeit® erx id) when a medication is prescribed electronically, an eprescription identifier is assigned to the prescription the eprescription identifier of each medication received in the renewal request will be searched to see if there is a matching identifier in the patient’s prior script this matching locates the best possible matches from the patient’s prior scripts, as matching is done on the eprescription level if a match is found, the tag (found in patient chart) will display underneath the medication if no match is found with the eprescription identifier, the system will then attempt to match chemical, strength and form (e g , ccdd ntp) this matching is less exact since the matching is done at the medication level only, and other elements of the prescription (e g , directions for use, frequency) may vary if a match is found, the tag (found in patient chart, potential match) will display underneath this medication to signal that these matches should be manually reviewed the system can find up to three matches using the ccdd ntp logic if more than one match is found, the most recent match will be shown at the top and the other matches can be viewed by clicking on the show more link though this is a less confident matching level, it does help to narrow down possible replacement matches by using three criteria (i e chemical, strength and form) the prescriber can update their decision on the pharmacy requested medication or on the medication found using matching logic for the medications found using matching logic, only ‘approved' decision can be selected in the work centre window, select the prescribeit management view a list of eprescription renewals will be displayed and is sortable by date, patient, status, prescriber, pharmacy, and a warning triangle a warning triangle for an eprescription renewal denotes the originating prescriber for the eprescription is different from the eprescription renewal prescriber the statuses pending all incoming eprescription renewal requests will have this status actioned once print or send response is pressed in the prescribeit renewal order details window for the eprescription renewal request, this status will display draft once a decision is made about each item in the eprescription renewal request and save locally is pressed in the prescribeit renewal order details window, this status will display error profile receives a notification if an error occurs on the pharmacy side when they receive the sent response, and this status will display you will also receive an error notification task for the eprescription renewal(s) for the patient this task contains links to the eprescription(s), and the encounter created for the eprescription renewal from the encounter, you can print or cancel the eprescription renewal unassigned the patient demographics received in the renewal request do not match with any patient details in profile under review a prescriber has sent response as under review for at least one medication in the renewal request the prescriber must do a subsequent response for the under review medications to change the status of the renewal order from under review to actioned to action a pending eprescription renewal, double click the item to open the prescribeit renewal order details window here, you can view the patient information, the created date of the renewal request, the provider for whom the request is created, the local pharmacy information in profile and the pharmacy information according to prescribeit®, and the renewal order(s) for the patient if any changes have been made to the order(s)by the pharmacy, these will be seen here as well you can click to show the renewal request details as html to see the prescription information all the pending eprescriptions for this patient are listed each eprescription renewal can be actioned individually by clicking into the field under the decision column for that eprescription renewal and selecting one of the following options approved – if this is selected, the format of the medication that the pharmacy sent will be populated into the patient’s medical record denied – a reason is required for declining an eprescription renewal, selected from the dropdown list in the reason column deny and replace – if this is selected, the replace renewal prescription window opens so up to 5 new or renewal orders can be created in this window, the original prescription details are displayed new prescriptions can be searched and created, or usual prescriptions or past prescriptions can be used, as per the usual process once this is saved, the prescribeit renewal order details window is updated with the replaced prescription information (denoted by a green dot) and replace with this new prescription is entered as the reason under review – this is selected when further assessment or time is required to make a decision a reason is required, selected from the dropdown list in the reason column as these renewals need to be actioned in a timely manner, check the under review checkbox in the status field list in the prescribeit management filter window a separate filter can also be created for eprescriptions with this status the decisions for these eprescriptions can be changed in the prescribeit renewal order details window alternatively, all the eprescription renewals can be approved or declined at the same time by clicking the mark all icon in the toolbar and choosing the appropriate status an eprescription renewal instruction may be modified by double clicking it to open the edit renewal prescription window if changes are made to the prescription instructions, the option in the decision column will change to approved with changes this alerts the pharmacy to review the eprescription renewal in detail once you have actioned all the eprescription renewals, click send response in the prescribeit renewal order details window to send the eprescription renewal decisions to the pharmacy to be notified of incoming renewal requests, a work notification can be enabled in the work notifications tab of the general view in the preferences window, check the prescribeit renewal requests checkbox unassigned patients management in the prescribeit management view, requests for eprescription renewals for unknown or unmatched patients are displayed with unassigned status and the patient’s name is in italics to ensure eprescriptions renewals with this status display, check the unassigned checkbox in the status field list in the prescribeit management filter window a separate filter can also be created for eprescriptions with this status when the eprescription renewal is double clicked, this opens the prescribeit renewal order details window in this window, you can click mark all as denied and press the send response button, or you can press the a ssign patient button to search for existing patients in the select patient window, which is populated with the patient’s hcn once the eprescription renewal is assigned to an existing or new patient, the status changes to pending and you can perform all the actions as per usual for all eprescription renewal requests that have been automatically or manually matched with a patient, but where no response has been sent, there is an unassign patient button available in the prescribeit renewal order details window pressing this button and pressing yes in the subsequent confirmation dialog box will unassign the eprescription renewal request from the patient, change the status of the eprescription renewal request to unassigned , and the unassign patient button will switch to assign patient any changes made will be rolled back once this happens, you can now deny all or assign the eprescription renewal to another patient and go through the renewal management process again once the send response button is pressed, no changes can be made in the prescribeit renewal order details window learn more click below to read more about prescribeit® prescribeit® administrative workflow docid\ krwej6aib9qmrqwil 495prescribeit® pharmacy clinical communication docid\ ymk4t6wurgsvawcu0xkl0