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Table of Contents
TABLE OF CONTENTS
INFORMATION SECURITY AND CONFIDENTIALITY .................................................................................... 4
OVERVIEW ............................................................................................................................................... 5
LEARNING OBJECTIVES ......................................................................................................................................5
TIPS AND TRICKS ..............................................................................................................................................5
SOLUTION ICONS .............................................................................................................................................5
SIGNING ON ............................................................................................................................................. 6
PRESCRIBING .......................................................................................................................................... 7
ADDING PATIENT PREFERRED PHARMACIES ...........................................................................................................7
TIPS FOR USING THE PHARMACY SEARCH ...............................................................................................................9
PATIENT PREFERRED TAB ...................................................................................................................................9
DOCUMENTING HOME MEDICATIONS ................................................................................................................11
ENTERING A NEW PRESCRIPTION.......................................................................................................................12
PRESCRIBING ROUTING ERRORS ......................................................................................................................15
RENEWAL REQUESTS ......................................................................................................................................16
TELEPHONE...................................................................................................................................................16
RX RENEWAL REQUESTS.................................................................................................................................17
EXAMPLES: ...................................................................................................................................................20
Amoxicillin: ...........................................................................................................................................22
Enalapril: ...............................................................................................................................................23
Diazepam: .............................................................................................................................................24
ORDERS TO SIGN ...........................................................................................................................................25
RENEWAL REQUESTS SAME MEDICATION, DIFFERENT FORMULATION ......................................................................30
REPLACING A RENEWAL REQUEST WITH A DIFFERENT MEDICATION .........................................................................31
REJECTING RENEWAL REQUESTS .......................................................................................................................32
RENEWAL REQUESTS FOR CONTROLLED SUBSTANCES ............................................................................................33
RECOMMENDED WORKFLOW: RENEWAL REQUESTS FOR CONTROLLED SUBSTANCES ...................................................33
LOGGING OUT ........................................................................................................................................ 36
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EMR Documentation ePrescribe
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Overview
OVERVIEW
This reference guide was designed to supplement a hands-on, instructor led session. Pictures of various screens
have been included in order to show general information placement. Please note that these are standard screens
and may not match exactly to those at your site.
LEARNING OBJECTIVES
• Send a new prescription to a pharmacy via ePrescribing
• Reject an eRenewal request from a pharmacy
• Modify an eRenewal request before accepting
• Find a patient match for eRenewal requests that have no match
• Address routing errors from new prescriptions in the Message Center
• Verify preferred pharmacy information (add new, delete old information)
• Pull in external Rx medication hx into medication hx list
SOLUTION ICONS
Solutions use unique icons to designate buttons that have specific functionality. To view the icons and their
meanings for a particular application, open the table of contents, located in the left pane of the application’s
Help viewer. Expand the Menus and Toolbars book, and then select the Toolbar topic to display the
application’s icons in the main pane of the Help viewer.
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SIGNING ON
Follow this procedure to log into the application:
1. Double-click the PowerChart icon on the desktop.
• The Cerner log-in screen displays.
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PRESCRIBING
ePrescribing allows a physician or practitioner to electronically write a prescription and transmit the
prescription to the pharmacy electronically. ePrescribing software utilizes a network to provide a secure,
HIPAA compliant encoded communication link to and from participating pharmacies. Providers must be
valid prescribers and be registered with our credentialing medical staff office and have an SPI #.
Users will have the ability to receive and respond to prescription renewal requests from pharmacies.
When prescription renewal requests are received from a pharmacy electronically, an eRx renewal request
is created and is viewable in PowerOrders and the Message Center.
New Functionality:
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4. Right-click on the pharmacy you would like to add to the patient’s preferred pharmacy list and
click the Add button.
Note: If the patient has multiple pharmacies on the Preferred Pharmacy list, you can choose the
default pharmacy by right-clicking the pharmacy name and choose Set as Default.
5. During subsequent visits, verify with the patient that the pharmacy information is correct. If
patient has changed pharmacies, follow the steps above to add the new pharmacy.
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Note: When renewing an existing prescription routed to a pharmacy with ePrescribing, the system will
not retain the original pharmacy as the routing selection because it cannot be assumed that the
pharmacy is still valid.
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The following are two options for multiple prescriptions with a mix of scheduled or controlled (pain
medications, sedatives) and non-controlled medications (antibiotics, blood pressure medications, etc).
1. If you want to, Print all prescriptions (per patient request).
• Enter the scheduled medications first and the printer will default for the remaining orders.
2. If you want to, Send non-scheduled medications electronically and print the scheduled
medications.
• Enter the non-scheduled medications first, select the pharmacy, and use this for all non-
scheduled orders
• Enter the scheduled medications last and the printer will default for the remaining orders
Note: This is a recommendation to help organize the workflow when ordering multiple scheduled and
non-scheduled medications at the same time. It is possible to place them in any order and any grouping.
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EMR Documentation ePrescribe
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• Plans
o The Patient Prescription coverage will be listed here.
NOTE: External Rx History is a tool to verify the accuracy of the Medication History, gather
additional details or prompt the patient for medications that have not yet been documented.
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EMR Documentation ePrescribe
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The following text is displayed when the system is unable to send the prescription to the pharmacy based
on the current order details: Send to Pharmacy is not available because at least one of your unsigned
prescriptions is not eligible. (Note the default Send to option is Printer in these situations).
Send a prescription to the pharmacy is not an available option in the following situations:
6. Schedule medications are excluded by DEA regulation. These prescriptions may be printed, and
the print option will default.
7. Critical Patient Demographics are missing (these are viewable on the demographic banner) Last
Name, First Name, Gender, Date of birth.
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There are three routing error messages that can be seen in Message Center:
1. Prescription routing temporarily unavailable.
2. Unable to communicate with pharmacy.
3. Prescription too long for pharmacy system.
• The total length of the combined order details is currently limited to 350 characters. The
special instructions field is limited to 255 characters, but a combination of long special
instructions, PRN instructions, or other SIG line order details may cause the character limit
to be exceeded.
Once a routing error is received, the prescription should be printed and given to the patient or if the
pharmacy calls stating they did not receive the prescription, a verbal phone order is provided.
Note: It is not recommended to attempt to re-transmit the prescription electronically because in
most cases the cause for failure cannot be corrected by the end user and the prescription will fail
again.
Within the routing error message, the user can:
1. Click the pharmacy name to view information about the pharmacy and the prescription to
place a call to the pharmacy.
2. Click the Med List button to open the patient’s Medication List and print the prescription
and hand it to the patient.
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3. Enter a comment that includes the name of the prescription to the message indicating what
action was taken After the prescription is called, faxed or given to the pharmacy/patient.
4. Save the message to the patient’s chart and delete from the message center.
eRx Non-Match
• Renewal request for an order that did not originate from ePrescribing is received.
• A single patient match cannot be determined because multiple or no patients meet the
criteria for the suspect match on Last Name, Gender, Date of Birth, and Zip Code.
eRx Non-matches go to the Nursing Message Center pool. They are displayed in an eRx Non-Matches
folder. The Patient Name column is empty showing that no match could be made.
RENEWAL REQUESTS
Note that there are two folders in Message Center; one for Renewals and one for eRenewals.
TELEPHONE
Renewal Requests will follow the current process with phone triage.
• Nurse will create a proposal and send to provider via message center.
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Reminders:
• RN must get pharmacy info from the patient and verify that it is in the Patient Preferred tab.
• When building the Rx proposal, the RN must confirm that it is going to the correct pharmacy.
• Provider can send electronically.
RX RENEWAL REQUESTS
Renewal requests are sent back from the pharmacy with the ordering provider’s. To pace your name on
the renewal, as well as enter the indication, you must select the change option. You must enter the
indication for the medication as well as the number of refills. You can then sign.
This must be done for each eRenewal Request. Once signed you will see who first ordered the
prescription and who renewed the prescription as details in the order information.
Note: You cannot accept all with eRenewal Requests. You must click the delta icon for each Rx
individually.
Note: Click the refresh button after any action in the Message Center, or when returning to the
Message Center after taking action in a patient’s chart. This ensures that the information displayed is
up-to-date.
eRx Renewal
• Renewal request for an order that was originally placed through ePrescribing is received
and a patient match has been determined from the patient associated to the original
order.
• eRx Renewals and associated documentation (Response tab in message) will be saved to
the encounter that the original order was placed on, unless you selected the AMB
communication encounter.
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• The Response tab is the documentation that includes the original request(s) from the
pharmacy along with any responses and modifications made by providers and is saved to
the patient’s chart.
• Modifying a renewal creates an active prescription on the patient’s profile for that
orderable and sends an approval response to the pharmacy.
• The signature line details (dose, route, frequency, etc.) sent in the renewal request is
stored in the special instructions field of the prescription.
• The Response tab shows the actions that the user has taken on the message.
• A status of Not Approved New Rx to follow status is sent to the pharmacy and includes the
updated information and any note that may have been entered on the eRx renewal
request.
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8. Click the Request tab in the message to view the renewal requests that have been addressed.
EXAMPLES:
Message with multiple renewal requests:
• Amoxicillin (non-scheduled)
• Enalapril (non-scheduled)
• Diazepam (scheduled medication)
Scheduled medications are easily identified as they do not allow accept or different dose actions.
Only reject or replace with non-scheduled medication.
1. Click the request window action options to take action on all orders displayed in the request
message.
• The system warns if you try to accept a scheduled medication using the Accept All option or
the Accept All and Next, and blocks the accept action. Note: Kaleida Policy states the
Accept All option cannot be used because the indication must be documented.
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EMR Documentation ePrescribe
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AMOXICILLIN:
1. Select Reject.
• You do not want to renew, because this is an Acute treatment and the patient needs to be
seen.
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ENALAPRIL:
You want to approve this renewal.
1. Select the Delta and choose Same Medication, Different dose or formulation.
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DIAZEPAM:
You may want to replace with a different medication.
1. Select reject.
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ORDERS TO SIGN
Rejected proposals are not included in Orders for Signature as these do not require additional signature.
1. Click the Sign button to sign the orders and return to the message.
• The renewal response is created with all order actions taken from the medication list:
• All order actions have been saved to the chart at this time.
• The scheduled medication has been printed as specified by the provider.
2. Provider may forward the message to a specific resource or a pool to complete the final
communications with the pharmacy if needed.
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EMR Documentation ePrescribe
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3. Provider then deletes the original message as all actions are completed.
4. If forwarded for further communication, the staff may open the message and hyperlink to
obtain pharmacy contact information.
Note: The message is located in the eRx Renewals folder because the original message was
a renewal from the pharmacy.
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EMR Documentation ePrescribe
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• If there are multiple patients with the same name, add a comma and first initial after
the last name to reduce the number of results.
• When the patient is located, select the Ambulatory Communication encounter.
• Once a patient is selected, the Patient Match dialog box closes and the system displays
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EMR Documentation ePrescribe
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2. Select the replace action to launch the Medication List with the order on the scratch pad ready to
be modified.
• The order details can be modified as needed before signing the order.
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Note: Messages to staff members can be included at this time. (i.e., call the patient and advise
them to schedule an appointment).
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EMR Documentation ePrescribe
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11. Physician launches the Med List and enters a new prescription for the controlled substance.
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EMR Documentation ePrescribe
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LOGGING OUT
When you have completed your activities, remember to log out of the application you are working on
for security purposes. Logging out can be done in one of the following three ways:
1. If you are exiting the application temporarily, but planning on returning to that computer shortly,
click Suspend User on the toolbar. This returns the screen to the log on window and places the
cursor in the password field.
2. If you want to shut down the application completely, click Exit on the toolbar or the X in the
upper right hand corner of your screen. Keep in mind that shutting down the application will
require the next user to re-launch the application, which requires a greater amount of time.
3. Select Exit Application, to open the Exit Application window. The first option available allows
you to prepare the application for the next user. This returns the screen to the log on window
and places the cursor in the user name field. The second option will completely shut down the
application and the third option allows you to suspend the application.
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