e-Prescribing and Medications FAQS

How do you order and document medications given in the office?

A typical medication template can do 3 things (in addition to including text in any section of the note).

  • Include the med favorites you would like to select (the actual prescription still has to be created, but saves the step of searching).
  • Create a task for the nurse to administer the medication with the exact dosing.
  • Automatically add CPT codes when the template is applied.

Here is an example: You can create a template that includes the following (using ceftriaxone as an example).

Orders/Workflow Tab:

  • Med Tab: Select med favorite Ceftriaxone 500mg (create entry in medications chart).
  • Other Tab: Ceftriaxone 500mg assigned to Nurse and Usage is standing.

Procedure Tab:

  • J0696 Ceftriaxone 2 units
  • 96732 Injection code 1 unit

Workflow

  1. This template can be applied to the note from the Assess/Plan tab (as well as CC and Exam tabs).
  2. Select medication on Meds tab and create prescription in chart (this does not create a task for the nurse).
  3. The nurse will get the task to administer the medication.
  4. Go into the medication entry in the patient's chart and enter:
  • information about site of admin if injection
  • lot and expiration date
  1. The nurse will mark the task as complete.
  2. Charges will automatically be sent to the superbill.

Another option is to give your nurses proxy privileges for in-house medications. You would still utilize the same template, but instead of the provider creating the medication the nurse would do so, as the med favorite would be marked as able to be written by proxy. This saves the step of the provider creating the prescription in the medication chart.

How can a mid-level provider add a Supervising Physician to their prescription?

The NP will need to select the supervising physician's initials in the Supervising Physician Field when the NP writes the script.

If the supervising physician does not change on a daily basis, you can also set your preference under System Preference, so that you are not required to validate the supervising physician on a daily basis. If the preference is not selected, OP will remember the supervising physician.

To set the preference:

  1. Navigate to Utilities > System Administration > System Preferences > Special tab > Prescribe tab.
  2. Select or deselect the checkbox to "Revalidate ERX supervisor on a daily basis" based on whether or not the supervising provider changes daily.

If you are printing the prescription, you will need to select the option of prescription with supervising. If you do not see that option in prescription printing options, please contact Support to get that report added to your system. 

How do I reprint another provider's prescription without editing it?

In OP, you cannot as a provider print another providers prescription. You would have to refill or recreate it so that your name appears on the script. Alternately, if they were truly just a reprint, you could have a nurse who only has Send privileges do so.

How do I set up a nurse for proxy privileges?

Your scribe should be logged in as themselves, not the main provider, when they are scribing.

Note: Everyone should use individual logins so that their work can be tracked. The main provider will ultimately review and sign off on the note.

Here is a review of eprescribing privileges:

  • If an MA/Nurse is given Send privileges, then the MA/Nurse can send a script that a provider has written without making any changes.
  • If an MA/Nurse is given Proxy privileges, then the MA/Nurse can create and send a script for a med that has been tagged as available by proxy. This script will need to be cosigned at some point in the eRx Center. When creating the script the MA/Nurse will indicate who the supervisor is and their name will appear on the script.
  • Mid-Levels: If the NP has full eprescribing privileges and is not writing scripts via proxy, they cannot send another provider's scripts whether they are a mid-level or a physician. The reasoning behind this is that each provider is responsible for their work and if they make any changes to the prescription their name would need to be on the script. 
  • Staff who have send privileges can only send prescriptions as written.
  • Staff with full prescribing privileges could edit the prescription, and if they did it should be assigned to their name.

Prescription levels are set in the Staff/Provider directory and each person who has proxy privileges needs to have paperwork filled out with OP. Remember, for all the medications you would like your nurses to write, you must create a favorite for that medication and mark it as a proxy med.

Is there a way for front office/nursing staff to put in patient’s pharmacy before physician sees patient?

To accomplish this, it is easiest to have your MA/Nurse set up as a provider agent with Proxy Privileges. This way the MA/Nurse can populate the Pharmacy list with your practice's most common favorites when you are starting out (they can do this through a test patient).

Each time a pharmacy is selected from the pharmacy list, it is also added to the Address Book. The Front Desk will be able to select it when checking the patient in from the Coordination of Care tab. Once a pharmacy is in the Address Book, you can also edit it and add notes such as cross streets so you can easily identify it. You can also search the Address Book by Pharmacy ID. If your Front Desk does not do this, then the MA/Nurse can add it to the Coordination of Care tab. By adding it to the Coordination of Care tab it will appear on the patients pharmacy.

How do I create prescriptions with dosing in teaspoons instead of milliliters?

OP is set to create all prescriptions in milliliters.

How do I make medication favorite default to certain number of refills?

Currently, we do not include refills as part of the favorites.

How do I record a non-med written prescription?

To record a written prescription for a non-med item such as Durable Medical Equipment (DME) or Therapy orders:

  1. Go to:
    Patient's Chart (Chart button) > Medications tab 
    or
    Patient Chart (Chart button) > Encounters Tab > Start a New Note button > Med Review tab.
  2. Click the Add a New Prescription button ( button).  The Prescription writer window will appear.
  3. Click the Purpose dropdown menu and select Order (non-med) from the dropdown list.
  4. Make the appropriate selection in the Type dropdown.
  5. Enter the order details.
  6. Click the Print button to print the prescription. 

How do I setup EPCS?

Overview

EPCS requires certain areas in OP to be set up before electronic prescribing of controlled substances can be enabled.  These areas are described below.

Provider Set-up 

To enable EPCS for a provider, the provider's Federal DEA number must be entered in the Staff/Provider Directory in the Federal DEA# field.  This is a required field.  In addition OP includes the NADEAN # field in the Staff Directory (under the Provider Info tab).  If providers in your practice have been issued a Narcotics DEA (NADEAN) number, you must add their NADEAN number to the NADEAN # field in their profile in the Staff Directory.

Utilities > Manage Practice > Staff/Provider Directory

Logical Access Control (LAC) 

Utilities > Manage Practice > EPCS Access Control

The LAC is configuring providers (who have completed the IDP process) in OP as either active or inactive. This is a two-step process which requires a user with System Administrator permissions other than the provider being activated or deactivated to open the LAC.  Any provider with EPCS credentials may perform the second step by entering their passphrase and the PIN number from their token.  

A user must be a System Administrator or have the following individual permissions: AA_AccessSecurity.mi and AA_SystemAdmin.mi to access the LAC. This must be a user other than the provider being activated/deactivated.
  1. Click on Utilities.
  2. Select Manage Practice.
  3. Select EPCS Access Control. This is OP functionality that enables System Administrators to set LAC for providers. 

Note: Both the Granting Administrator and the Provider who is being activated must do the remaining steps in this section together on the same computer.
  1. OP launches the EPCSGold web page in a separate browser window. The logged in System Administrator is the administrator that grants permission.  The Administrator name must be entered in the Administrator field.

  1. Select a provider to activate.
  2. Authorizing Prescriber: Enter the NPI Number in the Enter NPI field for the provider who will be entering their passphrase and PIN from their token (this can be any provider with credentials, including the provider being activated/deactived).
  3. Click the Validate button to validate the provider's NPI Number.
  4. Have the provider enter the token they will be using for EPCS prescriptions.

  1. Have the provider enter their Passphrase and PIN from the token.
  2. Click the Authorize button.

Provider Dashboard

Utilities > Manage Clinical Features > EPCS Prescriber Dashboard

The Provider Dashboard allows providers to manage their Passphrase and the authentication tokens assigned to them. Tokens include:

  • Hard token -- a device that generates authentication codes regularly and is associated with the EPCS prescriber's account
  • Soft token -- similar to a hard token but rather than use an external token it is an application that runs on a device (such as a mobile phone or tablet)
  • Biometric authentication -- physical data that is unique to the provider (such as a fingerprint)
  1. Open the EPCS Prescriber Dashboard.

OP launches the EPCSGold web page in a separate browser window. The NPI Number is pre-populated.


  1. Enter your Passphrase. The EPCSGold web page displays the Token and One Time Password (OTP) fields.

To manage your Passphrase:

  1. Select Profile.
  2. Click Change EPCS Passphrase.
  3. Select token and enter your PIN.
  4. Enter your old Passphrase and then enter a new Passphrase to replace the old one. 

To manage your token(s):

  1. Select the Tokens tab.
  2. Select your token. This is only necessary if you have more than one token (such as a hard token and a soft token). The system defaults to the last token you selected.
  3. Enter the PIN that your selected token is currently displaying in the OTP field. The EPCSGold web site displays a list of tokens associated with the user.
  4. Activate, deactivate, add, or remove tokens as necessary.  

Prescription Monitoring Program (PMP)

The Coded Values window allows you to set up a link in the Prescription Writer window to the PMP web site for your state.

  1. Select Online Resource Location under Code Table Purpose.  
  2. Click the Plus button to add a new record.
  3. Enter the URL under Description.
The URL you enter in the Description field will be your state's login page to the Prescription Monitoring Program (PMP).
  1. Enter "PMP" under Guidelines / Other Data.

  
The hyperlink to your PMP and field to document any confirmation number provided can be found on the Prescription Writer once a Schedule II-V drug has been selected.


How do I add pharmacy to OP?

Version 14.9

Add a Pharmacy to Favorites from SureScripts Master List

If you are unable to locate a pharmacy in the SureScripts Master List, contact the pharmacy. The pharmacy is responsible for contacting SureScripts and requesting to be added to the network. OP Support will not be able to add a pharmacy to the SureScripts Master list.
  1. Click Utilities > Manage Clinical Features > Pharmacy Favorites. The Choose a Pharmacy window displays.
  2. Click the SureScripts Master List tab.
  3. Search for a pharmacy by entering information in the top panel of the Choose a Pharmacy window.
  4. Click the Search button.
  5. Highlight the pharmacy to add to the favorites list.
  6. Click the Add to Favorites button.
Note: Retail is the default search option. To search for Mail Order pharmacies, select the Mail Order checkbox.

  1. You will receive a pop-up window to confirm that you want to add the pharmacy to the practice favorite list. Click Yes to add the pharmacy.

Add a Pharmacy to Favorites from All previously used by any patient List

  1. Click Utilities > Manage Clinical Features > Pharmacy Favorites.
  2. Click the All previously used by any patient tab.
  3. Highlight the pharmacy to add to the favorites list.
  4. Click the Add to Favorites button.

  1. Click Yes on the Confirm window.

Remove a Pharmacy from the Favorites List

  1. Click on the Favorites tab if not selected. 
  2. Highlight the pharmacy to remove from the Favorites list.
  3. Click the Remove from Favorites button.

Note: Removing a pharmacy from the favorite list does not remove the pharmacy from OP. For information on deactivating a pharmacy click here.
Version 14.8

If you have access to Utilities, you may build a Favorite Pharmacy list for the Practice by accessing Utilities > Manage Clinical Features > Pharmacy Favorites.

To add a pharmacy favorite:

If you are unable to locate a pharmacy in the SureScripts Master List, contact the pharmacy. The pharmacy is responsible for contacting SureScripts and requesting to be added to the network. OP Support will not be able to add a pharmacy to the SureScripts Master list.
  1. Access the choose a Pharmacy window (Utilities > Manage Clinical Features > Pharmacy Favorites).
  2. Click the SureScripts Master List tab.
  3. Search for a pharmacy.
  4. Highlight the pharmacy.
  5. Click the Add to Favorites button.
Note: Retail is the default search option. To search for Mail Order pharmacies, select the Mail Order checkbox.

  1. You will receive the following pop-up window to confirm that you want to add the pharmacy to the practice favorite list. Click the Yes button to add the pharmacy.

To remove a pharmacy from the Favorites list:

  1. Click on the Favorites tab. 
  2. Highlight the pharmacy.
  3. Click the Remove from Favorites button. The same steps apply to the All Previously Used by this Patient tab tab.

Where do I put a patient's favorite pharmacy?

To accomplish this, it is easiest to have your MA/Nurse set up as a provider agent with Proxy Privileges. This way the MA/Nurse can populate the Pharmacy list with your practice's most common favorites when you are starting out (they can do this through a test patient).

Each time a pharmacy is selected from the pharmacy list, it is also added to the Address Book. The Front Desk will be able to select it when checking the patient in from the Coordination of Care tab. Once a pharmacy is in the Address Book, you can also edit it and add notes such as cross streets so you can easily identify it. You can also search the Address Book by Pharmacy ID. If your Front Desk does not do this, then the MA/Nurse can add it to the Coordination of Care tab. By adding it to the Coordination of Care tab it will appear on the patients pharmacy.

For more information see Patient Register: Coordination of Care.

How do I transfer EPCS tokens to another provider?

In the event that your practice has questions or issues regarding tokens used for EPCS, you will need to contact DrFirst Support. This would include, but is not limited to, tokens no longer working and the transfer of tokens.