Electronic Prescribing through Surescripts Network

Summary

The Net Health Employee Health and Occupational Medicine has been certified to send and receive electronic prescription messages on the Pharmacy Information Exchange Network run by Surescripts, allowing Net Health Employee Health and Occupational Medicine prescribers to send the prescriptions they write directly to the patient's chosen pharmacy via the Surescripts network.

The Sure Scripts network is national in scope although it is not licensed in every state. Over 57,000 pharmacies subscribe to the network, including most major chains, and updates are received on a weekly basis. While access is available to those many pharmacies, you can create and maintain a list of pharmacies in Net Health Employee Health and Occupational Medicine to which you routinely submit prescriptions, and make your selection from that more manageable list. When a pharmacy is needed that is not on your local list, access to the entire network of Surescripts subscribers is just a click away.

In addition to submitting a prescription you can send a message to the pharmacy to cancel an already submitted prescription. In addition, the pharmacy can submit refill requests as well as requests to change an already submitted prescription. Not all pharmacies support all these features, but Net Health Employee Health and Occupational Medicine will not allow you to submit a request for a service which is not available with the indicated pharmacy.

Net Health Employee Health and Occupational Medicine also provides the ability to carry a list of each patient's preferred pharmacies.

Related to electronic prescribing is the medication reconciliation feature which improves your ability to identify current medications a patient is taking or has taken. It is only applicable to Private Practice visits. The Medications Reconciliation routine has the ability to identify prescriptions that have been placed through the Surescripts network and paid for by the patient's current payers, which might include one or more entities (For instance, group insurance and co-insurance.) The list can include prescriptions submitted by providers outside your clinic, as long as they were submitted through Surescripts. These meds are displayed on a screen along with items from the Current Medications problem list. If there are Surescripts items which the patient has not reported, they can be moved directly to Current Medications without having to return to the PMH tab. The fact that the physician has reviewed the patient's meds can be documented in the charting note by checking a box. In addition, when this window is opened, Net Health Employee Health and Occupational Medicine does a full check for possible drug interactions for all meds.

Additional information may be found in the Electronic Prescribing Administration Guide; for a copy of the document, please contact Net Health Support at: 844-464-9348 option 3, or ehoccmed-support@nethealth.com.

For a copy of this manual click here

For DR. First Onboarding procedures, click here.

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The medication reconciliation does NOT display a complete medication history for the patient! It only shows items that were prescribed through Surescripts.

Submit a Prescription

For the user, creating the electronic prescription is a simple matter of clicking the Submit to Pharmacy button which will become available when set up for this, instead of Print, Fax or E-mail. On the prescription writing screen prescribers who have been certified through Surescripts will see a Submit button in addition to the regular Print button. (You can still print and fax scripts when necessary.) Select the pharmacy, click Submit, and Net Health Employee Health and Occupational Medicine will manage the rest.

Refill Requests

The e-prescribing system supports refill requests. When a patient contacts the pharmacy for a refill which is beyond the number authorized by the last prescription, the pharmacy can send a refill request back to the prescriber via the Surescripts network asking the prescriber for approval. There are several possible responses available to the prescriber:

Yes authorizes the refill.
Denied does just that.
Yes with Changes authorizes the refill but with some variation from the original prescription, for instance, only allowing 1 additional refill instead of 2.
Denied, with New Rx to Follow will walk the prescriber through creating the new prescription right then. The request screen includes pertinent information about the patient such as current meds, etc.

Refill requests are handled by the Task/Messaging in Net Health Employee Health and Occupational Medicine. The server upon receiving an incoming communication puts it into an Net Health Employee Health and Occupational Medicine Message to that provider. When a provider logs in to Net Health Employee Health and Occupational Medicine the software checks to see if this user is a prescribing provider and if so, starts a service that monitors local tables for incoming messages addressed to that provider. When a message arrives, the Net Health Employee Health and Occupational Medicine messaging icon gets a red(?) background to indicate that there are messages waiting. Error feedback from new prescriptions also sends message, as does a change request message.

It is possible for the pharmacist to send a refill request electronically for a prescription which does not have a record in Net Health Employee Health and Occupational Medicine. This is especially likely to occur in the early weeks or months using Net Health Employee Health and Occupational Medicine when pharmacists will have prescriptions on record with allowable refills which were submitted prior to your use of Net Health Employee Health and Occupational Medicine.

Cancel a Prescription

Prescriptions can be cancelled using Surescripts. The effectiveness of a cancellation message is dependant upon how much time has passed since the prescription was submitted, as well as events at the pharmacy in that interval. Assuming the prescriptions has not been dispensed and picked up by the patient, the prescriptions will be completely voided. Even if it has already been counted and bagged, the pharmacy will return the med to stock, although if the prescription has already been picked up by the patient that is obviously not possible. In that case, the prescription will be cancelled, but it may be that all that accomplishes is eliminating refills. The system will return a confirmation about the status, dispensed or not.

Change a Prescription

The system supports change requests from the pharmacy to the prescriber. For example, it might be that prior authorization is required be for the prescription can be submitted, but it was not received. In that case, the prescriber needs to request an authorization number from pharmacy. Another possible change could involve the question of whether the brand product on this prescription can be substituted with a generic product.

It is not necessary that the original prescription have been submitted electronically for the pharmacist to request a change. You could have faxed the original to the pharmacy, but the pharmacist might choose to send back a change request electronically.

Insurance Eligibility and Formulary Information

Surescripts provides insurance eligibility and formulary information to help the provider write a prescription that the patient's insurance will cover. This includes information about any medication he might want prescribe. It will indicate whether the insurance company will cover that medication, whether a co-pay is required, if there are restrictions about generic/brand, and preferred packaging.

Net Health Employee Health and Occupational Medicine e-Prescribing Administrator

Sure Scripts requires that doctors respond to messages within 48 hrs. and further requires that Net Health Employee Health and Occupational Medicine put an alert on the prescriber's computer screen when there is an incoming message from the network. We know, of course, that doctors don't sit in front of a computer screen all day, nor are they necessarily in the clinic every day, making that a less than reliable method of managing communications. Therefore, at each client site using electronic prescribing there needs to be an Net Health Employee Health and Occupational Medicine e-Prescribing Administrator who does look at the computer screen with due frequency through the day. This person is designated in Net Health Employee Health and Occupational Medicine User Code rights.

Incoming communications to prescribers are distributed using the Net Health Employee Health and Occupational Medicine Task/Messaging system. Copies of all incoming communications are also routed to the e-Prescribing Administrator who is responsible for perusing the list of messages periodically through the day for matters which need handling. Suppose, for instance, Dr. Jones is not in today when a message arrives concerning one of his patients. The Administrator will get a copy of the message and either contact Dr. Jones for instructions or have a different provider handle the matter.

On a rare basis there might be an incoming error message, for instance, a communications problem at the pharmacy might result in a new prescription not getting through. In this case, the Surescripts network would send an error message to the ePrescribing Administrator explaining the problem. The prescriber might then have the prescription faxed.

Depending on clinic hours, the 48 hr. response time requirement may require provisions for checking the system at least once during weekends.

Behind the Scenes

Net Health maintains a server which provides a gateway to the Surescripts network. Communications from and to your site are routed through that gateway. It runs software we wrote, but which Sure Scripts has certified.

A communications service developed by Net Health runs on a server at your site. That (non-dedicated) server must have access to the Internet and to the Net Health Employee Health and Occupational Medicine data folder. When a prescription or other request is submitted, Net Health Employee Health and Occupational Medicine writes the information to a data table which the communications server is constantly polling. When it finds a waiting outbound message it sends it to the Net Health Surescripts gateway which directs it to the final destination. The process is reversed with incoming messages. The local communications service receives messages back from the Surescripts network via the Net Health Employee Health and Occupational Medicine gateway. It stores the information in a local table and, using the Net Health Employee Health and Occupational Medicine Task/Messaging system, alerts the prescriber to whom the message is addressed.

The setup procedure for this service includes registering all prescribers with Surescripts. You will send certain information to Net Health which will enter it on the gateway server and submit it to Surescripts which runs it through a verification process. Once Surescripts certifies the prescriber it assigns a Surescripts Prescriber Identifier number (SPI). The SPI is posted into the Net Health Employee Health and Occupational Medicine Presciber table on the gateway server, at which point the prescriber is able to send electronic prescriptions.

Surescripts maintains a pharmacy directory which contains the prescribing capabilities of all 48,000 pharmacies subscribing to their "RxHub network". Net Health receives weekly updates which are passed down to your Net Health Employee Health and Occupational Medicine database, probably on weekends when traffic is light. The directory indicates whether the pharmacy can electronically handle refills, cancellations, and changes. Net Health Employee Health and Occupational Medicine will not submit an unavailable service.