4 Common Reasons Why Printing is Your Only Option for Rx

Have you ever run into this screen while preparing to send prescriptions off to the pharmacy?

screenshot of omeprazole suspension

Seems like a bit of a mystery, right? Well, wonder no more! Here are the four most common reasons why your prescription is unable to be sent electronically. And the good news is, there are ways to fix each one!

Scenario #1

Probably the most common reason of all – the prescription you’re trying to send out electronically was entered manually, on the fly – known as “free text”. To confirm that your prescription is in fact a free-text one, close out of the Prescription Review (think final signing screen), and use the anchor buttons to navigate down to the yellow Review & Sign section. Do you see a little medicine bottle with a question mark inside just in front of the medication name? If so, you can consider this case closed!

screenshot of omeprazole suspension (compound)

What does this really mean: Prescriptions that are entered on the fly as free-text do not qualify for electronic transmission to pharmacies, hence the only option being to print. Specifically, the network PCC eRx uses to connect providers to pharmacies, known as Surescripts, does not allow prescriptions entered as free-text to be sent electronically. You’ll find this to be most common with compounds or DME’s that you searched for and didn’t find, then scrolled down and selected “Add Custom Medication” while still in the patients eRx chart. Additionally, you could be renewing from an old DrFirst prescription you entered previously, which was entered as free-text at that time. In general, entering a prescription as free-text is perfectly acceptable, as long as you do not expect it to be transmitted electronically.

Don’t want to print? Once you’ve identified that the prescription was entered as free-text and is accompanied by the little medicine bottle with the question mark (which will only show in the Review & Sign section) , you have a couple of paths you can traverse. Consider deleting the entry from Review & Sign, and try one of the following:

  • Double check your search technique: It is important to remember that the results displayed during medication search are filtered out by the age of your patient, in what is referred to as Quick Rx search. The Quick Rx search function is on by default for all medication searches. Furthermore, entries such as DME’s and Supplies will NOT be shown in the Quick Rx search. For those type of entries, always click on the Full Product Search button, and I suspect you’ll see what you’re looking for! Also, less is more. If you’re having trouble tracking down a medication, consider entering a little information, leaving out dashes and things like that. Adding too much specific information can inadvertently exclude the medication you’re after. It is possible you’ll find the medication you’re after by adjusting your search techniques, thus avoiding the free-text option altogether.
  • Have an eRx Administrator add this medication to your practice’s available entries:  So you’ve checked your searching and conclude the medication you’re after simply isn’t in the database of entries. This might apply to compounded oral suspensions, Magic Mouthwash, Speech Therapy prescriptions, etc. Again, you could free-text these at the time of prescribing inside the patients chart – but you’ll save a lot of time by having your eRx Administrator add these, practice wide, in PCC eRx > Administration > Custom Medication Items. Once these entries have been added, they WILL qualify to be sent out electronically. Plus, they’ll be much easier to find, next time! Click here more specific information on this configuration option.

Scenario #2

You selected a medication to renew from either Medication History or Prescription history that was migrated over from the old eRx system, and are now unable to send it out electronically.

What does this really mean: PCC migrated all known prescription and medication information for all of your patients when we moved to the new PCC eRx in 2017. In the majority of cases, these entries are A-okay and can be used to renew from for future prescriptions. However, occasionally the old DrFirst prescriptions are missing required data. Most notably, this issue will arise if you skipped the sig code drop downs, and manually entered directions in the Instructions to Patient field in the old system. You might identify these migrated prescriptions either by the serial number in Prescription History, as it will start with two letters, a dash, and a few numbers – such as AA-867530999, or any prescription written prior to your switchover, likely in May or June of 2017.

screenshot of migrated data from old eRx

Don’t want to print? It is important to remember that in order for a prescription to be sent out electronically in PCC eRx, you must either fill out all of the standard sig code drop downs, or choose “Instructions Only” in the top right hand corner when creating a new prescription. This also applies to prescriptions being renewed from the old eRx system! So where do you start? Back in Review & Sign, click on the red Edit Pencil, and consider the following:

  • Is this prescription something easily prescribed with standard sig code drop down menus? Once inside the Edit Prescription window, you might notice a few omissions that can be easily added, such as missing quantity for number of tablets for each dose, route, frequency, etc. If so, select the appropriate options from standard drop downs for any missing fields and hit Save. From there, this prescription should qualify to be sent out electronically! If you try a few different things, or there doesn’t seem to be anything obvious missing – the next easiest step is to delete the pending Rx in Review & Sign, and start over from scratch. Once you’ve either fixed up the migrated prescription entry by adding any deficient information, or added a completely new one, next month’s renewal should be a piece of cake.
  • Are you renewing something that simply doesn’t fit well with the sig code drop downs (Prednisone tapers, for example)? These are the more interesting of the two. You likely bypassed the need for the standard sig code drop downs in the old eRx, and free-texted the directions to the patient. In order to proceed with something like a renewal on an older Prednisone taper, or another prescription with complex instructions, you’ll want to highlight the current text in the Instructions to Patient section, select Copy and start with a fresh prescription. Once you’ve selected the medication you’re looking to prescribe, you can click “Instruction Only” in the top right hand corner, and paste in the directions from the old prescription. Or, simply choose to write a brand new set of directions if appropriate.

Again, keeping in mind that PCC expects that the large majority of migrated prescriptions will not result in print-only options, so feel free to use the Renew feature from either Prescription History or Medication History.

Scenario #3

You’re brand new at the office, and your Office Manager or an PCC EHR Administrator has added you in PCC EHR User Admin already. Or, you’re filling in at your Saturday or AfterHours clinic, but you don’t normally prescribe there. You can search and enter prescriptions just fine – but when it comes time to send them to the pharmacy, the only option is print.

What does this really mean: Each provider (including each individual location) must be assigned what is called a Surescripts Provider Identifier (SPI) in order to send out prescriptions electronically. New accounts and new locations can sometimes need manual intervention from PCC Support staff in order to be properly configured for SPI assignment.

Don’t want to print? Speak to your PCC EHR Administrator to ensure they’ve added your eRx roles and locations in PCC EHR User Admin. If all looks correct, reach out to your Client Advocate. They’ll review your account and ensure that you’ll be able to prescribe for any locations you’ve been assigned.  If, for any reason, you happen to be missing an SPI, we’ll get it added, and you’ll be able to send your prescriptions electronically!

Scenario #4

You’ve prepared a prescription for a medication, didn’t free-text it, and did not select Renew for a migrated entry, and you’re not at a new location and you’ve been prescribing without issue – but you still can’t seem to send it out electronically. You might have selected something such as Sodium Fluoride Chew tabs, Lupron injection, an oral contraceptive or EpiPen Jr.

What does this really mean: In order for a prescription to qualify to be sent electronically, certain codes must be present in the background. To be specific, the dose form and dispense Unit of Measure must contain what’s called a potency unit code so that Surescripts understands what is contained in the electronic message. If those codes are not present, the prescription will be stuck in paper-only mode. Since moving to the new PCC eRx, we’ve identified and resolved a number of these missing potency unit codes – but there are still a few out there. PCC and FDB continue working to eliminate these medication-specific issues; however if you do encounter one, there are some workarounds available to you.

Don’t want to print?

  • Consider the Dispense Unit of Measure (think total number of tablet or mL’s): Is it something like chew-tab or injection? Or maybe even tablet(s) with the plural form in parenthesis? These entries can sometimes be missing the proper potency unit code. If you click on the drop-down for the Dispense Unit of Measure, try to select something from the upper section, above the dotted line. Sometimes switching to tablet instead of tablet(s) does the trick.

screenshot of EpiPen Jr

 

  • Take a look at the Dose Form at the top of the Edit Prescription window: These ones are a little trickier! If your prescription for Sodium Fluoride Chew Tabs or an oral contraceptive is stuck in paper-only mode, take a look at the Dose Form. Some of the more “complex” formulations of medications are currently causing a hiccup in the system. In the drop down for Dose Form, you might see an alternative option that suits your need. If not, you might try creating an Instruction Only version of this prescription, but you’ll need to delete the current attempt and start over.  Keeping in mind here that while there will be Drug-Drug, and other Drug interaction checking performed, there will be no Dose Range for Dose Amount or Dose Frequency on these manually entered prescriptions – so be sure to double check your intended doses!screenshot of Sodium Fluoride Chew Tab
  • Handwrite on a paper pad, give your Pharmacy a call or proceed with printing the Rx: Most states still allow printed, handwritten and phoned-in prescriptions, so if you find yourself in this situation where even changing the Dispense Unit of Measure and/or Dose Form does not help, consider these fall-back options.
  • Contact your Client Advocate at PCC: Our goal is for you to be able to send out any prescription electronically (as allowed by your state, of course). When you can’t do that – we’d like to know! PCC will continue to track any additional instances of these missing codes, and can help you determine if this is indeed the issue preventing electronic transmission.

If you’ve reviewed the above scenarios, and still find you’re unable to send a prescription out electronically, give us a call! We’re here to help.

Questions about PCC eRx? Contact PCC Support

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