Sunday, May 31, 2009

E-prescribing Crap

I had started writing this a while back, and hadn't planned on putting it up today, but since my esteemed colleague over at the The Angry Pharmacist decided to talk about it today, I will too.

Regardless of what your government or insurance company tells you, e-prescribing is a pain in the ass. It is free for me to do it, but your unfortunate pharmacy is paying around 30 cents a script each time your doctor sends this crap over the internet.

It takes me, literally, 3-5 minutes PER DRUG to send this over the internet, with a decent high-speed DSL internet connection. As opposed to the 1 minute or less for me to neatly write it out, call in, or fax in.

The U.S. government is so enamored with this way to reduce efficiency and waste time that, starting 2 years ago, they began pressuring us to do this. In fact, Medicare pays us a small bonus to use it for Medicare patients. As a result, I am doing it too, because I can use the money. But that doesn't mean I like the system. I think the whole program should be cancelled and e-prescribing ditched.

But MOST frustrating to me is what happens when I have to do a controlled substance refill online. Yes, this group of drugs includes things like Methadone and Percocet, but also includes more pissy drugs like Lyrica and Ambien.

Here it is:

For refills on regular drugs: I have to click on "approve" or "disapprove". Simple enough.

For controlled drugs: I also have to click on "approve" or "disapprove".

BUT if I click on "approve" it says "This is prohibited by law. Click on the 'contact me' button to send a message to the requesting pharmacy that they need to request this from you by either means, i.e. fax or phone"

So I click on "contact me". Sounds benign, huh? But wait...

What then happens is that the pharmacy gets a message that ONLY says "Prescription denied by physician" (and they pay 30 cents for that). It doesn't say ANYTHING about actually trying to reach me by another method. I've personally verified this with 3 local pharmacies.

So the pharmacy tells my patient that I am the one at fault, because, after all, I refused to fill it (even though that isn't what I did). And so Mr. Patient gets angry, and calls my office pissed to yell at my staff and me.

What I don't understand is:

1. Why doesn't it actually tell them to contact me by another method (like it says it will)

2. WTF does it let them submit controlled requests online, WHEN IT ALREADY KNOWS I CAN'T REFILL THEM THAT WAY ANYWAY!!!

I'm now stepping down, putting my soapbox away, and shutting up, since my complaining won't matter at all to the bureaucrats who actually can change this.

Thank you, TAP, for bringing this up.


Lipstick said...

Excellent post Dr. Grumpy!! Of course, I could actually write that on all your posts! I can't wait to get over to TAP and read his post. We at the Lipstick Pharmacy (not our real names) hate e-prescribing too.

The e-prescribing companies have basically assuming that the biggest problem with prescriptions is that they are illegible (so I guess that's why all your drop-down menus are ridiculous).

We receive e-prescriptions all the time all are perfectly legible...and perfectly illogical. We still have to call the offices just to make sure we don't dispense the wrong thing...arrrgh.

Oh, and you know what else is weird...sometimes it takes several hours for the e-script to appear and sometimes it is instantaneous.

And if the doctor practices out of several offices...the e-script companies haven't addressed that yet either.

Sorry if I soap-boxed in your comment section. :)

ERP said...

Too bad - it sounds like it could be a piece of cake if it were better designed. Maybe Apple should create a programme and call it the Iprescribe, then it would work!

Anonymous said...

I have to agree that these are a PITA as well... from the patient's perspective! You don't know how many times I have gone to the pharmacy after my appointment and the script hasn't even shown up yet... then there is the requisite calling the doctor's office to see if it was actually transmitted or if it is just delayed. Just give me a piece of paper already! I -HATE- this.

Rx Intern said...

Medicine and Pharmacy aren't practiced like they used to be. These new stunts that they're pulling just makes me confused. Likely: More errors, more money wasted, more time wasted, more angry patients, more angry physicians, more angry pharmacists, and more angry people. Apparently, our professions get screwed, whether we like it or not.

Kate said...

These are a total pain for patients too. Sometimes I like to hold on to a script and fill it at my leisure for certain reasons--like I am not quite out, have to finish a similar med before starting a new one, etc. With the e-prescription, it is sent to my pharmacy and I am expected to pick it up within a week. For my local pharmacy, I was told they mail the prescription to you after a week and bill you or something, instead of re-stocking it.

Sometimes I have had doctors send it to a pharmacy without even asking me! They go to another room, come back, and say: oh I sent ... to your pharmacy before asking me if I even wanted to take said medication. What if I don't want the med? Then I have to call the pharmacy and say no, don't fill this. There isn't an un-submit as far as I know.

Sometimes I ask for a script when I know I won't be in for a couple months, and may need it before that time is up. I hate requesting refills through the pharmacy because they never let you know when they have actually reached your doctor and gotten it filled. I always end up needing to call, or coming in to early or too late.

The pharmacy system is very close to a meltdown. The current wait at my pharmacy for new fills is 2-3 hours, if you tell them it's a rush and you are out, or 2 days for a typical fill. Outrageous. The number of errors is also on the rise, some of them very dangerous such as giving a patient double the dose of pill of something that didn't have much of a size difference. I'm glad I check before leaving the pharmacy. They have also shorted me pills on numerous occasions. One time I didn't have any proof and had to pay for an early refill as I didn't realize they gave me 30 not 60 until halfway through the month. I'm careful now!

Something needs to change soon.

Thanks for all the informative and funny posts! I'm a neuro patient and can relate to quite a bit of it (New Daily Persistent Headache).

Best wishes.

pharmacy chick said...

Guess what. I filled a prescription the other day for a guy who, at the window asked if it was e-prescribed. I checked and said..yes it was. He said AND I QUOTE " I wrote the software for that".
um. thanks.....

Grumpy, M.D. said...

PC- you should have told him that wasn't something to be proud of.

Jaded Pharmacist said...

Yeah, I'm not completely sold on the E-Rx either. From a tech/intern standpoint, it's just another hassle. I've had several occasions where we've had to clarify/change an order for one reason or another, and we get a verbal auth from the office. The doctor/nurse/whoever *sends a fricking E-Rx of the same thing we get a verbal auth.* Now I understand this might be necessary to keep a patient profile up-to-date, but it's there a 'store to profile' feature to this (or shouldn't there be)?

However, changes that *could* (and I can't emphasize this enough) improve efficient have to start somewhere, even if it starts with a setback or two (or more). We'll see, but I have a feeling this will be about as successful as Exubera...

Kacey said...

Thanks for explaining something I never knew about. I am still old fashioned enough that I actually pick up my Rx's at the doctor's office and hand carry them to the pharmacy. I guess I shouldn't be surprised that pharmacies have been ripped off.... the whole country is being prepared for Socialized Medicine and we all will learn a different way of living or not living.
I read TAP's blog first and came over here. He has so much to say and's a shame that he goofs it up with all the dirty, offensive words.

Unknown said...

Dr. Grumpy, I cannot thank you enough for being aware of the many, many failings of this system! Although electronic prescribing is touted as the new best thing, it's nothing more than more ridiculousness. TN already has a legibility law requiring prescriptions to be typed or written in BLOCK LETTERS, but there's no enforcement or subsequent penalty. Mandating the e-RX system does nothing but ensure increased errors, especially since it lacks a standardized sig code! It's bad enough taking voicemail/paper RXs instructing "1 tablet po by oral route prn as needed for pain" (sadly, this is not an exaggeration); e-RXs give my pharmacy computer aneurysms all damn day from idiotic, idiosyncratic drug listings, instructions, and doctor contact information.

You're also correct in that prescriptions ineligible for electronic transmission (i.e., controls) do NOT instruct us, the lowly pharmacy minions, to contact the prescriber by another means. We check the exception queue and read "DENIED BY PRESCRIBER." end transmission. But my very favorite component of all of this mess is that once a doctor has signed up for electronic prescribing, WE CAN NO LONGER FAX THE OFFICE FROM OUR SYSTEM. That's correct, e-Rx usurps faxing entirely, which makes it even more frustrating when I call the doctor's office & whichever bitchmonkey answers the phone tells me to send the request electronically or by fax, because they don't do verbal authorizations. Fantastic. That's usually when I suggest the patient finds a new doctor.

Unknown said...

ps- I can appreciate Kacey's dislike of TAP's lexicon, but a day full of correcting unnecessary mistakes and getting yelled at by angry patients because their drugs aren't ready due to said mistakes wears a body down...especially when the mistakes are LIFE-THREATENING (metronidazole? no, mr. coumadin patient, I think not)...saints swear after a week with us...

Rebeca said...

We frequently hear that the U.S. pharmaceutical companies have to charge so much for their drugs because of the amount of money they spend on the research and development of new drugs. The truth is that European drug companies spend just as much on research and development but charge much less for their drugs.

However, the European companies don’t spend the billions of dollars on TV advertisements and ads on radio and in magazines. They also don’t spend the billions of dollars on lobbyists that the U.S. companies do.

one more angry tech said...

Point and click prescribing has turned healthcare into even more of a fast food gimmick. I work at one of these big chains and for about 2 months we actually had a sign telling patients to "ask their provider about E-Prescribing!" I hope they regret it when they try to snort a tube of fluticasone ointment up their nose because the system has nasal spray and topicals next to eachother. Maybe we could spend alittle more time thinking about solutions to improve efficiency and minimize mistakes. Let's ask ourselves, "Does this seem reasonable?"

Anonymous said...

I think it's because there needs to be fingerprint/retina scan as password for the prescription function. Also, if the person selects the wrong menu, say nasal spray instead of topical, the directions should adjust, or at least flag this (context sensitive). Finally, if cost of business went up $0.30 cents per rx, have pharmacy get tax credit, or some other re-imbursement from the government that mandates it's use; why not give some of that bonus from the Md insentive side?
As a pharmacist (and computer programmer) with 18 plus years experience, given the task, it would be child's play for me to secure, simplify, and safeproof this system. (But that would cut into the ill-gotten gains they are now makin LoL!)

Linda said...

Last year my Doctor e-prescribed my one & only medication to Walgreens without my consent. I had just picked up my last refill on the previous years Rx the week before. This caused it to look like I requested a refill 3 weeks early and even though I tried to straighten it out that day, my insurance denied my Rx when I really did need it 3 weeks later. This year they did the same thing. I couldn't remember all the problems from last year so this year they did it and I got the same call from Walgreens. When I went to refill it 3 weeks later, Walgreens had actually DELETED my new Rx from their system. They can't e-prescribe without requesting a refill. That's OK if my yearly appointment is always on the first week of the month, otherwise the system is incompatible with itself. They all say it is up to me to request a hand-carried Rx, but they do it so fast I don't stand a chance!

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