Saturday, October 22, 2011

E-Prescribing can be E-vil

The prevalence of electronic prescribing and faxing of prescription orders has generally made things more convenient for customers and probably decreases wait time as well, but as all pharmacists know it is a mixed blessing. The attempts to plug in a 'personalized' prescription into a computer program can lead to some pretty interesting prescriptions, like "Apply 9999 applications topically ", or my personal favorite from this week, a prescription for Plan B, quantity 60 tablets, with 11 refills. Customer then arrives and is totally taken aback that it's not 'ready yet,' either because we have received no prescription or the one we did receive is completely nonsensical. Heaven help me, there are days when I really miss the old fashioned exercise of someone visiting their doctor, being handed a prescription, and then being responsible for choosing a pharmacy and bringing that prescription TO IT. Y'know, kind of like having a little responsibility all their very own self.

So now we not only have the responsibility to fill your prescription correctly, with all the usual challenges associated with that, but we seem to be charged with hunting down that prescription and obtaining it for you as well. If we didn't get it, then it's up to us to seek it out, right? Clear the decks, folks, I'm about to spend 20 minutes on the phone trying to track down one prescription from Giganto Orthopedic Surgery Group and by the way, it's lunch time and please leave a message.

The problem is even worse when, like me, you work in a medical building/clinic when we seem to be held accountable for any prescription written by any doctor in the building whether the patient fills it with us or not. It doesn't matter how many times you tell me "THEY TOLD ME THEY SENT YOU MY PRESCRIPTION" --- I can't fill a prescription that I don't freakkin HAVE. Really, I wouldn't lie to you. We actually had a customer claim her doctor had faxed us
her prescription, watched us tear apart the pharmacy looking for it, acted like a complete bitch and finally rolled her eyes and said, "Well, I've got it out in my car -- do you want me to go get it?" I said, yeah that would be swell. Then I went in back and looked for a sharp object to do myself in with.

And then there are the people who want to 'read' you their prescription over the phone because they didn't want to be bothered stopping at the pharmacy, nor do they want to wait while it's being filled. Sigh.

When it comes to electronic prescribing I know there's no going back, but some days I feel there are just as many errors, just as many problems to clarify, AND the added bonus of leaving people with the notion that everything's going to be done for them. It's the fast-food, drive-through-ability of everything. We'll find the prescription, we'll figure out what your insurance is, we'll wrap it up and tie a bow on it and do it in 10 minutes. Dang, it's frustrating.

14 comments:

MDB said...

Some days I really hate E-prescribing, days like today. I had a collection of idiots sending in e-scripts for things that made no sense or completely lacking info such as "metformin 1 qd 5 refills", which strength of metformin??? I also had "Cisapride 1 tablet a day for erectile dysfunction". Then one office kept complaining that all the scripts they sent yesterday and today were not going through, of course they were sending for klonapin, ativan, adderall, and oxycodone. All of which I can't take e-scripts for and the last two I can't even take a fax for.

WarmSocks said...

Patients aren't too fond of it, either.

Faxing isn't much better when your phone number is errantly programmed into Big Medical Group's fax database.

I'd much rather hand carry my prescriptions to the pharmacy.

Anonymous said...

I also work in a pharmacy located within a clinic. What drives me nuts is when they call in wanting us to ask the doctor for refills and then those refills need to be sent to "Giant Pharmacy" down the street.

I then ask why they have not contacted "Giant Pharmacy" down the street about this. They always say they have but the refill hasn't been approved yet so they want me to call the doctor and get it done faster.

Or they think that because I am in the same building as the doctor, and they are out of refills they can just wait while I get the refill approved AND it will be done in 20 minutes or less. They don't believe me when I tell them it still takes 1 to 3 BUSINESS DAYS for the doctor to get back to me just like any other pharmacy. Sigh.

Anonymous said...

My family has very few prescriptions per year, and I always get frustrated now. The e-script is wrong, lost, at the wrong pharmacy, etc. It takes me 1-2 days (and at least 3 10 minute phone calls) to get the medication. I much preferred the paper version. Morning Dr. appt, drop off script, pick up in evening or next morning.

I have started asking for a print off of the e-script and transmission confirmation, I can check to make sure it's correct and make sure the nurse sent it.

Frantic Pharmacist said...

Yup ... I sometimes wonder if people realize they can still ask the doctor for a paper copy to hand carry to the pharmacy. I think I would prefer this myself, to be honest.

Lastrefills said...

Very nicely written. I recently received an e-script wherein the sig read insert 100 enemas at bedtime. Then I met the patient and for a brief moment considered that the directions might have been intentional.

Andie said...

E-scripts are the devil.

Anonymous said...

I get e-scripts all the time where the "sig" line and the "instructions" line are significanly different. For example...I'll get hydrocortisone 2.5% cream. Sig: "Apply TOPICALLY bid." Instructions: "Apply TOPICALLY to affected areas of eczema tid x 14 days, then prn AS NEEDED not to face, axilla, or groin." The very best part is calling the office for clarification and the receptionist pulls up the script and READS IT TO ME. First... you're not authorized to read that to me. Second... I CAN READ!!

Anonymous said...

E-scripts suck and 90% of doctor's offices don't know what the hell they are doing. Always ask for a written rx or copy of the e-rx, because your doctor's office is going to screw it up and the pharmacy staff gets really tired of catching hell for mistakes that aren't ours.

Technically Insane said...

I hate e-scripts. Because we are in a super small town in the midwest and 80% of the time the customers arrive before the darned script. I dont know if there is some wierd delay sometimes (the time veries on the script several hours from time sent to recieved) or if they dont sent them correctly. Who knows! Also, my personal PCP just started E-scribing and he hates and and cant figure it out even after I tried helping him one day....

Vagabond Rx said...

Yep, we get the same thing here in the Yukon with scripts written on Plexia software. Different sigs typed in by the doc - what are we supposed to put on the label? Don't understand why the software **allows** them to send off an rx without a dug name or a strength. Our Rx software won't allow us to fill an Rx without having completed all required fields.

My own Family Physician was trying to do up an rx form me on Plexia while I was in her office one day. There are fields that are auto-populated by the software which can really cause a problem if you don't actually look at what will print out. There are drop-down menus that are useful but ONLY if you actually READ what's on the screen and the instruction manual.

To me it's a lack of respect for the health care practitioner who has to read and interpret the rx, and for the waste of time of everyone involved. As my Dad used to say: if a job is worth doing, it's worth doing right.

Anonymous said...

I HATE E-prescribing!!! As a professionals in the medical field what can we do about the situation???????? Iam ready to scream..

Anonymous said...

All of these comments and the number one complaint is ERROR. The government says e-script allows for "LESS ERROR" I say "someone will get their self sued big time over this and soon... if no one puts a stop to this paperless madness!!!!!!!!

meddiva1 said...

I write on a blog on Medicare Part D, and I'm so glad I came upon your blog and this post. I just finished blogging about the benefits of e-prescribing for patients, but now I'm going to go back and mention that there are some pitfalls -- and I'll also stress that everyone should request a paper script as backup. I think I'll also do a blog on what people should and should not expect when they go to the pharamcy, based on your blog and others' comments. Really an eye-opener that needs to be shared "kindly" with the public.