Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Tuesday, June 3, 2014

Further ERx Thoughts

I got an email notice from Practice Fusion, letting me know that my e-prescribing privileges would be deactivated, "in accordance with Surescript's policy" if I don't send an e-Rx within a month.  It actually used the word, "month", didn't give me a specific date, which I find curious.

I guess I haven't e-prescribed in a while. I'm assuming 6 months, since that was the initial time I was allowed before losing my privileges.

The thing is, I don't really want to e-prescribe. You may recall, I signed up for Practice Fusion for the sole and explicit purpose of using their free eRx service.  I was under the impression that e-prescribing would be required by 2015, and I wanted to make sure I didn't have to scramble, or pay a fortune, at the last minute.

But I don't like picking medications, along with their forms and strengths, from a drop down menu. Why people think this is less likely to lead to error than writing down exactly what you mean is beyond me. Something as simple as a mild tremor could lead to an error.

I don't like checking the system for the auto-refill requests. I don't like the "refill as needed" option, which I still don't understand (it allowed for no refills). I don't like the formatting of the EHR, with pop up windows covering up important information unless you upgrade to a paid version. And I don't like having my patients' information floating through the cloud. I try to limit the amount of that information-name, DOB, phone number, and the actual Rx, and NO diagnosis-but I still don't trust it. Maybe it's no different than any other way a pharmacy can access a patient's data, but it seems like it's not just the pharmacy that has it. It's out there in the cloud.

I'm confused about the requirement for e-prescribing. Lately I've been wondering if it only applies to Medicare providers, like the meaningful use requirements. When I poke around online, I still find this:

"As of March 27, 2015, all prescriptions (including prescriptions for controlled substances) issued in New York State must be electronically transmitted, with certain limited exceptions."

The same page also reminds readers that as of March 27, 2013, controlled substances can be electronically prescribed, provided that,

"The practitioner and pharmacy...use a certified software application that is consistent with all federal security requirements to process electronic prescriptions for controlled substances."

Supposedly, the security requirements can be accessed through this link:


But there's a lot of information on that page, with a lot of links, and the most recent "clarification" update is from October of 2011. It's confusing.

There's also the following, that's specific to NY State law:

"New York State regulations also require each pharmacy and practitioner to register their certified software application with the Department of Health, Bureau of Narcotic Enforcement (BNE). Please visit BNE's webpage at www.health.ny.gov/professionals/narcotic for additional information."

THAT page has a blurb about what the BNE does, and a bunch of links, none of which led me to where I could register.

Now, the reason I'm so interested in e-prescribing controlled substances is that if I'm going to keep my privileges with Practice Fusion, I need to eRx something soon. And since I write for refills on most of the non-controlled meds I prescribe, the prescription I'm most likely to write next is for something controlled.

The underlying assumption here is that I want to keep my e-prescribing privileges. If I let them lapse, then supposedly it will be harder to have them reinstated. But I don't see how I can be refused the option of e-prescribing at the same time that I'm being required to e-prescribe. And that idea assumes that I WILL be required to e-prescribe, starting in March of next year.

But will I? ICD-10 is being pushed off a year. Why not this?


  1. Don't forget that the EHR and electronic prescribing are essentially businesses invented by Congress. As such they are designed to make somebody lobbying Congress a lot of money. When you describe the steep disincentive for losing your e-prescribing privileges, the first thing that comes to my mind is that you are not generating any revenue for the software owner (advertising clicks or other fees). Let's face it, we have all been registered on sites that we have not frequented in years and can go back and sign in at any time. After you are registered to use it, there is no cost to anyone to keep you in the database.

    You will be required to e-prescribe, but it has nothing to do with clinical reasons. Somebody has to make a buck off doctors and doctors don't have a say in that.

  2. I worked in a system for many years where I e-Rx'd within a closed system. It was pretty easy and I had not real concerns. Now I am out in the "real" world and I don't trust e-Rx as much. I do it but find myself calling in prescriptions because they don't always go through and I don't trust it. There are arguments for both sides but I agree with George that all the changes in health care are mostly (not all) driven by profit. What is so very true is that doctors and patients don't have much to say about all this.