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.

Thursday, November 20, 2014

RxNT in More Detail

I just finished my training session to use RxNT's e-prescribing software, so I thought I'd give readers a rundown of what it looks like and how it works.

The home page looks like this:

But you have the option of switching your startup page to Patient History, Scheduler, or Prescription Watch. Since I'm not using the EHR or scheduling software, I chose the Prescription Watch, which looks like this:

The Prescription Watch also has a patient search box (not shown) in the upper right hand corner.

When you enter a new patient, the only required information is name, DOB, address, and gender. But it offers all kinds of demographic options, which are helpful if you're using the program for charting. There's also the option to import all your patient information if you already have it in some suitable electronic form. And if you have multiple sources for a single patient, you can merge them.

I successfully sent off my first prescription with almost no difficulty. Almost, because it got stuck when I didn't enter the type of thing I was prescribing, namely, a tablet. I didn't notice that I was supposed to enter this, at first, and I wouldn't have thought it was necessary because the medication was listed as lexapro 10mg tablet, but apparently it needed that. Beyond that mild glitch, it was easy.

The trainer was pleasant and helpful and knowledgable, but it's really quite an intuitive system.

The other problem I was warned about, but didn't end up being a problem because I was warned about it, was that the various pharmacies that populate the list when you're looking for your patient's pharmacy each have a little check box to the left. It looks like, if you want to send the prescription, you just click on the box and it goes off to that pharmacy. But the box is just to add that pharmacy to your favorites. You need to click on the pharmacy's name to choose it and have the rx sent to it.

According to the trainer, you have to enter all the drugs you want on your "favorites" list individually, and there's no option to prescribe a drug and then click "add to favorites". The latter seems to be true, i.e. no click option, but I tried writing a new rx for a different patient (my dog), and instead of entering a medication, I clicked on "favorites", which should have been empty, but the search turned up lexapro, so I think the drug is added to favorites automatically. Same deal for the pharmacy-it was already entered as one of my favorites, with the option to remove it. I think, in general, there's a fair amount of redundancy in the system, which I consider a good thing.

Here's how lexapro comes up:

the little "?" on the left means the formulary status is unknown. There's a legend for the symbols:

The bottom of that same screen has several sections. The drug info:

Clicking on the blue highlighted phrase brings you to a screen with all drugs in that class.

Sig builder lets you create any administration method you like. Reference gives you a patient education monograph, patient counseling messages, and warnings, all of which can be printed out for the patient. Interactions gives you the obvious, but you set your level of interaction tolerance to mild, moderate or severe, depending on how many messages you can stand. It includes drug-drug warnings based on the patient's other meds, food interactions, and age- and diagnosis-based warnings. If you want to override an interaction, you don't need to justify it with a reason, like some other systems require. It just checks a second time to make sure you want to prescribe it, and then lets you do so.

The drug info also gives you recommended sigs:

And the option to create a new sig.

At the lower right, there's a list of alternatives-the same as the drug class list, I believe, with formulary information, I suppose based on whatever you've entered about the patient's insurance.

When I clicked on one of these drugs, it highlighted the drug, but didn't substitute it for lexapro, so I guess that has to be entered separately.

Oh, and there's an "add drug" button, if you want to send more than one prescription without starting from scratch.

I really like the delayed Rx feature:

You can do a one time rx, but schedule it for some time in the future. And then you can specify whether you want it placed in your "pending" queue that day so you can check it before sending it off-necessary with controlled substances, or you can just approve and transmit it without ever looking at it. Whoosh! And you can do the same with repeated prescriptions.

This feature is incredibly convenient. It also makes it easy not to see your patients very often, if that's how you want to manage your practice.

Some drawbacks to the system:

-If you send in a prescription, and then realize it was the wrong one, and you delete it, you need to call the pharmacy to tell them, because it doesn't automatically get deleted from their system, only yours.

-You can use the claims history to find other meds the patient is taking, with the patient's permission:

And you can add those meds to the patient's active list. You can also manually enter other meds you know the patient is taking. But if you delete a medication you didn't prescribe, it's completely lost to the system, unlike ones you did prescribe, which are retained in a list of deleted meds, and can be re-prescribed without having to enter the whole thing from the beginning. So if the patient is taking, say, prilosec, and has some adverse reaction to it, you can delete it from the system so you know the patient isn't taking it anymore, but the only way to record the fact that the patient took prilosec and can't tolerate it is if you write a little note to yourself. And there's a "notes"section that's independent of the chart notes, which you may or may not choose to use.

-There doesn't seem to be a screen that simply lists your patients, but I may just need to play around with it longer to find that, or it may be there only if you're using the EHR system.

-There's a "status" column in the list of recent rx's. If an entry is highlighted in green, that means the rx went through. Yellow means it's pending, and the system will keep trying as long as it's yellow, and red if it didn't go through. But there's no flashing light or message to let you know that a rx didn't go through, so if you take care of your prescribing first thing in the morning, you might not find out that a prescription didn't go through until the next day. You also can't sort the list of recently prescribed meds by field, it's just chronological. So you can't request that all the red statuses get lumped together where you can see them easily.

-I'm a little confused about the sig builder. I tried to create a new sig, which was lexapro 10mg 1 po 5 times per day. And it let me do that without any comment about maximum dosage. Since I just entered the sig, but didn't try to prescribe it, I'm not sure if it would have questioned me if I did try to prescribe it.

-This one is on the state of NY, not on RxNT, but when you prescribe a controlled substance, which I haven't done yet, you go through a screen that asks for your hard or soft token, so that's already a pain. But then, in addition, you have to complete the whole I-STOP business, which seems like big time overkill. I think the company is trying to hammer out this issue with the state, but I'm not holding my breath.

I haven't yet attempted to go through the identity proofing/two factor authentication process, so I'll post again to let you know how it goes.