ideaman911 wrote on Thursday, June 04, 2009:
Hi Folks;
As usual, I’m on a “never satisfied” jag 
To benefit from the Medicare "e-Rx Incentive" (see my recent coding advice in the Users forum) as well as to comply with state and DEA law re controlled substances (CS), I want to suggest a design approach. MY skills will require a huge improvement before I can CAUSE this, but hopefully I can cajole those others who can. I promise to help in any way I can.
In NYS, as I suspect is true in most states, CS needs a specific state-issued script form, and they cannot be sent electronically, including fax. As you can guess, bouncing between those issues, e-RX, and OpenEMR users unwilling to pay the proprietary systems costs while a free portal like Allscripts exists which is fully CCHIT compliant for Rx, is a quality concern, to say little of the tedium.
Conceptually, I plan to work on the following:
a) Store with a drug name in database if it needs CS process, and sort for print vs upload to e-Rx portal. But allow user an override, as for example if a patient insists they want a printed script (which is still OK for the Medicare incentive).
b) Accumulate for later process (eg when a house call provider gets to a hotspot where she can connect to ANY e-Rx portal, and/or connect to a printer. Allow single click ALL or ctrl-click selections for the e-file or print, with store as written once processed, but always allowing retrieval of any previously processed, to reproduce with similar add to data in OpenEMR.
c) A "formatter" which allows selection of four-panel or single as default, and storage of printer settings (the idea is to make it take as little action by the clinician or staff as possible to do the task they do most often each day with ability to override at any time.
d) The ability to auto-index the state code, or edit same, so OpenEMR would be able to track every CS script, while removing from prescribers the tedium of their entry. Almost all come in sequential groups, whether in pad or boxed form.
e) A "stream builder" for use with e-Rx portals which do NOT have direct ability for connectivity to OpenEMR. I did some work with GE to do MRP entry via barcoded materials tags which included tabs between fields, and see no reason that could not be duplicated, except use the data from OpenEMR. At worst it might require a limited number of mouse strokes to start, and possibly intermediate stops. But almost all could be automated to reduce errors (transcribe, data and location, to name a few), the reason GE paid me to do the barcodes.
f) If at all possible to obtain from FDA their full meds list with all the various dosages, etc. and add the CS spec plus add a per-insurer checkoff to indicate if prior auth is required. Selection should indicate in the patient record the date it expires, and dosage approved, both of which should display in the patient Rx listing. Ideally, we should also add to patient data whether they are on a monthly, 90 day, or other plan, and PROMPT users when the next is coming due, rather than so many "I ran out" calls on Sundays.
The objectives here are threefold:
a) Make the SIMPLEST process available that of using OpenEMR, both to store the data ONCE and automatically thereafter, rather than the multi-entry system as it now exists almost everywhere else.
b) Allow for online, offline, and non-linked portals to nonetheless be used efficiently, even while assuring that ALL meds are in the OpenEMR database for a patient.
c) Make that demonstrably so flexible that it can be easily tailored to the specifics of most users’ portals, work for any state forms, and require nothing that cannot be bought at the local Staples store.
EVERY psyche pro I have spoken to views the difficulties of repeated CS scripts and their tracking to be EXTREMELY important to their choice in EMR selection. I am hard pressed to believe it is less so for most other prescribers.
Thoughts anyone?
Joe Holzer Idea Man
http://www.holzerent.com