Weno prescribing issues

Using newly upgraded OpenEMR 5.0.1 on Linux 16.04 server. I’ve registered with Weno through Sherwin and enabled Weno entered my ID numbers under Admin>Globals>Connectors as well as for my individual user account. I’m using “Simplified Prescriptions”. I’ve imported the entire formulary (although at some point I’d like to trim this down so that I don’t have multiple entries for the same medication/dose - is this really necessary?). Likewise, I’ve imported the pharmacies for the town in which I live (as a start - ideally, I’d like to manually add NCPCP and NPI numbers for all the pharmacies to which I prescribe because very few of the pharmacies in my area are imported directly - also, I’d like to rename them as the names they are given by the system are not always indicative of what they are (I presume that won’t be a problem but for now I’m trying to keep things simple)).

Anyhow, I create a new prescription, and attempt to transmit it through Weno to the receiving pharmacy. I receive the following message and the prescription doesn’t go through. Any ideas? I had been having the same problem with 5.0.1-dev and eventually gave up, hoping that the problem would be solved with the “official” upgrade.

Send Complete - Prescription(s) Return Status
Weno Exchange LLC|2018-05-14|16:20:53.98267Z|||900|Transaction rejected - invalid message

The message was rejected because the prescriber ID is incorrect. See below.

This is the way it should arrive.

To fix this, the D102508 goes in the globals and the C36272 goes in the provider’s profile.

You can change or edit the drug database. I will find out what effect that will have on the prescriptions.

I am aware that there is a lot of redundancy in the program but what I was told is that each repeat of the drug should have a corresponding difference in price. I will find out if this is still true.

Thanks Sherwin. I’ll look into it and report back, maybe later today. You’re always so much help.

While you’re checking price issues, does it really matter? I would presume that the price is set by the receiving pharmacy, not by whatever is contained within my OpenEMR database. If it doesn’t matter, wouldn’t it be possible to simply remove all the higher-priced variations of any particular drug from the database in order to avoid the clutter? Ideally I’d have only one entry per drug/dose/formulation. I’d also rename them (for example - to Lipitor/Atrovastatin rather than separately) so one could search under either name and not have to remember generic names for medications one doesn’t use frequently. As to my other issues, is it feasible to simply phone the local pharmacies that are not contained within the pharmacy-loading file and then manually add in the NCPDP and NPI numbers from the Practice>Pharmacy section of OpenEMR?

Finally, now that my ID numbers are part of the public domain do I need to get new ones?

@Mouse55

I have checked and the drug list that is provided is a starting point for those that don’t have a drug database.

If you have a drug database, it can be imported into the table. Also, you can edit any data in the table you choose.

The ID numbers are for everyone to use since we no longer require registration to use the feature.

Please send me any more questions you may have.

Thanks, things are working like a charm now. I’ll feel free to trim the drug list down to reflect what I actually use. No sense in being flooded with multiple unneeded items. Also, are proper NDC codes (and all the prices) really necessary for the system to work properly? Ultimately, my goal would be to add an additional column with standard (for the medication in question) administration instructions (i.e. “1 TAB PO TID”, etc.) in it and then use that to populate the “directions” field when a medication is selected. That would save some time and/or at least provide a starting place for the prescription.

@Mouse55

That sounds like a great idea. Let me know when you have that done.

It may be obvious that I am not a medical professional. So, I only put in the table was given to me.

I wouldn’t mind working with you to include some of the enhancements so that we can share with the community.

Can I bug you for a review?
https://www.softwareadvice.com/medical/openemr-review/?step=1

I haven’t made much progress. I’m not bad at this stuff but I am a physician, not a programmer. First, I deleted all the avg_price stuff from the erx_drug_paid table. It doesn’t appear to be needed. I presume that the NDC codes will be required in order to make this all work and have therefore left it in place. Second, I’e added four additional columns: def_sig varchar(50), def_quantity varchar(15), def_refills tinyint and def_generic tinyint. So far I’ve filled these fields directly from within mysql (easily done with a .sql file) but I suppose that if this concept can be convinced to work then some sort of page from which one might enter and/or otherwise edit their own favored drugs might be eventually employed. def_ obviously stands for “default_”. My intent is that the contents of def_sig be used to fill the “directions” textbox once a medication is selected. Likewise, quantity would fill “quantity”, refills -> “refills” and def_generic could be used to set a favored modality in the substitution dropdown box. For the most part dosages and instructions for most of my patients don’t necessarily vary unless they are young children (in which case the fill-ins should be able to be over-written). Likewise, some medications (antibiotics) are not generally meant to be refilled whereas for others (blood pressure meds) one might generally want to write a prescription for which the refill box had a preset (but adjustable per MD preference) refill value. Likewise, some medications generally are dispensed in somewhat predictable quantities (20 tabs for a 10 day course of a twice daily antibiotic, for example) and any particular physician may wish to always use generics or perhaps to specify “no substitution” for one particular medication as a default. It would seem that such additions to the prescribing functionality would streamline the process of sending a prescription and minimize the typing that is required (especially important if one is using a tablet like an iPad, for example).

So far I’ve tinkered around a bit but am uncertain where (and how) to hook into existing code in order to trigger the system to harvest the requisite values needed to populate the quantity, directions, refill and substitution boxes upon leaving the drug box. I’ve tried the setting up a custom function triggered by the “onblur” event but no love so far.

As to your request for a review, I’d be happy to do so (again) but I have previously done so under a different user name.

@Mouse55
The interesting thing you said here was to have a page to edit the drugs that are in the drug table. I agree that should be added to the system under the Weno Admin.

Thanks for the review. I did not know. No need to do another.

Cheers!

The page wouldn’t be necessary unless one were to go off on the tangent I suggested, in which case the user/administrator should be given the ability to assign his or her own defaults for each particular medicine.

I’ve made some conceptual progress on the other stuff. My thoughts would be to use a regular input field to enter the drug name so that your weno-enabled search.php function could be used to auto-fill the field as it is now (I’d rather not use a drop-down list as that would effectively limit the prescriptions to those already imported into the system). One can then use AJAX to update the following fields referring to quantity, directions, refills and substitutions/generics as one wishes. I think I can make this all work but my work is hardly efficient. I do have the day job to worry about as well.