I'd like for nurses to eRx (e-Prescribe) and approve refill requests

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I like to suggest that nurses have the ability to send authorized prescriptions or that providers have the ability to forward their refill requests when out of office. These are very important issues.
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Robert Pritchard

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Doctor

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There are a few hacks we did to make this work, but I agree it would be much better the way an office used to work.
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Vijay Katukuri

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Could you please share your hacks to work around this system as this could almost be a deal breaker in my setup.

I do approve every prescription that comes in, but I let my staff either eRX the script or write the script (Schedule II drugs) and have them ready for me to sign between seeing patients.

If we move to PF, then I will have to write it myself and either eRX or print the script to sign.

What would be nice would be for my lead person to write the script under my name once I approve it and either eRX it or print it for me to sign.
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GirlfriendMD

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what would be even nicer, frankly, is to have a system that is very streamline and efficient that you just do it yourself, which is what we as providers should, ethically, be doing. All of the work around hacks are violations of the user license agreement and so cannot be posted here.
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Michelle L., Official Rep

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Thank you GirlfriendMD, this is a great point! We encourage all of our providers to use Practice Fusion as intended.

I also want to point out how much we appreciate your dedication to this suggestion. Thank you for your continued patience- I know this is a feature you are incredibly invested in having available through PF.
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Beverly Scarlett

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I strongly agree with GirlfriendMD. I am an office manager and see your current prescribing restrictions as a great time drain for the physician. Our physician currently authorizes refills and prescribes all medications personally and then our staff calls or faxes them in. It would take too much time for him to do this all himself in our busy family practice where many patients and multiple complaints and multiple medications. It is also disruptive that he opens the PF and has many refills requests that you are asking him to manually decline. Slows productivity too much for no reason. He should just be able to delete them.
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GirlfriendMD

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I am shocked to once again hear of a provider who finds it to onerous to complete the prescribing process on his own. Granted, I am very fortunate in that I have the luxury of 30 minutes per patient appointment in our practice model so that isn't an issue for me.
However, when I was in a more traditional practice model and doing eRx, first with drFirst/Rcopia and then with the Misys EMR (which was a terrible EMR system, just terrible), seeing anywhere from 27 to 35 patients a day as a solo provider, doing eprescribing was never so difficult so as to make me defer the task to my staff. As horrible as Misys was, I could at least batch prescribe and the prescribing process was simple and straightforward.
And yet, I see post after post about physicians who have given up this job to their staff because the e-Rx process in this EMR is so burdensome.
That, as much as anything, should be a convicting commentary, PF staff. I would think that at least some sense of professional pride would give you some sense of alarm and urgency in this issue.
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Craig Cleveland

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To Practice Fusion Staff only - this is an issue, you can see by the number of entries. I know you have to make the system work for all 50 states, but my solution did work and does not involve e-prescribing. It gives the physician the double check to be sure things going out are correct. It does speed up getting Rx's out of the office with minimal interference of doc-patient time. It is not illegal to have staff send in Rx's, even controlled drugs.
You know you have a good product and some work-arounds are necessary to allow the developers to do their thing and not be rushed.
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Serena Bernstein

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Can you share your solution? Is it some idea not usable for some reason? Personally, I spend all day on refills. I have to squeeze many days into one, I am not joking.
Can office staff log-in to PF and even document a refill that they faxed in?
thanks, Serena
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Michelle L., Official Rep

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Hi Serena, I am sorry to hear this workflow has caused a large amount of extra time dedicated to refill requests.

Currently there is not a way to document a staff member faxing a refill request and having this information be pushed or recorded when you are approving or denying refills. However, you can record this information within the Basic section of the patients chart- you will have to confirm this in the chart before denying the refill request.

Thank you for taking the time to post your feedback in the Help Forum, we certainly acknowledge this as a pain point for a majority of our provider. We will make sure to keep this thread updated with information as it becomes available on this workflow.
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Alan Levinstone

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This may be unbelievable but I just discovered: We use NP's. Their refill requests do to their own "Home" No one else in the office can see these refills. How can we get all refill requests to go all NP’s and MD’s as some NP just work 2-3 days/week so the refills are not being handled in a timely manner!!! Then anyone can handle the refills

I could not figure out why we were getting fax refill requests an people saying the pharmacy called us.
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Alan Levinstone

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PF has a giant hole. Unlike labs that come back to the general pot, refills only go to a specific physician/NP.

What happens when one is on vacation?

What happens when a doctor leaves as just happened to us? We still need to monitor her id to see if refills come to her, deny them, then reenter the scripts on another physician or NP.

Your employee stated we just share the id and password so someone can do the scripts. This is not a solution since I would need an employee going and out of 5 id’s all day to pick up new refill requests. Your employee does not understand how an office practice works.

I did not understand why we were getting faxed refill requests and irate patients and pharmacists saying we did not respond to a refill request.

PF must dump all refill request in a pot that all prescribers: MD. NP, PA can see refills like you do for labs.

Please fix this problem ASAP. This is quirk in PF juts like your email program that allow multiple ‘TO’ addresses but PF removes the email when the first person answers. WHY IS PF SO QUIRKY?
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Michelle L., Official Rep

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Hi Alan, from the scenarios you have outlined I can see exactly why this has become a pain point for your practice.

Looking specifically at your concern of a provider leaving or going on vacation, you can always suspend the refill request feature.

Please keep in mind, that while we work to explore and accommodate all of our customers suggestions, this Idea thread is an large undertaking. The timing for a request to be implemented depends a great deal on the complexity of the feature request.

We will make sure to update this thread as soon as we have more information on this suggestion.
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Alan Levinstone

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1. I think you do not understand the problem caused by poor programming in PF. We have 2 MD and 3 NPs That is 5 accounts to sign in and out by 1 person handling refills. How many times a day do we need to do this? We never know when refills come in. We would only sign in once and monitor one id if the scripts all came to everyone's id just as all labs are visible to all ids.

2.If we suspended refills, we would get faxed refill requests. How does that help us? The refill requests are not going away.

PF did not give enough though to this issue. I do not think the programming fix is that hard. Just show all refills for all ids. right now as you show a multi-recipient message under all the ids in the 'TO' section. When one person files the message, it disappears from all the other people. So when one person, does the refill, it can disappear from all other people. Q.E.D.
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GirlfriendMD

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Alan makes the key point: it does not address the needs of the patient to suspend the refill requests. Also, it does not address the issue of part time providers. We have providers who work 2 days a week, causing significant delay and unnecessary extra faxes and phone calls for refill requests. It's a time suck that only exacerbates the problem.
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Barry Gordon

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This is an important point. Physicians in my practice (and in most practices I know of) cover for each other. If you are using a fax or telephone system for prescription refills then someone can triage these requests to the covering physician. PF needs to send refill requests to a general area where they can be triaged to the covering physician. And, by covering physician, I am talking about a physician in our practice!
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JP

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This is so absolutely vital to the smooth functioning of a practice, and has been requested by so many it is hard to believe PF has still not addressed this. It causes problems on a daily basis when a practitioner is not in the office, and slows us down since support personnel cannot even access the ERX requests to have the physician address them verbally, etc. PF, please change this now!
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Alan Levinstone

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If one person has to use multiple ids, then what is the use of password protection.

Users should know that PF has created a serious legal liability for providers for failure to deal with refills in a timely manner. Someone will get sued and you will be joined as a party for this unbelievably poor programming method.

I just can’t believe this does not have the highest priority to fix.
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GirlfriendMD

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I think that you've really pointed out, Alan, that this thread is addressing 2 different issues: nurses generating and prescribing vs. other providers being able to approve/deny refills when a provider being out of the office. I think both are important, but as to the former, a cleaner/easier eRx system (writing and sending multiple Rx's without so many clicks in the process) would be a good fix. Simply assigning another provider or staff person (or both) to okay refills would solve the 2nd.
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Alan Levinstone

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"Simply assigning another provider or staff person (or both) to okay refills would solve the 2nd." Really this does not work and here is why. 1. each provider must give their password to the person doing the scripts so what is the use of passwords? 2. Only one person can use an id at a time. You can log on with same id as the active one thus kicking the 1st user off PF. So if you have an active MD, NP, or PA, they cannot be using PF at the same time. Yes they could create a dummy id to use PF simultaneously, but you can't prescribe from the dummy id. I do use this artifice so I can see patients while me nurse is doing refills. Yes I have to give her my password. I must re- log into my real id to send scripts, a pain. 3. Refills come in asynchronously all day to different providers. You cannot expect one person to log into 5 accounts multiple times a day to retrieve refills. That is unreasonable. How often do you ask them to do? Refill request should come to a common queue. Allow a filter by provider as done by with labs. This would solve all the problem and remove legal liability and patient annoyance (and stop faxes from the pharmacies) for not handling refills in a timely manner,
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GirlfriendMD

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Alan, you misunderstood, when I said 'assigning another provider or staff" I meant making sure that Practice Fusion adds that ability as a feature. I didn't mean giving someone else your log in as this is a violation of the user agreement. if you scroll up in this conversation you'll see multiple comments from me suggesting that there should be the ability for other providers to review each other's refill requests when out of the office.
In eClinical Works each provider could assign a staff member to be able to approve/deny refill requests on their behalf. Also, MD's were allowed to see all pending RF requests sent to the practice.
When an alternate physician approved and Rx, a notification would pop up saying "since you are a different physician from the original prescriber, the pharmacy will be notified that the request is denied with new Rx to follow" and a new prescription (new in that it was from a different provider) was automatically generated and sent.
There's no reason PF can't include such a feature, since it appears to be fairly standard in almost every eRx program I've used in the past (Misys, DrFirst's Rcopia and eCW).
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Barry Gordon

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MDs should be able to see all pending refills and act on those that are for themselves and other physicians for whom they may be covering.
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JP

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The link given in the note goes to a suggestion, not an actual feature. Is this a real feature. If so, How do I find it and use it?--JP
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Michelle L., Official Rep

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Hi JP, if you are referring to the link I provided above for suspending refill requests- this leads to an explanation of how to accomplish this action. If you are interested in doing this, please follow the post information.
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Karen Kyle

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I would like at least some way for others in the office to see what refill requests are coming in. Just allowing others to be able to deny refills is a huge time saver. Approximately 80% of the refill requests I get are from pharmacies that already have a valid script in their system for the medication they are requesting. This is because automatic refill systems at pharmacies generate those requests when a script is due without checking their own system for duplicate scripts. Given the volume of patients I see this is alot of wasted time. I would much rather have someone else sort through these and just give me the requests for refills that are truly needed. There should be a way to at least view the requests.

This is also needed for when the doctor is out of town or the office. Otherwise refills will go into a never-never land where the pharmacy tells the patient the refill request is being faxed - and it lands in a computer where no one sees it.
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MAFinOKC

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This is typical: A PF feature that is missing from the pathway that has been pointed out countless times for months or years is either simply ignored or users are told that that is a "great idea" and "thanks" and "we'll take it to our programmers," and then a whole lot of nothing happens. This thread started 7 months ago and was last contributed to 9 hours ago, and there is not ONE SINGLE reply from PF. So I'll reiterate as I've reiterated before: No matter what "enhancements" PF makes in the e-Rx pathway, they WILL NOT be appreciated and you will continue to get complaints instead of praise because the changes users want most are being IGNORED: To wit, making it possible for someone OTHER THAN THE PROVIDER to enter and change the patient pharmacy and to enter, update, and approve prescriptions. If your professed aim is to make LESS work for the provider, you've failed: Your e-Rx pathway makes MORE work, not less. Writing paper prescriptions is MUCH less time-consuming than using PF's e-Rx pathway, and to my dismay and chagrin, I find myself more and more trying to AVOID using, rather than using, PF's e-Rx pathway, and going back to paper Rxs, at least with non-Medicare/Medicaid patients. And one more thing: With Allscripts, there is 2-way communication between the pharmacies and the office. Once a patient is entered into Allscripts, their med list is populated with pharmacy records available to the clearinghouse. It's far from perfect, but it's a big help, especially when you have patients who can barely remember their own names, much less the names of their medications.

Your development staff really seems to be more or less oblivious to what it's like out here on the front lines and in the trenches, trying to care for patients all day long and day after day, while daily sinking deeper under the dead weight of continuously proliferating underfunded government mandates. I'm beginning to wonder if $40+K is sufficient compensation for all this time spent, headaches and lost productivity; INCLUDING the time it takes to get on this forum and post these messages, and then to wait for changes or answers that never come.
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Arvind Patel

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Good write up;.... but elsewhere detailed by me around the subject... pointing out the eRx effort applies to all eRx written and sent not just Medicare and Medicaid... could be wrong... but I will think.. you are an active contributor...
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JP

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Eloquently stated. WAKE UP, Practice Fusion. Begin with the customer in mind.--JP
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Linda

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Do you think you will have this feature in the future?
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Leilani Sivertsen

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I agree with the above statements! I was a "super user" for eClinical Works at another office I used to work at and now switching to Practice Fusion and having this problem is a major time waster!! I work for a provider who does house calls so since the provider is never in the office, it is impossible to know how many or which patients are requesting a medication refill. Time and time again pharmacies are calling saying they "faxed three requests" when they really have just sent it via escribing so the nursing staff is getting rude phone calls from the pharmacy because refills have not been done yet. Since 95% of our patients are geriatric, at least 3 or 4 Rx's need to be refilled at the same time. Calling Rx refills into the pharmacy is a large portion of the day that could be eliminated with a few simple clicks made by nursing staff. Not only would this significantly increase productivity but it would also provide time to communicate with patients, family members and other physicians/specialists that are involved in patient care appropriately. Besides, isn't the point of an EHR and EMR to have better access to patient care and to have primary practices become the "gatekeepers" of patient care? In order to do this, especially in this day and age where technology has allowed us to do progress at such a rapid pace, we all need to be able to utilize features like this to develop a more efficient workflow!!! Please add this feature!
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GirlfriendMD

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eClinicalworks had plenty of its own problems, but the one thing I have really learned to appreciate from having used them prior to this EMR is the prescribing interface. Once you've chosen your drug name, you have a drop down menu of standard available doses, of standard instructions (QD, BID, TID, etc), then of the length of treatment with most of the standard choices first (7 days, 10 days, 14 days, 28 days, 30 days, etc) and then for refills. This populates the Rx sig, sets a stop date for acute meds and then there's an allowed space for comments. While I understand that layout is at least somewhat proprietary for eCW in that it uses an interface similar to their charts and other functions. But there's no reason PF can't develop a similar interface.
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Leilani Sivertsen

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I agree, eClinical did have many flaws as well; it was also nice that you could select if you wanted patient to continue meds, refill or stop on each encounter. It makes for a much more accurate Rx List! Many of our patients are listed as still being on numerous abx b/c a stop date was not manually put in and it is very time consuming to go in and change the status; esp since it forces you to select a reason. Overall I think Practice Fusion is great (especially since it is FREE) but there is definitely room for much needed improvement and more consideration for suggestions by people that are actually using the software on a daily basis for patient care as opposed to getting input from developers that have never had to work in a busy office with a steady work flow.
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GirlfriendMD

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well it appears the recent Rx interface update does allow you to put "length of therapy" in the prescription. So at least we're moving one step closer to progress there.
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GirlfriendMD

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Also I HATE that I have to select a reason to stop a medication. I want "because I said so!" to be the default in there.
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Daniel A Gutstein

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How about a reason to stop a medication - DOSE CHANGE?!! Yeah, I hate that changing a dose requires stopping a med and starting a new one. Harrumph.
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Serena Bernstein

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good idea, if possible. I don't know why it wouldn't be possible. my reasons aren't on the menu so I have to lie to do it. A custom reason would be okay, if I need to put a reason.
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MAFinOKC

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Two more points:
1) Another important reason to have two-way communication from the pharmacies through the clearinghouse is another reason to which PF seems to be oblivious and which I have pointed out several times before: When it comes to prescriptions, the system records the dates written and renewed, so those are taken care of; what we NEED to know, what EMRs like Allscripts provide and PF doesn't, is the LAST FILL DATE.

2) Patients often self-d/c their medications but don't tell me until they're in the office again, which is often months later (or even years if they're lost to followup for a long time), and they DON'T remember the exact date they stopped the med. Sometimes they're hard put to remember even the MONTH they stopped the med. So since PF REQUIRES that we put an exact date when the med was stopped, you know what PF forces me to do? I lie, because I have no other choice. I arbitrarily choose a stop date that may or may not be even close to the actual date. The field needs options to put just the week or month or even the approximate month OR "Patient doesn't remember." And the reason for stopping the medication should be optional, and there should be a freetext option, because I don't know who set up the drop-down list of reasons for stopping, but it clearly was not a doctor. Sometimes the patient doesn't recall not only WHEN they stopped their med, but even WHY. We need to be able to note that.

Practice Fusion, take note: Patients don't go around thinking, "I've got to exercise military precision and consistency in the way I deal with my health and medical conditions so that when I see my doctor, he/she can put just the right bits of information into just the right electronic pigeonholes in just the right logical and precise standardized format." There is a clear impression that the folks at PF don't understand or appreciate that the practice of medicine isn't orderly and logical, where everything can be specifically categorized. Medical practice can be messy and disorganized because patients' lives, problems and thinking can be messy and disorganized. The difference between real medical practice and PF's concept as evidenced by how their EMR models medical practice is akin to the difference between real war and a computer war game.
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pamalamalu

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Staff will enter RX's in on MD's behalf... is there a way to have a drop box to change the provider so rx does not prescribe from the nurse, MA, or other delegated staff?

Thanks!!!
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Charles Raine III

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I suggest a system where designated staff could generate prescriptions and forward to the prescriber for electronic signature in bulk, sort of the way we sign imported documents.
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pamalamalu

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MD support staff are covered under the malpractice of MD and work under the direction of the doc. Refills are a routine function and task for MA and nurses. This functionality is a must
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Arvind Patel

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This till an Official picks up:

Firstly, the title of the page, though self explanatory for an old wish, the wish itself, though, voiced in unison, requires thoughts to be incorporated around what the laws of the land are.. in this case that would lands with a plural as the reference point in most aspects is state even tough approved by DEA and so on...

Though who want some change in this arena should give a run down who is authorized to Rx in which state... Most state allow the eligible providers to RX and the Experian, or prior otherwise, process of providing this functionality in PF is based on just that.

So that Users not belittle eRefills denial, a concept has to be invoked... a denial requires as much an authorization as the original prescription... so for denial let the support staff help etc is no argument...

The functionality in PF is still need to be enhanced in Rx space and detailed elsewhere previously with respect to drug-drug interactions and such... search word "wheel and spoke" referring to drugs located at each spoke in wheel configuration and one to many in interactions... currently sequential drugs if on addition of that new drug causing interaction alert is only that counts and triaging all this is challenging at best even for our trained EP and in corollary the discontinuation of a med is also complex as the void can unmask the problem for which that drug was prescribed in the first place as compensatory to allay side effects and so on..

After a study of all the states laws around this space, please detail which state has what and so on to guide the process of allowing the support staff to give final stroke around this matter; the study will give the picture of what limits we have to abide by. Any actions outside this limits can be tantamount to a violation... so you guessed it, if there not much movement around this topic, it is because of that. A quilt patterned requirements of state may pose a challenge for PF but still doable with effort... So my fellow users, it is time to contribute to this effort or else accept status as it is..
As mentioned before, i am not much impacted but I would like better functionality and straighten out some kinks around Rx system...

Expressly needed is the features for cross coverage of Eligible Providers to continue care say around Rx, reports, ability to view each others SOAP and other data etc. Common incoming repository to be worked e.g. Rx refills, reports, messages etc can be worked on and each step of the way needs restriction of function to the tasks authorized in primum
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GirlfriendMD

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Uh, support staff absolutely CAN make denials of refill requests, particularly when you have an office with an SOP or standard operating procedure with guidelines listed for allowing refills on various types of medications. DENYING a refill is NOT the same as writing or authorizing a prescription.
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Chun Hong

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Strongly agree, we need the feature that allow nurses to refill eRx for doctors
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Jay Ross, Official Rep

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Hi everybody,

I some really good news. We are actively working on a redesign of our prescribing workflow. Part of this will include the ability to process refill requests on behalf of another person. Please watch out for a new forum post under our updates section for more details on how this work work next week.
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Kelli Pavlish

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I'm only replying to reiterate the importance of this. If nurses can call in an RX on my behalf, they should be able to ERX one as well. I know it happens with other software at other practices.
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Fuad Zeidan

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I think it is allowed for the office employees to arrange medication lists, reconcile medications from different sources, then the doctor can review and approve finalize the print or send to pharmacy.
PF should allow everything regarding Rx list except final approval and sending,
The problem in PF is that every medicine has to be done one at a time, no patch processing, like I cant pick 5 of 10 medications by clicking in a small box near each and press send to pharmacy.
Some people try to change this to a medico-legal issue. it is not it is a software issue.
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Geoff Cox

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MAFinOKC is soooooo right. You guys just don't seem to listen. This is only ONE issue where this applies. Automatic chart closure and "click-to-patient-chart" from Prescription Refill is another. Please listen!!!
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Geoff Cox

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And Fuad is also right with sending multiple meds to pharmacies. Just make a few requested changes to show a good faith effort ...
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geoff moro

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We all want this feature!
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PF Staff Dylan

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Hi Everyone,

Our Program Manager, Jay Ross, has created a post to preview the new e-prescribing workflow, which addresses many of the requests from our community around the subject. Please visit the post linked below. Your feedback on this is welcome and encouraged. We appreciate your help in making Practice Fusion even better!

We want your feedback: Introducing a new e-Prescribing workflow

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