In Alberta we have a triplicate program to regulate and monitor narcotics prescriptions. PrescribeIT has introduced some complications with this process and there's a potential risk of one prescription being used twice at different pharmacies. Have you had any issues with narcotics abuse/over-prescribing with PrescribeIT?
One of the challenges in Ontario and other provinces is that if we want to send a prescription directly to a pharmacy at present, we rely on fax. A challenge I have encountered is that this often means - failed faxes, multiple faxes back and forth for clarifications when a dose is increased/ decreased and challenges when patients are due for an early release or should not have medications released early.
I’ve found quite frankly that patients who have prescriptions filled by PrescribeIT are much safer than our current framework for the following reasons:
- All drug data is transmitted electronically and not just an image as in a traditional fax
- I’ve never had a PrescribeIT transmitted script used twice. And frankly, this is impossible. PrescribeIT transmitted scripts are sent once, to a single pharmacy and are always received.
- We also receive dispense notifications of when a script was filled, this option has not been available to us before. It provides enhanced safety as I can be certain when a prescription is dispensed — the information I’ve never had before.
In Alberta, prescription requests usually go through MOAs (medical office assistants) BEFORE they cross the desk of a physician (well over half are declined before the doctor even sees them). With PrescribeIT, the workflow bypasses the MOA and goes straight to the physician. Has this increased workflow toward the physician been a problem at your office?
With regards to the prescriptions going through the MOA this is very common and the default workflow in nearly all offices in Ontario. This has not been an issue for us at all for a few reasons:
- MOA’s no longer receive, scan/ file, label and message physicians for prescriptions
- Renewals are processed simply using an “approve” or “approve all” button by the physician which saves time in having to select individual medications
- Lastly, the cost of faxing has been reduced as I now receive 40-50 less fax pages per month (a small but a noticeable improvement which will increase when adoption increases).
Please consult this document to learn more about PrescribeIT for TPP Alberta.
How can we fund a sustainable business model for pharmacists to help deprescribe. Can the funding for MED reviews go beyond matching drug lists and actually reward programs like Andy's that will integrate into circle of care for seniors at risk due to polypharmacy?
It is exciting that new technologies such as ClinicalConnect and ConnectingOntario, along with PrescribeIT, are helping to eliminate health care siloing in the community setting. This is making more comprehensive reviews and personalization of medications possible, a necessity in helping to combat polypharmacy and medication overuse that is problematic in our publicly funded health care system. Unfortunately, there does not seem to exist any funding for deprescribing or medication optimization funding yet from the government as it is still a very cutting edge and new concept. It will likely take a lot research and statistics to encourage the government to fund such a game changing program within our health care system. Unfortunately, this becomes a chicken or the egg story as it is not viable for many pharmacies to launch such initiatives if there is not adequate reimbursement for your efforts.
Are all the pharmacies in Ontario registered or connected with PrescribeIT? If you have used it, is it better than what is available now? How much does it cost to register for it?
I have been using PrescribeIT for over a year and can say that it has made my practice workflow seamless. Our previous use of auto-faxing was always causing headaches. PrescribeIT allows me to manage and track my own prescriptions and communicate directly with the pharmacist.
PrescribeIT currently has launched in select communities in Ontario, Alberta, New Brunswick, Saskatchewan and Newfoundland and continues to roll out across the country. There are no fees to prescribers.
Is Oscar based EMRs on the radar for PrescribeIT integration?
Oscar PRO are now fully functional with PrescribeIT. From what I understand often the main hurdle in getting software onboard with PrescribeIT is to ensure there are sufficient privacy and safety protocols to conform to regulations. The Well Health and Kai Innovations instances of Oscar PRO have done this, with a full rollout expected soon.
And, as my colleague Dr. Pepe points out, be it for Oscar EMR or other platforms the single most important thing users can do is emphasize the importance of the integration of technology like PrescribeIT in their EMR.
One hesitation I have to implementation is holiday coverage. I may have a Locum cover & need temporary old-style faxing resumed. Is this possible?
For the first few months of using PrescribeIT I had my colleague cover my practice by faxing prescription requests even though I am utilizing PrescribeIT. I wouldn’t consider this a barrier but would love to clarify this if you have more questions!
Does the requesting pharmacy have to be a PrescribeIT client in order for the program to work on the physician's end?
In your EMR, you will have the option to select when writing your prescription “draft, post only, print, fax or e-Sign and Send.”* If the Pharmacy you select is a part of PrescribeIT — the e-Sign and Send will be highlighted. If the Pharmacy is not yet a part of PrescribeIT, you can select one of the other options.
PrescribeIT® integrates seamlessly into electronic medical records (EMR) and pharmacy management systems (PMS), enabling prescribers to digitally transmit prescriptions to pharmacies. Transmission is secure, private, and directed to the patient’s pharmacy of choice.
*Please note the exact wording might differ across various EMRs.
Is pharmacy paying any fee to sign up for PrescribeIT? Any monthly or annual fees involved?
At the moment there are no fees charged to pharmacies for the foreseeable future. Currently, the program is fully funded by Health Canada. Eventually the plan is to have this program sustain its costs through slight fees to be charged to pharmacies for both new or renewal e-prescriptions. The fees will be charged on a per use basis and we will have lots of warning as to when these fees will start.
If I decide to add PrescribeIT to my EMR (Indivicare) do my colleagues have to as well or can I choose to use it myself only? Would there be any problems with my colleagues using the fax feature of our EMR? Also, is there a charge for using this tool?
Thanks so much!
When I started to use PrescribeIT in my office I was the first to add the service. Other physicians were not signed up for PrescribeIT in my office at the time and did not need to use it. Needless to say, quickly after I adopted PrescribeIT there was a wave of other physicians in my office who followed. There are no issues with your colleagues using the fax in your EMR. We continue to use fax and PrescribeIT alongside each other as many services still require a fax.
There is no charge! Let me know if you have more questions. Over the weekend I had two consecutive days where all prescriptions were sent through e-prescribing and it took about 50% less time than it currently does for me using a traditional fax.
If there is an 'oops,’ where a medication is prescribed in error, is there a 'recall' function?
Great Question! There is not a recall button, but Prescribers are able to cancel an existing prescription and issue a new prescription. However, PrescribeIT does not support a function to alter or modify a prescription after it has been sent.
A wonderful component of PrescribeIT is its clinical communications feature which allows prescribers and pharmacies to exchange secure messages through their electronic medical records and pharmacy management systems to discuss medication related issues or questions.
Is PrescribeIT helpful when you're prescribing from home or away from the office?
Yes, it is incredibly helpful especially when you are away from the office. PrescribeIT ensures that the prescription arrives without question when you are at home or away from the office and don’t have time to deal with failed faxes. It’s also incredibly helpful when we receive requests from pharmacists as we don’t need to read what the fax says and then prescribe the medication. We are simply given the option to approve the script and send it off. When I am processing my own prescriptions I usually tackle the PrescribeIT renewals first as they are the fastest to do!
How has PrescribeIT integrated within your existing workflow? How does it compare to traditional paper/fax prescriptions?
PrescribeIT integrates doctors’ e-prescriptions directly into Kroll, our pharmacy software. The prescriptions sent from physicians pop directly into our workflow. It has definitely helped improve our workflow as it reduces scanning and entering times required for inputting prescriptions, while also reducing the risk of transcribing errors. The prescriptions pop into your workflow exactly the way the doctor entered it, instead of having to be first interpreted by a pharmacy team member. The ability to use secure messaging between the pharmacy and prescribers increases the efficiency of the process as well.
Can you prescribe narcotics through PrescribeIT? Can you still fax or print prescriptions if needed?
Of course! PrescribeIT allows prescribers to electronically prescribe medications including narcotics, compounds and devices such as lancets and blood glucose test strips.
If a patient’s preferred pharmacy location is not yet connected to PrescribeIT, prescribers may continue to use their previous method of prescribing (i.e. print or fax)
Does PrescribeIT use a different technology than fax? Is it free or are fees involved in using?
With regards to the technology used, PrescribeIT is different from a regular fax which is sent from the primary care provider to the pharmacy as an image which is then re-entered at the pharmacy. With PrescribeIT we are sending actual prescription data to the pharmacy reducing the risk of medication errors but removing a traditional data entry step that pharmacists would need to carry out. The other nice thing is that the data which is sent does not end up in a stack of paper where it may be visible to individuals who are not prescribers or the pharmacists. As such there is an added layer of security. Lastly, Health Canada has provided seed funding to launch PrescribeIT which will subsidize the cost of the technology for several years.
Does PrescribeIT transmit any of the patient's supporting information (such as a diagnosis)?
Like regular faxed or paper prescriptions, the initial e-prescription transmitted to the pharmacy from doctors does not include a diagnosis unless the doctor includes it. However, the clinical communications feature in PrescribIT allows you to securely message the doctor directly through your pharmacy software to their EMR. It's great as you can skip the line and delays associated with faxing requests and speak directly with the physician. This definitely is easier and has improved turnaround time on getting responses.