Paul Ramsay Trainer Assisted By: Connie Vaske

1. ePrescribing Paul Ramsay Trainer Assisted By: Connie Vaske

2. Covered Topics • Overview • Configuration – Client and Server • Prescriptions – New and Refill Requests • RxHub Features • Basic Troubleshooting

3. Eprescribing Overview • Practice Partner Eprescribing is not Surescripts tm. • Surescripts is another company, another brand. • Eprescribing uses the Surescripts network. • McKesson and Surescripts are technology partners.

4. Eprescribing Overview Surescriptstm • Composed of two legacy networks: Former Sure Scripts network (for retail pharmacies) Former RxHub network (for insurance eligibility and mail-order pharmacies) • Merged in 2008: Former companies and networks are now known as just Surescripts. • Eprescribing uses both legacy networks under the unified Surescripts brand. Prescribers still configured with both Sure Scripts and RxHub credentials

5. Eprescribing Overview securely transmit and receive PHI • Practice Partner Eprescribing • Surescripts’ unified networks

6. Eprescribing Overview This flow of messages has four distinct waypoints on the journey from exam-room to pharmacy and vice-versa: McKesson Surescripts

7. Eprescribing Overview • Practice Partner Eprescribing module is designed to verify that a script is ready for transmission. • It reviews the practice and provider configurations to ensure that all required information will be in the actual outbound message. • If an element is missing, an error message will pop-up and list what element(s) need to be corrected.

8. Eprescribing Overview • The PPCH verifies that the script is from a currently subscribed and registered provider and practice. • If the script does not contain the registered information exactly, it will send a “601” error message back to the prescriber’s message box. • Discrepancies must be resolved by Practice Partner Support in consultation with EDI Enrollment to reconcile them.

9. Eprescribing Overview • The SSCH performs redundant and additional verifications. • Scripts must be from a registered provider • Destination pharmacy must also be registered in the Surescripts network. • Responds to Insurance Eligibility queries. (an RxHub feature) • Admin Console utility available to research retail pharmacy traffic.

10. Eprescribing Overview • Pharmacies are beyond the scope of McKesson Support. • Because large chains are centralized, there can be outages to entire chains. • Fax back-up service often covers these outages. • Most pharmacy related issues are supported via Surescripts Support. • The huge diversity of software at the pharmacies presents a maintenance challenges that must be resolved by the pharmacies.

11. Eprescription Configurationpatient records configuration • Eprescribing is a module of Patient Records. • Both must be version 9.3.2 or better • Eprescribing (Sure Scripts) was rolled out in 2008, but older versions are no longer valid. • Crossing versions (PP 9.2.2.1 and Eprescribing 9.3.1) will not work.

12. Eprescription Configurationpatient records configuration • Eprescriptions originate from both: • - a registered provider • - a registered practice. • To be registered, a site sent in an EDI enrollment form that was processed by the EDI Enrollment Team. • That process entered the individual providers and one or more practices in both the Practice Partner clearinghouse (PPCH, waypoint 2) and the Surescripts clearinghouse (SSCH, waypoint 3). • EDI processing generated an SSID and RxHubID for each provider. Those IDs must be entered into each provider’s credentials in the maintenance tab of Practice Partner Patient Records. • These credentials are necessary to utilize the two legacy networks of Surescripts (Sure Scripts and RxHub).

13. Eprescription Configurationpatient records configuration • In the Main Patient records window, select “practices” under the Maintenance Menu. • A site may have more than one practice: • The key is consistency between configuration in Practice Partner and the Clearinghouses. • For this example, only Practice ID “MFP” is registered, so that is the one we will configure.

14. Eprescription Configurationpatient records configuration • Edit the practice. • The General 1 tab must include the clinic’s full address, work phone, and NPI number.

15. Eprescription Configurationpatient records configuration • In the General 2 tab, click new provider or edit provider.

16. Eprescription Configurationpatient records configuration Edit the provider within the practice. Each Provider must have a Surescripts ID and an Rx Hub ID. • These IDs were generated as part of the Eprescription enrollment process, and can be researched by the EDI Enrollment Team (edienrollment@practicepartner.com) • These IDs must be entered accurately. Mistakes in the SureScripts ID will generate error messages. Mistakes in the RxHub ID will cause those features to fail.

17. Eprescription Configurationpatient records configuration • In the Main Patient records window, select “providers” under the Maintenance Menu. • Select a registered Provider and click “edit”:

18. Eprescription Configurationpatient records configuration • On the General tab, Eprescribing requires an entry in the Prescriber’s Work phone field at a minimum:

19. Eprescription Configurationpatient records configuration • On the Credentials tab, Eprescribing requires an entry in the DEA, NPI, and State license fields: If NPI # is unknown, enter “nodata”. There must be an entry. Also, if the prescriber does not have a DEA # (i.e. a Phys. Asst.), then there must be an accurate NPI number. An accurate DEA or NPI is required.

20. Eprescription Configurationpatient records configuration - REVIEW • Successful Eprescription transmission requires: • Practice Maintenance, • General tab: • Practice address • General 2 tab: • Prescriber ID (PVID) matches PPCH registration. • Accurate SSID in Sure Scripts column. • Accurate RxHubID in RxHub column. • Provider Maintenance • General tab: • Provider work phone • Credentials tab: • DEA number (“nodata” acceptable if NPI is present) • NPI number (“nodata” acceptable if DEA is present) • State License number

21. Eprescription Configurationserver Eprescription Configuration Utility • Eprescribing is supported by a Utility on the Practice Partner server. • This utility must be run on the server, not at workstations. • Usually located at: P:\ppart\pmsi.eprescription.configuration.utility.exe • A desktop shortcut to this utility is very handy.

22. Eprescription Configurationserver Eprescription Configuration Utility • The Eprescription Configuration Utility has four tabs: Messaging Configuration – Used to re-route messages Pharmacy Download – Sets the scope and schedule for pharmacy updates Interface Configuration – Sets the schedule for Eprescribing activity Status – Shows the status of the Eprescription Server software

23. Eprescription Configurationserver Eprescription Configuration Utility Messaging Configuration – Used to re-route messages In this example, Eprescription messages for Prescribers BS and LB are being re-routed to support staff. Eprescription Messages include: Error messages and Refill requests.

24. Eprescription Configurationserver Eprescription Configuration Utility Pharmacy Download – Sets the scope and schedule for pharmacy downloads and updates

25. Eprescription Configurationserver Eprescription Configuration Utility Pharmacy Download – Sets the schedule for pharmacy updates It is common for the automatic pharmacy update to be set around 4 am.

26. Eprescription Configurationserver Eprescription Configuration Utility Pharmacy Download – Sets the scope for pharmacy downloads and updates • The criteria list may contain both city/state and zip code entries. • Be sure to click “add” to avoid overwriting entries. • Do not include just “state” in list! It will download all epharmacies in that state. • Be careful with ranges of zip codes! They are not adjacent.

27. Eprescription Configurationserver Eprescription Configuration Utility Pharmacy Download – Can be executed on demand: • Click “Download Now”. • Two expected warnings: Scope may be large, and Total download. Accept them.

28. Eprescription Configurationserver Eprescription Configuration Utility Pharmacy Download – After a brief interlude, a pop-up will appear: • This means pharmacies will be pushed into the Practice Partner Pharmacy Table. • Mail Order pharmacies are counted seven times in this pop-up, but are entered only once into the table. There is not a direct correlation between the count shown here and the number of pharmacies actually populated into the table.

29. Eprescription Configurationserver Eprescription Configuration Utility Interface Configuration – Sets the schedule for Eprescribing activity • Eprescribing is not dynamic, instantly active. • Instead, the software performs a series of actions once a period. • The default period is 2 minutes. • Status Logging is turned off (unchecked) by default. • It is useful for troubleshooting, but generally should not be enabled.

30. Eprescription Configurationserver Eprescription Configuration Utility Status – Shows the status of the Eprescription Server software • The status should be “started”. • Clicking “Stop ePrescription Server” will stop Eprescribing functionality. • Ignore unsuccessful transactions. • When a pharmacy is downloaded, but already exists in the Pharmacy table, it is counted as an unsuccessful transaction.

31. Eprescription Trainingwriting a new prescription • Keys to a successful transmission to a retail pharmacy • Script originates in the registered provider and practice. • Prescriber’s credentials are accurate. • Eprescription subscription is up to date.

32. Eprescription TrainingWriting a new prescription • How to send a script • First, log in as the registered provider and practice • You will remain the operator that you logged in as. • If unsure, click on the “prov” button (stethoscope), and verify

33. Eprescription TrainingWriting a new prescription • Click on the Rx/Medications tab

34. Eprescription TrainingWriting a new prescription • The Patient’s current Meds list opens: • Click on “new”. The meds lookup appears.

35. Eprescription TrainingWriting a new prescription • Lookup desired medication. A dialog appears: Review and edit it.

36. Eprescription TrainingWriting a new prescription • Critical: Change print field to read “transmit as a group”:

37. Eprescription TrainingWriting a new prescription • Use the Note or Extended Sig fields to speak to the pharmacist:

38. Eprescription TrainingWriting a new prescription • Click “change pharmacy” to select an ePharmacy from the pharmacy table: • After Review, click OK. Script is NOT sent.

39. Eprescription TrainingWriting a new prescription • Med shows as red in patient’s meds list. • Generate another script, or click, “CLOSE”

40. Eprescription TrainingWriting a new prescription • A pop-up appears. • Here, “print” means “transmit” (from print field) • Click yes.

41. Eprescription TrainingWriting a new prescription • The patient’s pharmacy list pops up. • This patient had no associated pharmacies • Click the pharmacies button: • The Practice Partner pharmacy table opens.

42. Eprescription TrainingWriting a new prescription • Select an Epharmacy:

43. Eprescription TrainingWriting a new prescription • Pharmacy table can be a mixture of Epharmacies and manually entered pharmacies. • Epharmacies – maintained by download. • ID starts with “SS” • Has a value in the NCPDP ID column • Manually entered pharmacies • Manually generated ID, usually no “SS” • NCPDP missing, and not generally available.

44. Eprescription TrainingWriting a new prescription • If a desired ePharmacy is missing from your pharmacy table: • Do NOT manually enter it • pharm techs. do not know the NCPDP number. • Edit the pharmacy download tab in your Eprescription Configuration Utility • Add necessary city or zip info and download anew.

45. Eprescription TrainingWriting a new prescription • Once the desired pharmacy is selected, click OK. • You may be asked if you want to associate this pharmacy with the patient.

46. Eprescription TrainingWriting a new prescription • Clicking YES and/or NO will send the script. • Clicking CANCEL will not send the script. • The script will still be listed as pending on the patient’s Rx/Meds chart tab. Cancel suspends the transmission – Script is in limbo if canceled! • THAT’S IT. THE SCRIPT IS SENT.

47. Eprescription TrainingHow to handle a refill request • Prescribers must respond to refill requests within 48 hrs. • This policy is created and tracked by Surescripts, not Practice Partner. • Rule of thumb: if you don’t respond to at least 50% of Refill Requests in a timely manner, SureScripts can deactivate ‘Refill’ service without warning.

48. Eprescription TrainingHow to handle a refill request • But what if I am responding to refill requests in a timely manner? • A very common problem is that refill requests are not responded to properly. • For example, a refill request message is received:

49. Eprescription TrainingHandling refill requests You may think to click on the “link” button to access the patient’s chart.

50. Eprescription TrainingHandling refill requests • Do not click on the “Link” button • It’s an old habit to link to the patient’s chart, meds/rx tab, select the med and click “renew”. • While this is seductive, it is not a true “refill response”