CPOE stands for Computerized Physician Order Entry. Proper implementation of CPOE is crucial to reducing medical errors. CPOE feature is an integral part of PROGNOCIS, allowing user to place lab orders, radiology orders, and prescription. It also lets user store lab and radiology results when they are received.
Rx stands for Prescription. This option is used to prescribe Drugs to the patient. The prescription can be directly sent to the Pharmacy.
The Page Shows the selected Patient details like his Name, Age and Attending Doctor, when invoked through CPOE > Rx.
Pharmacy: This is by default the pharmacy entered in the last prescription of the Patient. This field is not mandatory and can be set to blank, because the patient rather than ask for a specific Pharmacy, might retain the option to go to any one while he is traveling. Start typing the pharmacy name and a list of matching names present in the master are displayed, so that one of them can be selected. If the selected pharmacy supports electronic prescription receipt, a prefix of eRx in red will be displayed.
User can use the search button to select a pharmacy from the master list of pharmacies provided by Surescript. All the pharmacies listed here are not available under Auto complete edit control described above.
If pharmacy is changed for a drug row, then remember to click on update button, otherwise it will not be saved.
In House: To select an InHouse drug check this Box. The drug List box will then display only the list of InHouse generic drugs.
Sample: If this is checked, then the drug is assumed to be dispensed InHouse, although it might not be part of the defined InHouse drug list.
Drug: Is the generic drug to be selected. Start typing the name, and the list box will get filtered accordingly. The List of drug will depend on the InHouse checked and the property for inactive Drug (rx.show.inactive.drugs). Compound drugs are considered.
Strength: On tab out from previous field, the dispensable drugs for selected generic drug are populated in the list box. The List of drug will depend on the InHouse checked and the property for inactive Drug. The strength list box may display a suffix of * to an entry, to indicate it is inactive. When the user selects a drug and strength the system tracks the last prescription of this drug made by this doctor earlier to any other patient. Based on that it selects the default value for Strength, Dosage, Frequency, Days, Bulk Quantity, Refills.
Pediatric Dosage Button:
button is displayed is the Patient is less than 18 years of age. This displays
the computed pediatric dosage for a day. The calculation is based on the
patient Age and Weight. The system finds the weight entered in vitals in
the current encounter. If this is not entered, the system finds the Normal
Average Weight for the specified patient age and sex. The Min-Max dosage
per day is computed and displayed. The provider can use his discretion to
decide the dosage and frequency accordingly. Note that this is just a message
displayed, which can be invoked by user if and when required. It in no way
inhibits / warns a user from prescribing any drug. DEA Class: If a drug falls under DEA class then, its class is printed in red color.
Dosage: Specifies the dosage of the drug to be taken at a time. This field can take any number or fraction or text like 'Half'.e.g. 2 OR 0.5 OR OR 'Half'
Dosage Unit: A list of standard Units supported by Sure script are available as a list Box. User can select one of them. Users can define more units if required. However note that only sure script units can be selected for Bulk Quantity. And that if a non sure script dosage unit is selected, the same is not set to Bulk Unit and the Bulk Qty is not computed.
Frequency: is displayed as a list of codes Or names based on property rx.freq.byname On tab out from previous field (dispensable drugs), the freq list box is set. If the selected drug was never used, the default frequency selected will be the one which signifies daily. Selected frequency will be used to calculate the bulk quantity. It is also likely that in case of Ointments, there is no frequency specified. For such a case, user can select *NA* (for Not Applicable), and bulk will not be computed.
PRN: It is to indicate that the patient can take this drug on requirement basis. The label can be changed in the property rx.prn.label. The check box is unchecked by default.
Days: It is the number of days for which the drug is prescribed. This needs to be specified as a whole number.
Dispense Qty: This is also referred as Bulk Qty, calculated for tablets and capsules only. For calculating, first it tries to take the initial numeric part of dosage entered. If dosage was entered as a valid number like 3 OR 0.5R the calculation will be correct. In case of ½ it will compute based on 1, in case of "Half", it will be computed as Zero. The user can edit the bulk quantity if required. Qty is always set to 1 for Other Types (Liquids / Ointment)
Dispense Unit: By default same as dosage unit. If this is selected to be different then the Qty is not computed by the system. Note unlike the dosage unit, the user defined units are not considered, Only the Units defined by sure script are considered.
Refills: It is the number of refills that the patient can take from the Pharmacy.
Reason: A space to enter the justification upto 50 characters is provided.
Comments: Instructions for taking the drugs can be entered here like 'Not on empty stomach'. User can click on the View Button, to see the comments in a bigger pop up and edit them as necessary. Edit length is 255 characters.
Substitute: If checked, tells the pharmacy to dispense a substitute drug, if the prescribed drug is not available.
Long Term: May be a provider has prescribed a drug for hyper tension for a month. But the fact is that the patient would need to continue taking it for a long time. The provider can mark this as a Long Term. This way, the drug continues to be seen as part of current medication even after one month.
Start Date: The pharmacy is supposed to dispense the drug on or after this Date. On save, this date is set to encounter start date by default, unless explicitly entered by the user.
Diagnocis: Click on the button, to select an Assessment ICD code. This can later facilitate analysis report on the drugs prescribed for various diagnoses.
No of Units: These are the Billable Units. This is relevant for InHouse drugs, where the associated CPT/HCPC Codes are transferred to Assessment with these Units.
Valid Upto Date: The pharmacy is supposed to dispense drug only upto this date. This is not the date up to which the medication is to be taken by the patient.
Formulary Status / Copay / Coverage: On start of the encounter the system gets the Eligibility Information from Surescript about this patient. (Note it is not necessary to have entered any patient insurance). There can be multiple Pharmacy Benefit Eligibilities received from surescript. Considering the first eligibility from the list, the program displays the Formulary Status / Copay / Coverage details for the selected drug. Alternately if the user has selected an alternate eligibility by clicking on the eligibility
button, that
would be considered for working out the same for the selected drug.Direction: Direction is a combination of dosage, dosage unit, Freq code or Name and number of days. User can edit this up to 255 characters. User can click on the view Button to invoke a bigger popup for easy editing.
The default format is Dosage+Dosage Unit+Frequency+Days
Frequency can have a value of C (for Code) or N (for name), accordingly it will be displayed as TID or Thrice a day.
Days can be:
- Blank to display Blank (i.e. for X Days not included in direction)
- FD for X Days
- DD dispense X Days
Drug Info Button: Having entered both the drug and its strength click on this Button to see all the detail Information available in FDB including How to use, Side effects, Drug interactions, Min/Max Daily Adult Dose. A print button is also displayed at the bottom.
Update Button: Click on this Button or hit enter while entering any other field to Update the entry. A current row is shown in different background color on the Rx Tab. All details entered in this top part of the screen pertain to the current row. Update button will transfer field values from this part of the screen to the current row, and make the next row as current.
Prescribed Drugs Table
The Bottom half of the screen displays all the drugs prescribed in the encounter. Click on any row to make it current (light blue background). All the fields are transferred to the top part of the screen, so that they can be edited.
Drug Selection
Select Drug using the
Button- This button displays list of Generic Drugs not Dispensable Drugs
- There are two tabs on the search to give list of
- Doc Pref Drugs
- All Drug
- Custom Drugs are also included
- This search does not display Only InHouse Drugs
On Selection, the search returns the Generic Drug Ids.
If selected Drug is available as In House, it sets the In House check Box.
Select Drug using the
Button- Invokes Drug Search also displaying the Therapeutic Drug Class
- The Dispensable Drug is found considering selected Drug as Doc Pref
- If it is not found as Doc Pref, it will consider All Drugs option listed above
- Dispensable Drug details as saved in the Order Set.
- The search displays the list of Drugs as on Current Medication screen
- User is free to mark any Drug under Current List Box option as Refill
- User can also select the Old Med List Box option and mark any drug as Add to Rx. In either case a Drug entry is added to prescription
Delete Check Box:
- A drug added in prescription can be deleted by checking this check Box
- Mark the drugs in the prescription which need to be sent to Printer
/ fax / eRx
- By default a newly added drug will be selected. Note that, it multiple selected drugs are sent out, they will be sent to the Pharmacy
- Displays the Drug name and Strength
- The Drug names in this table are displayed in Bold, it they are for
InHouse. A prefix of a Check Mark is displayed if it is already Sent
- A prefix of Red is displayed if eRx is applicable
Comments: Drug Comments entered if any
Disp: Dispensable Qty
Refills: Refill count
The bottom row of the screen display:
Allergy: Allergies to Generic Drug, Allergens, Cross Sensitivity are the ones which are displayed in Red at the botton left of the screen
Cur Med: A button to invoke Current Medication as seen on Facesheet with all its functionality, in a pop up
PMH: Display details based on a template defined
Med Hist: The medical history details are displayed
Action Buttons:
Save: If a clinical staff saves the prescription the status changes to Entered. If a provider or a person with approve rights saves it, the status is set to Approved.
On save the system checks for
a) Duplicate drug prescribed
b) Patient Allergy to Generic Drug
c) Patient Allergy to Dispensable Drug
d) Allergens
e) Cross Sensitivity
f) Drug-Drug Interaction
Allergens and Cross Sensitivity defined in the Face Sheet allergy is considered. Drug-Drug interaction considers the prescribed drugs and Current Medication drugs for interaction. These checks are done using the algorithms of FDB.
Duplicate drugs are not allowed. In case of all other allergies only a warning is displayed and does not stop the provider from prescribing the drug.
The system also checks for precautions and gives appropriate warning.
Send: It allows the user to send the prescription order to a pharmacy by Fax, Print or E-mail. User without approve rights cannot edit the prescription once it has been sent. However only a provider can add drugs to the prescription and send it again.
Preview:
is possible for InHouse or Pharmacy Dugs. A List Box of all applicable Templates
is available. In case of InHouse, all Templates with name starting from
InHouse are considered. For Other Pharmacy all templates (including InHouse)
are considered. User can select a template and then Print/Fax the prescription.
Print Button:
prints both the InHouse Prescription As well as Other Pharmacy prescription.
Both appear in different formats/templates. (For InHouse dispensing, Pharmacy
Name and Address must not be printed). In House Prescription uses alphabetically
the first prescription template with the name starting with 'InHouse'. Non
InHouse prescription uses alphabetically the first prescription template
without any constraints on its name. Fax Button: The prescription can be faxed to the Pharmacy by clicking
button.
InHouse drugs are not considered.eRx Button: Drug applicable for eRx are sent electronically using this
button.
Note that drugs eligible for eRx cannot be printed / faxed (until they have
been sent electronically)Order Set Button: This button is displayed only when the login person is a provider. The current prescription can be saved as a Order Set by the provider. This button displays the list of all existing Order Sets. User may decide to overwrite an existing Order Set or create a new one. User may select any one of the Order Set. All the drugs in the current prescription along with their details like strength, dosage, frequency are saved in the selected Order Set overwriting any existing information. The provider can thus make Order Sets of often prescribed drugs for various common ailments.
Dispense Button: This button is displayed only when the login person is a provider. The current prescription can be saved as a Order Set by the provider. This button displays the list of all existing Order Sets. User may decide to overwrite an existing Order Set or create a new one. User may select any one of the Order Set. All the drugs in the current prescription along with their details like strength, dosage, frequency are saved in the
Access Control: User can come to this option by many routes:
a) Encounter > Prescription
This is the most common and natural route. If the encounter is closed, Prescription cannot be edited, it can only be viewed. If the encounter is live Prescription can be edited.
b) CPOE > Rx
If there is no Current Patient Encounter, this option is disabled. If it is present, it is as good as taking the Encounter > Prescription route.
c) CPOE > Refill
The Provider/Clinical Staff would get a call from a patient requesting for a Refill. The objective is to be able to complete the process at the earliest. A click on this option displays a Patient selection search pop up. Only patients who do not have an open encounter and who have at least one closed encounter are displayed. Select a patient. The system creates a new encounter for the patient, with the encounter type as RR (Refill request), and the prescription screen is displayed. By default the Rx tab will display all the drugs prescribed in the previous encounter. The provider may flag as delete drugs which he doesn't intend to order. He also retains the flexibility to add supporting drugs by clicking on the button or adding new rows or selecting any drug from the past Rx tab. Please note the subtle difference, the Rx tab was populated with only the drugs in the previous encounter while the past Rx tab displays the list of all drugs prescribed to the patient in all encounters in the past six months. This period of six months is also set as a default property, which can be changed. Finally Save the prescription. Then click on Send, to send the prescription to the Pharmacy. The system automatically closes the encounter also. However if the user goes to some other option in Prognocis without Approve and Send, then the encounter remains open (it appears on the Provider’s Home page), and user will have to deal with it like any other open encounter.
d) Message to Approve
In case a clinical staff has created a prescription, the provider gets an Alert to Approve it. Click on the messages to come to this screen.
e) Message from Patient Portal
Once Patient Portal is operational, the provider will receive a Refill request message from the Patient. When provider clicks on the message, the system prompts an error if there is any open encounter for a patient. If there is no open encounter, he will come to this prescription screen, a new encounter will be created, Rx Tab will be shown populated with Drugs requested by the Patient. Doctor can now Add / Remove / edit if required, He then Saves and Sends to Pharmacy. The encounter is automatically closed, and a message is sent to patient.