CPOE stands for Computerized Physician Order Entry. Proper implementation of CPOE is crucial to reducing medical errors. The CPOE feature is an integral part of PrognoCIS, allowing the user to place lab orders, radiology orders, and prescriptions. It also lets the 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 sent directly to the pharmacy.
The page shows the selected patient's details like 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 asking for a specific pharmacy, might retain the option to go to any pharmacy while traveling. Start typing the pharmacy name, and a list of matching names present in the master is 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.
The user can use the Search button to select a pharmacy from the master list of pharmacies provided by Surescripts. Not all pharmacies listed here are available under the autocomplete edit control described above.
If the pharmacy is changed for a drug row, then remember to click the Update button; otherwise, it will not be saved.
In-House: To select an in-house drug, check this box. The Drug List box will then display only the list of in-house generic drugs.
Sample: If this is checked, then the drug is assumed to be dispensed in-house, although it might not be part of the defined in-house drug list.
Drug: This is the generic drug to be selected. Start typing the name, and the list box will get filtered accordingly. The list of drugs will depend on whether the In-House checkbox is checked and the property for inactive drugs (rx.show.inactive.drugs). Compound drugs are considered.
Strength: Upon tabbing out of the previous field, the dispensable drugs for the selected generic drug are populated in the list box. The list of drugs will depend on whether the In-House checkbox is checked and the property for inactive drugs. The Strength list box may display a suffix of * for an entry to indicate that it is inactive. When the user selects a drug and strength, the system tracks the last prescription of this drug made by this doctor previously for any other patient. Based on that, it selects the default value for Strength, Dosage, Frequency, Days, Bulk Quantity, and Refills.
Pediatric Dosage Button:
button is displayed if 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's 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's age and sex. The minimum-maximum dosage
per day is computed and displayed. The provider can use their discretion to
decide the dosage and frequency accordingly. Note that this is just a message
displayed, which can be invoked by the user if and when required. It in no way
inhibits or warns a user from prescribing any drug. DEA Class: If a drug falls under a DEA class, then its class is printed in red.
Dosage: Specifies the dosage of the drug to be taken at a time. This field can accept any number, fraction, or text like 'Half' (e.g., 2, 0.5, or 'Half').
Dosage Unit: A list of standard units supported by Surescripts is available as a list box. The user can select one of them. Users can define more units if required. However, note that only Surescripts units can be selected for Bulk Quantity. Additionally, if a non-Surescripts dosage unit is selected, it is not set as the Bulk Unit and the Bulk Qty is not computed.
Frequency: This is displayed as a list of codes or names based on the property rx.freq.byname. Upon tabbing out of the previous field (dispensable drugs), the frequency list box is set. If the selected drug was never used, the default frequency selected will be the one which signifies daily. The selected frequency will be used to calculate the bulk quantity. It is also likely that in the case of ointments, there is no frequency specified. In such cases, the user can select *NA* (for Not Applicable), and the bulk quantity will not be computed.
PRN: This is used to indicate that the patient can take this drug on an as-needed basis. The label can be changed in the property rx.prn.label. The checkbox is unchecked by default.
Days: This is the number of days for which the drug is prescribed. This must be specified as a whole number.
Dispense Qty: This is also referred to as Bulk Qty, which is calculated for tablets and capsules only. To calculate this, the system first attempts to extract the initial numeric portion of the entered dosage. If the dosage was entered as a valid number like 3 or 0.5, the calculation will be correct. In the case of ½, it will compute based on 1, and in the case of "Half", it will be computed as zero. The user can edit the bulk quantity if required. The quantity is always set to 1 for other types (liquids or ointments).
Dispense Unit: By default, this is the same as the dosage unit. If this is selected to be different, then the quantity is not computed by the system. Note that, unlike the dosage unit, user-defined units are not considered; only the units defined by Surescripts are considered.
Refills: This is the number of refills that the patient can obtain from the pharmacy.
Reason: A space to enter a justification of up to 50 characters is provided.
Comments: Instructions for taking the drug can be entered here, such as 'Not on an empty stomach'. The user can click the View button to see the comments in a larger popup and edit them as necessary. The maximum edit length is 255 characters.
Substitute: If checked, this tells the pharmacy to dispense a substitute drug if the prescribed drug is not available.
Long Term: Maybe a provider has prescribed a drug for hypertension for a month, but the patient would need to continue taking it for a long time. The provider can mark this as Long Term. This way, the drug continues to be seen as part of the current medication even after one month.
Start Date: The pharmacy is supposed to dispense the drug on or after this date. Upon saving, this date is set to the encounter start date by default, unless it is explicitly entered by the user.
Diagnosis: Click this button to select an Assessment ICD code. This can later facilitate an analysis report on the drugs prescribed for various diagnoses.
No of Units: These are the billable units. This is relevant for in-house drugs, where the associated CPT/HCPCS codes are transferred to Assessment with these units.
Valid Up To Date: The pharmacy is supposed to dispense the drug only up to this date. This is not the date up to which the medication is to be taken by the patient.
Formulary Status / Copay / Coverage: At the start of the encounter, the system gets the eligibility information from Surescripts about this patient. (Note that it is not necessary to have entered any patient insurance). There can be multiple pharmacy benefit eligibilities received from Surescripts. Considering the first eligibility from the list, the program displays the Formulary Status / Copay / Coverage details for the selected drug. Alternatively, if the user has selected an alternate eligibility by clicking the eligibility
button, that
selection would be considered for working out the same for the selected drug.Direction: The direction is a combination of dosage, dosage unit, frequency code or name, and number of days. The user can edit this up to 255 characters. The user can click the View button to invoke a larger 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 detailed information available in FDB including how to use, side effects, drug interactions, and minimum/maximum daily adult dose. A Print button is also displayed at the bottom.
Update Button: Click this button or press Enter while entering any other field to update the entry. A current row is shown in a different background color on the Rx tab. All details entered in this top part of the screen pertain to the current row. The Update button will transfer field values from this part of the screen to the current row, and make the next row current.
Prescribed Drugs Table
The bottom half of the screen displays all the drugs prescribed in the encounter. Click 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 a Drug using the
button- This button displays a list of generic drugs, not dispensable drugs.
- There are two tabs on the search to provide a list of:
- Doc Pref Drugs
- All Drugs
- Custom drugs are also included.
- This search does not display only in-house drugs.
Upon selection, the search returns the generic drug IDs.
If the selected drug is available in-house, the system selects the In-House checkbox.
Select a drug using the
button- Invokes a drug search that also displays the Therapeutic Drug Class.
- The dispensable drug is found by considering the selected drug as Doc Pref.
- If it is not found as Doc Pref, the system will consider the All Drugs option listed above.
- Dispensable drug details as saved in the Order Set.
- The search displays the list of drugs shown on the Current Medication screen.
- The user is free to mark any drug under the Current list box option as a refill.
- The 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 the prescription.
Delete Checkbox:
- A drug added to the prescription can be deleted by selecting this checkbox.
- Mark the drugs in the prescription which need to be sent to the printer, fax, or eRx.
- By default, a newly added drug is selected. Note that if multiple selected drugs are sent, they will all be sent to the pharmacy.
- Displays the drug name and strength.
- The drug names in this table are displayed in bold if they are in-house. A checkmark prefix is displayed if it has already been sent.
- A red prefix is displayed if eRx is applicable.
Comments: Drug comments entered, if any.
Disp: Dispensable quantity
Refills: Refill count
The bottom row of the screen displays:
Allergy: Allergies to generic drugs, allergens, and cross-sensitivities are displayed in red at the bottom left of the screen.
Cur Med: A button to invoke Current Medication as seen on the Face Sheet with all its functionality in a popup.
PMH: Displays details based on a defined template.
Med Hist: Displays the medical history details.
Action Buttons:
Save: If a clinical staff member saves the prescription, the status changes to Entered. If a provider or a person with approval rights saves it, the status is set to Approved.
Upon saving, the system checks for:
a) Duplicate drugs prescribed
b) Patient allergy to generic drugs
c) Patient allergy to dispensable drugs
d) Allergens
e) Cross-sensitivities
f) Drug-drug interactions
Allergens and cross-sensitivities defined in the Face Sheet allergies are considered. Drug-drug interaction checks consider the prescribed drugs and Current Medication drugs for interaction. These checks are performed using the algorithms of FDB.
Duplicate drugs are not allowed. For all other allergies, only a warning is displayed, which does not prevent the provider from prescribing the drug.
The system also checks for precautions and displays appropriate warnings.
Send: This allows the user to send the prescription order to a pharmacy via fax, print, or email. Users without approval 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 in-house or pharmacy drugs. A list box of all applicable templates
is available. In the case of in-house drugs, all templates with names starting with "InHouse" are considered. For other pharmacies, all templates (including in-house)
are considered. The user can select a template and then print or fax the prescription.
Print Button:
prints both the in-house prescription and other pharmacy prescriptions.
Both appear in different formats or templates. (For in-house dispensing, the pharmacy
name and address must not be printed). The in-house prescription uses the alphabetically
first prescription template with a name starting with "InHouse". Non-in-house prescriptions use the alphabetically first prescription template
without any constraints on its name. Fax Button: The prescription can be faxed to the pharmacy by clicking the
button.
In-house drugs are not considered.eRx Button: Drugs eligible for eRx are sent electronically using this
button.
Note that drugs eligible for eRx cannot be printed or faxed (until they have
been sent electronically).Order Set Button: This button is displayed only when the logged-in user is a provider. The current prescription can be saved as an Order Set by the provider. This button displays a list of all existing Order Sets. The user may decide to overwrite an existing Order Set or create a new one. The user may select any of the Order Sets. All the drugs in the current prescription along with their details like strength, dosage, and frequency are saved in the selected Order Set, overwriting any existing information. The provider can thus create Order Sets for frequently prescribed drugs for various common ailments.
Dispense Button: This button is displayed only when the logged-in user is a provider. The current prescription can be saved as an Order Set by the provider. This button displays a list of all existing Order Sets. The user may decide to overwrite an existing Order Set or create a new one. The user may select any of the Order Sets. All the drugs in the current prescription along with their details like strength, dosage, and frequency are saved in the
Access Control: The user can access this option via several routes:
a) Encounter > Prescription
This is the most common and natural route. If the encounter is closed, the prescription cannot be edited; it can only be viewed. If the encounter is active, the prescription can be edited.
b) CPOE > Rx
If there is no current patient encounter, this option is disabled. If it is present, it functions the same as taking the Encounter > Prescription route.
c) CPOE > Refill
The provider or clinical staff member receives a call from a patient requesting a refill. The objective is to be able to complete the process at the earliest. Clicking this option displays a patient selection search popup. 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 set to RR (Refill Request), and the prescription screen is displayed. By default, the Rx tab displays all the drugs prescribed in the previous encounter. The provider may flag for deletion any drugs that they do not intend to order. The provider also retains the flexibility to add supporting drugs by clicking the button, adding new rows, or selecting any drug from the Past Rx tab. Please note the subtle difference: the Rx tab is populated with only the drugs from 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 Send to send the prescription to the pharmacy. The system automatically closes the encounter as well. However, if the user navigates to some other option in PrognoCIS without approving and sending, then the encounter remains open (it appears on the Provider's Home page), and the user will have to handle it like any other open encounter.
d) Message to Approve
If a clinical staff member has created a prescription, the provider receives an alert to approve it. Click the message to access this screen.
e) Message from Patient Portal
Once the Patient Portal is operational, the provider will receive a Refill Request message from the patient. When the provider clicks the message, the system prompts an error if there is any open encounter for the patient. If there is no open encounter, they will be directed to this prescription screen, a new encounter will be created, and the Rx tab will display the drugs requested by the patient. The doctor can then add, remove, or edit items as required, and then save and send them to the pharmacy. The encounter is automatically closed, and a message is sent to the patient.