March 2015, Vol 3, No 3 - The First Word
Donald J. Dietz, RPh, MS

While shopping for a new automobile for the first time in 7 years, my wife and I were in awe over the advances in technology. Little time was spent “under the hood” discussing the car’s engine and power. More time was spent discussing safety features, internal climate control, various audio options, and ways to use our phone safely when driving. Bragging about the number of cup holders has been replaced by the number of USB ports to charge our electronic devices.

Trying not to be overwhelmed, I asked the salesperson whether most customers used all of this new technology. Although he was not positive, he believed that most people became comfortable with a few features, ignoring the rest, and only using a small portion of the technological advances.

I believe those in our profession may employ the same decision process, and use only select features of available technology in our retail pharmacy practices. Electronic prescribing (e-prescribing) is one area where this is top-of-mind, because of the I-STOP (Internet System for Tracking Over-Prescribing) legislation, which would require all prescriptions issued in New York, including those for controlled substances, to be transmitted electronically by March 27, 2015.1

Using e-Prescribing

The New York legislature requested a 1-year moratorium on the e-prescribing mandate. The state’s Medical Society asked for the delay to provide all prescribers enough time to properly install the needed software and obtain the required certifications for transmitting controlled substance prescriptions electronically.2 Governor Andrew Cuomo recently signed legislation to postpone it for a year.

Through monitoring this game-changing legislation that would virtually eliminate paper prescriptions in New York, my thoughts turned to the impact it would have on retail pharmacy. Almost all retail pharmacies are able to accept electronic prescriptions, including ones for controlled substances. Most of the attention regarding this new change to electronic prescriptions has rightly focused on the prescriber, as they are the issuer of the prescription. However, this technological enhancement also has implications that will impact retail pharmacy.

There are often situations where a pharmacy is unable to dispense a prescription, including when drug products are not in stock or an inordinate period of time is needed to obtain a medication (eg, over the weekend for an acute pain medication). Suspected misuse or clinical Drug Utilization Reviews may also result in dispensing delays. When this happens with a paper prescription in most pharmacies today, we return the hard copy prescription to the patient with an explanation. If appropriate, the pharmacist may help them locate the product at another pharmacy in the chain, or at another nearby pharmacy. What happens if this is an electronic prescription? I am aware of a retail pharmacy chain that cannot provide a hard copy of an electronically received prescription for the patient to take to another pharmacy. How, then, is the pharmacy going to electronically communicate to the prescriber that they could not dispense the prescription?

The pharmacy should be able to use the e-prescribing route in reverse to communicate back to the prescriber. Although it is probably not mandatory that the return communication to the prescriber be electronic, it would be desirable if the processes pharmacists and prescribers are asked to use are consistent.

Be Aware, Prepare for Change

The SCRIPT Standard developed by the National Council for Prescription Drug Programs (NCPDP) supports many different types of transactions between prescribers and pharmacies.3

These transaction types include ones that allow the pharmacy to send a message to the prescriber requesting a new prescription for a patient, or additional refills for an existing prescription. Another transaction type can be used when the pharmacy needs to request a change in the original prescription, such as allowing for generic substitution. My guess is that many systems are able to perform these transactions, but many of the pharmacies and prescribers using those systems are not adequately trained to use this technology. Plus, if all systems used in the prescriber’s office or pharmacy are not set up to use these transaction types, then these electronic messages cannot be sent or received successfully, leaving these parties with the “old-school” methods of using the telephone and sending faxes to communicate with each other.

Although there is technical capability for the pharmacy practice management system to notify the prescriber that a prescription has been filled, partially dispensed, or not dispensed, this technology is not widely used today. Pharmacy systems also have the functionality to suggest an alternative to a prescribed medication. However, even if the pharmacy community jumped on board to use this feature, my belief is that most prescriber systems do not capture or easily report this back to the physician’s office for action, because it would not be information that is generally acted on by the prescriber. These options could provide the means for the communication desired if the systems at the pharmacy and prescriber’s office are set up to use them. However, this may not happen until the ability to send and receive these types of messages is considered a required element for e-prescribing. Even if this capability existed in pharmacy and prescriber systems, users at both ends would need to know how to send and receive the messages, and would need training if they did not know how to do this.

Mandatory e-prescribing may become a reality in New York next year. If it is successful at reducing fraudulent prescribing activity, expect other states to pass similar legislations to move away from paper prescriptions. Now is the time to think about how this change would impact your retail pharmacy workflow and procedures. My suggestion is to identify challenges that would arise and present them to your management team, along with any suggestions on how to solve the workflow or customer service issues. There may be a need to involve your pharmacy’s software system vendor. A final suggestion is to make sure proper training is available; it is important that all users receive thorough training, provided by the software vendor or a corporate trainer, to ensure complete and proper use of their system.




References

  1. Res 1232-2012. Internet System for Tracking Over-Prescribing Act. http://legistar.council.nyc.gov/LegislationDetail.aspx?ID=1050966&GUID=9BE15E6C-410C-42C1-9826-DE7814FEFC7C&Options=&Search=. Accessed March 10, 2015.
  2. Medical Society of the State of New York. http://www.mssny.org/MSSNY/Governmental_Affairs/State_Advocacy/MSSNY-Testimony-2015.aspx. Accessed March 10, 2015.
  3. National Council for Prescription Drug Programs. Problem Solving and Innovation. www.ncpdp.org/stan dards. Accessed March 10, 2015.
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