IT Administration and Diabetes Management Part 2: E-Scripts

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There is a lot of confusion in the medical world about electronic prescriptions. First, it is important to realize the distinction between an e-script and an electronic signature or electronic document. An E-Script, the likes of which a doctor is able to send to a pharmacy, has a series of validation requirement, including a contract between a licensed carrier and the company. An E-Signature is modern lingo for typing your name in on a computer and perhaps or perhaps not having it verified by 3rd party validation. It has legal status and is identical in stature to using a stamp to sign something:

Both E SIGN and UETA establish that electronic records and signatures carry the same weight and legal effect as traditional paper documents and handwritten signatures stating: A document or signature cannot be denied legal effect or enforce ability solely because it is in electronic form

However, e-signatures and regular signatures are not the same thing as a signature on a signed medical prescription. An E-script is a verified electronic medical prescription issued to a pharmacy or other service provider with a NCPDP(aka NAPB) number which stands for National Council for Prescription Drug Programs.

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In most cases, if a clinician’s office or pharmacy is talking about “e” anything, they are usually referring to electronic prescriptions between a pharmacy and a clinician via a provider like Sure scripts, and not a simple electronic signature provided by a consumer level organization like eSign Live.

To be able to obtain (or request) E-scripts you need to have two things:

  1. An NCPDP unique identification number(usually this is found via a simple search by the clinician in a database, zip code is most often used to pull up pharmacies in the area)
  2. A processor that you contract with, which verifies and communicates the authenticity of the prescription. Sure scripts is a very common e-script facilitator and processor which integrates with many CMS’ (Content management systems) like QS1.

The NCPDP is basically like a fancy phone number for e-scripts (and only e-scripts). This number is issued to a pharmacy and usually tied in with Medicare, Medicaid, and other billings for said pharmacy and its subsidiaries. Often providers who aren’t related or a subsidiary to a pharmacy may not be able to be issued a NCPDP number and in that case simply cannot receive e-scripts or request refills.

It’s best to think of the word e-script as a proprietary term, instead of an electronic prescription. An electronic prescription can simply be a prescription that was scanned into computer. An e-script is a very specific communication with very specific providers, parameters, and limitations on both ends of the transfer.

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Each doctor’s office and processor interface is different, so they will have a different way to access pharmacies who accept e-scripts. For example, some processors allow lookup by NCPDP while others may not. There is no unique standard, but each one has a way to track and look up new pharmacies.

We might get a question like “Where do I find the refill requests sent by a pharmacy?” and a typical processor response would be (from Sure scripts website):

It can be found in Messages section under Messages ->ePrescription -> received folder. The refill requests can be process by clicking on the Process button.

The limitations of these e-scripts are pretty severe. First, a pharmacy has to receive 5 new scripts from a provider before they can request a refill. In some cases they also cannot request new orders, only refills. These things are minimally possible with an e-script service (again from Surescripts):

Your connection to the Surescriptsnetwork enables you to:

  • receive new prescriptions
  • send requests for prescription renewals
  • receive renewal approval or denial responses from prescribers
  • receive new prescriptions for controlled substances*
  • receive “cancel” transactions (CANRX) from prescribers*
  • send “change” transactions (RxCHANGE) to prescribers*

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This functionality may not be available in all pharmacy software applications. Please contact your pharmacy software vendor to ensure they are certified for and have implemented these transaction types. You may also need to update your software to ensure that your pharmacy management system is capable of these transactions.

 

Anything not listed there may not be possible through e-scripts for all providers.An important item of note is that the pharmacy can’t affect the CMN (Certificate of Medical Necessity) or Rx. Those forms are almost always entirely generated on the clinician’s side. This is a factor with complex items that require significant document justification before and after the service is provided.

What becomes clear is that e-scripts don’t necessarily provide for everything. As a DME (Durable Medical Equipment) provider, often e-scripts limitations are inadequate to provide service. You can also provide a HIPAA compliant fax line, or something like a Docusign applet that will let clinics sign up and fill out prescription forms online, and also that allows us to signup new patients online automatically.

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These documents would need to be HIPAA compliant since they contain PHI (Patient Health Information). That would mean extra security which would often mean a new website or a platform like Docusign which has a HIPAA compliant SKU (stock keeping unit) at the time of this writing.

Many doctors and clinics assume all prescriptions are eligible for e-scripts, however due to the nature of the provider being unable to request new patient orders, and the requirements necessary to request refill orders, e-scripts are ideal for pharmacological usage and occasionally unusable for DME, particularly in cases where the patient only gets a new order or a very infrequent order. Orders that require specific information to appear on the CMN are also very difficult since that information has to be relayed to the doctor ahead of time. Clinics who want to partner with service providers should work with them individually to determine the best way to pass along vital prescriptions.

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