Scenario: Refill request received by phone or by fax before e-prescribing
Step No. | Step | Performer | Step Type | Deprescription | Documents | Key Information |
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E-prescribing enabled renewal request pathway (a) |
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1a. |
Receive renewal request message(s) | E-prescribing system | Automatic | E-prescribing prescription automatically receive pharmacy request of medication renewal | None, electronic message | Request details, patient ID |
2a. |
Match patient information | E-prescribing system | Automatic | E-prescribing system automatically match renewal request with patient information in practice management system to confirm that patient is seen in the clinic | E-prescribing system is linked to the practice management system to have automatic update of patient information including name, medical record number, address, phone number, and appointment dates | If clean match on patient: a renew request item is added to prescriber task list with patient information; If no clean match on patient: a renew request item is added to prescriber task list with blank patient information |
Not E-prescribing enabled renewal request pathway (b) |
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1b. |
Retrieve renewal request message(s) | Office staff | Retrieving | Take or retrieve fax or phone message from a pharmacy or patient to request medication renewal; if phone, transcribe message to a note; call pharmacy to clarify request as needed | Request fax or phone message | Telephone message transcribed to notes |
2b. |
Deposit message for staff authorized for renewal approval | Office staff | Handoffs |
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3b. |
Authorized staff retrieve message/fax | Authorized Office Staff | Retrieving |
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All renewal requests (pathways a and b rejoined) |
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4. |
Check whether request meets protocol for authorization vs. needing physician review | Authorized office staff | Decision | Staff person verify renewal request is for patient seen in the clinic, check protocol criteria for approving request without physician review and route request to physician or to be approved per protocol | Protocol for staff renewal and E-prescribing system linked to the practice management system; patient chart as needed | If physician review required: Send to physician task list (step 5b) If protocol authorization: Go to step 5a |
Protocol-approval pathway (c) |
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5c. |
Document protocol renewal | Office staff | Processing | Approve renewal on E-prescribing system and save records in E-prescribing | E-prescribing system includes lab results, current medication list, and insurance coverage information; if needed, pulls patient chart | Request approved, record saved in E-prescribing |
6c. |
Transmit to pharmacy | E-prescribing system | Automatic | Completed preprescriptionion automatically be transmitted to the pharmacy that requests renewal | Pharmacy that requests renewal prescription enabled pharmacy with up-to-date information including name, address, and phone number | Preprescriptionion sent |
Physician-review pathway (d) |
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5d. |
Prescriber approve or decline request or change medication | Prescribing physician/NP | Decision | Decide if prescriber has approved request by looking up information such as last visit, lab results, current medication list, insurance coverage; complete preprescriptionion and save records in E-prescribing | E-prescribing system includes lab results, current medication list, and insurance coverage information; if needed, pulls patient chart | Preprescription written and automatically saved; if needed, prints preprescription |
6d. |
Fax/phone transmit to pharmacy | E-prescribing system | Automatic | Completed preprescriptionion automatically be transmitting to the pharmacy that requests renewal | Prescription enabled pharmacy with up-to-date information including name, address, and phone number | Preprescription sent |
All renewals (pathways c and d rejoined) |
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7. |
Fax/phone transmit to pharmacy | Office staff | Contingent processing | For pharmacies not E-prescribing enabled, staff fax or phone completed preprescriptionion to pharmacy | Fax or electronic message | IDs of pharmacy, patient and also request details |
8. |
For controlled substance, print preprescriptionion for patient to take to pharmacy | Office staff | Contingent processing | Controlled substance preprescriptionion must be printed, wet-signed by prescriber, and picked up by patient | Paper preprescription | Request details, patient ID |