Clinical Exchange ePrescribe User Guide

Version 1.2
08/29/2018

Inspiring a Better Healthcare System

Table of Contents
1.0 New Rx ........................................................................................................................................ 3
1.1 Creating a New Rx ......................................................................................................................... 3
2.0 Renewals (Electronic Refill Requests) ................................................................................................ 9
2.1 Renewal Enrollment ...................................................................................................................... 9
2.2 Responding to a Renewal .............................................................................................................. 9
2.2 Matching the prescription ........................................................................................................... 10
3.0 Electronic Change Request .............................................................................................................. 13
3.1 Rx Change.................................................................................................................................... 13
3.2 Therapeutic Change .................................................................................................................... 14
3.2.1 Deny Change Request ........................................................................................................... 15
3.2.2 Change Drug ......................................................................................................................... 16
3.3 Generic Substitution .................................................................................................................... 18
3.4 Prior Authorization ...................................................................................................................... 18
3.5 Rx Change enrollment process..................................................................................................... 19
4.0 Electronic Cancel Request ............................................................................................................... 20
4.1 Rx Cancel ..................................................................................................................................... 20
5.0 Revision History .............................................................................................................................. 23

This user guide covers the workflows for non EPCS (electronic prescribing of controlled
substances) prescriptions. A separate user guide is available for EPCS.

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1.0 New Rx

1.1 Creating a New Rx

This document shows the typical steps a user will take to create a new
prescription

Select “Rx””New Rx” from the Main Menu then search and select a patient

An eligibility check is performed and, if benefit information is found on the

patient, the screen below is presented to the user.

Clicking “Select” will load formulary information specific to the patient’s

insurance and will display during the creation of the prescription.

Clicking “Use None” will ignore formulary.

The next screen displays the Rx Pad.

Fields defined with a blue dot are required and may change based on the drug
requested.

Drop down boxes allow the user to select items from their preference list while
clicking the magnifying glass allows the user to search the database.

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If a benefit plan was selected and the user searches for a drug, they are
presented with formulary information in the far right column.

Once the user selects a drug, a list of drug alternatives will be shown, if
available, from the formulary.

The user may choose to “Keep the Current Drug” or select a drug from the list
that is displayed.

This is an example of a drug that has no alternatives available.

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This is an example of a drug alternative list.

The SIG field will display directions for the prescription.

The user has the option to use a practice or prescriber favorite, an industry
standard (patient must be between 18-64 years of age) or free text directions
when required.

If a favorite is used, the Quantity, Days Supply and Refills fields will auto populate
since these fields are saved as part of the favorite.

When an industry standard is selected and the patient is between 18-64 years of
age, a calculation for Quantity and Days Supply is completed automatically.

In the example below the user can add a Quantity of 30 and the Days Supply
will calculate based on the sig.

In this case, the Days Supply matches the Quantity of 30.

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If the Sig was “take 2 tablets by oral route once a day” the Days Supply would
show 15 for a Quantity of 30.

Users can also add the Days Supply first and the Quantity will auto populate.

Refills 0-99 and PRN are accepted in this field

Units of Measure- This is a required field and will auto populate in most cases. If
the field is blank, the user may select form the list of NCPDP standards.

Wt- May be added and will be sent to the pharmacy. The weight is also used for
dosage checking which is also available from New Rx pad

Notes to Pharmacist-This field allows the user to add any notes to the script they
feel are necessary. These notes are sent to the pharmacy and stored with the
script in the patient’s Rx History

Issue to- Will default to the last pharmacy used for this patient. The user may
select from a drop down list of preferred pharmacies or do a search of the
pharmacy database by clicking on the magnifying glass

Issue Via- Will default to electronic. The user may select from other choices such
as Print, Administered, Telephoned, Hand Written, etc. Only Electronic or
Electronic/Print are sent to the pharmacy.

Save as Prescriber preference or Save as Facility preference are selections

available to quickly add a script to a preference list.

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DUR warnings are presented in the top right of the Rx Pad after a drug is
selected.

These warnings look for Drug to Drug, Drug to Allergy, Drug to Condition (if ICD10
is used) interactions.
Severe warnings will show up as Red, Moderate as Yellow, and Mild as Green.

Red DUR warning details must be viewed before the prescription can be issued.

Based on practice DUR configurations, other warnings may or may not be

required to be viewed.

The warnings will always display on the Rx Pad regardless of preferences.

Other buttons on the Rx Pad:

Rx History-This will link the user back to the patient’s Rx History. This can be useful
if a DUR warning is displayed and the prescriber needs to look at the medication
history.

Monograph- Drug information provided by First Data Bank

Build Sig-Allows the user to create a sig using database fields vs free text. Sigs
created using the Sig Builder can calculate Quantity / Days Supply.

Reported Rx-Changes the view to a simplified Rx pad that only requires a drug
to be added.

Dosage- users can do dosage checking based on data added to fields

presented on this screen

Insert Allergies-adds any active allergies from the Allergies tab in the patient
chart to the prescription.

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ISSUE-Issues the prescription

HOLD-Places the prescription on hold. The prescription can be found under the
Rx Authorizations where the user can make any required changes before
authorizing it.

When the user clicks “ISSUE” or “HOLD” a confirmation page will display.

Clicking “Create Another” from this screen will allow the user to create another
Rx for the same patient without reselecting the patient and benefit plan.

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2.0 Renewals (Electronic Refill Requests)
Electronic refill requests are sent from a pharmacy to a prescriber once the
practice has enrolled for the service.

2.1 Renewal Enrollment

Electronic refill requests are not automatically enabled at go-live. To begin receiving
electronic refill requests from the pharmacy, the practice should follow the process
outlined below.

To enroll the practice a NEW prescription must be sent on a patient (we

recommend a Test Patient) to a pharmacy called Training Done Pharmacy.

The pharmacy can be found by performing a pharmacy search on the new Rx

Pad.

Once this transaction is sent, ALL prescribers at the practice will be enabled for
electronic refills in approximately 24 hours.

2.2 Responding to a Renewal

Click on “RX””Authorizations”

Electronic refills will show as a RENEWAL in the list.

The Lock Icon indicates a controlled substance. (controlled substances are

covered under the EPCS user guide)

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Open the details of the refill request.

If no changes are required, the user simply clicks the “Authorize” button.

Changes can be made to most fields prior to authorization with the exception of
the drug.

If a new drug is required, the user must deny the refill request and create a new
prescription.

If the prescription needs to be denied, the user can select a reason from the
drop down list and click the “Deny” button.

NOTE: The denial reasons are from the NCPDP standard and cannot be
modified.

2.2 Matching the prescription

When possible, the matching process is automated based on a unique message

id that is tied to the prescription.

If the message ID’s match, the prescription is automatically matched to the

patient and becomes part of the medication history.

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If the prescription shows NO in the matched column, the user must manually
match the patient in order for the prescription to become part of the
medication history.

This is an important step that should be completed as part of the renewal

process.

Check to see if the prescription is matched.

Click the “Match/Edit Patient & Drug” button

The system will search for a matching patient based on the demographics that
have come from the pharmacy in the refill request.

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Click the “Select” button to select the patient to match to the prescription.

The drug should automatically match.

Once this step is completed, the prescription becomes part of the patient
record after the user completes the transaction.

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3.0 Electronic Change Request

3.1 Rx Change

An Rx Change request is initiated by the pharmacy when the pharmacist

identifies a need to make a change to the original new prescription that was
submitted.

Change Requests will show up in the Rx Authorizations with a status of Change

Pending.

Change and Cancel transactions will always be at the top of the pending list.

There are 3 types of Change Requests that may come in:

 Therapeutic Interchange
 Generic Substitution
 Prior Authorization requests

The type of request is visible in the top left corner of the details screen.

Screens may look different based on the Change request type.

A Change Request will come into the Rx Authorizations with a status of Change
Pending

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To work the Change Request, select the prescription by adding a check mark to
the line and selecting “Details” or by double clicking on the desired line.

3.2 Therapeutic Change

The top portion of the screen shows the original request while the bottom shows
the Change Request details.

Users are allowed to deny the change, approve the change, modify the
change or completely change the prescription from this screen.

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3.2.1 Deny Change Request

Select a reason from the dropdown and click “Deny”

Select an alternative from the list provided by the pharmacy and click
“Approve”

Copy the Original Rx Info to the Modify Rx Details Pad in the Requested Change
Section.

Change fields and then click “Approve”

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3.2.2 Change Drug

Click the “Change Drug” button to change the prescription entirely.

This would only be used when the user does not want to modify the original
script or use one of the requested changes sent by the pharmacy.

Clicking the “Change Drug” button takes the user to the Rx Pad and allows
them to create a new prescription.

Notice the details of the original script are displayed for the end user to
reference.

Once the new script has been completed the user will click “Continue”

Clicking “Back to Change Rx” will send the user back to the original Change Rx
screen.

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 The user is directed back to the Change Request screen with the updated Rx
details populated.

Click “Approve” to finalize the transaction.

The user will see an Issued confirmation page when the script is sent.

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 3.3 Generic Substitution

The user is only allowed to Approve or Deny this type of Change Request.

3.4 Prior Authorization

The pharmacy may send the COB in the request.

It is up to the practice to obtain the prior auth and Approve the change or
Deny the request.

A field is provided to add the Prior Auth Number if required by the payer.

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3.5 Rx Change enrollment process

Rx Change is not automatically enabled at go-live. To begin receiving Rx Change

requests from the pharmacy, the practice should follow the process outlined below.

 The Local Site Admin user will navigate to the ADMIN-ACCOUNT MANAGEMENT-
MANGE USER screen
 Click the Enable Rx Change button that is located towards the top right of the
screen.

NOTE: The request can also come through On24/7 or the Help Desk for practices
that do not have access to Account Management

Once the Admin user completes this process all the caregivers at this site will be
enrolled for Rx Change. It may take 24-48 hours for the enrollment process to complete.

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4.0 Electronic Cancel Request

4.1 Rx Cancel

The Cancel Rx Request message is used to notify the pharmacy that a previously
sent prescription should be cancelled and not filled or to cancel any remaining
fills on an existing prescription.

The message is originated by the prescriber system as a Cancel Rx Request

message.

The Cancel Rx Response message is sent from the pharmacy to the prescriber
system in response to a Cancel Rx Request message.

Select a prescription to cancel from the Patient Chart-Rx History tab.

 Select a prescription from the grid and Click the “Cancel Rx” Button
OR
 Open the details of a prescription and click the “Cancel Rx” Button

Click the “Cancel Rx” Button.

A message will pop up asking to confirm the cancellation process.

Note: The user may cancel the entire prescription or discontinue the remaining
fills on a partially filled prescription.

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The pharmacy will see either selection as a cancellation.

The Cancel Request will remain in the Rx Authorization screen as Response

Pending until the pharmacy responds back to the request.

When the response is returned from the pharmacy, the Response Received is
displayed.

To acknowledge the message and remove it from the Authorization screen,

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open the Details, review the response from the pharmacy and click the “Cancel
Reviewed” button.

Cancelled prescriptions can be found in the Patient Chart-Rx History under the
Cancelled section

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5.0 Revision History
Version Number Published Date Change Description
1.0 08/03/2018 New document
1.1 08/06/18 Renewal Enrollment Added
Change Enrollment Added
1.2 08/29/2018 Change Enrollment updated

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