Prescription entry
Note: Before you can enter prescriptions, you must set up a 'pin' for the provider:
This can be used as a standalone screen or with the EHR/PHR screen. They are fully integrated and designed to work together.
The prescription screens are larger than most of the billing screens. We recommend a minimum resolution of 1024 X 768 so that you are not required to 'scroll' to see all the screen.
To use as a standalone screen, you can access prescriptions from the main patient entry screen. Press the 'Prescription' button
The first screen you will see (if you have existing prescriptions for this patient) is the 'lookup' screen:
From this screen you can:
1. add a new prescription
2. edit/revise the highlighted prescription.
3. Print/fax the highlighted prescription (to fax you must have a fax-printer driver setup on your computer. Ask your hardware technician to install this if necessary.)
4. Transmit the highlighted prescription. You must be setup. More about that later.
Here is an example of the prescription that can be printed and faxed (or faxed directly from this screen if you have a fax-printer driver)
Here is how it might look if you have a 'Brother' printer/fax - multifunction machine:
You will get a screen like the one below. Put in the number that you want to receive the fax. You can enter the pharmacies you want in the address book/speed dial so you don't need to look up the number each time you fax.
Note that HIPAA may not allow faxed prescriptions after January 1, 2009. If that is the case, you will need to print the prescription and give it to the patient. Stratford plans to support EDI prescriptions depending on client demand. EDI will require going through a centralized 'clearinghouse' such as SureScripts. We will provide more details as we get them. You should check on our main web site for the most up to date information. We welcome your feedback.
Note that this faxing procedure works anywhere in the Stratford program. You could fax a copy of a report to Stratford if you want support. Here is an example of using a 'Brother' brand multi function machine. We have several of these. We use the scanning function daily. It may seem clumsy at first, but if you will start scanning your documents instead of filing the paper, you can improve your efficiency many times. We use it so much, we have a computer dedicated to scanning. We made it very easy to sit and scan many documents. We save them in PDF format to a very large hard drive in a folder named 'scan' with sub folders to indicate what is being scanned. Those documents are instantly available to any workstation in the company. You only need to backup the 'scan' folder every night onto CD/DVD to have all your documents secure. Use a naming system such as 20040320_1032_Rx_3498a2 to save a prescription for a patient with the account ID 3498a2. By entering the date this way, your folder can be sorted so that you can archive old files easily.
COMPUTER SCREEN IMAGE
Press the 'Add a New prescription for this patient' button to add another prescription. You will see this screen:
Here you can right click to get a list of providers or you can manually type in the lookup code for the correct provider.
Note: be sure you have a pin set up for this provider. See the description later in this document.
In the drug description text box you can enter your medication similar to the example given. You can also lookup an existing medication that is in your 'formulary' which is a table that you can use to enter those medications and dosages that you use often. To do the lookup, enter a dot (.) and then a few letters of the medication you want.
For example, if you want to enter Keflex 500 MG capsules , you would enter .KEF500
and press the tab key to get this screen: (assuming you already set this up by entering the Rx for a patient in the past)
Enter the remaining information for the prescription. The default is no refills and 'ok to substitute' so the pharmacy can give a generic or equivalent brand medication. You can change the number of refills if needed. If you do not want the patient to get a substitute you must enter '1' or right click and select from the small 'shortcut menu'.
In order to transmit your prescriptions, they must be in a specific format. To help with this Stratford offers a drug lookup function. This function is NOT part of the standard setup because it must be updated at least monthly. It will stop working if you do not update after 45 days. There will be a 'nag popup' on the main menu to remind you to update when needed. Stratford does not charge extra for this function.
If you choose to have the drug lookup option and transmit your prescriptions, here is more information.
Note the button on the main prescriptions screen labeled 'Drug Lookup'. For example, say you know you want to prescribe Keflex, but you do not know the specific format required for transmission. You can fill out the screen like this:
Press the 'Drug Lookup' button. If you see this message:
This indicates that you do not have the necessary database to do a drug lookup. This database is made up of many data tables that require more than 60 MB of storage. While that is not much storage for most modern computers, it would make the standard installation excessively large and would require much more time. Also, you are required to update the drug listing at least monthly (you are not required to update the billing software). If you want to use these files, you must update them on a regular basis, at least monthly - generally more often than a regular software update. You will need to get these from Stratford. These must be downloaded from the Stratford web site. We cannot provide them to you on CD. You can use the StratfordAccess utility to get these files at any time quickly.
Note: this function will stop working if you do not update the drug files for more than 45 days. You will see a warning on the main menu after 30 days with a countdown to 45 days. Stratford updates these files on the main web site at least weekly. You can download them anytime 24/7 (except for the very few times we may be doing web maintenance) at no additional charge. This may seem like a pain, however, it is necessary to make sure you have accurate information. There are special codes that will be printed on your prescription so that the pharmacist will know exactly what you want in the event that the text description is not exact (as it is not for some medications).
After you have the drug data files installed, you can access this screen:
This screen will default to the drug description that you entered (if possible). From here, you can scroll the screen to select the exact drug that you want. For a drug that is no longer protected by patent, there may be many different versions displayed. You should select the strength (ex: 500 MG) and dosename (ex: CAPSULE) that you want.
The tradename will usually show one or more possible selections that match or nearly match your entry. After you have selected the drug you want, as indicated above in green, the computer will select the first package size as that is generally not important to the person who is prescribing. That is the quantity(s) that is/are available to the pharmacist. Of course, you can click on one of the package sizes in the grid on the right side if you want something specific. For example, if you prescribe Ultravate ointment, you may want to select 15 grams rather than 50 grams as there is a substantial difference in price. This will indicate to the pharmacist that you know the exact sizes available and the NDC number that is specific for that drug in that size. You should should chose a package size with the exact quantity and form that you plan to use if possible. If you do not see exactly what you want, select something close if possible. For example, if you want a capsule, do not select something like 200 ML. Reference the Dosename grid for a translation. The pharmacist will dispense what you want if the package size is different. This screen is 'busy', but it has all the information that the FDA publishes about each drug. If you are able to find a drug that is what you want the patient to have and you select the correct Tradename and package code, you will see the NDC number text box completed and the 'Select' button turn green. That NDC number is specific for the exact drug/strength/form/etc that you want.
After you press the 'Select' button you will go back to the prescription screen.
You should not modify the description in any way. It is the description published by the FDA so the pharmacist will not need to call your office to confirm what you wanted.
Next, enter the quantity and the directions.
You may not care about the details of the drug, however, they are important to the pharmacist. It will help the pharmacist substitute if you allow a substitution. The primary reason for substituting is to get a lower priced drug. In some cases, the patient's insurance may have a formulary that will require a different drug. The pharmacist may not have the exact drug that you prescribe in stock, but will usually have an equivalent drug. If you use the standard Stratford printed prescription or you transmit your prescription, the pharmacist will see the 'Label code' and the 'Product code' that you can see on the 'FDA drug information tab'
Note: The software will determine whether or not you have entered this exact prescription in the past. If not, it will be saved in your library so that the data entry is much faster next time. You will not need to use the drug lookup button next time.
When you are entering a new prescription for a patient you will see the most recent previous prescriptions for this patient in the grid on the upper right of the screen. If you are re-prescribing the same medication for a patient that you prescribed in the past, you can click on that medication in the grid and get this selection:
If you select 'Yes', you will copy that prescription the way you entered it before as a new prescription:
That was quick. This is just a copy until you save. That means you can easily change the doctor name, quantity, pharmacy, etc.
The provider IDs used on a prescription are entered on the regular Provider screen. Access this from the main directory by selecting #8, then select 'Maintain the billing provider names and ID numbers. Select a provider from the lookup screen. You will see this screen:
In the center of the screen you see a tabbed folder. 3 of these tabs are for prescription related IDs and other information.
The provider DEA number and state medical license number are in the 2nd tab. When you first fill out this form for the provider, here is a 'trick': If you double click on the label titled "DEA Schedules" it will automatically check all the little boxes for the various schedules. Then if the provider is not authorized for one of the schedules you can easily uncheck it. Schedule 2 drugs can never be sent electronically. Only Schedule 1 drugs can be transmitted in most states.
This tab has a button that you must use to set up your 'pin' - much like a pin that you have with your debit card to use at an ATM to withdraw money. This button is not well documented because it is like a password. Only people who read this section of the manual will see it. If you do not set up a pin, you will get a warning when you try to create a prescription.
The 3rd tab has information that is used when transmitting prescriptions using the 'SureScripts' mailbox. If you don't have an answer to some or all of these questions, go on to the 4th tab.
The 4TH tab has information that is ONLY used when transmitting prescriptions using the 'SureScripts' mailbox. Even though you probably already entered the specialty from the cms.gov/Medicare web site for your billing requirement, SureScripts requires a completely different code from the AMA listing. We have all of them pre loaded exactly like we pre loaded the cms.gov listing. If you are not familiar with these codes you can right click on the text box. Notice that the text box initially has a yellow background indicating that it is a requirement. The SPI and other fields are also required, but you do not enter them. Stratford webservices will retrieve that information and save it to your provider record. In this context, SureScripts refers to the provider as a prescriber since they are uniquely authorized to write a prescription.
For billing, an absolute requirement is the NPI. That is all that is necessary for you to register and transmit a prescription. You have already entered your NPI so you should not need to enter any additional. Just press the 'Activate' button.
In the image above see (1) arrow which points to the 'electronic prescriptions enabled' indicator. When you are registered with SureScripts by pressing the Activate button with the (2) arrow, that indicator will be checked. In addition, the text boxes labeled SPI, Service level, Active Start Time and Active End Time will be filled out for you.
If you press the Activate button without entering the AMA specialty listing, you will see this:
You may right click on the SPI text box to get the AMA specialty code listing. There are more than 150 for you to select.
The prescription function was added to the Stratford program in 2004 and, like all Stratford software is being constantly upgraded. We appreciate any feedback you give by email to support@stratfordsoftware.com
Here is the screen after the provider is activated with Surescripts:
If you have entered your pin, you are ready to create and transmit prescriptions.