SOAPedia Home > Documentation > Chart - Workspace > 3. Docutainers Menu > Rx Manager > Rx Manager - SOAPware 2009 > Rx Manager Redesign
Rx Manager Redesign
Table of contents
- 1.1. Revised Interface
- 1.1.1.
- 1.1.2. Adding a New Rx
- 1.1.2.1. Adding from within Rx manager (preferred, going forward)
- 1.1.2.1.1. Eligability
- 1.1.2.1.2. Searching
- 1.1.2.1.3. Quick List
- 1.1.2.1. Adding from within Rx manager (preferred, going forward)
- 1.2. Add new prescription using a previous created prescriptions
- 1.2.1. Quick List
- 1.2.2. Medications List
- 1.3. Editing Medications
- 1.3.1. Using/Defining Drug Courses
- 1.3.2. Direct Editing
- 1.1. Revised Interface
- 2. Automatic workflows!!!!
- 2.1. Expand History
- 2.2. User Requests
Design Question/Issue:
What would be the impact of adding a field to medications or the sig that explicitly told SW how many days the prescription covers? This would enable us to calculate stop dates, be proactive on compliance measures and possible in the future automate certain refill tasks BEFORE the patient contacts you. It would greatly free up how we define and display the SIG component.
- We realize the current SIG/Dose and Dispense - tells your brain this (how many days of meds prescribed). However, with free text sigs, complex sigs etc. the computer simply can't read this free text.
- Even our third party drug database includes commonly used Sigs for most medications in only free text. This is perfectly fine for all current prescribing scenarios where only humans are expected to interpret the information. We could even convert all of these free text sigs into single click selections that read much more like clinician users expect (i.e. BID, TID etc.)
- And, end users can add additional SIGS as needed.
- Also, we have the option to key these free text sigs the SIG header itself - if a free text sig is selected then the structured contents of the current SIG are removed and replaced with the free text one.
This is a huge shift, and will need a bit of design for backwards compatibility. Obviously, we have recently gone the structured SIG route and don't want to lose that or invalidate work users have already done.
Revised Interface
The screens below are very early, rough and incomplete mocks-ups and not the suggested, final appearance. They are included to give a "general" idea of the concepts. The actual drug information would appear much like it would on a spreadsheet (i.e. straight rows and columns). Most/all items are actually within selection lists. This promises to remove some of the clutter of reviewing lists of meds where each med has a trail of sub-items of varied length.
The Pharmacy drop-down display full pharmacy info on a single line. When beginning to type a pharmacy name in the field, a drop-down will appear listing all pharmacies that match (much like with chart rack). The list of pharmacies would actually be in columns/rows so you can sort the resulting list by column (i.e. Pharmacy name, city, street, Zip, phone, fax etc.).
Allergies and basic patient demographic info is added to the display within Rx Manager.
The Medications tab provides a quick way to view all medications the patient has ever been prescribed.
The History tab display a complete transaction log of all events refills, add/remove, start/stop, print, fax edits etc.
-We still have to figure out a means to display the actual prescription fill history that comes back from pharmacies and PBMs and reconile that display with prescriptions authorized from within RxManager.
Adding a New Rx
For Legacy users- support prescription entry In the actual Rx Field of Encounter (SOAP) note
- Support of - Direct Rx Field data entry, code expansion, selection from ST Items or filled in by docuplate.
Adding from within Rx manager (preferred, going forward)
Previous versions of Rx Manager did not allow you to actually create a script within the manager itself - this has been addressed. SOAPware may be more approachable by training everyone to create there scripts within the manager and allow it to update the soap note.
Eligability
- How to best display formulary information that is specific to patient and prescription being considered?
Searching
Begin typing the name of a drug (or any keyword)in the Find field. After three characters have been typed, a list will appear - further typing will result in a more refined list of results. Only Structured Rx's that exist in your local library system will be displayed.
Quick List
How to build GUI presentation?
Begin typing a drug name or drop down the list and select it. Either a double-click on or a select/highlight + pressing enter will insert the drug into the active script.
Add new prescription using a previous created prescriptions
Quick List
Inside of Rx Manager you can pre-define commonly used drugs and their default values and store them to a Quick Access list - each users has their own list. These drugs can then be added to the patients script with a single click.
Medications List
Within the patient's medication list, either double-click on a listed medication or select/highlight and then click on the Add icon listed in the 'Action' column to insert that medication into the patient's active script.
The patient's medication list shows ALL medications that have been prescribed via the Rx Manager.
Editing Medications
Using/Defining Drug Courses
Drug Courses are a new concept for SOAPware. In a nutshell you can fill in a medication and tell SOAPware to remeber the pre-filled values. You can then repeat this process with a new set of values FOR THE SAME MEDICATION as many times as you want. Then when you use the medication, you are presented with a list of predefined courses and selecting one will install the changes to the medication values. The legacy method of doing this was to create multiple SMARText items - one for each set of values and then insert the correct one during the patient visit. Each course can be displayed using your own custom text (500 mg tablet BID or 250 mg tablet TID etc.) .
Drug courses are also available via a Quick Access when you click or active a drug and within the Rx Manager. It would be presented as a drop down list by clicking on the drug name.
Below is a mock-up screen shot. The 'Active' column (to be renamed) is simple a check box for each med to include or exclude it from he Printing/Faxing/eRx actions you may perform. By default, all items are checked as the submit button will route them in the correct fashion.
Actions column contains buttons to remove, view Epocrates and other drug info, etc.
The status column shows if and how its been sent/printed etc.
Direct Editing
Each medication listed in the patients script/rx pad view and any 'Active' medications listed in the patients Medication ist can be directly edited - much like using a spreadsheet. Clicking on the drug name drops down a list of predefined Drug Courses for automatic SIG/data entry.
Automatic workflows!!!!
- Edits made to the Rx Pad/Script will automatically be added/updated in the active encouner/SOAP note (if one is present and editable)
- Edits made to active medications in the Medications List will automatically be updated/added/removed from the Active Medications field in the Summary.
- Finally - the active script/Rx pad will be compared to the current patient's Active Rx list in the Summary.If differences are found the users will be prompted as to whether they wish to reconciled the two.
Expand History
Note -We still have to figure out a means to display the actual prescription fill history that comes back from pharmacies and PBMs and reconile that display with prescriptions authorized from within RxManager.
User Requests
Below are specific requests made by users - my response in red is how I believe the new system implements them.
In the RxManager header, in addition to patient information, inlcude:
Preferred Pharmacy
Pharmacy (Insurance) Benefits and Formulary
Allergy information
What other info is really needed?
Some things are missing that we would have to have:
Does not include any columns regarding refills, fill history, etc. (would include amount dispensed)
Not entirely sure how to do this - a large number of eRx refill requests are simply free text. Add a user editable column ?
Functions to refill, create new, etc.
Done - easy to add an existing Rx from the patient Med List or 'Refill' an Rx from the med list (one click). If you have a medication take it for a while, go off of it then come back on it is that considered a refill ? or would it be like starting a new drug ?
How transmitted (eRx, Fax, Printed, Sampled, etc)
Status column will define this. In addition the Send button handles all of this automatically, scheduled drugs are either printed and or faxed, erx capable pharamacies are sent via eRx - those that arent are automatically faxed. User can override the 'Send' button and specify directly (as they did in previous versions with options to directly fax, print or sample).
Should this name be changed from Status to something such as "Transmit" or something else. Do physicians consider status in a drug list to more likely indicate whether med is current/active, discontinued, on-hold, etc.?
Comments column
Have one - actually two - each Rx has a Comment area that is sent to the pharmacy - each history element has a notes field for misc notes.
Filter to just show active, inactive meds.
I've segmented out the patient Meds list which contians a list of all Rx's active and inactive the patient has ever had and the Rx History - which shows all the transactions involving the Rx's. Ok ????
The med list can be narrowed to show active, inactive and all. Items can be switched between the two with a single click (summary is updated automatically, after a prompt, where the stop date is entered by the user).
Quick means to change status from active(started) to inactive (suspended)
See above
Prescriber
Listed on Rx Pad, Med List and Rx History
Pharmacy
Listed on Rx History
would like to see a Tab created for Medication History. Any time a medication is added to a SOAPMF note which is then signed, the medications in the Medication field would automatically be added to the Medication History Tab. This tab would be a form similar to what most of us use in paper charts with columns for the current date, the medication name, strength, directions, quantity prescribed and refills authorized. Start and stop dates would be nice additions, along with a column for entering comments such as why a medication was discontinued (ie, tx completed, side-effects, cost, etc.) (These could even be selectable from a drop-down list.)
Such a tab would greatly simplify the task of tracking medications over time, and could easily be printed for ease of review if needed, or for faxing to a hospital when a patient gets admitted, etc.
I have worked with other less complex EMRs which have done far better at tracking medication history than SW does. I believe that SW needs to do a much better job in this area!
The proposed method does not do directly what is requested - it is assumed that all Rx's are managed via Rx manager. So this brings up an interesting question - should we have a mode that forces Rx Manager to be displaed when the SOAP Rx field is activated ?
We can do what is requested but I estimate the time to code to roughly equal the time to do all of the above. What we would do is look at the current patients Rx History, see if there was a currently active Rx that matches the one(s) in the Rx field, if not add one, if so update it it if needed.
Rx Selection
Prescribers have always been used to the fact that writing a prescription is a task which did not occur directly in the chart. So if a pop-up of a prescription pad comes up to write the prescriptions, no big deal. What would be great is if this presentation of the prescription writing interface allowed us to quickly populate a prescription using the ST items which would then be filled into the Medication section of the progress note, and then the Summary Side of Active Medications was automatically updated with that item.
Drug Courses, Quick List, Direct Editing and Drug Searching make the complete creation of a script within Rx manager possible. Legacy users would most likely use dcouplates and code expanders to fill in the encounter/SOAP medication field and then move to Rx Manager to finish the prescribing process. (Or, again, we could automatically pop up the Rx Manager when the encounter medication field is entered.
Rx Editing
How would I do this? First, when you would click on the heading "Medications" in the SOAPMF note, this handy prescription pad would pop-up. There would me a place for Medication 1. You would click in this box, and as you start to type the name of the medications, it would drill down the ST List of medications so you could select this. Now the dosage strength drop down list would become active, with only the available strengths for that medication listed. You would then move to the SIG: column and choose a frequency (such as daily, BID, TID, QID, etc.) and then number of tablets/pills from a drop down list. Next, we choose the Dispense: which could give the option of 7-day supply, 10-day supply, 14-day supply, 30-day supply, 90-day supply, or custom. Choosing custom would allow you fill in a more specific number of pills. Finally, there would be a box to check if you wanted DAW, and there would be a box for Comments to be added.
Believe the new Rx Pad fulfils this nicely.
Pharmacy Organization
There needs to be a better way to organize the pharmacies in the drop down list. Currently, the pharmacies appear to sort by name (alphabetical) and store number. The address and phone are then indicated on the same line. This is cumbersome when looking for a particular pharmacy, as the text is quite small, the pharmacies are not sorted by city, area code, etc. I would like to see the pharmacy database updated so that the store name, store number, address, city, state, zip code, area code, phone prefix, and phone last 4 are separate cells and the pharmacies can be searched or sorted based on any of those criteria. It would make finding the patient's choice of pharmacy easier.
The new pharmacy drop down is segmented as described above and as you type a name the list displayed narrows. New pharmacies can be added 'on the fly'
Automation
By writing my scripts in SW, I can transfer them to the medlist a little easier (sometimes) than if I wrote them separately. But it is still far from automatic--it is far too easy to NOT update the med list. At least, though, I always have the med history in the patients chart (but even that can be very hard to read).
See the automated workflows above. I believe these address the issues.
The History tab display a complete transaction log of all events refills, add/remove, start/stop, print, fax edits etc.
Andy
When I click on a med in medication list to send it to Rx pad, I will be able to see it is clicked (so I don't click it again?)
Narrowing the meds list--is that a single click, to choose active, inactive or all? If I move a med to inactive, does that update its stop date in history?
Quick List: when I create a script in a patient's chart, can I add it to the quick list with one click? (I think that is important--customizing on the fly)
Andy
What isn't clear to me as of this reading is how the history will display. The current history tab is a mess. There needs to be a way to quickly see, for any given med, when it was started, changed, and stopped. It appears SW will look at that (it checks against the med list to see if a med is changed)--but how will it display that? Looking through every instance of prescibing the med as in the current history is too awkward.
Andy edited 00:05, 4 Nov 2008
A question about how it matches meds, to see if they need to be updated/added. If a patient is on Calan SR 240, and I write a script for verapamil SR 240 (same med, different name) will it add verapamil as a new med? Or change the Calan to verapamil on the list? What if I change from Zantac 150 to Zantac 300? To me, that is a dosage change, but there is different ST for each in the database. (Not just a customization, a separate blank ST with a different header). Probably not a big deal, but thinking about this up front may save confusion later.
Andy
If I understand the workings correctly, if I currently have a ST Item "zol100" which is for "Zoloft 100 mg 1 tablet daily #30 Refill:3 Substitution: Allowed", I should be able to type this shortcut (zol100) into the Find box, select it, and then all the correct ST items will autopopulate? Then all I would have to do is click Send and it will go to the pharmacy, it will be added in the History tab, and if this is a dose change this will be tracked, and the medication will populate into the Medications sections of the SOAPMF note and the Summary Side. If this is how it will work, this is what I want and you are a genius for the day!
All these ideas are driven by you the user.
Or is there a simple way I can just select the drug and say I only want to see changes? Maybe with a saved view? (But I wouldn't want to create a saved view for each drug on each patient...)
My old EMR let me select a drug from the list, click history, and see this info. I used that feature very frequently, often to track the relationship between drug dosing and labs or vital signs. (I can't send drug changes to Flow Sheets can I? That could be real useful...)
Andy
Andy
Andy