E-Prescribing (eRX)

[indest]

Good evening everyone,

I am a hospitalist in a state that mandates E-Prescribing for all prescription medication. As a hospitalist, I don't practice outpatient medicine and therefore cannot prescribe outside of work. Recently, someone I knew was in need of antibiotics, for which I couldn't prescribe secondary to this E-Prescribing law. So my question is, what app/software are people using and how much does it cost? So far I see the DrFirst product as a good contender, but I would hate to spend $360 a yr for the possibility of writing 1-2 script/yr. If it was a service I would use frequently, it be a different story; but for a service I intend to rarely use, I was wondering if there was a free or cheaper option. Maybe a service that charges me per script I write... Thanks in advance!

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[DrMetal]

Good evening everyone,

I am a hospitalist in a state that mandates E-Prescribing for all prescription medication. As a hospitalist, I don't practice outpatient medicine and therefore cannot prescribe outside of work. Recently, someone I knew was in need of antibiotics, for which I couldn't prescribe secondary to this E-Prescribing law. So my question is, what app/software are people using and how much does it cost? So far I see the DrFirst product as a good contender, but I would hate to spend $360 a yr for the possibility of writing 1-2 script/yr. If it was a service I would use frequently, it be a different story; but for a service I intend to rarely use, I was wondering if there was a free or cheaper option. Maybe a service that charges me per script I write... Thanks in advance!

Tell your friend to go see their doctor. These E-prescribing laws were put into place for this exact reason (and of course it's not worth the $360/year for 1-2 scripts). Once upon a time in Hollywood (CA of course), there were one too many doctors prescribing things for friends and acquaintances. Paper scripts made this too easy and enticing.

 

[indest]

Tell your friend to go see their doctor. These E-prescribing laws were put into place for this exact reason (and of course it's not worth the $360/year for 1-2 scripts). Once upon a time in Hollywood (CA of course), there were one too many doctors prescribing things for friends and acquaintances. Paper scripts made this too easy and enticing.

In my opinion, if I am a licensed physician and I am willing to take the risk of prescribing the med (using my medical judgement and keeping a record of the interaction), I don't see why I shouldn't be able to prescribe the med. I did recommend a PCP visit in the above scenario, but I don't see why I, as a fully licensed physician, should be restricted in how I prescribe meds (provided that I do so responsibly). This is however my opinion and hence why I opted to make this thread. Surely, I am not the only one who have come across this issue and feel this way.

 

[DrMetal]

In my opinion, if I am a licensed physician and I am willing to take the risk of prescribing the med (using my medical judgement and keeping a record of the interaction), I don't see why I shouldn't be able to prescribe the med. I did recommend a PCP visit in the above scenario, but I don't see why I, as a fully licensed physician, should be restricted in how I prescribe meds (provided that I do so responsibly). This is however my opinion and hence why I opted to make this thread. Surely, I am not the only one who have come across this issue and feel this way.

Your license doesn't warrant unethical practice. If you're prescribing for a friend, co-worker, hot girlfriend (my favorite), then chances are that there's a 'conflict-of-interest' there, or at least it can be perceived that way. And sometimes the perception is enough to get you in trouble, if something goes wrong.

Look I get it, there's a far cry between rxing a friend a Z-pack for bronchitis vs #60 Norco for their back pain. But the latter was abused by many paper scripting physicians, hence the current situation.

I happily tell my friends I'm a rounding hospitalist and thus can't prescribe then anything. Now, as far as the hot girlfriends go . . . .well

 

[chessknt]

Good evening everyone,

I am a hospitalist in a state that mandates E-Prescribing for all prescription medication. As a hospitalist, I don't practice outpatient medicine and therefore cannot prescribe outside of work. Recently, someone I knew was in need of antibiotics, for which I couldn't prescribe secondary to this E-Prescribing law. So my question is, what app/software are people using and how much does it cost? So far I see the DrFirst product as a good contender, but I would hate to spend $360 a yr for the possibility of writing 1-2 script/yr. If it was a service I would use frequently, it be a different story; but for a service I intend to rarely use, I was wondering if there was a free or cheaper option. Maybe a service that charges me per script I write... Thanks in advance!

Honestly it sounds like you're ****ed unless you move to another state. Pharmacy wont take written rx, phoned in rx or faxes from out of state? I have many patients who travel and occasionally I send an rx to another state for them. Seems nuts to me to make that impossible.

I agree with you--it isn't 'unethical' to prescribe a medication that is over the counter in the vast majority of the world like amoxicillin, zofran or flexeril and erecting barriers to uncontrolled drugs isn't saving anyone, especially in the world of $200 doctor visits.

 

[indest]

Your license doesn't warrant unethical practice. If you're prescribing for a friend, co-worker, hot girlfriend (my favorite), then chances are that there's a 'conflict-of-interest' there, or at least it can be perceived that way. And sometimes the perception is enough to get you in trouble, if something goes wrong.

Look I get it, there's a far cry between rxing a friend a Z-pack for bronchitis vs #60 Norco for their back pain. But the latter was abused by many paper scripting physicians, hence the current situation.

I happily tell my friends I'm a rounding hospitalist and thus can't prescribe then anything. Now, as far as the hot girlfriends go . . . .well

So just because people drive fast, we should now ban driving? Virtually everywhere in the US, those who abuse the speed limit are the ones that pay the consequences (not everyone). Those who abuse their Rx power should be solely punished. Now imagine person X cannot see a physician quickly and only has access to me and a NP staffed urgent care. Does it mean that them going to the NP is a better option than a residency trained, BC physician? Do you know how hard it is to see a primary care physician in the US? Do you know what the wait is?

 

[HemeOncHopeful19]

Your license doesn't warrant unethical practice. If you're prescribing for a friend, co-worker, hot girlfriend (my favorite), then chances are that there's a 'conflict-of-interest' there, or at least it can be perceived that way. And sometimes the perception is enough to get you in trouble, if something goes wrong.

Look I get it, there's a far cry between rxing a friend a Z-pack for bronchitis vs #60 Norco for their back pain. But the latter was abused by many paper scripting physicians, hence the current situation.

I can kinda see where you’re coming from but in the past when I’ve had my spouse go to urgent care for example she is then seen by a midlevel… and it costs us $40 (and it costs the “system” hundreds). I’m not sure that is really better care for anyone.

 

[DrMetal]

So just because people drive fast, we should now ban driving?

I wouldn't know. I can't afford fast cars (I live in southern California, with a mortgage, 2 teenage kids, a bad whiskey habit).

 

[Ubba]

There is nothing illegal or unethical about rxing yourself acne cream or a family member Augmentin (provided that the latter is indicated, of course; abx resistance, etc.). The worst that can be said is that it's "frowned upon", and some states will only allow you to call in an Rx for yourself if it's an urgent situation (e.g., Zofran for a flight).

That said, beware of 2 pitfalls:
1. You are not protected legally if the person for whom you rx the med is not officially under your care and therefore covered by malpractice insurance.
2. Never ever even consider rxing controlled substances independently of your structured practice.

EDIT: It turns out that while its a-ok federally, there may actually be (a minority of) states that are dumb enough to prohibit self-prescription of even non-controlled substances. Check your state laws before prescribing yourself acne cream instead of wasting a $120 copay and an afternoon at the dermatologist's office.

 

[DrMetal]

That said, beware of 2 pitfalls:
1. You are not protected legally if the person for whom you rx the med is not officially under your care and therefore covered by malpractice insurance.
2. Never ever even consider rxing controlled substances independently of your structured practice.

Those are some pretty good pitfalls!

You guys may not be convinced, so you'll have to be burned once before you get it. Go nuts . . .

 

[HemeOncHopeful19]

Those are some pretty good pitfalls!

You guys may not be convinced, so you'll have to be burned once before you get it. Go nuts . . .

Have you been burned? Care to share your cautionary tale? I just can’t see how my wife would plan to sue me over some Keflex.

 

[DrMetal]

I just can’t see how my wife would plan to sue me over some Keflex.

Depends on the status of your marriage. It's amazing what her crazy sister can convince her to do.

I rx'd abx once for a friend, no labs (didn't have the means to get them), she turned out to have a MDRO, pyelo, spent a couple nights in the hospital, was fine. Still, I wish she had gone to an urgent care where (maybe) they would've sent off cultures. close call, but still . . .

 

[HemeOncHopeful19]

Depends on the status of your marriage. It's amazing what her crazy sister can convince her to do.

I rx'd abx once for a friend, no labs (didn't have the means to get them), she turned out to have a MDRO, pyelo, spent a couple nights in the hospital, was fine. Still, I wish she had gone to an urgent care where (maybe) they would've sent off cultures. close call, but still . . .

I appreciate your story and I do think it’s a fair warning to all. No sister in law btw

 

[mszzeta]

Good evening everyone,

I am a hospitalist in a state that mandates E-Prescribing for all prescription medication. As a hospitalist, I don't practice outpatient medicine and therefore cannot prescribe outside of work. Recently, someone I knew was in need of antibiotics, for which I couldn't prescribe secondary to this E-Prescribing law. So my question is, what app/software are people using and how much does it cost? So far I see the DrFirst product as a good contender, but I would hate to spend $360 a yr for the possibility of writing 1-2 script/yr. If it was a service I would use frequently, it be a different story; but for a service I intend to rarely use, I was wondering if there was a free or cheaper option. Maybe a service that charges me per script I write... Thanks in advance!

I am doing similar things as OP using Veradigm: Welcome to Veradigm ePrescribe The cost is similar but I am happy to pay for the convenience.

There is certainly some ethical issue and legal risk for prescribing a medication without a formal medical encounter. However, it is ultimately up to one's own judgement.

 

[rokshana]

I am doing similar things as OP using Veradigm: Welcome to Veradigm ePrescribe The cost is similar but I am happy to pay for the convenience.

There is certainly some ethical issue and legal risk for prescribing a medication without a formal medical encounter. However, it is ultimately up to one's own judgement.

And your state’s laws in this regard.

 

[chessknt]

And your state’s laws in this regard.

Is there a state where prescribing an uncontrolled substance without clinical documentation is a crime?

 

[VA Hopeful Dr]

Is there a state where prescribing an uncontrolled substance without clinical documentation is a crime?

Maybe not a crime, but my state's medical board will absolutely sanction you for it.

https://llr.sc.gov/med/PDF/Establishment%20of%20Physician-Patient%20Relationship%20as%20Prerequisite%20to%20Prescribing%20Drugs.pdf

 

[chessknt]

Maybe not a crime, but my state's medical board will absolutely sanction you for it.

https://llr.sc.gov/med/PDF/Establishment%20of%20Physician-Patient%20Relationship%20as%20Prerequisite%20to%20Prescribing%20Drugs.pdf

Fair enough but they would never find out unless you were reported by the person you prescribed it for (or I guess the pharmacist if it is for yourself or someone else with the same last name as you). Has anyone in SC been sanctioned for this before? I find it impossible to think it has never happened statewide there.

 

[GorillaPanic]

I use an app called iPrescribe. It's free, it works. No cost unless you need to prescribed controlled substances (but, yeahhhh, don't do that lol).

 

[DrMetal]

You guys are playing with fire man, I'm telling ya . . . .

Look, for most of your friends and family you can settle them with OTCs and reassurance. And you can tell them to F-off when you know there's nothing wrong. Unlike with your real patients (with whom you worry about complaints, Yelp Reviews, etc), you can be honest with your friends/family (when they don't need anything).

If they do need something, make 'em get seen, and help them with that process.

 

[jm192]

You guys states require electronic RX even for non-controlled? Our state is about a year into electronic prescription requirements for controlled substances.

 

[indest]

I use an app called iPrescribe. It's free, it works. No cost unless you need to prescribed controlled substances (but, yeahhhh, don't do that lol).

I thought as of 2 months ago, it cost $30/month.

You guys are playing with fire man, I'm telling ya . . . .



Look, for most of your friends and family you can settle them with OTCs and reassurance. And you can tell them to F-off when you know there's nothing wrong. Unlike with your real patients (with whom you worry about complaints, Yelp Reviews, etc), you can be honest with your friends/family (when they don't need anything).

I always have lawsuits in the back of my mind. At the same time, I also want to learn my options should I need to prescribe outside of the hospital. Maybe I do a small concierge medicine practice and use a free open EMR. If I can find out a good E-Prescribing system (maybe free), that will help with overhead. Although not there yet, I like to learn and keep my options open. Hence why I posted this thread.

 

[VA Hopeful Dr]

Fair enough but they would never find out unless you were reported by the person you prescribed it for (or I guess the pharmacist if it is for yourself or someone else with the same last name as you). Has anyone in SC been sanctioned for this before? I find it impossible to think it has never happened statewide there.

Sure, happens all the time. But it comes down to your risk tolerance. I make all of my family establish care with me. Once they are in the computer and have 1 office visit, then I can do weekend stuff like this for them.

 

[dozitgetchahi]

There is nothing illegal or unethical about rxing yourself acne cream or a family member Augmentin (provided that the latter is indicated, of course; abx resistance, etc.). The worst that can be said is that it's "frowned upon", and some states will only allow you to call in an Rx for yourself if it's an urgent situation (e.g., Zofran for a flight).

That said, beware of 2 pitfalls:
1. You are not protected legally if the person for whom you rx the med is not officially under your care and therefore covered by malpractice insurance.
2. Never ever even consider rxing controlled substances independently of your structured practice.

Also, some states’ medical boards are much more strict about this stuff than others. In Ohio, for instance, this kind of prescribing is basically verboten, and if caught can lead to real problems for your license.

 

[Ubba]

Also, some states’ medical boards are much more strict about this stuff than others. In Ohio, for instance, this kind of prescribing is basically verboten, and if caught can lead to real problems for your license.

Good to know, thanks for the heads-up 👍