| DESCRIPTION OF ENHANCEMENTS |
The Inbound Electronic Prescribing (eRx) v5.0 enhancements include updates to
prescriptions for controlled substance medications.
Patient Centric View
ERX LOOK-BACK DAYS: Default value 365 (Feb 27, 2020)
ERX PATIENT DOB ED LOCKED BY NW WT IP HD CCR OTH TOT
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1] TESTONE,ONE 08/12/1956 12 0 0 4 0 0 0 4
2] TESTTWO,TWO 08/12/1956 12 0 0 7 1 0 0 8
3. TESTSIX,SIX 09/30/1938 6 0 0 1 1 0 0 2
4. TESTFOUR,FOUR 11/10/1965 3 0 0 4 0 0 0 4
5] TESTNINE,NINE 12/18/2014 1 1 0 2 0 0 0 3
...
In the example above lines 1, 2 and 5 have a ']' indicating that those
patients have at least one controlled substance medication prescription.
d) In the Prescription View the prescriptions for controlled substance
medication will also be marked with ']' as shown below:
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PSO ERX HOLDING QUEUE Feb 26, 2021@14:26:24 Page: 1 of 1
PSO ERX HOLDING QUEUE
Below is a list of all the applications involved in this project along with
ERX LOOK-BACK DAYS: Default value 365 (Feb 27, 2020)
Patient DOB Drug Provider STA Rec Date
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1] TESTONE,ONE 8/12/56 ALPRAZOLAM 1MG TAB PROV,TEST I 02/28/21
2] TESTONE,ONE 8/12/56 TESTOSTERONE PATCH PROV,TEST I 02/12/21
3] TESTONE,ONE 8/12/56 METHYLPHENIDATE 5MG T PROV,TEST I 01/31/21
4. TESTONE,ONE 8/12/56 ALBUTEROL INHALER PROV,TEST I 01/29/21
...
In the example above lines 1, 2 and 3 have a ']' indicating that the
their patch number:
prescription is for a controlled substance.
e) In the Patient Centric View the SORT ENTRIES (SO) action was modified to
add a new option to sort: ELAPSED DAYS (ED). The action was also changed
to allow the user to separate the sorted prescriptions into two groups:
Controlled and Non-Controlled Substances. Independently of which option
the user picks they will be prompted whether they want to group the list
by controlled substance or not as shown in the example below:
Select Item(s): Next Screen// SO SORT ENTRIES
1.) PATIENT NAME
2.) DATE OF BIRTH
3.) ELAPSED DAYS (ED)
Select one of the following sort criteria:
Enter response: 3 ELAPSED DAYS (ED)
Do you want to group by controlled substance?
APPLICATION/VERSION PATCH
Enter Yes or No: YES//
If the user answers YES the patients with at least one prescriptions for
a controlled substance medication will be moved to the top of the list
while the others will be moved to the bottom as shown below:
---------------------------------------------------------------------------
1] TESTONE,ONE 08/12/1956 6 0 0 4 0 0 0 4
2] TESTTWO,TWO 08/12/1956 5 0 0 7 1 0 0 8
-----------------------------------------------------------------
3] TESTNINE,NINE 12/18/2014 2 1 0 2 0 0 0 3
3. TESTSIX,SIX 09/30/1938 3 0 0 1 1 0 0 2
5. TESTFOUR,FOUR 11/10/1965 0 0 0 4 0 0 0 4
...
f) When a DO NOT FILL marked record is received in the eRx Holding Queue it
will be identified in the header with the text below (in reverse video)
when the user is view viewing such record, as shown below:
eRx Holding Queue Display Apr 01, 2021@09:58:15 Page: 1 of 3
OUTPATIENT PHARMACY (PSO) V. 7.0 PSO*7*617
eRx Patient: TEST,PATIENT
eRx Reference #: 2002894 ERX HAS DO NOT FILL INDICATOR PER PROVIDER
eRx HT: (cm)() eRx WT: (kg)()
---------------------------------------------------------------------------
...
Note: The only two actions that can be performed on a DO NOT FILL record are
REJECT and REMOVE.
g) When viewing an eRx record the DEA# will be displayed along with the
CONTROLLED SUBSTANCE (PSD) V. 3.0 PSD*3*89
other information about the Provider (eRx and VistA) as shown below:
...
eRx Provider Primary Telephone: 555-220-0303
eRx Provider: TEST,PROVIDER
DEA#: TP1234568 NPI: 123456789
Vista Provider: TEST, PROVIDER F.
DEA#: TP1234568 NPI: 123456789
...
h) For controlled substance medication eRx records the DEA Schedule will
be displayed right after the drug name (eRx and Vista) in the following
format:
eRx Holding Queue Display Apr 06, 2021@10:22:57 Page: 1 of 3
eRx Patient: CS-ONLY,ONE
eRx Reference #: 4928403
eRx HT: (cm)() eRx WT: (kg)()
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eRx Drug: MEPHOBARBITAL 100MG TABLET [C-IV]
the current eRx functionality to allow the VA to receive and dispense
Below is a list of new and changed functionality delivered by this patch to
eRx Qty: 30 eRx Refills: 0 eRx Days Supply: 30 eRx Date: APR 06, 2021
eRx Sig: TAKE ONE TABLET BY MOUTH ONCE DAILY
Vista Drug: MEPHOBARBITAL 100MG TAB [C-IV]
Vista Qty: 30 Vista Refills: 0 Vista Days Supply: 30
...
i) The VistA Patient selection/validation for controlled substance
medication eRx records will perform a check whether the selected VistA
patient has a ZIP CODE on file or not. If the VistA patient does not
satisfy the DEA requirements for receiving, processing and dispensing
have a ZIP CODE on file the following message will be displayed:
i1. VistA Patient Selection/Edit (user will be allowed to proceed):
**************************** WARNING(S) *****************************
Patient does not have a current mailing or residential address on file.
************************************************************************
i2. VistA Patient Validation (user will not be allowed to proceed):
electronic prescriptions for controlled substance medications.
Unable to validate - VistA Patient does not have a current mailing
or residential address on file.
j) The VistA Provider selection/validation for controlled substance
medication eRx records will perform a few checks to validate whether the
selected VistA Provider is eligible to write the prescription:
j1. Provider does not have a valid not expired DEA# on file:
***************************INVALID PROVIDER*****************************
Missing VistA Provider DEA#
************************************************************************
j2. The VistA Drug was previously selected and VistA Provider is not
authorized to write to the VistA drug DEA schedule:
***************************INVALID PROVIDER*****************************
VistA Provider TEST,PROVIDER is NOT authorized to write to the schedule
(C-II) of the VistA drug selected.
************************************************************************
1. New HOLD, REJECT and REMOVE codes
j3. VistA Provider's DEA # expires prior to eRx written/issue date:
***************************INVALID PROVIDER*****************************
eRx Written Date/Issue Date is after the VistA Provider DEA expiration
date (MM/DD/YY).
************************************************************************
j4. eRx Provider's DEA # does not match VistA Provider DEA # (allows
selecting the provider with a warning but blocks validation)
---------------------------------------------------------------------------
*********** WARNING (edit) / INVALID PROVIDER (validation) *************
Provider DEA mismatch (eRx: TP123456 | VistA: TP654321)
************************************************************************
j5. The VistA Drug was previously selected and is a DETOX drug and VistA
Provider does not have a valid not expired DETOX # on file (VistA
drug must be previously selected):
*********** WARNING (edit) / INVALID PROVIDER (validation) *************
The following new codes have been added:
VistA Provider TEST,PROVIDER does not have a valid DETOX#
************************************************************************
j6. During Provider validation the functionality that allows the user to
assign the same provider to other prescriptions that match the eRx
provider was changed to check whether the VistA provider is
authorized to write each prescription if they are for a controlled
substance or detox medication. If the VistA provider is not
authorized a message will be displayed for the eRx and it will not
be selected/validated for the prescription.
k) The VistA Drug selection/validation for controlled substance medication
eRx records will perform a few checks to validate whether the selected
VistA Drug can be used for the prescription:
k1. When the user selects the VALIDATE DRUG/SIG (VD) action and then
selects the Edit (E) action to select the VistA dispense drug to
associate it with the eRx record the prompt 'Select GENERIC DRUG
NAME:' will now allow the selection of a drug marked as Controlled
Substance. Before, CS drugs were not allowed to be selected.
HOLD Codes:
k2. VistA Drug selected is NOT marked as a controlled substance
medication the eRx record is for a controlled substance (user will
be allowed to proceed with a warning):
**********************************WARNING*******************************
eRx Drug is indicated by the prescriber as CS ([C-IV]) and VistA Drug
selected is Non-CS. Please, review and make sure you selected the
correct drug.
************************************************************************
-----------
k3. The VistA Drug selected is locally (not NDF matched) marked as a
controlled substance medication and the eRx record is not for a
controlled substance (does not have a digital signature). User will
not be able to select the drug:
*******************************INVALID DRUG*****************************
eRx is not digitally signed and VistA drug is non-CS and VistA drug is
not matched to an NDF item marked with a CS Federal Schedule but is
locally marked as a controlled substance ([C-II]).
electronic prescriptions for controlled substance medications. Up until now
HCR - PRESCRIBER'S CS CREDENTIAL IS NOT APPROPRIATE (New)
************************************************************************
k4. The VistA Drug selected is matched to and NDF item marked as a
controlled substance medication and the eRx record is not eligible
for a controlled substance (does not have a digital signature). User
will not be able to select the drug:
*******************************INVALID DRUG*****************************
eRx is not digitally signed and VistA Drug is marked as CS ([C-III]).
************************************************************************
HWR - CS PRESCRIPTION WRITTEN/ISSUE DATE HAS PROBLEMS (New)
k5. The VistA Provider was previously selected and is not authorized to
write to prescription for the DEA schedule of the VistA Drug :
******************************INVALID DRUG******************************
VistA Provider TEST,PROVIDER is NOT authorized to write to the schedule
(C-II) of the VistA drug selected.
************************************************************************
k6. The VistA Provider was previously selected and does not have a valid
HIS - PROVIDER DEA# ISSUE (New)
not expired DETOX # and the VistA Drug selected is a DETOX drug.
*********** WARNING (edit) / INVALID PROVIDER (validation) **************
VistA Provider TEST,PROVIDER does not have a valid DETOX#
*************************************************************************
l) In the eRx Holding Queue Display where a single prescription is displayed
a new hidden action called View Audit Log (AU) was introduced. This new
functionality will allow the user to track every edit made to the eRx
during the transcription of the eRx data to match the VistA corresponding
HRX - HOLD FOR RX EDIT (New)
entries. The log looks like the screen below and can be sorted by
DATE/TIME, FIELD NAME or EDITED BY columns.
eRx Audit Log May 14, 2021@15:27:57 Page: 1 of 2
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eRx Patient: TEST,OUTPONE F
eRx Reference #: 494949
-------------------------------------------------------------------------
DATE/TIME [^] FIELD NAME EDITED BY
-------------------------------------------------------------------------
HDE - DRUG USE EVALUATION (New)
Jan 28, 2021@09:47:45 PATIENT TEST,USER F
Old Value:
New Value: TEST,OUTPONE (L4SSN: 7944 | DOB: DEC 18,2014)
Jan 28, 2021@09:48:06 DRUG TEST,USER F
Old Value:
New Value: LOESTRIN FE 1/20 TAB,28 (NDC#: 51285-0080-70)
Jan 28, 2021@09:48:13 SIG TEST,USER F
Old Value:
HTI - THERAPUTIC INTERCHANGE (New)
New Value: TAKE ONE TABLET PO ONCE DAILY
Jan 28, 2021@09:48:18 QTY TEST,USER F
Old Value:
New Value: 30
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+ Enter ?? for more actions
DT Sort by DATE/TIME EB Sort by EDITED BY
FN Sort by FIELD SH Show/Hide eRx Value
Select Item(s): Next Screen//
HSC - SCRIPT CLARIFICATION (New)
l1) The actions DT, FN and EB are used to sort the list by the columns
DATE/TIME, FIELD NAME and EDITED BY respectively. The SH action will
show o hide the original prescription value for the field from the
eRx record as shown below:
...
Jan 28, 2021@09:47:45 PATIENT TEST,USER F
eRx Value: TEST,OUTPONE F (L4SSN: 7944 | DOB: DEC 18, 2014)
Old Value:
New Value: TEST,OUTPONE (L4SSN: 7944 | DOB: DEC 18,2014)
HGS - GENERIC SUBSTITUTION (New)
...
m) Besides the "]" (closing square bracket) described in the letter d)
above to identify CS (digitally signed) eRx records once you select a
specific record it will display on the top right corner of the
scrollable are the following note (in reverse video) "EPCS DEA
VALIDATED" to indicate to the user processing the record that the
electronic digital signature has been validate and also to comply with
SureScripts requirements for CS prescriptions. In addition, these
records will also contains the foot note:
This prescription meets the requirements of the Drug Enforcement
Administration (DEA) electronic prescribing for controlled substances
rules (21 CFR Parts 1300,1304, 1306, & 1311).
n) When the user selects the action EC (eRx Change Request) for a CS eRx
record they will be limited to selecting only one of the following two
values below (P or U):
Select RX change message request code: ?
REJECT Codes:
Answer with ERX SERVICE REASON CODES, or NUMBER, or BRIEF DESCRIPTION,
or CODE TYPE ABBREVIATION, or NCIT SUBTYPE
Do you want the entire ERX SERVICE REASON CODES List? y (Yes)
Choose from:
9999 P Prior Authorization Required
9999 U Prescriber Authorization
Select RX change message request code:
o) When a Pending Order is un-accepted (see 5a below) a new entry will be
the eRx Holding Queue restricted the selection of a controlled substance VA
-------------
added to the Status History for the related eRx record to indicate that
it was un-accepted and sent back to the eRx Holding Queue. Below is an
example how it will display:
Select Action:Next Screen// SH Status History
-------------------------------------------------------------------------
...
07/17/20@10:48:50 PR PROCESSED
Entered By: USER, NAME F
Comments:
PVD03 - Missing/bad digital signature on inbound CS ERX (New)
07/18/21@14:17:30 HRX HOLD FOR RX EDIT (eRx Un-Accepted)
Entered By: USER, NAME F
Comments: Wrong Patient associated with Rx
Type <Enter> to continue or '^' to exit:
5. Patient Prescription Processing [PSO LM BACKDOOR ORDERS]
Complete Orders from OERR [PSO LMOE FINISH]
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PVD04 - Prescriber's CS credential is not appropriate (New)
A few changes have been made to the Pharmacy Backdoor options listed above
to comply and facilitate the processing of controlled substance medication
prescriptions:
a) When viewing a Pending eRx Order the user will have the available a new
hidden action called 'Un Accept eRx' (UA) which after answering a few
prompts the record will be sent back to the eRx Holding Queue for
further processing there, as shown below:
...
PTT03 - Patient's mailing address is missing/mismatched (New)
Select Item(s): Next Screen// UA UA
Select HOLD reason code: HOLD FOR RX EDIT// HRX HOLD FOR RX EDIT
Comments (Optional): Wrong Patient associated with Rx
This eRx will be Un-Accepted and sent back to the eRx Holding Queue.
Confirm? N// YES Please wait...
eRx successfully un-accepted and placed back on the eRx Holding Queue.
DRU06 - Controlled Substances are disallowed (Renamed)
Type <Enter> to continue or '^' to exit:
b) When viewing a digitally signed eRx pending order the first line of the
scrollable area will display the text "Processing Digitally Signed eRx
Order" in reverse video to indicate to the user the they are processing
a prescription for a controlled substance medication.
c) Also, for digitally signed eRx pending orders at the end of the
scrollable area there will be a foot note that says:
DRU06 - CS prescription written/issue date has problems (New name)
This prescription meets the requirements of the Drug Enforcement
Administration (DEA) electronic prescribing for controlled substances
rules (21 CFR Parts 1300,1304, 1306, & 1311).
d) Digitally signed eRx pending orders cannot be edited. In order to edit
any field on this type of pending orders they user would have to either
Un-Accept the pending order, edit it in the eRx Holding Queue and then
Re-Accept it; or finish the pending order and then edit the Active or
Suspended prescription.
ERR99 - Other
e) A new hidden action called Jump to eRx (JE) was included in the list of
hidden actions available for an eRx pending order or an eRx active
prescription. When a user viewing a pending order or an active
prescription types JE it will take them to the eRx Holding queue to
the screen showing the corresponding eRx record. Once they quit out of
eRx record they will return them back to pending order or active
prescription.
f) When a new CS eRx is finished and becomes an ACTIVE prescription it will
display "Digitally Signed eRx Order" on the message bar right above the
actions.
g) The trailing document of the prescription label will have the "(DSIG)"
to indicate that the prescription was digitally signed.
h) The 30th piece of the ORC segment in the HL7 message sent over to OPAI (Outpatient Pharmacy Automated Interface) will contain "EL" for
Digitally Signed eRx Controlled Substance prescriptions.
6. HPS Sustaintment issues
REMOVE Codes:
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The Inbound eRx JAVA application is a component of the PRE IEP program that
provides the capability to receive inbound eRx's from an external provider.
The JAVA application provides a user interface that allows end users to
manage and monitor eRx processing from external sources.
This patch resolves the incomplete users list displayed by the User
Management screen in the Inbound eRx web-based application.
Defect Tracking System Ticket(s) & Overview:
-------------
============================================
INC11772378 - Inbound eRX web application not displaying correctly
INC18070242 - Inbound eRX web application not displaying correctly
Problem:
--------
The User Management screen allows Administrators to add new users to one or
more sites (Station ID), enable users, disable users, modify user roles and
existing user records by assigning them to one or more sites. This screen
will only display for users with Administrator access. However, User
dispense drug for any incoming electronic prescription due to the fact that
REM09 - ERX Issue not resolved-Provider contacted (New)
Management screen is currently displaying limited number of users, not the
entire list of users.
Resolution:
----------
Refactored Java code in order to fix the User Management component of the
Inbound eRx application. After the fix is implemented, complete list of users
is displayed on the User Management screen.
Patch Components
================
Files & Fields Associated:
File Name (#) Field Name (#) New/Modified/Deleted
----------------- -------------------------------------- --------------------
ERX HOLDING QUEUE (#52.49) Modified
DO NOT FILL (#10.5) Modified
STATUS HISTORY sub-file (#19) Modified
- UN-ACCEPTED ERX FLAG (#.04) New
2. CMOP Controlled Substance Rx Dispense Report [PSO CMOP CS RX DISPENSE
AUDIT LOG sub-file (#20) New
- EDIT DATE/TIME (#.01) New
- FIELD NAME (#.02) New
- EDITED BY (#.03) New
- NEW VALUE (#.04) New
CONTROLLED SUBSTANCE INDICATOR (#95.1) New
CS DIG SIGNATURE DIGEST METHOD (#95.2) New
CS DIG SIGNATURE DIGEST VALUE (#95.3) New
CS DIG SIGNATURE VALUE (#95.4) New
CS DIG SIGNATURE X509 DATA (#95.5) New
REPORT]
PRESCRIPTION (#52) ERX SIGNATURE STATUS (#312) New
Protocols Associated:
Protocol Name Type New/Modified/Deleted
------------- ------- --------------------
PSO ERX ACCEPT ERX Action Modified
PSO ERX AUDIT LOG MENU Menu New
PSO ERX AUDIT LOG SHOW/HIDE ERX VALUE Action New
---------------------------------------------------------------------------
PSO ERX AUDIT LOG SORT BY DATE/TIME Action New
PSO ERX AUDIT LOG SORT BY EDITED BY Action New
PSO ERX AUDIT LOG SORT BY FIELD NAME Action New
PSO ERX HIDDEN ACTIONS Menu Modified
PSO ERX JUMP TO ERX Action New
PSO ERX UN-ACCEPT Action New
PSO ERX VIEW AUDIT LOG Action New
PSO HIDDEN ACTIONS Menu Modified
PSO HIDDEN ACTIONS #3 Menu Modified
PSO PMP HIDDEN ACTIONS MENU #2 Menu Modified
The report option above was modified to include the ampersand sign (&)
Templates Associated:
Template Name Type File Name (#) New/Modified/Deleted
------------- ---- ------------- --------------------
PSO ERX AUDIT LOG List N/A New
before the Rx # to indicate the prescription is an eRx prescription (e.g.,
&29039001A)
3. Released and Unreleased Prescription Report [PSO RELEASE REPORT]
the functionality was not 100% compliant with the DEA requirements (21 CFR
---------------------------------------------------------------------------
The report option above was modified to include the ampersand sign (&)
before the Rx # to indicate the prescription is an eRx prescription (e.g.,
&29039001A)
4. Complete Orders from eRx [PSO ERX FINISH]
---------------------------------------------------------------------------
A few changes have bene made to the eRx Holding queue option above to
comply and facilitate the processing of controlled substance medication
prescriptions.
Part 1311 Subpart C) for receiving, processing and dispensing controlled
a) A new filter was introduced to allow the user to select the type of
prescriptions to be loaded on the eRx Holding Queue as shown below:
Select one of the following:
Non-CS Non-Controlled Substance
CS Controlled Substance
B Both
substance electronic prescriptions. This project addresses all the DEA
Select eRx Record Type: B//
b) If the selection above is either CS or B, a new filter prompt was added
to allow the user to further filter based on the CS Schedule of the
controlled substance medication as shown below:
Select one of the following:
1 Schedule II
2 Schedules III - V
requirements and enables the eRx Holding Queue to process incoming electronic
3 Schedules II - V
Select Schedule(s): 3//
c) In the Patient Centric View if a patient has a prescription for a
controlled substance medication the line item will be marked with a
closing square bracket (]) following the line number as shown below:
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PSO ERX PATIENT CENTRIC VIEW Feb 26, 2021@14:19:30 Page: 1 of 2
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