Electronic Prescribing

The eRx software is capable of receiving electronic prescriptions for non-formulary medications. If CHCS determines that an electronic prescription is for a non-formulary drug (which is determined by the formulary status in the CHCS Formulary Management (FRM) file), that prescription will be placed in the CHCS holding queue for pharmacy intervention. Commercially, civilian providers are able to select and transmit any medications within their Electronic Health Record (EHR).

Within the electronic prescribing holding queue, the user selects one or more eRx's then selects inquiry from the action bar. At the device prompt, the appropriate printer name is entered. If more than one eRx's has been selected, each eRx will be printed on a separate page. Please see training slides or the User Guide for additional information.

MTF pharmacies may initially have a low auto-match rate of eRx patient to CHCS patient because civilian providers sending eRx's may not be including the specific information required for auto-population in CHCS (e.g. Patient SSN, DOD ID, etc.) Please see training slides or the User Guide for additional information on the patient matching criteria.

The auto-match rate of the electronic prescribing solution can be increased through MTF and civilian provider collaboration regarding specific information required for a successful auto-match to occur.

The eRx software is programmed to automatically remove electronic prescriptions from the holding queue after 365 days. MTFs may choose to manage the holding queue based on local business practices. Removal of an eRx from the holding queue is irreversible and will require a new prescription to be sent from the civilian provider. Please see training slides or the User Guide for additional information on the holding queue capabilities.

Yes, the electronic prescribing solution allows validation of eRx’s in the error queue. The electronic prescribing solution notifies the user of identified errors. Please see training slides or the User Guide for additional information on the error queue capabilities.

The electronic prescription must contain all legally required information for a valid prescription (e.g. Patient Name, Medication Name, Directions, Quantity, Refills, Provider, etc.)

MHS utilizes commercial electronic prescribing industry standards (i.e. NCPDP) to ensure compatibility with electronic health records and commercial ePrescribing networks.

Yes, the electronic prescribing networks supports controlled substances. However, the electronic prescribing solution in CHCS is not certified to receive and process electronic prescriptions for controlled substances.

Currently there are no plans to enhance the electronic prescribing solution in CHCS to support receipt and processing of controlled substances via electronic prescribing. The future MHS Electronic Health Record may be able to support the receipt and processing of controlled substances.

The electronic prescribing solution in CHCS is not certified to receive and process electronic prescriptions for controlled substances. The MTFs will be required to have the proper documentation (i.e., hard copy prescription or faxed prescription) as required by the DEA prior to dispensing a controlled substance. View the DEA requirements for a valid prescription

An eRx is received as text, not in a computerized image format. The MTF may print the eRx and scan the printed copy into the automation based on MTF workflow and/or business rules.

The eRx software is programmed to automatically remove electronic prescriptions from the holding/error queue after 365 days.

New providers identified through the electronic prescribing solution are added to CHCS using existing functionality and business processes. Users with the Provider Add/Edit security key should follow current CHCS business rules and local MTF policy for adding providers during the eRx provider validation process.

The original eRx and resulting CHCS prescription can be viewed using the Prescription Inquiry (PRI) capabilities. Please see training slides or the User Guide for additional information on the updated PRI functionality.

Information regarding guidance for defining electronic prescribing pharmacies in CHCS may be found in the Implementation Guidance document.

Electronic prescriptions processed (i.e. Validated) from the holding/error queue are integrated into current CHCS workload reports (e.g. HVR, VSR, etc.)

Electronic prescriptions processed (i.e. Validated) from the holding/error queue are treated like prescriptions received through CPOE/Pharmacy Order Entry.

The electronic prescribing solution provides the MTF prescription information before the patient arrives at the pharmacy and affords the MTF the option to fill prescriptions before the patient arrives; thereby reducing wait times and delays. Wait times, however, are dependent upon a number of factors including the MTF’s current business processes, procedures (batch vs teller), as well as workload.

Validating an electronic prescription in many cases is faster than typing a prescription because the electronic prescribing solution incorporates the look and feel of existing CHCS functionality. Efficiencies are achieved through familiarity, the intuitive user interface, and auto-matching capabilities. One of the benefits of ePrescribing is improving accuracy by eliminating translation and transcription errors.

The ordered quantity will be similar to that of a hard-copy prescription. Electronic prescriptions may be received with additional qualifiers (e.g. metric quantity, metric units, etc.). The pharmacy staff should apply clinical judgment regarding quantities ordered.

Current MTF practices for drug file maintenance of unused/outdated entries are automatically applied to the medication selection list within the CHCS electronic prescribing module.

MTFs should follow local policy for the creation or modification of electronic prescribing pharmacies within CHCS. The MTF electronic prescribing POCs will need to contact the PASS at least 45 days prior to implementing or changing a CHCS ePrescribing pharmacy site to ensure updates are communicated with the electronic prescribing network.

Fax numbers provided by the MTFs will be used for backup in the event any portion of the electronic prescribing process/network is down.

Electronic prescriptions within the holding queue are segregated from the rest of CHCS functionality (e.g. auto-batching) until processed (i.e. Validated). The fulfillment of electronic prescriptions may be incorporated into existing MTF workflow (e.g. fill-ahead, bank teller).

The electronic prescribing solution utilizes the "non-formulary" and "IP/OP" indicators associated with the pharmacy site's formulary group within the CHCS Formulary Management (FRM) option. Please see training slides or the User Guide for additional information on Drug Matching capabilities.

The status of electronic prescriptions processed with the Remove function are changed from "pending" or "error" to "removed". Electronic prescriptions that are removed from the holding queue are permanently deleted from CHCS after 15 months.

The electronic prescribing solution in CHCS does not allow for outbound ePrescribing (e.g. MTF Provider to MTF, Mail, or Retail pharmacies). MTF providers can continue to use AHLTA/CHCS to prescribe medications to MTF pharmacies connected to the same CHCS host.

Implementation and activation is a multi-step process, which needs to be coordinated with the Pharmacy Operations Support Contract (POSC). Detailed information regarding the necessary activities can be located in the Implementation Guide.

Provider outreach allows MTF pharmacies to manage the transition from paper to electronic prescriptions. A recommended outreach approach and customizable pamphlets are included with the Implementation guidance.

The following documents are available: training slides, user guide, implementation guide, and CHCS release notes. Provider outreach to facilitate receipt of electronic prescriptions, as part of the "soft" opening allows MTF staff to become familiar with the electronic prescribing solution prior to full go-live. Please see the Implementation Guide for additional information on Provider Outreach and Go-Live activities.

Yes, the processing of electronic prescriptions may be incorporated into various existing MTF workflows (e.g. fill-ahead, bank teller).

Yes, any provider connected to a commercial electronic prescribing network may send an electronic prescription to any pharmacy on the ePrescribing network.

The electronic prescription may be transferred verbally based on local, state and federal rules, regulations and laws. Once the prescription is transferred the user would use the Remove function from the eRx holding/error queue and select Transfer as the Removal Reason. The user would document the receiving pharmacy's information (name, phone, etc.), receiving staff member's name, etc. The electronic prescribing solution currently does not support electronic prescription transfers.

The CHCS ePrescribing software will be available to all MTFs in the United States, as well as Guam and Puerto Rico.

A MTF specific civilian prescribers-volume report can be obtained from the Pharmacy Operations Support Contract (POSC) by calling 1-866-275-4732 Option 1.

It depends. A provider's EHR may have been configured to send the electronic prescription directly to your fax machine or your pharmacy may have been previously registered as a fax enabled pharmacy with the electronic prescribing network. Reaching out to the provider of a faxed prescription will allow for provider education on the availability and published name (DoD "pharmacy name" ePhcy) of your pharmacy to facilitate the transition. Please see the Implementation Guide, and provider and patient flyers for additional information on Provider Outreach.

Yes, there is a chance that your pharmacy may receive electronic prescriptions for patients that will not pick-up a medication. The electronic prescribing network allows connected providers to send an electronic prescription to any connected pharmacy. The MHS ePrescribing solution attempts to reduce the occurrence of erroneous eRx's from reaching your pharmacy through the standardization of the published pharmacy names (i.e. DoD "pharmacy name" ePhcy).

Industry best practices support the transmission of the patient's SSN. The use of FMP/SSN is unique to the DoD/MHS.

No, when the required information is received in the eRx and the medication matches multiple CHCS drug entries based on the Drug matching business rules, the Drug auto-match will occur on the latest drug files entry (i.e. the highest IEN). Please see the CHCS Release notes, user guide, and training slides for additional information on Drug auto-match business rules.

After validation occurs, the clinical warning screen is presented for resolution to users with the appropriate security keys (i.e. PSGRPH = CCS menu option), or the prescription is placed in warning status. Please see the CHCS Release notes, user guide and training slides for additional information on prescription auto-creation and clinical screening business rules.

When an eRx has been Validated or auto-created, the result is an actionable prescription and may be processed in the same manner as prescriptions received from AHLTA or entered by the pharmacy staff.

No, in-house MTF providers will continue to prescribe medications using the current processes (i.e. AHLTA or CHCS).

MHS pharmacies will be published to the electronic directory. MTF's are encouraged to provide a fax number to the PASS as backup in case the ePrescribing network is unable to deliver the prescription electronically.

The prescription auto-creation process from an eRx was disabled on February 3, 2015.

No, the electronic prescribing holding/error queue was designed to receive, store and process eRx's. Business rules have been built in the holding/error queue to assist with maintenance. When an electronic prescription reaches 366 days old from the date written, the eRx status changes to Expired and no longer viewable from the holding/error queue. Expired prescriptions older than 15 months are deleted from the underlying database. Processed (Validated) eRx's are associated/linked with the resultant's CHCS prescription and are not deleted. Please see the CHCS Release notes, user guide and training slides for additional information on Validation, Removal and other business rules.

The DoD electronic prescribing intermediary (PDTS) will hold the electronic prescription and will retry to send the eRx to the MTF. When the retry attempts are unsuccessful, the eRx will be sent to the MTF as a fax, if configured, or returned to the civilian provider as undeliverable.

No, clinical screening (if available) on the civilian provider's electronic health record would occur prior to sending the electronic prescription to the ePrescribing network.

CHCS workload will be generated after the electronic prescription results in an actionable CHCS prescription (e.g. print labels, dispense, refill, etc.); this will follow standard CHCS business rules.

Guidance is to follow your MTF policies. The example presented would be similar to when an AHLTA or pharmacy entered prescriptions expires.

Any CHCS prescription may be viewed using the Prescription Inquiry (PRI) option. An indicator to the right of the order number identifies the prescription source. A prescription received as an eRx is identified with indicators of "(eRx SYS - Entered)" or "(eRx PHR - Entered)."

Electronic prescriptions may be printed via the holding/error queue Inquiry function prior to processing (Validated). The use of a specific printer that can be defined in the Outpatient Site parameters; different colored paper and scanning the printed eRx may be logical extensions depending on your pharmacy's policies, processes and workflow. Please see the CHCS Release notes, user guide, and training slides for additional information on PRI screen enhancements, holding queue actions, and other related functionality.

Provider information required for a legal prescription based on local, state and Federal rules, regulations and laws will be received. Generally, the civilian provider's EHR is configured to send the practice name, provider name, street address, city, state, zip code and phone number, as well as the provider's National Provider Identification (NPI) and/or Drug Enforcement Agency (DEA) number(s).

Retrieval of electronic prescriptions from a different holding queue may be dependent on current policies and practices for accessing pharmacy sites outside your MTF, Division, and Service.

No, the electronic prescribing solution utilizes a single queue that displays electronic prescriptions based on the selected status (i.e. Pending or Error).

The electronic prescribing solution contains business rules to alert users when a non-formulary or inpatient use only medication is selected. The CHCS Drug portion of the Validate screen displays a "NON-FORMULARY" or "INPATIENT ONLY" indicator. The business rules do not take into account a populated Inactive Date. The identification and maintenance of non-formulary medications listings in CHCS facilitate increased auto-creation and accurate alerts. Please see the CHCS Release notes, user guide, and training slides for additional information on drug auto-matching, holding queue actions and other related functionality.

Yes, the DHA Pharmacy Operations Division and Beneficiary Education and Support Division are working through the plans to notify and educate patients and providers when the electronic prescribing solution has been successfully activated by all MTFs in the United States.

An Enterprise formulary tool is available for use by the MTF pharmacies at no additional cost. The tool is currently provided through the Electronic Clinical Reference contract (LexiComp® is the current vendor).

For MTF pharmacies that current accept prescriptions from civilian providers, the minimum number is one, while the maximum is scalable to accommodate the business practices of each MTF. As with faxed prescriptions, ePrescribing enables the prescription to reach the pharmacy prior to the patient arriving; therefore allowing greater flexibility with how, when, and where to process.

The eRx business rules for patients are First/Last names, DOB, and gender. All these must match along with the one of the following identifiers; DoD ID, SSN, or street address. Once a patient is found, an indicator of "Match Found" will be displayed in the "Validate eRx Patient" screen. Please refer to the eRx User Guide for more information.

When an eRx has been Validated, the result is an actionable prescription and may be processed in the same manner as prescriptions received from AHLTA or entered by the pharmacy staff.

Within the electronic prescribing holding queue, the user selects one or more eRx's then selects inquiry from the action bar. At the device prompt, the appropriate printer name may be entered. If more than one eRx's has been selected, each eRx will be printed on a separate page when a device is specified. The eRx information will be displayed on the screen when a device was not specified. Please see training slides or the User Guide for additional information.

Users should follow local MTF policy for selecting the appropriate provider during the eRx provider validation process.

The eRx software is capable of receiving electronic prescriptions for non- formulary medications. If CHCS determines that an electronic prescription is for a non-formulary drug (which is determined by the formulary status in the CHCS Formulary Management [FRM] file), that prescription will be placed in the CHCS holding queue for pharmacy intervention. Commercially, civilian providers are able to select and transmit any medications within their Electronic Health Record (EHR). Please refer to your local MTF policies for processing non-formulary prescriptions.

A provider's EHR may have been configured to send the electronic prescription directly to your fax machine or your pharmacy may have been previously registered as a fax enabled pharmacy with the electronic prescribing network. Reaching out to the provider of a faxed prescription will allow for provider education on the availability and published name (DoD "pharmacy name" ePhcy) of your pharmacy to facilitate the transition. Please see the Implementation Guide, and provider and patient flyers for additional information on Provider Outreach.

All eRx will be in the holding queue; the user can look up a patient using different methods (please see the "search function" in the training materials. If the eRx does not appear in the holding queue, try checking the error queue. There are several reasons why an eRx maybe sent in this queue (please refer to the error queue section of the training material).

The prescription auto-creation process from an eRx was disabled on February 3, 2015.

CHCS does not currently have the capability to unvalidate a validated electronic prescription.  The validation process associates the electronic prescription to the actionable prescription and may be processed (edited, transferred, cancelled, etc.) in the same manner as prescriptions received from AHLTA or entered by the pharmacy staff.

No. There is not a limit on how many e-prescriptions can be received/stored in the holding queue. However, the holding queue will only display an e-prescription for up to 365 days from the date it was received. Once the e-prescription has passed the 1 year term, it will be automatically removed from the queue with its status updated to EXPIRED.

Changes may be requested by completing the MTF e-Pharmacy Demographic Change Request Form. For assistance completing this form or any other related information, e-mail the DHA PASS general mailbox or call the DHA PASS at 1-866-275-4732 / (210) 536-6650, press option 1.