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The "I Can't Believe There's No Abortion Thread" Part Deux: Electric Boogaloo

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  • Originally posted by Deutsche Gopher Fan View Post
    I don’t know enough about any of this to be dangerous. But I do know that many insurance companies, esp my former employer, can make it a nightmare to get 90 day supply of certain drugs
    Yeah, 90-day supplies basically error out on the CVS website. "LOL YOU WANT WHAT?"
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    College Hockey 6       College Football 0
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    Originally posted by SanTropez
    May your paint thinner run dry and the fleas of a thousand camels infest your dead deer.
    Originally posted by bigblue_dl
    I don't even know how to classify magic vagina smoke babies..
    Originally posted by Kepler
    When the giraffes start building radio telescopes they can join too.
    He's probably going to be a superstar but that man has more baggage than North West

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    • Originally posted by dxmnkd316 View Post

      That's not what I'm saying.

      If I have an eScript, they get sent first to the pharmacy and put on hold. Once on hold, I can call them up and request one of them be filled. If they don't have it, I have to sent a MyChart message to my doctor (you can't call anymore) and ask to have that eScript cancelled and sent to a new pharmacy. In the time it takes for me to send that message, have her write a new script, and the pharmacy receive it is usually a 12- to 24-hour process. In the time it takes that system to turn around, the pharmacy could be out of that medicine. Wash rinse repeat.
      When I do an eVisit via MyChart, it specifically says "Do not ask for refills. Call your pharmacy first." So it's not like I can just call around every month and then call my doctor and say send it to HyVee this month.

      If I had a paper script, I could walk into target and say, do you have this? No? I can drive to Hy-Vee and check there. Or I could call and drop it off. No bouncing back and forth. That's entirely the fault of the system and the legislatures forcing the system on everyone.

      Obviously this is a situation where shortages are straining a system, but it's not like this isn't common. There's a massive shortage! It's very common!
      I guess I'm still unclear on the situation. So the office won't let you call them? They have phones, right? Then you can call them. The turn around time might be even longer though.

      Again, the situation is related to the frustrating lack of supply. I get that if you had a paper script you could walk up and say "hey do you have this now" or call and say "do you have this" and if so, just go straight there. And in that case, I guess yeah it's a bit frustrating. But considering for like 99.99999999999% of prescriptions it improves speed and reliability - while helping reduce abuse of controlled substances in most states - I think your situation is annoying as hell but certainly not an exhibit as to why eprescribing in general is bad.



      Counter example. In our new Epic system we're currently developing, I'll be able to refill prescriptions by logging in, clicking "refill". And 3-4 days later the inhaler shows up in the mail. This will be true because I'll use our internal pharmacy and commercial pharmacy customers would have a slightly longer lead time, but there are a lot of me. And even for CVS customers, we'd probably direct them to CVS directly and cut out the middle man entirely.


      Plus, again on the opioid epidemic. ED provider thinks a patient needs a painkiller. Gets the order queued up for CVS. Checks the PDMP and see the patient is on a **** TON of it through multiple providers. Cancels the order and follows their doctor shopping policy and works on addiction treatment instead of "here's your script" and out the door.
      I gotta little bit of smoke and a whole lotta wine...

      Comment


      • Originally posted by dxmnkd316 View Post

        Yeah, 90-day supplies basically error out on the CVS website. "LOL YOU WANT WHAT?"
        Again, to the contrary. Depending on your insurance, it may be cheaper to have a 90 day supply than a 30. The Flovent I was on until last summer when my insurance decided they knew better than my doctor and stopped covering it was $40 for a 90 day supply or $120 for a 30 day supply. Not even exaggerating. (Now I use our internal pharmacy and my copay is $5 for 30 days)
        I gotta little bit of smoke and a whole lotta wine...

        Comment


        • Originally posted by Swansong View Post
          I am utterly baffled by that. It's the easiest thing in the world. Push a few buttons, go pick it up at the pharmacy (or they mail it to you). I used to maintain the Surescripts interface. It just... worked.
          Chiming in because I started with all paper, then worked with a choice and then was forced to go all Escript.

          Paper the flow was simple- Discuss with the pt as you wrote the scripts. The pt saw what was written. They could bring to diff pharmacies if needed. Often the pharmacies would have loss leaders so they could save boatloads of money. If I had a really sick pt I could call the pharmacist, speak to a real person, ask availability and they would make it up so the pt didn't have to wait while feeling awful. Also if the pt had transportation issues I could call ahead so they could have it ready. (this was really imp for young Mums who took the bus or got a ride that was time sensitive

          Choice of paper or EHR- OK. Could still give written scripts so the pt had a choice. They could present the script to pharmacy- often the paper was faster than it having to route thru the system, queue and wait until the set time that the tech pulled it off the system

          Required EHR- Increased the time pts had to wait by hours (not an exaggeration- some places it was 3+ hrs and in a few next day). Penalized if we didn't use the system- they withheld increasing amts of our withhold if we gave paper and by the time I left there was a lifetime penalty imposed by BCBS if I went over a certain percent of paper scripts. Unable to give a VO (verbal order). No way of bypassing the wait for the pts who were in need. THere was no fast track. Pharmacies cleared orders on the hour. That meant if I submitted a script at 1:05 then they had to wait a full hour before it was taken off and then more time for it to be filled.

          Often system has triggers that slow the process. Pt has Pen allergy. Prescribe Keflex- 2% cross allergy= they call hours later to ask did I know this? Am I sure. Yes, I fvcking am. Now the pt is 5 hrs without the antibx, still waiting.

          If the pt had some RF that were from LT pharm and others going to local one that meant opening and closing things to get it to capture reliably. I cannot begin to list all the people I know who have issues with the scripts for acute illness being sent to LT pharm because the system can't handle switching back and forth. Error often doesn't get identified until after office is closed because people are so used to waiting hours before being able to pick up.

          Push a few buttons? HAHAHAHAHA!
          Write a script- Staff jots a note asking for RF and notes last appt, next appt. Quick sift thru the written chart to do review of last notes or anything else that has happened since last RF- less than a minute because they are all visible and can be skimmed--> write OK to RF with instructions. Jot a quick note to staff saying it is ready or call it in. I could do 20+ RF in less than 15 minutes.

          Renewal via EHR- message asking for RF--> open multiple windows to review last notes, messages, other interactions- when was last script, last appts, insurance coverage (changes depending on time of yr). Open up med, click buttons to OK med, amount, RF. Open up another window to send message to either pt or staff. Each bit of info takes time to load, no matter how fast they load it is still way more steps and you are at the mercy of how things were entered.

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          • Sc will now be hearing two more abortion cases this term

            goody

            just start the gulags now to murder women

            Comment


            • I have a niece in Austin. I hope to God she moves if she ever decides to get pregnant.

              I no longer recognize the Country of my birth.

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              • Les, we're just never going to see eye to eye on this. Literally millions of good healthcare providers (from MDs to nurses aids) disagree and find EHRs to be incredibly beneficial, not to mention patients. I'm not sure when the last time you used an EHR, but what you're describing hasn't been a reality for many years.

                Pining for a paper process is literally - literally - doing what the right wing neanderthals are doing with their pathetic wishing for "the good ol days". We aren't going back and we shouldn't, because the benefits far outweigh the losses. And not for nothing, but it's because of this absurdly strong refusal to embrace the modern that we're finally, in the 2020s, going through the same growing pains that every other industry went through in the 90's and 00's.


                And yes. Approve an RX request is quite literally as easy as a few clicks. Look in your request folder. Click one. See what it is. If you want more info, click the report - that's right there in the message - to tell you the med list and allergies and contraindications. Or click another button to see the entire chart. And then click "approve". Or "refuse" and route the message to your medical assistant to follow up.


                Or.... someone pulls the refill request fax off the machine and gives it to a nurse, who gives it to the correct doctor, who then needs to go find the record on the shelf, dig through, decide to approve (maybe), tell the admin who needs to call the pharmacy or fax it back. Yeah, totes easier! It used to take me days when my script ran out before CVS would have the new one and I could go pick it up. Now, with my PCP (who uses the EHR I work on), that yearly renewal is done in the same day, and I can pick it up at CVS that day or the next*.




                *as of January it's a few extra days because my new pharmacy mails it, because I don't want to drive to Dedham.
                I gotta little bit of smoke and a whole lotta wine...

                Comment


                • Originally posted by leswp1 View Post
                  I have a niece in Austin. I hope to God she moves if she ever decides to get pregnant.

                  I no longer recognize the Country of my birth.
                  I can't understand how any woman with an education past the 4th grade could continue to live in the slave states.
                  Cornell University
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                  • Swan, I won't disagree that eScripts probably save time for most prescriptions. But I'll also add this isn't a rare script. It's been in the top probably 25-30 for decades.

                    It creates a real farking mess when it's stressed like with the shortages we're seeing now. And shouldn't even use the word "now" because this is like year two of crisis level shortages and like year five or six of regional shortages. The system and our laws need to do better. Because this isn't just a patient care issue, it's a massive cost to everyone.

                    Generally I find electronic records to be a good thing. But in this instance they are making things worse
                    Code:
                    As of 9/21/10:         As of 9/13/10:
                    College Hockey 6       College Football 0
                    BTHC 4                 WCHA FC:  1
                    Originally posted by SanTropez
                    May your paint thinner run dry and the fleas of a thousand camels infest your dead deer.
                    Originally posted by bigblue_dl
                    I don't even know how to classify magic vagina smoke babies..
                    Originally posted by Kepler
                    When the giraffes start building radio telescopes they can join too.
                    He's probably going to be a superstar but that man has more baggage than North West

                    Comment


                    • Originally posted by dxmnkd316 View Post
                      Swan, I won't disagree that eScripts probably save time for most prescriptions. But I'll also add this isn't a rare script. It's been in the top probably 25-30 for decades.

                      It creates a real farking mess when it's stressed like with the shortages we're seeing now. And shouldn't even use the word "now" because this is like year two of crisis level shortages and like year five or six of regional shortages. The system and our laws need to do better. Because this isn't just a patient care issue, it's a massive cost to everyone.

                      Generally I find electronic records to be a good thing. But in this instance they are making things worse
                      I hear that, but lay the blame where it belongs then, which is on the manufacturer. You said yourself that you had to do almost all the leg work anyway.


                      Also - depending on the policy of your provider's company - they can print scripts anyway. If they use Epic, they just set to Order Mode to "Print" and it'll print. This is used in EDs very regularly, for patients that aren't sure where they will fill a script (or homeless patients, or whatever).
                      I gotta little bit of smoke and a whole lotta wine...

                      Comment


                      • Anyway. abortion. Should be legal in almost all circumstances. And f these fascists.
                        I gotta little bit of smoke and a whole lotta wine...

                        Comment


                        • Driving through rural Michigan, the signs are some unholy blend of:

                          Anti-Abortion
                          MAGA
                          You need Jesus/Bible verse out of context
                          Seed and Feed 1 mile ahead
                          Weed 3 miles ahead
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                          • Originally posted by MissThundercat View Post
                            Driving through rural Michigan, the signs are some unholy blend of:

                            Anti-Abortion
                            MAGA
                            You need Jesus/Bible verse out of context
                            Seed and Feed 1 mile ahead
                            Weed 3 miles ahead
                            Drove through Branch Township on the way to Ludington last weekend, past Stephen Lee's "Trumpland" masterpiece.

                            Comment


                            • Originally posted by MissThundercat View Post
                              Driving through rural Michigan, the signs are some unholy blend of:

                              Anti-Abortion
                              MAGA
                              You need Jesus/Bible verse out of context
                              Seed and Feed 1 mile ahead
                              Weed 3 miles ahead
                              No "US out of UN"?

                              Pretty much every rural area, unless there's university there. Voltaire wrote about "la betise de la campagne" in the 1720s and nothing has changed in 300 years.


                              Last edited by Kepler; 01-06-2024, 04:42 PM.
                              Cornell University
                              National Champion 1967, 1970
                              ECAC Champion 1967, 1968, 1969, 1970, 1973, 1980, 1986, 1996, 1997, 2003, 2005, 2010
                              Ivy League Champion 1966, 1967, 1968, 1969, 1970, 1971, 1972, 1973, 1977, 1978, 1983, 1984, 1985, 1996, 1997, 2002, 2003, 2004, 2005, 2012, 2014, 2018, 2019, 2020

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                              • Idaho won’t even allow abortion for an ectopic pregnancy. Beyond bonkers

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