Prescribing Security
Prescribing Security
“Pearls”Italic text
This document is designed to detail the different Medication Prescribing Security functions within V11 Allscripts Enterprise EHR (formerly TouchWorks EHR)
Security can be set at the Medication Schedule level, the Security Classification level and at the User level.
Medication (Meds) Preferences:
Preference Name: Non-scheduled Meds Order Authorization Request
This Preference determines if/when authorization is required when prescribing Non-scheduled Medications.
Choices are:
1. Prospective - meaning that authorization is required before the order can be processed (become Active in the system). Once a non-authorized user has entered the Rx information the System will generate and send an Authorize Order task to the Provider the user has entered as the Ordering Provider. The prescription will remain in a Status of “Needs Authorization” until the Provider authorizes the order. It will not be sent or printed until authorized.
2. Retrospective - meaning that authorization is required after the order is processed. The system will create and task the Ordering Provider that was entered by the user in the Rx as the Ordering Provider. The Rx is Active at the time the user submits and will be sent immediately. The task to the physician is an alert so to speak of what was sent and requires that the Provider sign noting he has seen the information.
3. Not Required - authorization is not required.
Preference Name: Schedule II Meds Order Authorization Required or Schedule III to V Meds Order Authorization Required
These are 2 individual preferences and determines if/when authorization is required for Schedule II or III to V medications.
The settings are: Prospective | Retrospective | Not Required and the behavior for setting is as noted above for Nonscheduled MedsOrderAuthorization
Security Codes:
These codes can be assigned to the individual user or an entire group of users
Security Code Name: Med Order Protocol
This security allows users (not user/providers) to specify “By Protocol” when completing an Rx order. This will allow users with this code to order non-scheduled and scheduled II drugs WITHOUT sending an “Authorize Order” task to the prescribing Physician. Users who have this security will have an additional field on their Rx Order entry screen where they click the drop down and choose the setting that reads: Per Protocol
The system then sends the Ordered By: Provider a Retrospective task, alerting that the Rx has been completed. *Be very careful with this one. While this can be monitored (after the fact), this setting basically allows the user (an unlicensed user) to prescribe and print any Rx.
Also, there is often much confusion about the Security Code: Can Prescribe
This code does nothing more than grant the user access to the New Rx screen. If that user does not have a License and/or the above noted Security Codes, having Can Prescribe will not allow that user to truly “Prescribe”. Think of this security code as the equivalent of giving a nurse a blank prescription pad and allowing her to write out the prescriptions for the Physician for him to sign. She can write prescriptions on this pad all day long, but until the physician signs them they are not a legal prescription. This code is for the user who be completing all the prescription details within TouchWorks, but will be sending the completed Rx order to the physician to authorize.
Security at the User Level:
In the actual individual User set up the following is the case:
If the user type is a User/Provider and they have a current License and DEA entered in the system they will, by default, have Full Prescribing Security. It is the documenting of this License information that allows this security. This is important to note as it pertains to PA’s, NP, and Residents. They are Licensed Providers, a license will be entered into the system, but you may not want them to have the same Full Prescribing Authority of a Physician.
Within TouchWorks you can limit these individuals at the DEA level. Perhaps they have no DEA and therefore the system will only allow them to Prescribe without authorization or supervision those medications that do not require a DEA.
You can further limit their prescribing ability by checking the box in their specific User Details that reads: Rx Supervision Required. A User/Provider with this noted will be required to select a “Supervised By” Provider when completing the Rx order entry screen. The system will then send the noted Supervised By: Provider a Retrospective Task. Again, the Rx will be active, the physician is not authorizing the Rx prior to it actually being completed, but is signing off after the fact.
Also note the following fields are also displayed on the Rx Order Entry screen: Ordered By – who is ordering the medication
Managed By –select the provider who is primarily responsible for managing the patient’s care now or in the future
Supervised By – the Provider selected by the User/Provider who requires Rx Supervision
Example of what the different roles will display:
For the Nurse with Can Prescribe security only...the Medication Order Entry box will display both Order By and Managed By fields Blank and highlighted in Yellow. The nurse must choose an Ordered By: Provider and when he/she does this the system automatically defaults this same Providers name into the Managed by field and sends this Provider a task to Authorize the prescription order.
For the Resident who has a License on file and Rx Supervision Required...the Medication Order Entry box will display and default the Residents name into both the Ordered By: and Managed By: fields. (in most cases the Resident leaves their name in the Ordered By: field, but changes the Managed By: to the physician who is primarily responsible for the patient. Also note, The Supervised By: field will default the name of the Supervised By: provider last entered by that Resident. This can be helpful for those residents who work with one physician one day and another one the next. They only need enter the name once that day.