1. CPRS Version 29: New Functionalities

2. Three Main Features
Adds Mental Health Treatment Coordinator (MHTC) to the Header Bar
Problem list uses SNOMED terminology rather than ICD-9
Allows appropriately credentialed providers to prescribe controlled substances via CPRS

3. 1. Mental Health Treatment Coordinator (MHTC)
MHTC staff added to:
Patient Inquiry button Primary Care button

4. 2. Problem List Change – SNOMED Terms Used
SNOMED-CT: Systemized Nomenclature of Medicine-Clinical Terms
A comprehensive clinical terminology
One of the designated standards for the electronic exchange of clinical health information
Being implemented internationally within the IHTSDO member countries (International Health Terminology Standards Development Organization)

5. SNOMED Terminology Search will display both SNOMED and ICD-9
ICD-9 will display for previously entered problems no need for change. New problems will display SNOMED. Details will display ICD-9.

6. 3. Ordering Outpatient Controlled Substances
NEW FEATURES
Opt – Can order Schedule 2-5 thru CPRS
Opt - Requires e-Sig (same as before)
Opt - Requires PIV card w/PIN number
Opt - Requires valid current DEA # OR valid VA #
Opt - Requires valid Detox/Maintenance ID# for
Suboxone ordering
Inpt - can order Schedule 2-5 meds (same as before)
Inpt – Discharge Meds require e-Sig & PIV (Opt)

7. Authentication
CPRS system must authenticate the Prescriber’s credentials on a hard token (Smart Card or PIV Card)
CPRS must display a mandatory message with DEA-required intent language that the Prescriber must consent to.
Only after the Prescriber consents to the DEA-required wording can the prescription transmit to VA Pharmacy.

8. Smart Card
The Smart Card to be used for the DEA e-Prescribing is the VA-wide PIV Card.
Entry of the PIN satisfies the two-factor authentication required by the DEA (Signature code plus PIN number)

9. Writing and Signing a Controlled Substances Order

10. Sample Schedule II-III Drugs:
Schedule II Drugs Schedule III Drugs
Acetaminophen/Oxycodone Acetaminophen/Codeine
Amphetamine Acetaminophen/Hydrocodone
Cocaine Aspirin/butalbital/Caffeine
Codeine Buprenorphine/Naloxone
Fentanyl Methyltestosterone
Hydromorphone Opium Tincture (Paregoric)
Meperidine Testosterone
Methadone Thiopental
Methylphenidate
Morphine
Oxycodone

11. Sample Schedule IV-V Drugs
Schedule IV Drugs Schedule V Drugs
Alprazolam Atropine/Dipheoxylate
Chloral Hydrate Ephedrine
Chlordiazepoxide Codeine/Guaifenesin Syrup
Clonazepam Acetaminophen/Codeine Syrup
Diazepam
Lorazepam
Meprobamate
Midazolam
Modafinil
Naloxone/Pentazocine
Phenobarbital

12. New Validation Change No DEA# and no VA# assigned
Error message will be specific to the drug schedule

13. The first time you place a CS order, you will see this screen to sync your PKI (PIV card):
Click “Yes”
Click “OK”

14. Signature Display Changes
Non CS Meds appear here.
Controlled Substances appear here.

15. Attestation Statement
Click box next to CS Attestation statement and SMART card required will appear.

16. Smart Card Not Inserted
Only if you never put in the Smart Card and properly sign

17. Enter PIN to Complete Process

18. IMPORTANT! CPRS will still not allow you to sign the order:
… if the provider has a current, valid DEA# or VA#. If the problem is the PIV card:
Do NOT call pharmacy to fix. They cannot help.
Contact your service ADPAC or PIV Sponsor for assistance.
If you cannot remember your PIN number for your PIV card, contact PIV Office. After hours, contact the AOD or VA Police to reset.
PIV Card Renewals:
Contact the PIV Office at least TWO months prior to your PIV card expiring so they can re-issue.
Make sure they request a RENEWAL on your card and NOT a NEW card so your current card remains ACTIVE.

19. If the chart will not allow you to sign the order:
Have another provider enter orders for your patient and sign.
You may deliver a handwritten paper script to Pharmacy for filling. This method is only to be used if all other resolution attempts have failed.

20. Notification / Alert Changes

21. Notifications DEA AUTO DC CS MED ORDER
Message Text: “Med order(s) DC’d. Resubmit or contact Pharmacy.”
Trigger : Triggered by Outpatient Pharmacy when the contents of a controlled substance med order does not match those that are processed by pharmacy (e.g., patient address changed)

22. Notifications DEA CERTIFICATE REVOKED
Message Text: “Med order(s) DC'd. Cert revoked. Contact Pharm.”
Trigger: Triggered by Outpatient Pharmacy when the prescriber's PKI certificate is revoked after the order is submitted in CPRS, but prior to Pharmacy processing the order

23. Notifications DEA CERTIFICATE EXPIRED
Message Text: “DEA certificate expired. Renew your certificate.”
Trigger: Triggered by Outpatient Pharmacy when the prescriber's PKI certificate expires after the order is submitted in CPRS, but prior to Pharmacy processing the order.

24. Notifications

25. Reason for DC on Orders tab:

26. Reason for DC on Order Details: