1. SureScripts
The Basics

2. Terminology
Prescriber – Provider, Fellow, Resident, Nurse Practitioner, or Physician Assistant
Service Level – The level of e-prescribing capabilities a Prescriber or Pharmacy has.
SPI – SureScripts Prescriber ID (think of this as SureScripts’ version of a Prescriber’s NPI (National Provider ID).
PON – Prescriber Order Number. It is an VUMC internal reference number that represents a single prescription, which identifies the prescription, patient, provider, etc.
SureScripts Message ID – It is an external reference number used to track the e-Prescription.

3. Terminology, cont’d
E-Prescription – Computer-based electronic generation of a prescription.
E-Prescribe (or e-prescribing) – Computer-based transmission of a prescription between a prescriber and a pharmacy.
NewRx – Prescriptions e-prescribed from RxStar (This does not have any association with VUMC’s Renewal prescription policy.).
E-Renewal Request – A prescription request sent from a pharmacy to a provider with the intent of renewing the prescription.
E-Renewal Response – The prescriber’s response to the pharmacy’s e-Renewal Request (accepted, denied, etc.).

4. Terminology, cont’d
Synchronous Error – Real-time error response from SureScripts indicating that the e-Prescription was not received by the intended recipient, pharmacy or prescriber. Asynchronous Error – Delayed error response from SureScripts indicating that the e-Prescription was not received by the intended recipient, pharmacy or prescriber.

5. Prescriber registration
In order for a prescriber to e-prescribe, the prescriber must be registered with a Prescribing Vendor, in this case Vanderbilt’s Prescribing Vendor (RxStar/StarPanel).
To register a prescriber, we need the following information:
Prescriber Name
Prescriber Identifications
Clinic Name
Clinic Address
Clinic Phone Number
Clinic Fax Number
The prescriber must also be credentialed and active within the VISTAR (Providers, NPs, PAs, and Fellows) or GME (Residents and Fellows) database.

6. Prescriber Registration, cont’d
Currently, a prescriber can have one of three Service Levels:
0 – Disabled: Prescriber cannot e-prescribe.
1 – NewRx: Prescriber can only e-prescribe from RxStar.
3 – NewRx & Renewal: Prescriber can e-prescribe from RxStar and receive/response to e-Renewal Requests from pharmacies.
Prescribers can determine their e-prescribing level by looking in the top-right corner of RxStar.
Admins can also see a prescriber’s Service Level within the RxStar Admin Console.

7. Pharmacy Registration
Once a pharmacy certifies and completes the registration process, the pharmacy/vendor will have similar registration Service Levels:
0 – Disabled: Pharmacy cannot accept or send e-prescriptions.
1 – NewRx: Pharmacy can only receive NewRx e-prescriptions.
3 – NewRx & Renewal: Pharmacy can receive NewRx e-prescriptions and send/receive e-renewal Requests/Responses.

8. E-Prescriptions
In order to send/receive e-prescriptions the following must occur:
Prescriber has a Service Level which supports sending and/or receiving e-prescriptions (e.g. Level 1 or Level 3).
Pharmacy has a Service Level which supports sending and/or receiving e-prescriptions (e.g Level 1 or Level 3).
E-Prescription qualifies for e-prescribing (i.e. transmitting/e-prescribing the prescription). – See next slide.
If all of the above conditions are met, then the prescriber can e-prescribe the prescription.

9. Qualified E-Prescription Details
Drug Name – Coded/Structured using FDB (First DataBank), our medication database.
Directions – Coded/Structured or Free Text sig; cannot exceed 140 characters.
Dispense Amount/Unit – Coded/Structured
Refill Count – 0-12 refills
Substitution – Allow substitution or dispense as written
Written Date – Date prescribed
Note (optional) – Currently, concatenates from several fields; cannot exceed 210 characters.
Member ID
Special Instructions
Pharmacy Comments
Dose Calculation (Preference Setting)

10. Troubleshooting E-prescriptions
Start with the RxSummary
Confirm that the prescription was e-prescribed (submitted electronically).
Some users will report an issue with e-prescribing, when they actually faxed the prescription.
Next, use the e-Prescription Dashboard to confirm e-prescription state.
“Accepted and verified by ultimate receiver” indicates the pharmacy received the e-prescription.

11. Troubleshooting e-prescriptions, cont’d
“Accepted and pending by receiver; free standing error still possible” indicates the pharmacy has not verified receipt of the e-prescription and an Asynchronous Error is still possible. (Note: Currently, pharmacies are not required to VERIFY receipt of the e-prescription).
Each e-prescription has a unique SureScripts Message ID. When reporting a Help Desk ticket for e-prescriptions, please include the MRN for RxStar-related troubleshooting and the SureScripts Message ID for e-prescription routing troubleshooting (e.g. The pharmacy said they didn’t receive the e-prescription.).

12. questions