Getting Started with Epic: Document a Refill Encounter

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• Follow this path: Epic > Patient Care > Refill Medication or select from the Toolbar.
• The Search for a Patient window opens:

1. Search for the patient using Name/MRN, to filter the results add Birth date and/or Zip Code.

2. Use the Recent Patients tab to find a patient that was recently accessed.

3. Click Find Patient.

4. From the Patient Encounter Selection screen click to Create an Encounter.

5. Click Accept.

• The Patient Encounter Creation screen will open:

6. Enter the Provider name.

7. Click Accept.

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• The Refill encounter will open to the Call Intake screen.
• Here the user will have access to Chart Review to see historical information for the patient and a Take Action tab for the provider to update other items that may be necessary.

1. From the Contacts section click to enter if this is an Incoming Call, Outgoing Call or Other call.
2. Enter the name of the person calling or being called, relationship, and phone number.
3. Click Accept.
   • ​​​​​​​Click the speed buttons in the contacts section to quickly pull in information from the patient's chart, such as the patient’s name and phone number.​​​​​​​
   • The Contact Comments is not the place to document the telephone call. It is used to add comments regarding patient preferences and restrictions when calling, such as “Only call cell phone number on file between hours of 12:00pm and 3:00pm”.

4. The Reason for Call is automatically added as Prescription Refill Request and the date.

5. The Note for the call can be opened on the right sidebar.

6. When complete click Accept.

• To view Detailed Encounter Information:

7. Click This Call tab.

8. From Detailed Encounter Info click the chevron (double arrow icon) to display this section.

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1. Enter a Name, Address, City, State, or ZIP to search for a Pharmacy.

2. Click the box to bring up search results near the Patient and clinic’s Zip codes.

3. Check any filters to Filter Search Results.

4. Click Search.

5. The search will provide Insurance suggested mail-order pharmacy results that are geographically near the patient’s primary address location.

6. Click to select the appropriate pharmacy.

7. Click Accept.

• The Insurance Suggested Mail-Order Pharmacy banner flag will appear on the recommended pharmacy search options when managing the patient’s pharmacy from Haiku.

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• From within a Refill Request encounter, or an existing clinical encounter, users can reorder medication following the below steps.

1. Open the Med Management section.

2. Click the Pharmacy hyperlink to e-prescribe, if no pharmacy has been attached click the Select pharmacy hyperlink.

3. From the medication list, click the circular arrow icon for the medication needing to be Reordered.

4. The pencil icon will open the Medication Details for any editing that may need to be done.

5. Click the lightning bolt icon opens to Adjust Sig.

6. The X icon will discontinue medication.

7. The medication will appear in the righthand Sidebar under the Orders tab.

8. Click the medication to open the order.

9. Complete any required fields for the prescription.

10. Search for diagnosis and select Add.

11. After all required fields are completed, click Accept.

12. Mark the medication as Approve All for the pharmacy.

13. A user with prescribing privileges can click SIGN ORDERS.

14. Support staff can click PEND for a provider to sign later.

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• The Adjust Sig feature is found in the Medication Management navigator section, allowing users to quickly make simple changes to parts of a medication's sig.
• When users modify order details using Adjust Sig, the original order is discontinued behind the scenes and a new order with the added details is created.

• The following details can be updated using Adjust Sig:

  • Medication Dose

  • Frequency

  • Duration

  • End Date

  • Dispense Quantity

  • Number of Refills

  • Admin Instructions

• From the Medication Management section.

1. Click Adjust Sig.

2. The Adjust Sig window will appear.

3. Change any necessary information.

4. Click Sign.

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• To route a pending request from an encounter:

1. Open the Routing section.

2. Select the PCP from the Care Team button or begin typing the provider’s name.

3. Click the Close Workspace button. An Rx Request In Basket message will be sent to the PCP with pended medications for approval or denial.

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• Providers can respond to approve, refuse, or edit refill requests – sent by patients via MyChart or other Epic users – directly from within In Basket.
• From a provider’s In Basket:

1. Click on the Rx Request folder.

2. Click on a message to preview the request.

3. Patient’s request opens in the preview window.

• A Refill Protocol lists criteria about the medication and the patient. If all criteria are true, then the protocol passes. Failed criteria indicate problems that should be addressed before the refill is approved.

• If there were any signed, pended, or refused orders for the same medication in the past two weeks, it would display within the In Basket message.

4. When a provider clicks  Approve As Requested:

• The refill order is automatically signed.
• The telephone encounter is closed.
• The message is marked as Done.
• The sender is sent an Rx Response In Basket message

5. When provider clicks Refuse: Appt Req, Refuse: Dup Req, Refuse: Refill’s on Rec

• The Refusal Reason screen appears.
• The order is not signed.
• The message is marked as Done.
• The sender is sent an Rx Response In Basket message

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• Respond to routine Rx Request messages in a few clicks using QuickActions. For example, create a QuickAction that refuses a request, indicates that the patient needs an appointment, files a note to the chart, and removes the associated message from In Basket.

1. On the In Basket toolbar, click the arrow to the right of the Manage QuickActions button.
2. Select Rx Request Sign or Rx Request Refuse.

3. The Rx Request QuickAction Editor window opens:

a. Enter a brief name for QuickAction Name field.

b. To have a chance to edit a response before it is sent, tick the Show before filing? check box.

c. To automatically close the refill encounter after sending a response, tick the Close encounter after filing? check box. This option is helpful if no additional follow-up with the patient is necessary.

d. For approvals, select the number of refills to approve. Select As requested to approve all refills or select Other and enter the number of refills to sign.

e. In the Note field, optionally write a note that will be filed in the patient's chart. Any SmartLinks used are personalized for the patient when running this QuickAction.

f. In the Routing section, select from My List, PCP, or Sender to select a recipient such as the person who sent the request.

g. In the Routing comments field, enter any comments to appear in the Rx Response message that is automatically sent to a nurse pool.

h. Click Accept.

• A new QuickAction button will appear on the report toolbar in the Rx Request message folder.

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• When a physician is reordering medications that have an existing pended reorder from an external pharmacy, they can discard the previous pended reorder and continue reordering, just as they can for orders that did not come from an external pharmacy. When users discard reorders from an external pharmacy, they must enter a refusal reason in the form that opens, which sends the refusal reason to the external pharmacy.
• From Med Management:

1. The Existing Modification window pops up with three button options: Keep Previous and Resume Reordering, Discard Previous and Resume Ordering, and Cancel when an external/internal refill request is pending in the RX Refill In Basket folder.

2. When a user selects Discard Previous and Keep Previous and Resume Reordering button the Refusal Reason window opens, select the appropriate reason.

3. Click Accept.

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