Clinicians

Prescribing

Drug search, the CDS alerts you must answer, controlled substances and EPCS, and what "Sign & transmit" actually does.

8 min · Clinicians · lesson v1

Prescribing lives in the patient's chart, not in the staged visit: the button is ℞ Prescribe (e-Rx + CDS).

The form

  1. New prescription opens with:

    • Favorites: — practice presets shown as ★ [name]; the tooltip is honest about what they do: prefills the form; you still review CDS and sign
    • Medication (RxNorm) with the search box search drug…; results show the code in monospace beside the drug name
    • Sig (directions) — e.g. 1 tablet by mouth daily
    • Controlled substance (requires EPCS authenticator code) — a checkbox
    • Urgency (optional)
    • Pharmacy

    Screenshot pending capture

The pharmacy label changes to tell you what it is doing: · finding nearby… while it asks for location, then · nearest first. Options read like CVS Main St — 1.2 mi (EPCS) — the (EPCS) suffix marks pharmacies that can accept controlled prescriptions electronically.

The alerts

  1. Clinical decision support runs as you pick the drug. Alerts appear as [severity] title with a category, the detail, and the evidence behind it.

    Four severities: contraindicated (red), high, moderate, info.

    Anything above info reveals a required field: Override reason (required — CDS alert present), placeholder clinical rationale to proceed.

    Screenshot pending capture

Controlled substances

Ticking Controlled substance reveals EPCS authenticator code (TOTP).

Sending it

Sign & transmit becomes Transmitting…, then you get ✓ Transmitted to [pharmacy] ([message id]).

The button stays disabled while any of these is missing: the sig, the pharmacy, an override reason when an alert above info is showing, or the EPCS code on a controlled substance.

What usually goes wrong

Using a favorite as a shortcut past the alerts. The tooltip says it: you still review CDS and sign.

Typing "patient tolerates" as an override reason. It becomes part of a permanent record that you prescribed against a flagged contraindication. Write the actual clinical reasoning.

Assuming a controlled prescription went out. It didn't. Confirm what your practice's real path for controlled substances is before you rely on this.

Picking a pharmacy without checking (EPCS). For a controlled prescription, a pharmacy that can't accept it electronically is a wasted trip for the patient.

Check yourself

No score, no account — just make sure you can answer these before you move on.

  1. A red [contraindicated] alert appears — a documented allergy. Does the software stop you?

    Show the answer

    No. It shows ⚠ A contraindication is present (e.g. documented allergy). Proceed only with explicit clinical justification. and requires an override reason, but Sign & transmit is not disabled. The decision is left with the clinician, and the reason you type becomes part of the record.

  2. What makes Sign & transmit stay greyed out?

    Show the answer

    A missing sig, a missing pharmacy, a missing override reason when an alert above info is present, or a missing EPCS code on a controlled substance. Notably a contraindication alone does not disable it.

  3. You ticked Controlled substance and entered a TOTP code. Is that a compliant EPCS prescription?

    Show the answer

    Not in this build. Real EPCS needs DEA identity proofing, a certified two-factor ceremony through the e-prescribing vendor, and a third-party audit. The code field here is a synthetic stand-in so the workflow can be learned — controlled prescriptions are hard-gated from real transmission.