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The New Year Ushered in a New SCRIPT for E-Prescribing

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SCRIPT — which is capitalized but isn’t an acronym — is the backbone of nationwide electronic prescribing. It is a standardized set of data elements, codes and transactions developed and maintained by the members of the National Council for Prescription Drug Programs, or NCPDP. 

Today, 85% of prescriptions are electronically prescribed in this country. Periodically, the standard receives a major update based on feedback from prescribers and pharmacies that requires coordinated changes in every EHR and pharmacy system.  

On Jan. 1, 2020, the industry adopted its first update in almost seven years by moving to NCPDP SCRIPT Version 2017071, and this standard is expected to be fully implemented by the end of 2020.

This latest version of SCRIPT (an update to v10.6) includes important functionality and transactions identified by the industry as vital enhancements in improving patient safety, clinical communications, and administrative efficiencies for physician practices and pharmacies. All told, SCRIPT Version 2017071 makes hundreds of improvements to the e-prescribing process, all of which will better the overall e-prescribing experience for physicians, pharmacists, and patients. 

Let’s take a look at some of the most significant changes to the new SCRIPT standard: 

  1. Larger signature field: One element of electronic prescriptions that has been problematic for prescribers over the years is the sig, or patient instructions, field. All previous versions of SCRIPT have limited the length of this field to 140 characters, which in many cases was insufficient for prescribers to express their instructions to patients as they wished. To address this, the sig field has been expanded to 1,000 characters. 
  2. Do not fill: Prescribers may now indicate that the prescription should not be filled because it is a cover prescription for a previously called in emergency prescription or should be kept on file until the patient requests it.
  3. Prohibit refill requests & follow-up prescriber information: Prescribers may indicate that they do not want to receive renewal requests (such as in the case of emergency rooms or urgent care) and/or they can designate an alternate prescriber for follow up.
  4. Ability to send discrete ingredients in compounds: EHRs will be able to specify up to 25 discrete ingredients and the quantity of each ingredient for a compounded medication.

As part of the SCRIPT upgrade, most EHRs and pharmacy systems are further adopting three new ways to communicate important prescription changes: CancelRx, RxChange, and NewRxRequest. Ensuring that a prescription has been canceled has historically been a major patient safety concern. With CancelRx, prescribers can cancel a sent prescription electronically. When a prescriber discontinues a medication in their EHR system, CancelRx sends an electronic message to the pharmacy. Prescribers can also enter notes within the message giving the pharmacist more information in order to communicate additional elements about the patient’s care. 

Additionally, there are multiple reasons why a pharmacist may need to clarify or share additional information about a patient’s prescription, such as for a possible therapeutic substitution or the need for a prior authorization. RxChange, which is expected to be rapidly adopted by pharmacies throughout 2020, is an electronic message initiated by the pharmacist that can convey such change recommendations, and prescribers can choose to approve or deny the request in the EHR. 

NewRxRequest is a new message designed to eliminate the need for a phone call or fax for common situations where a pharmacist needs to request a new prescription. This message allows a pharmacist to request prescription upon the expiration of a prescription or at a patient's request which can then be approved or denied within the prescriber’s EHR. As this is the newest SCRIPT transaction, we are expecting to see early adoption in the latter portion of 2020.

All in all, NCPDP SCRIPT Version 2017071 modernizes e-prescribing to improve patient safety and prescription accuracy, eliminates many faxes and phone calls, and supports a better experiences for prescribers, pharmacists and patients. 

To learn more, talk to your EHR vendor to understand how these new capabilities are incorporated into your prescribing process and to ensure you have access to all of the additions and enhancements of the new SCRIPT standard.

Andrew Mellin, MD, MBA is the Vice President of Medical Informatics at Surescripts, where he helps the Surescripts Network Alliance improve the care experience for both physicians and patients with a focus on technology and smart workflow solutions. Dr. Mellin has over 20 years of experience in health information technology, patient quality and safety, consumer health and EHR implementation and adoption. Dr. Mellin is Board Certified in Internal Medicine and worked as a part-time hospitalist in St. Paul, MN for 15 years.

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