LSS Hints: Linked vs. Unlinked Medications and Patients

When refill request are transmitted electronically to the EMR from the pharmacies, they come as linked or unlinked patients, and either a linked or unlinked medications.  This results in three different refill requests:

• Unlinked Patient: Patient is not linked, medication also not linked
• Unlinked Medication: Patient is linked, but medication is not linked
• eRx Renewal: Both patient and medication are linked

Unlinked Medication:  The exact medication on the desktop task list has not previously been transmitted via eRX from the EMR to the particular pharmacy

• Medication dose, frequency, refills, etc., may not exactly match previously transmitted medications
• Previous prescription was called in, faxed in, or otherwise conveyed to the pharmacy without being transmitted via eRx

Linked Medication: The exact medication on the desktop task list has been been previously transmitted from the EMR to the particular pharmacy.

Unlinked Patient: The exact name of the patient, including middle initials, middle names, nicknames, etc. that is transmitted from the pharmacy is not in the EMR.  The patient may be in the system, however, under a slightly different name.  Any eRX refills that result in an unlinked patient will also be unlinked eRx medications.  There are five fields in which discrepencies can result in an unlinked patient:

• First name
• Last name
• Date of birth
• Zip code
• Gender

If the patient is not in the EMR system (wrong patient transmitted from the pharmacy), that will also result in an unlinked patient.  The nurse who receives the unlinked patient eRx refill will have to manually determine if the patient is in the system under a slightly different name or if the patient is not in the system.

Reasons for unlinked patients:

• Patient not in the EMR
• Middle initial included in one system and not the other system
• Jane Doe
• Jane L. Doe
• Parts of names included in one system and not the other system
• John Joe Smith
• John Smith
• Nicknames or familiar names used in one system
• Sandy vs. Sandra

The possibilities for eRx refills are then as follows:

• eRx Renewal: Easiest to handle, both patient and medication are linked
• Unlinked eRx medication : Second easiest to handle, patient is linked
• Unlinked eRx patient:  Will also probably have an unlinked medication.

For each of these situations, there is a slightly different procedure to follow:

• eRx Renewal: eRx Renewal task
• Unlinked eRx medicationt: Unlinked eRx Medication task followed by the eRx Renewal task
• Unlinked patient: Unlinked patient task, followed by Unlinked eRx Medication task, followed by the eRx Renewal task

Hopefully, these problems will gradually be taken care of:

"Over time, unlinked erx tasks will become fewer and fewer. As we create/transmit a script in our system a “trace #” is assigned to that script. Then, in the future, when the pharmacy sends a refill request for that medication, that same trace # is included with the request. This trace # tells our EMR exactly who the patient and provider is and will not create an unlinked pt task." - Avera IT