February 22, 2010


Electronic Prescription “Fill Status”: A useful idea but a flawed standard

Perhaps you’ve heard of “Fill Status.” In 2006, it was tested as part of the AHRQ-funded e-prescribing study to be considered one of the “Initial E-Prescribing Standards.” This particular functionality allows a pharmacy system to send a message to an e-[rescribing or EHR system that the prescription was dispensed to the patient.
Fill status is an official standard, but even if you e-prescribe regularly; you’ve probably never seen it.
There are a couple of reasons it isn’t in common use yet.
The most obvious reason is that although several e-prescribing and EHR systems are capable of receiving and displaying these messages, almost no pharmacy systems are sending these messages yet.

But there’s an even more important reason why you aren’t seeing “Fill Status” messages. They aren’t helpful in the vast majority of cases. First, there is usually an adequate work-around: much of the fill status information is also available as part of the medication history that comes from both pharmacies and payers through Surescripts. Second, unless every pharmacy consistently and uniformly sends “Fill” messages, what does it mean if you don’t see one? A more relevant indicator would be a “NOT Filled” message – that the medication was not picked up by the patient. (If pharmacies begin to send “NOT Filled” messages, I believe they should be sent for the first fill only, and not for each expected refill).

This leads us into another possible issue:

Suppose we (as providers) receive a “NOT Filled” message (if they existed)—what then? Are we responsible for tracking down the patient and urging them to take their medication (and, of course, videotaping our end of that conversation in case there’s a law suit)? I contend that patients are responsible for their own care, and our responsibility ends with the prescription and instructions…until their follow-up visit, at which time having this information would be very helpful.

So, in summary:
  • Fill Status is rarely used
  • Fill Status is not likely to be helpful in it’s current form
  • It might be helpful to receive messages that patients did not pick up their medications
  • Patients are responsible for following our instructions, and we should not be held responsible for tracking them down if they don’t take their medication

Peter N. Kaufman, MD

About pkaufman

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).