Drug Database Migration - Coming Soon to DrChrono!

What should my practice do to be prepared for this migration?

1. Ensure all clinical and administrative staff review this FAQ guide prior to the go-live migration.
2. Update all mobile devices (iPhones/iPads) to the latest version of DrChrono EHR: 11.0.105.
3. We suggest providers review their Prescription Favorites checking for obsolete NDC's that need updated to minimize electronic prescribing interruptions. See "Electronic Prescriptions" section below for instructions on how to perform update these prescription favorites.

What can DrChrono EHR users anticipate from the LexiComp to FDB drug database migration?

User Interface Impacts

Users can expect minimal impact when it comes to interacting with the new FDB drug database. A majority of the migration has taken place in the background. Most of the impact is relative to provider prescription favorites and when refilling existing medications for patients. Continue reading to see how DrChrono will automatically convert medications and how to work with obsolete NDCs when it comes to prescription favorites and patient current medications.

Existing Prescription Data Impacts

All existing “Lexicomp” allergy and prescription data will remain intact in the patient’s chart as is. DrChrono will use the Lexicomp coded NDC and RxNorm values in order to interact with the new FDB drug database and continue providing drug-drug and drug-allergy interaction alerts; support prescription refills; generate prescription reports and clinical summaries; complete medication reconciliation and to lock clinical notes that are unlocked during the transition.

The migration's impact will primarily affect areas of the system where searches occur for new medications, compounds, or supplies.

Once your practice has been migrated to FDB, when viewing a patient's medication records, original data will persist. However, any search to add a new medication or send a new electronic prescription will yield results from the new FDB database.

For instance, renewing a prescription originally utilizing a Lexicomp drug won't have any adverse impact since we have the correct RxNorm value to map to. Therefore, there should be minimal disruption to current processes and workflows.

Minor differences in how drugs are named using the new database can be expected.

Examples include:

Lexicomp Drug Name	First Databank Drug Name
Adderall 10 mg oral tablet	Adderall 10 mg tablet
TraZODone 50 mg oral tablet	trazodone 50 mg tablet
amoxicillin-clavulanate 875 mg-125 mg oral tablet	amoxicillin 875 mg-potassium clavulanate 125 mg tablet
gabapentin 300 mg oral capsule	gabapentin 300 mg capsule
acetaminophen-hydrocodone 325 mg-10 mg oral tablet	hydrocodone 10 mg-acetaminophen 325 mg tablet
amphetamine-dextroamphetamine 10 mg oral tablet	dextroamphetamine-amphetamine 10 mg tablet
Testosterone Cypionate 200 mg/mL intramuscular solution	testosterone cypionate 200 mg/mL intramuscular oil
fluticasone 50 mcg/inh nasal spray	fluticasone propionate 50 mcg/actuation nasal spray,suspension
buPROPion 150 mg/24 hours (XL) oral tablet, extended release	bupropion HCl XL 150 mg 24 hr tablet, extended release
pantoprazole 40 mg oral delayed release tablet	pantoprazole 40 mg tablet,delayed release
buprenorphine-naloxone 8 mg-2 mg sublingual tablet	buprenorphine 8 mg-naloxone 2 mg sublingual tablet

Which areas of the platform will be impacted by the migration?

Prescription Favorites

DrChrono advises users to review their Prescription Favorites for obsolete favorites after the migration to minimize their e-prescribing disruptions. Users access their Prescription Favorites by selecting the Account > eRx Settings screen. Any favorites that DrChrono won't be able to update will display in Red with an "NDC code disassociated or sunset, reselect to fix" warning. Users can use this screen to mass update these prescriptions favorites by following the steps below:

Click on the Edit button to edit the prescription favorite. Select the X to delete any favorites which are no longer applicable to your prescribing workflows.

Then search for and select the correct new medication from FDB.

Note: you may need to search for the drug by brand/generic name to find the correct active medication to update your favorite with.

Press the Save button to update the Prescription Favorite.

Send SeSe

Allergies

The process for adding a patient's allergy to a medication will remain unchanged. Similar to the Medications List, existing information about a patient's allergy to a medication will be preserved on the patient chart. When adding a new specific drug allergy to a patient chart, the system will provide FDB database results. The same applies to drug-drug allergies and drug-allergy interactions.

In a case where a drug-drug or drug-allergy interaction is detected, a disclaimer will appear stating:

"The information contained in the First Databank (FDB) databases is intended to supplement the knowledge of physicians, pharmacies, and other healthcare professionals regarding drug therapy problems and patient counseling information. This information is advisory only and is not intended to replace sound clinical judgement in the delivery of healthcare services. FDB disclaims all warranties, whether expressed pr implied., including any warranty as to the quality, accuracy, and suitability of this information for any purpose. Copyright 2022 First Databank, Inc."

Send eRx

Providers who prescribe electronically can expect that, after June 20th, 2024, the search functionality for medications, compounds, and supplies will retrieve results from the FDB database. The user interface and workflow on the Send eRx page will remain unchanged. Prior Authorization workflow, Patient Benefits check functionality, and e-prescribing process are all expected to stay consistent.

Additionally, provider favorite medications lists will convert on-the fly on the Send eRx page. As providers select a medication favorite, it will be automatically converted for the user. Users can expect to see an alert, "Drug description is updated based on FDB representative NDC," (see image below) when the conversion has taken place. DrChrono will automatically update the medication name with the FDB drug name as part of the provider's normal prescription workflow once the patient's prescription has been printed/sent electronically.

In the event that DrChrono could not find an active medication to convert your prescription favorite to, the user should use the Medication search field to find the correct medication and continue with his/her normal prescription workflow.

Medications List

Similar to changes on the Send eRx page workflow, after June 20th any searches related to adding a medication to a patient's medications list will draw results from the FDB database. Previous additions and inactive flags associated with medications can still be viewed or edited as before. Editing an existing medication remains unchanged unless you directly modify its name; any other alterations such as notes or linking it to appointments do not affect its current state.

Furthermore, active medications can be re-sent even if they were added previously. When refilling a Lexicomp medication, users can expect that the new prescription will use the FDB drug database and may see minor differences in the Drug Name per the examples above.

DrChrono will automatically update the drug to the correct FDB version (see example below) where the provider selects to re-send the Zoloft 100 mg oral tablet.

Zoloft Prescription converted to FDB:

In the event that DrChrono was unable to find a new medication for one of the the patient's current medications, users will see a red triangle icon to the right of the medication with a hover alert stating "this medication's NDC code is obsolete". If one of these medications is selected to be refilled, DrChrono will set the prescription to a Compound.

To continue with this prescription, select the Medication tab and then search for and select the correct FDB drug using the Drug search field.

The provider is now ready to continue with the normal electronic prescribing workflows.

Medication History via Surescripts

For providers with patients with Medication History Consent enabled you will continue to see the existing medication history and functionality. Updating history will continue to pull from Surescripts and any medications merged to their patient chart will map to the FDB drug database using the RxNorm values for accuracy. For more information on Medication History via Surecscripts click here.

Mobile

Users of the mobile app can ensure access by keeping their device software up to date. The FDB database will be compatible with version 11.0.104 forward. If you are receiving a "Feature not supported" alert on your mobile application, you need to update your app to the latest version.

For further details on updates for the iPad and iPhone apps, click the below help center articles.

What is the most recent version of the iPad app?

What is the most recent version of the iPhone app?

Clinical Decision Rules

Users who create custom Clinical Decision Rules can expect this functionality to stay consistent. Any previously created rules using Lexicomp data will remain unchanged. Editing a custom rule will also retain Lexicomp data unless the user modifies the actual drug or allergy. Some important updates include allowing users to search for drugs by brand in this area, with results displaying generic names. Additionally, there will be more allergies available on this screen compared to before the migration. For instance, latex was not considered an allergen in Lexicomp but is recognized as one with FDB.

CCDA

The CCDA file contains vital patient information, encompassing details about medications and allergies. In line with the aforementioned aspects, patient CCDA files will retain their information and only transition to FDB when specific modifications are made to medication or allergy records, or if Lexicomp medications are re-sent via the e-prescribing workflow post-migration. For more information on the CCDA file import process click here.

Reconciliations

During the CCDA import process for a patient, reconciliation of existing medications and allergies may be necessary. Pre-migration medication and allergy data can be aligned with the new FDB database information. The reconciliation process should remain unaffected due to backend mapping of values linked to the medications. For more information on the reconciliation process click here.

Database update frequency

The FDB database updates on a weekly basis instead of monthly updates. If there is missing information related to drugs, compounds or supplies within the database; users can contact our support team for us to submit requests for its addition with FDB.

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