Skip to main content

​
Overview

Use this workflow when a provider directs a medication change for an existing prescription. This includes:
  • Dose changes (same medication, different strength or frequency)
  • Drug substitution (different medication, same therapeutic class)
  • Discontinue + new (stop old medication, start new medication)
The Concierge/Ops team coordinates the change across ECW, PioneerRx, AllCare.ai, and Freshdesk, ensuring pharmacy and facility are properly notified.

​
Quick Reference

SLA: Urgent changes within 4 hours; routine within 24 hours
Escalation: Provider clarification needed → follow up within 24 hours
Systems: ECW, PioneerRx, AllCare.ai, Freshdesk

​
Workflow Diagram

​
Step-by-Step Procedure

​
1. Receive and Verify Medication Change Order

In Freshdesk:
  • Receive order change via fax, email, or Freshdesk ticket
  • Confirm patient details and nature of the change
In ECW:
  • Open patient chart → Medications tab
  • Locate the original/current medication
  • Review medication history and current dosing
In PioneerRx:
  • Search for patient
  • Verify current active orders for the medication
  • Note current strength, quantity, and refill status

​
2. Identify Type of Change

Dose Change:
  • Same medication, different strength or frequency
  • Example: “Lisinopril 10mg daily” → “Lisinopril 20mg daily”
Drug Substitution:
  • Different medication, same therapeutic class
  • Example: “Lisinopril 10mg” → “Losartan 50mg” (both ACE/ARB class)
Discontinue + New:
  • Stop one medication, start a different one
  • Example: Stop “Metformin 500mg” → Start “Metformin ER 1000mg”

​
3. Create Tele-Encounter for Provider

In ECW:
  • Navigate to patient chart → Encounters → New Tele-Encounter
  • Encounter type: “Change of Medication” or “Medication Modification”
Document Changes Clearly: OLD MEDICATION (DISCONTINUE):
  • Name, strength, dose, frequency
  • Reason for discontinuation (if known)
  • Last fill date
NEW MEDICATION (START):
  • Name, strength, dose, frequency
  • Clinical justification for change
  • Quantity and refill count
  • Special instructions
Attach Supporting Documents:
  • Faxed provider order (if applicable)
  • Clinical notes explaining the change
  • Lab results or other clinical context

​
4. Assign to Provider and Set Priority

Assign to Treating Provider:
  • Select patient’s assigned provider
  • Ensure encounter is properly assigned
Set Priority: URGENT:
  • Safety concern or adverse reaction
  • Medication interaction requiring immediate change
  • Critical dosage adjustment (e.g., anticoagulant, insulin)
ROUTINE:
  • Dose optimization for chronic condition
  • Therapeutic substitution for cost/formulary reasons
  • Planned medication adjustments
Notify Facility:
  • “Medication change request submitted to provider for review and approval.”

​
5. Monitor Provider Response

Check Tele-Encounters:
  • Monitor for provider action
  • Verify provider approves the change and e-prescribes new medication
Provider Actions: A) Approves and E-Prescribes:
  • Provider discontinues old medication in ECW
  • Provider e-prescribes new medication to PioneerRx
  • Proceed to Step 6
B) Requests Clarification:
  • Provider has questions about the change
  • Contact facility/requestor for additional information
  • Create new tele-encounter with clarified details
C) Modifies the Order:
  • Provider makes adjustments to the proposed change
  • Document provider’s modifications
  • Proceed with provider’s final decision

​
6. Verify Changes in ECW and PioneerRx

In ECW:
  • Verify old medication is marked as discontinued with date
  • Verify new medication is added to active medication list
  • Confirm provider signed the encounter
In PioneerRx:
  • Wait 30 minutes for e-script transmission
  • Verify new e-script received for the new medication
  • Confirm old medication is flagged for discontinuation
If Issues:
  • E-script not received → Check ECW, contact PioneerRx support
  • Old medication not discontinued → Follow up with provider

​
7. Coordinate with Pharmacy

Notify Pharmacy Intake Team:
  • Create or forward Freshdesk ticket to pharmacy
  • Include:
    • DISCONTINUE: [Old medication details]
    • START: [New medication details]
    • Facility contact and delivery instructions
Pharmacy Actions:
  • Process new medication order
  • Retrieve old medication from facility (if applicable)
  • Dispose of discontinued medication per protocol
  • Deliver new medication

​
8. Update Facility

Call or Email Facility: Subject: Medication Change for [Patient Name] Message: 
DISCONTINUE: [Old medication name, strength, frequency]
START: [New medication name, strength, frequency]

Change ordered by: [Provider name]
Date: [Date]
Delivery ETA: [Expected delivery date/time]

Please:
1. Discontinue administration of old medication immediately
2. Begin new medication upon delivery
3. Update medication administration records (MAR)
4. Dispose of old medication per facility protocol

​
9. Document and Close

In AllCare.ai:
  • Add note: “Medication change: D/C [old med], started [new med] per [provider] on [date]”
In Freshdesk:
  • Final update:
    • “Medication change complete”
    • “Provider: [name], Date: [date]”
    • “Pharmacy processed, delivery ETA: [date]”
    • “Facility notified of change”
  • Change ticket status to Resolved

​
Systems Used

​
ECW

  • Create tele-encounter documenting the medication change
  • Verify old medication discontinued and new medication added
  • Attach supporting clinical documentation

​
PioneerRx

  • Verify new e-script received
  • Coordinate discontinuation of old medication
  • Track new medication dispensing

​
AllCare.ai

  • Document medication change with clear before/after details
  • Link to ECW encounter

​
Freshdesk

  • Track change request through provider approval to pharmacy delivery
  • Coordinate with pharmacy intake team
  • Log facility notifications

​
Safety Considerations

​
High-Risk Medication Changes

Require extra verification and documentation:
  • Anticoagulants (warfarin, DOACs)
  • Insulin and diabetes medications
  • Seizure medications
  • Cardiac medications (antiarrhythmics, beta-blockers)
  • Opioids and controlled substances
Additional Steps:
  • Verify clinical justification is documented
  • Confirm provider is aware of change implications
  • Ensure facility understands new dosing/administration
  • Schedule follow-up monitoring if needed

​
Allergy and Interaction Checking

Before finalizing change:
  • Verify patient has no allergies to new medication
  • Check for drug-drug interactions with other active medications
  • Review contraindications based on patient conditions

​
Troubleshooting

​
Issue: Provider questions the requested change

Solution:
  • Review clinical context and rationale for change
  • Contact facility or original requestor for clarification
  • Provide additional clinical information to provider
  • Document provider’s final decision

​
Issue: Pharmacy cannot retrieve old medication from facility

Solution:
  • Instruct facility to dispose per their protocol
  • Document disposal method in Freshdesk
  • Ensure facility confirms old medication is no longer in use

​
Issue: Facility continues administering old medication after change

Solution:
  • Call facility immediately to confirm receipt of change notification
  • Verify facility updated their MAR (medication administration record)
  • Escalate to facility administrator if needed
  • Document all communications

​
Issue: New medication not covered by insurance

Solution:
  • Pharmacy will identify coverage issue during processing
  • Contact provider for alternative medication or prior authorization
  • Keep facility informed of delay and reason

​
Video Walkthrough

🔗 Change of Medication Training Video