Clinical EMR Overview: Medication Order Management & ePrescribing

Overview

This guide covers how to draft, edit, and e-prescribe medication orders in the Clinical EMR (Elation), who is authorized to take action on prescriptions, and CareHub best practices for managing medication changes and discontinuations. Following these standards ensures an accurate medication record in Elation and proper data flow into CareHub.

Audience: Prescribing providers and authorized Rx delegates
Permissions: Only provider-level users or authorized Rx delegates should take action on medication orders in the clinical EMR. 

Medication vs Prescription

In Elation, a medication can be documented or prescribed; it's important to understand the difference to determine how to action each: 

Document Meds (Document Med Pt is On): allows any user to create and add to the permanent or OTC med list. Actioned from clinical profile or Rx drop-down. example: patient-reported medication upon enrollment. 
Prescription: written by PACE prescribing provider; can be designated as permanent or OTC (we do not recommend Temporary). Actioned from clinical profile or Rx drop-down. example: new diagnosis requires new medication order. 

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Prescription Management

Who can create a draft, edit, and sign a new prescription? 

Prescribing Providers

Licensed prescribing providers (physicians, NPs, PAs, etc.) have full access to create, edit, sign, send, and discontinue prescription orders in Elation. 

Authorized Rx Delegates (Staff)

Staff members may be designated as Authorized Rx Delegates.  Authorized Rx Delegates can:

• Draft new prescription orders on behalf of a prescribing provider
• Edit existing draft prescriptions
• Discontinue medications only on behalf of providers they are explicitly delegated to

CareHub Best Practice: Only prescribing providers or their authorized staff delegates should take any action on the prescription form in Elation. Staff who have not been formally designated as Rx Delegates must not initiate, edit, or discontinue prescription orders. If you need delegate access, contact your practice administrator. 

Warning: current permissions in Elation allow for any user to create a draft or edit an existing draft. 

Delegate assignments are managed by a practice administrator under User Account settings in Elation. Additional details: Clinical EMR Overview: User Permissions - Staff delegates

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Prescription Types

What to use in the clinical record

Elation supports several medication list types. Understanding which to use is critical for data accuracy in CareHub.

Permanent Rx Meds

recommended for all active medications

Permanent Rx entries appear on the patient's active medication list and flow into CareHub. This type should be used for:

• All ongoing, chronic medications
• Short-term medications such as antibiotics or steroid tapers

Permanent OTC Meds

OTC orders follow the same workflow as Permanent Rx and also flow into CareHub. Use this type for non-prescription medications being actively documented in the clinical record.

Temporary Meds ⚠️ 

not recommended for use

Temporary Rx orders do not flow into CareHub and therefore should not be used in the clinical record. Even for short-course medications, a Permanent Rx should be entered instead.

CareHub Best Practice: For short-term medications (e.g., a 7-day antibiotic course, a 5-day steroid pack), enter the order as a Permanent Rx. Then send an office message to the care team as a reminder to discontinue the medication in Elation when the course is complete. This ensures the medication is visible in CareHub for the full duration of treatment and accurately discontinued when no longer active.

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New Prescriptions (Rx)

How to create a draft, edit, and sign a new prescription

There are two ways to start a new prescription in Elation:

• From the top of any patient chart, click Rx → Prescription Form (Rx/OTC/CS)
• Select the Rx/OTC/CS link within a legacy visit note or non-visit note draft

Each option opens the Prescription Form.  Proceed with completing the prescription fields. Fill in as much detail as needed. Fields marked with an asterisk (*) are required:

Field	Details
Medication name & strength*	Search Elation's medication database by name and strength. If a medication is not found, it can be manually added to the database.
Sig*	Enter complete patient directions — include dose, route, and frequency.
Qty* / Units	Specify quantity and select from supported unit abbreviations (e.g., mg, tab, cap).
Refills*	Enter the number of refills authorized.
Days Supply	Indicate the intended supply duration.
Pharmacy	Search by pharmacy name plus city, street, zip code, or store number. The last pharmacy used for a patient will pre-populate for future orders.
Packaging / NDC	Review packaging and NDC information to select the appropriate product.
Add to Permanent Med List	Check this box to add the medication to the patient's active medication list. This should be checked for all ongoing or short-term medications entered into Elation.
Save as RX Template	To save a medication, Sig, Qty, Units, Refills, Days Supply, and packaging/NDC for reuse on future patients, click the Save as Rx Template button.

Note on Controlled Substances: The ePrescribing workflow for controlled substance medications (EPCS) has additional steps and requirements. Refer to the Elation EPCS Guide for step-by-step instructions.

Multiple scripts can be added to a single Prescription Form. After the orders have been added, proceed with the following options: 

• Prescribe
  • Sends all prescriptions that have a pharmacy selected to the pharmacy AND prints all prescriptions that do not have a pharmacy selected and prescriptions that cannot be sent electronically.
  • If a Staff Rx Delegate selects Prescribe and controlled substance prescriptions with a pharmacy destination are in the queue, the controlled substance prescriptions and their pharmacy destinations will be saved as a draft (and found in Requiring Action section of patient chart). 
• Print All & Close
  • Prints all prescriptions, even if any of the prescriptions in the queue has a selected pharmacy destination, and closes the form.
• Sign & Close 
  • Signs all prescriptions and closes the form.
• Save as Draft & Close
  • Saves all the information entered as a draft in the Requiring Actions section of the patient’s chart, including all medications in the form. Drafts can be created and saved by both prescribing providers and authorized staff delegates, and should be reviewed and sent by the prescribing provider prior to finalization. When the draft is reopened, all queued medications will reopen together in the prescription form.
• Discard
  • Discards the selected prescription in the form.

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ePrescribing to a Selected Pharmacy

Once the prescription form is complete (review the prescription for accuracy) and a pharmacy has been selected:

1. Select Prescribe option, which opens a Prescription Summary 
2. Confirm the prescribing location at the top of the Prescription Summary window. 
3. Choose the appropriate send action:
   • ePrescribe Only — sends the prescription electronically to the pharmacy
   • ePrescribe & Print Pt Copy — sends to the pharmacy and prints a copy for the patient in one step

Note: If the patient does not have a preferred pharmacy on file, search by pharmacy name combined with a city, zip code, street name, or store number. The Surescripts pharmacy directory covers approximately 85% of pharmacies nationally. Pharmacies not listed must contact Surescripts directly to be added — Elation is unable to add pharmacies to the directory.

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Managing Dosage or Frequency Changes to Existing Medications

When a patient's dose or frequency for an existing medication changes, IntusCare does not recommend utilizing the RX: Change Dose functionality in Elation. 

CareHub Best Practice for Dosage/Frequency Changes:

1. Discontinue the existing medication order (see below for how to discontinue correctly)
2. Create a new Prescription Form with the updated dose or frequency
3. E-prescribe the new order to the pharmacy

This two-step process ensures that the medication history in Elation and CareHub accurately reflects what the patient is currently prescribed. Using the Rx Change function is not recommended as it may not produce a clear, reliable medication history.

Elation doesn't allow for suspended or on-hold medications.  Additional details on how to manage: INFO: Clinical EMR - Medication Management - Suspended, On-Hold, and Temporary Medications

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Discontinuing Medications

Discontinuing a medication is the correct way to remove it from a patient's active medication list. This applies to Permanent Rx Meds, OTC Rx Meds, and any short-term medications entered as Permanent Rx.

Discontinue → if your practice is stopping the medication
Document Discontinue → if another provider/patient stopped it 

How to Discontinue a Medication in Elation

1. Navigate to the patient's medication list in the chart.
2. Locate the medication to be discontinued.
3. Select Discontinue from the medication actions.
4. If you are an Authorized Rx Delegate, select the name of the provider you are discontinuing the medication on behalf of. Delegates can only discontinue for providers they are assigned to.
5. Verify the Discontinued date.
6. Optionally, enter details in the Additional reason field (note: this field is not transmitted to the pharmacy if a cancellation request is sent).
7. If the medication was previously sent electronically to a pharmacy that accepts electronic cancellations, check the box to Send a cancellation request to the pharmacy.
8. Click the blue Discontinue button to save.

Additional details: INFO: Elation- Medication Management-Discontinuing Medications

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IntusCare Best Practice Recommendations 

Action	Recommended Practice
Drafting Rx	Provider or authorized Rx delegate only
Editing drafts	Allowed before signing; any user can edit draft - review script(s) for accuracy before signing off
Dosage/frequency change	Discontinue then add New Rx (do not use RX: Change Dose)
Discontinuation	Use Discontinue or Document Discontinue
Remove medication	Do not use (instead Discontinue)
Temporary medications	Do not use (instead use Permanent Rx Meds)
Short-term meds	Use Permanent Rx & office message reminder

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Need help? 

For questions about prescribing access, delegate setup, or medication management in Elation, contact the IntusCare support team.