Open Forum

Hello 

We are looking to implement the Medication Refill Protocols in In Basket workflow and would like to get feedback on if organizations that have implemented this within their EHR-

Do the support staff approve/sign per protocol or Pend and route to the clinicians?

Which roles (MA, LPN, RN) primarily complete this work in your organization? 

Any feedback or insight would be much appreciated. 

Thank you, 

Carrie

Hello Melissa, 

I am curious about the "Epic refill protocols" you are talking about. Are these located within Epic? Are they an Epic product that needs purchased?

-Lindsay

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Lindsay Miller MSN, RN, AMB-BC
Ambulatory Nursing Professional Development Specialist
lmiller3@metrohealth.org
The MetroHealth System
Cleveland, Ohio
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Original Message:
Sent: 06-23-2026 07:21
From: Melissa Taylor
Subject: Medication Refill Protocols in In Basket (Rx Request workflow)

Hello Carrie,

Our organization has been using the EPIC refill protocols in our primary care practices for several years, and we are now exploring opportunities to expand the drug classes included. Increasing the number of medications eligible for protocol‑based refills will allow a greater proportion of requests to be processed efficiently.

EPIC's recommendations indicate that up to 88% of refills can be managed through these protocols. While I'm not fully comfortable reaching that level yet, expanding our use of the protocols will help reduce in‑basket burden and minimize delays in getting medications to patients.

In our current workflow, Medical Assistants complete the refill process. If a medication meets all required criteria (such as recent visit, upcoming appointment, and necessary labs) the MA signs the order. Medications that do not meet criteria are pended to the provider for review.

Hope this is helpful!

Best ~

M

Melissa Taylor, MSN, RN, AMB-BC, NE-BC

Director of Ambulatory Nursing

 Primary Care & Ambulatory Care Coordination

Elliot Clinical Services

Phone: 603-663-3503

Email: mtaylor@elliot-hs.org

 

 

This document contains information constituting records and/or testimony relating to activities of a quality assurance committee and is therefore protected from direct or indirect means of discovery, subpoena, or admission into evidence in any judicial or administrative proceeding, pursuant to NH RSA 151:13-a and/or RSA 329:29-a.

 

 

I will need to verify the official name within Epic, but I believe it is Refill Protocols. This allows nursing staff to sign medication refill orders if all criteria are met. We are working on implementing this within our organization but struggling with aligning this with scope of practice as our current refill team is staffed with MA and LPN only. 

Original Message:
Sent: 06-24-2026 16:35
From: Lindsay Miller
Subject: Medication Refill Protocols in In Basket (Rx Request workflow)

Hello Melissa, 

I am curious about the "Epic refill protocols" you are talking about. Are these located within Epic? Are they an Epic product that needs purchased?

-Lindsay

------------------------------
Lindsay Miller MSN, RN, AMB-BC
Ambulatory Nursing Professional Development Specialist
lmiller3@metrohealth.org
The MetroHealth System
Cleveland, Ohio
------------------------------


Original Message:
Sent: 06-23-2026 07:21
From: Melissa Taylor
Subject: Medication Refill Protocols in In Basket (Rx Request workflow)

Hello Carrie,

Our organization has been using the EPIC refill protocols in our primary care practices for several years, and we are now exploring opportunities to expand the drug classes included. Increasing the number of medications eligible for protocol‑based refills will allow a greater proportion of requests to be processed efficiently.

EPIC's recommendations indicate that up to 88% of refills can be managed through these protocols. While I'm not fully comfortable reaching that level yet, expanding our use of the protocols will help reduce in‑basket burden and minimize delays in getting medications to patients.

In our current workflow, Medical Assistants complete the refill process. If a medication meets all required criteria (such as recent visit, upcoming appointment, and necessary labs) the MA signs the order. Medications that do not meet criteria are pended to the provider for review.

Hope this is helpful!

Best ~

M

Melissa Taylor, MSN, RN, AMB-BC, NE-BC

Director of Ambulatory Nursing

 Primary Care & Ambulatory Care Coordination

Elliot Clinical Services

Phone: 603-663-3503

Email: mtaylor@elliot-hs.org

 

 

This document contains information constituting records and/or testimony relating to activities of a quality assurance committee and is therefore protected from direct or indirect means of discovery, subpoena, or admission into evidence in any judicial or administrative proceeding, pursuant to NH RSA 151:13-a and/or RSA 329:29-a.

 

 

Thank you for your input. This is very helpful. One area that our team is struggling with is defining which roles may sign the medications per protocol while aligning with our scope of practice. Can you share what state you are in? 

Original Message:
Sent: 06-23-2026 07:21
From: Melissa Taylor
Subject: Medication Refill Protocols in In Basket (Rx Request workflow)

Hello Carrie,

Our organization has been using the EPIC refill protocols in our primary care practices for several years, and we are now exploring opportunities to expand the drug classes included. Increasing the number of medications eligible for protocol‑based refills will allow a greater proportion of requests to be processed efficiently.

EPIC's recommendations indicate that up to 88% of refills can be managed through these protocols. While I'm not fully comfortable reaching that level yet, expanding our use of the protocols will help reduce in‑basket burden and minimize delays in getting medications to patients.

In our current workflow, Medical Assistants complete the refill process. If a medication meets all required criteria (such as recent visit, upcoming appointment, and necessary labs) the MA signs the order. Medications that do not meet criteria are pended to the provider for review.

Hope this is helpful!

Best ~

M

Melissa Taylor, MSN, RN, AMB-BC, NE-BC

Director of Ambulatory Nursing

 Primary Care & Ambulatory Care Coordination

Elliot Clinical Services

Phone: 603-663-3503

Email: mtaylor@elliot-hs.org

 

 

This document contains information constituting records and/or testimony relating to activities of a quality assurance committee and is therefore protected from direct or indirect means of discovery, subpoena, or admission into evidence in any judicial or administrative proceeding, pursuant to NH RSA 151:13-a and/or RSA 329:29-a.

 

 

Original Message:
Sent: 6/24/2026 4:49:00 PM
From: Carrie Kranz
Subject: RE: Medication Refill Protocols in In Basket (Rx Request workflow)

Thank you for your input. This is very helpful. One area that our team is struggling with is defining which roles may sign the medications per protocol while aligning with our scope of practice. Can you share what state you are in? 

Good Morning Carrie!

We utilize the Health Catalyst Embedded Refills program, that has been integrated into our Epic EHR. It allows our medical directors to determine the exact medications they wish to delegate, as well as the parameters for refill (visit within x-months, appropriate lab value within x-months, etc) for each medication. The Health Catalyst program then guides our team members in whether the medication refill request passed protocol (can be refilled for up to one year), or failed (missed appt, lab result below threshold, etc) in which case our team members are allowed to provide one courtesy 100-day supply, and help the patient address the reasons for protocol failure.

We allow RNs, LPNS, and certified MAs to approve/sign refill medications within our Health Catalyst database following the standards above. The majority of the refills are completed by our certified MAs given the strict guardrails that we have put in place. In rare instances, or for medications that are not delegated (controlled substances, etc), the team member will pend and route to the clinician.

Hope this helps! Health Catalyst has been an incredible tool for us.

------------------------------
Emma Alonso RN, MSN, CNL
USFTGP Physician Services Educator
emmaclarke@usftgp.org
------------------------------

Hi Carrie,

The quick response is:  Only RN's, LVNs, and Pharmacy Technicians can approve (sign) refills via Standing Medical Order (order mode).  If criteria and not met they are routed to a physician / APP.  The provider must co-sign the order with-in 48 hours.

I would caution anyone using medication refills to check your state scope of practice.  Meds can only be ordered by a licensed provider and if MA or RN or lPN are signing the orders, they are practicing medicine without the proper license. 

Check your state scope to make sure you are not setting yourself up to get thrown under the bus if a mistake is made 

------------------------------
Elizabeth
------------------------------

Good Morning Carrie

Our clinic worked on a process so many in box tasks could be diverted away from the Clinicians.  We created a standing order policy.  Our pharmaceutical safety committee met and developed 2 lists of medications that were available through our formulary. We are an FQHC with access to 340B so we had to be very explicit in our instructions and protocols. Most of our "refill" requests from patients come in when the patients prescription has basically expired (e.g. there are no refills left, patient needs a new prescription) and they were out or almost out of medication. We needed a process to keep the patients in compliance with their medications and decrease the number of requests to clinicians.

When I first began looking at the process that  had been in place, Pharmacy Techs and RNs were allowed to push through a "refill" of the prescription  as long as the clinician was aware.  What that meant is that the prescription was refilled as written and sometimes prescriptions were for a years worth of medication.  I discovered that this process allowed patients to skip necessary lab tests and in person visits. Not a best practice at all. So I created a policy and removed the term "refill".  No staff member can "refill" a prescription. The committee approved the creation of a standing order policy specific to RNs and Pharmacy Techs to provide patients with a "courtesy fill" of approved medications. "Courtesy fill" was defined as providing the patient with 30 days worth of medication, one time only. If the medication was not on the list, a "courtesy fill" would not be provided. Patients are informed of the 30 day limit, scheduled an appointment with their PCP within 30 days and if lab tests are needed they are ordered (we listed all necessary lab tests next to each approved medication). The lists (one for approved formulary medications, one for approved behavioral health medications) were developed and approved not only through our pharmacy safety committee but also went through Compliance and Clinician Compliance. The standing order was signed by our CMO.

It took time and a lot of effort but the results have been excellent. Patients are seen in clinic with their PCP at least annually. Patient lab tests are kept current, responses to medications are monitored more closely.  Again, there are some medications that are not on our approved lists and those medications must be managed by the ordering provider.

Best wishes on this journey

Lori