Drug inventory

Drug inventory: turn it on

Drug inventory tracks the drugs you keep on the shelf: what you received, from which lot, when each lot expires, which multi-dose vials are open, what each dose used, what was thrown away, and what it all cost. It is optional and builds on In-office medications: a dose given from stock takes itself off the shelf.

1. Switch it on. In Admin > Additional Features, turn on Drug inventory and click Save Changes. It ships off and needs In-office medications, which it switches on with it.
2. Open Inventory on the toolbar. The button appears for people who can see stock or its reports (hide or move it under Customize your toolbar). The Drug inventory workspace has seven tabs: Stock, Receive, Orders, Counts, Alerts, Reports and Items. A practice with more than one location gets a Location switcher at the top.
3. Set up in this order. Add your items and suppliers, link each protocol to its stock item, then receive what is on the shelf today.

Who sees what

Practice administrators have all three. Someone with only the cost permission, such as a billing manager, sees just the Reports tab. Without the cost permission, money shows as “—”. Choosing a lot while giving a dose needs none of these: anyone who can record doses sees the lots.

Items and suppliers

Items is “Every drug the practice keeps in stock.” Click Add item and search the drug by name or NDC (your protocols and the FDA directory). A directory product then shows Package you buy, its package sizes listed like 1.5 mL prefilled syringe · NDC 50458-0564-01; choosing one “Fills the NDC, package type and amounts below”: the package NDC, package type, counting unit, volume, drug per unit and units in one package, wherever the package states them. A product with a single package has it chosen already. Check the details it fills in:

Then open each protocol in Admin > In-office medications and set its Stock item, so doses draw from that item’s lots. Show inactive items lists items you no longer stock.

Suppliers

Below the items, Suppliers is “Where the practice buys its drugs. Used on purchase orders.” Add supplier takes the Name, Account number, Contact, Phone, Email, Ordering website and Notes.

Receive stock

Receive puts a delivery on the shelf: “Scan each box, or add a line by hand. Each line is one lot.” Stock goes into the location shown at the top.

1. Tie it to an order, if there is one. Choose the Purchase order (or click Receive on the order itself), then Fill in from … to start from what is still to come. Each line can name its Order line.
2. Scan each box. Point the scanner at the box. Hero fills the item (by NDC), the NDC, the lot and the expiration. Scanning another box of the same lot adds a package to that line (“Added another package of lot …”). An NDC the FDA directory doesn’t list can still be recognized from RxNorm, the national drug vocabulary. A product you don’t stock yet says so with its package size, e.g. “Invega Sustenna (1.5 mL prefilled syringe) isn’t stocked yet. Add it as a new item.”; Add “…” as a new item opens the item editor with that package’s details already filled.
3. Check each line. Item, NDC on the box (choose from the list when one barcode matches more than one NDC), Lot, and Expires (MM/YYYY or MM/DD/YYYY; Hero shows Good through …). When the barcode didn’t clearly separate the lot from the expiration, tick The lot and expiration match the box after checking them.
4. Enter the quantity and cost. Quantity in packages or in the item’s counting unit (Hero shows the total, e.g. = 2 syringes, or the mL for a multi-dose item). The cost is per package or per unit, and its label follows the item (Cost per package, Cost per syringe); it comes “From the invoice. Leave empty if you don’t know it.” An unknown cost stays unknown and is never counted as $0; on an order line, leaving it empty uses the order’s price.
5. Say whose stock it is. Practice stock, Sample, or A patient’s own medication with Find patient. A sample can be given but is never billed as drug; a patient’s own lot is offered only when giving to that patient.
6. Click Receive (it reads Receive 3 lots, and so on). The Received box lists each lot with its new on-hand count. If any line can’t be saved, nothing is.

Each receipt keeps its own cost. A lot’s cost per unit is the average of what you paid for it, weighted by quantity, and each dose records the cost at the time it was given.

Stock, lots and open vials

Stock is “What’s on the shelf” at the location: one row per item with On hand, Usable, On order, Reorder at, Status (In stock, Low, Out or Below zero) and, for cost viewers, Value. Chips flag a controlled drug and any open vials past their discard date. Search by item, NDC or lot, or tick Only items that need attention.

Usable is what you can actually give: on hand, minus expired lots, lots that expire before a new order would arrive (Supplier lead time in Settings, 14 days by default), patients’ own supply, and quarantined or recalled lots. Reorder suggestions and low-stock alerts use it.

Lots

Open an item to see its lots: Lot, Expires (with the days left), Owner (Practice stock, Sample, or Patient’s own with the patient’s name), Status (Available, Quarantined, Recalled, Used up, Disposed), Quantity and, for cost viewers, Cost each. Each lot’s menu holds:

The gear on an item’s row opens Reorder settings for this location: Reorder point (“Suggest an order at or below this many.”), Usual order size and Full-stock level (“Orders top stock back up to this many.”).

Open vials

Multi-dose vials that have been punctured are listed under Open vials: the vial and lot, when it was Opened, Discard by, the mL Left, and its status (Open, Past discard date, Empty, Expired, Discarded). Discard by is 28 days after the first puncture at the same clock time, even across a daylight-saving change, or the item’s manufacturer rule, and never later than the lot’s expiration. Discard opens Discard this vial with a Reason (and a Witness for a controlled drug); what was left in it is recorded as waste. Anyone who can view stock can discard a vial.

Recall lookup

1. Click Recall lookup and enter the Lot number and the NDC or product code from the recall notice, then Look up.
2. Read both lists. On the shelf shows every holding of that lot at every location and owner. Patients who received it lists every documented dose from that lot, including doses recorded before Drug inventory was turned on.
3. Click Mark as recalled with the Recall notice or reference. “Marking the lot recalled blocks it everywhere: every location, practice stock, samples and patients’ own supply.”

Giving a dose from stock

With Drug inventory on, the Lot and expiration part of Give medication starts with From stock: the lots of that product, earliest expiration first, each as Lot …, exp …, 3 on hand. A sample says (sample), and a patient’s own lot appears only for that patient, marked (brought by this patient). Expired, recalled and on-hold lots are listed but can’t be picked. The lot you choose fills in the lot number, expiration and NDC, and decides whether the dose is practice stock, a sample or the patient’s own.

• Scan to pick. Scanning the box picks the lot when exactly one lot on hand matches; otherwise the matching lots are listed first.
• What comes off the shelf. A single-dose syringe, vial or kit: the packages used, including what was thrown away. A tablet: the count. A multi-dose vial: the mL drawn.
• Multi-dose vials. Choose Use open vial (opened …, use by …, 6.5 mL left) or Open a new vial, which asks when it was First punctured (the real time, which starts the discard clock) and the Vial size (mL). The size is filled in from the lot’s package (“One vial of this lot’s package.”, so 1 mL from a tray of 25 × 1 mL vials); left empty, Hero uses the stock item’s package size. Then enter the mL drawn. A vial past its use-by time can’t be used: discard it.
• No stock on record. “No stock on record here. Type the lot below.” A lot typed by hand is documented on the dose but not taken from stock. When a dose takes more than a lot has on record, it still saves and the count goes below zero with an alert, unless the practice turned off Allow a dose to be saved when no stock is on record.
• Removing a dose. The drug stays used unless the dose was never given and you put it back on the shelf. A dose first recorded on the wrong chart is recorded again with Use stock already recorded from voided entry, so it isn’t taken twice; see Correct, amend or remove a record.

Reorder suggestions and purchase orders

Orders starts with Reorder suggestions: “Items at … whose usable stock plus what’s on order is at or below the reorder point.” Each suggestion shows Usable, On order, Reorder at, the suggested Order in whole packages (enough to reach the full-stock level, and at least the usual order size) and the Supplier. A line such as 3 patients due in the next 30 days use this item is there for information; it doesn’t change the amount.

1. Tick what to order and click Create purchase orders. Hero makes one draft per supplier: “Review each draft, then mark it ordered once you’ve placed it with the supplier.” New order starts one by hand, with the Supplier, Expected by, each item’s Packages and Cost / package, and Notes.
2. Place the order with your supplier, then click Mark as ordered. Print and Download CSV give you a copy to send.
3. When it arrives, click Receive on the order. It opens the Receive tab filled in with what is still to come (see 24.18). A partial delivery leaves the order Partly received.

Orders move through Draft, Ordered, Partly received, Received and Cancelled. Cancel order is offered only until anything has been received.

Counts

Counts: “Count what’s on the shelf and post the differences. Controlled substance counts keep a witness and the time of day.”

1. Click Start a count and choose what to count. Cycle count (“A few items you choose.”), Full count (“Every lot at this location.”) or Controlled substance count (“Every controlled drug at this location, with a witness.”). A controlled count also asks the Time of day (Opening of business or Close of business), the Registrant DEA number the stock is held under, and the Witness.
2. Decide on a Blind count. It hides the expected quantity until each lot is counted, so the count isn’t influenced by it.
3. Count each lot. Enter what you find under Counted (0 if none). Hero shows the Expected amount and the Difference, with an optional reason. Each lot is compared with its stock at the moment you counted it, so a dose given while the count is open isn’t counted against you.
4. Finish. Finish count asks Post 2 corrections and finish? (or Everything matches. Finish the count?). Corrections go into each lot’s history. Cancel count posts nothing.

Alerts

Alerts is “Stock that needs attention.” Hero checks stock every hour, and a count on the tab shows how many are open.

An alert clears on its own when the problem is fixed. Acknowledge hides it until it gets worse (“It comes back only if it gets worse.”). Show Open, Acknowledged, or Open and acknowledged, and tick All locations to see every location at once. Anyone who can view stock can acknowledge.

Two options in Admin > In-office medications > Settings > Drug inventory, both off by default: Make to-dos for inventory alerts (for the people who manage stock), and Send a daily email of inventory alerts, a short summary with no patient information.

Reports and drug costs

Choose a report from the list on the left of Reports. Reports run on your practice’s calendar days, from the first of this month to today unless you change From and To. Choose a Location or all of them, and download any report as CSV or Excel. Reports live in the Inventory workspace, so they need Drug inventory on.

Reading the revenue and margin report

• Drug cost is the lot’s cost per unit when the dose was given, times what the dose used. Supply cost is the protocol’s Supplies per dose.
• Allowed comes from the payer’s remittance (ERA). Until one arrives it shows the billed amount, marked Allowed is estimated.
• Insurance paid adds every payer level’s current claim; replaced and voided claims are left out.
• Patient responsibility (billed, not collected) is what the payer assigned to the patient, not what the patient paid.
• Estimated margin = allowed − drug cost − supply cost. A blank drug cost is unknown: it is left out of the margin and the row is marked Cost unknown. Underwater means allowed is less than the drug cost.
• Cash visits are listed as cash visit, not itemized.

The report doesn’t yet include what patients actually paid you, so treat the margin as an estimate. Reports that list patients are recorded in the access log.