October 16, 2025
Following are this week’s updates. If you have questions, please contact [email protected].
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Medical Update: Client Orders and Medication Management Rx’s Order Signature Concerns
New features are being deployed that impact Client Orders and Medication Management Rx. During this transition, county medical staff should carefully review medications and prescriptions. Providers will need to exercise precautions due to discrepancies in what they ordered and the screen display as a result of the new features.
CalMHSA has been testing heavily in QA systems, and Streamline is working to rectify the situation, but given that the July MSP has other essential system updates, these discrepancies will NOT be resolved by Oct. 20, when the MSP is released into county production environments.
Four features will be released:
- Usage of new terms to clarify medication directions (Sig)
- A free-text Sig box for customizing sig instructions
- Dose calculator in Medication Management Rx
- Client order signature’s comments to appear in Client and Group MAR
Medication Accuracy Concerns
Concerns are summarized below, with additional details and examples available via the following links:
July MSP Medication Management Feature Alert
July MSP Client Orders Feature Alert
Order Setup’s Dose Defaults Will Be Wiped (Impacting Client Orders)
Streamline has indicated that any defaults configured for orders in the Order Setup screen will be cleared during the July MSP installation. This resetting of default values must occur, as the medication chosen for a default will now drive the actual defaulted amount. The defaults — such as dose, day supply, refill count, max quantity, and instruction text — can be re-entered following the MSP update.
On the positive side, for cases where the desired defaulted dose is the standard mediation itself, ‘no’ default is necessary (SmartCare previously required a default for all med orders; that is no longer the case). For cases where default is more than the standard amount, that can be specified in the appropriate size desired. For example, acetaminophen 325 mg could be defaulted as two pills by entering ‘650’ in the default dose. When prescribed, and acetaminophen is chosen, it will default as 650 mg’s, i.e. 2 pills.
CalMHSA has searched the affiliated county databases for orders and order sets that were set up using defaults that will need to be reentered; the list is short. We will work to send a list of the affected medications to those counties ASAP.
Do NOT Use Medication Rx and Client Orders’ Free-Text Sig
CalMHSA strongly recommends NOT using free-text sig in Client Orders and Medication Rx. We advise providers against using and/or modifying any text that appears in the free text order pop up. This is because SmartCare is transmitting both the discrete order field sigs data and what is in the free text order text box pop up. If there are discrepancies between the two, the pharmacist or downstream user will see both order sigs. This can lead to inconsistencies and confusion for anyone reviewing or taking action on the medication.
We have outlined in the links above the details of when a provider may encounter the free text functionality, and we ask counties to advise their providers not to change words in the free text order sig text box pop up. If an order needs modification, instruct prescribers to go back to the discrete data order sig section. CalMHSA is requesting that Streamline disable this functionality until they can build a proper free text sig workflow. Streamline has committed to disabling this functionality via a configuration key, but this will take one to two weeks.
Weight-Based ShapeDose Calculator: Medication Management Rx
The new Weight Based Dose Calculator is available only within the Medication Management Rx workflow and currently supports pediatric clients only. CalMHSA is in discussions with Streamline to include adult medications that require weight-based dosing and make this available in Client Orders.
Medication Management Rx & Client Orders: Layman’s Terminology
Streamline has integrated more simplified verbiage as part of the order sig to include patient-friendly language, including:
- Aligning verbs with the dosage form
- Spelling out units instead of using abbreviations
- Including the total dose in the Sig
However, this is not ubiquitous of all medications/prescriptions (e.g., compound medications or alternative formulations).
Downstream CalMHSA-Developed Builds
In addition, CalMHSA developers are actively working to integrate these new features into custom screens (e.g., Medication Reconciliation, Client Medical Face Sheets): notes (e.g., Services for Psych Medical Note Template); Medication Widgets; and Medication Key Phrases. Backend data issues being cleaned up in partnership with Streamline are leading to delays for our team to be able to build properly. We anticipate fixing these builds by early November.
July MSP Updates in Production Oct. 20
The July MSP will be loaded into all Production environments on Oct. 20. CalMHSA appreciates all users who participated in testing and submitted feedback. The August MSP is scheduled to deploy to QA environments on Oct. 28.
Inquiry Locking: Requests Due Oct. 31
The deadline to request a script from CalMHSA to implement the inquiry locking functionality is end of the day on Friday, Oct. 31. If a county has not requested a script by then, any subsequent request will be considered a billable enhancement. More details.
Electronic Prescription Status Report Permissions Changed
On learning from a county that the Electronic Prescription Status report is not set up for CDAG permissions — and because it is related to medication management — CalMHSA has removed permissions from base user roles, except the CalMHSA and County Affiliate Sys Admin user roles.
The report will be made available to the Medication Rx user role, which provides access to the e-prescribing module the county is using. Since that module allows users access to the information, which isn’t under CDAG permissions, we allow this type of information to be seen in SmartCare as well. Update details:
- Removed from the Billing, Billing Supervisor, Medical Records/Quality Assurance, Reception/Front Desk user roles
- Added to the Medication Rx user role
- Remains granted to the CalMHSA SysAdmin and County Affiliate SysAdmin user roles
Configuring Box 18 on Form HCFA 1500 to Display Admit and Discharge Dates
As part of this weekend’s deployment, an update will be released that changes how Box 18 populates on the HCFA 1500 form.
After the update, Box 18 will appear blank by default. Since most payers require Box 18 to be completed when the place of service is inpatient, it’s important for counties to configure their settings accordingly. Instructions for setting up Box 18 to populate only for inpatient locations are available on the website and can be applied beginning next week.
TADT Updates: Outpatient Timeliness Doc in QA
The newest version of the DMC-ODS outpatient timeliness document is now in QA systems for testing. This document was used as the template for the other documents, as it includes all possible questions. Please review this document in your QA system and provide feedback via [email protected] by Oct. 24. See TADT 2025 Design Changes (for 2026 Submission) for more details on the changes that were made.
Other timeliness documents are in progress. Providing counties with an update of the template document allows for your testing and feedback to inform the remainder of our development.