E-Prescribing – Do the Current Initiatives Make any Sense?

In recent times there has been a lot of discussion about electronic prescribing (or e-prescribing). In this blog I want to run through just what I believe would constitute a satisfactory e-prescribing system for Australia. The criteria I would apply are as follows.

Criterion 1.

The E-prescribing should be fully compliant with all aspects of AS 4700.3(Int)-2007 : Implementation of Health Level Seven (HL7) Version 2.5, Part 3: Electronic messages for exchange of information on drug prescription.

This would include electronic messaging of standardised content between prescriber and dispenser as well as support of the other medication management functions the Standard envisages.

Criterion 2.

The terminology used is the current version of the Australian Medicines Terminology (AMT) which in SNOMED CT compliant. This is a minor problem at present as I understand this is still a work in progress with a completion date somewhere in 2009.

Criterion 3.

The act of prescribing should be supported by Level 4 clinical decision support based on approved knowledge databases of established quality and consistency.

Criterion 4.

There be effective communication between dispensing and prescribing systems to enable assessment of issues such as compliance and medication abuse, while avoiding any leakage of such information to any third party without the agreement of the patient.

Criterion 5.

There be absolutely no access to prescription data by any commercial interests – most especially any pharmaceutical companies.

Criterion 6.

If any centralised ‘store and forward’ hub networking technology is to be used (as I would prefer) for allowing a prescription to be held until requested by a dispensing computer system then the hub should be controlled as a key piece of national e-health infrastructure by the Commonwealth Government (or a Government owned agency with appropriate governance in place to totally protect the public interest and patient privacy).

Criterion 7.

All access to the National e-Prescribing network should be fully protected by appropriate security, encryption and privacy mechanisms.

Criterion 8.

Access to the National e-Prescribing network should be via a fully open and standardised mechanism with an entity like Australian Health Messaging Laboratory (AHML) certifying compliance before access is permitted.

Criterion 9.

Of course, there should be only one national network with competition being encouraged based on the quality of the prescribing and dispensing systems offered by those who connect to the network.

At present there are three potential offerings in trial or in development on the table.

First we have the NT e-Prescribing Initiative.

Details of the approach being adopted can be found here:

http://publishing.yudu.com/Freedom/Acqew/Pulse+ITMay2008/resources/index.htm?referrerUrl=

(at page 11)

Or here:

http://www.health.nt.gov.au/news/2008/news_14_05_nt_delivers_national_first_electronic_prescriptions.shtml

Second we have the commercial ScriptX initiative.

Details of this can be found here:

http://publishing.yudu.com/Freedom/Acqew/Pulse+ITMay2008/resources/index.htm?referrerUrl=

(at page 17)

Or here:

http://www.corumhealth.com.au/news-detail.aspx?cid=1&navid=-1&newsid=24

Lastly I am assured that Medicare Australia has been considering how it might get into this space to augment their on-line presence and leverage the data they already hold.

I will leave it as an exercise for the reader to see how close each of these might be to what I believe is desirable.

Essentially I believe we should have a National E-Prescribing infrastructure that is open, fully standardised, fully SNOMED CT based system with hub controlled ultimately by Government.

Competition should be at the prescribing and dispensing client level. Trials of half-baked systems have their place – but they will not lead to the national infrastructure we need.

This is a project Government should support soon so we don’t wind up with a mess of incompatible and non-standardised systems.

David.