It is fair to say that there is an almost universal consensus that using a clinical computing system to formulate and then output a medication prescription can improve the quality, accuracy and frequently the efficiency of the prescribing process.
In Australia there has been a very substantial adoption of computerised prescription formulation and printing, especially in General Practice but increasingly in relevant specialist practice. What has not been widely undertaken to date has been the communication of the prescription to a pharmacist for dispensing.
A few days ago we had the following announcement.
e-Script roll out underway
Rollout of the first Australia-wide electronic prescription platform began yesterday in pharmacies in Victoria and New South Wales, in readiness for connecting GPs and medical specialists into the platform in April.
eRx Script Exchange will enable GPs and medical specialists to send prescriptions electronically through a secure, encrypted gateway, for later retrieval from a patient’s pharmacy of choice anywhere in Australia. The first pharmacies are successfully downloading prescription and external repeat data from eRx.
The rollout commenced in pharmacies using Fred Dispense, and will quickly expand to other pharmacy and prescribing vendors starting with medical prescribing software provider Best Practice.
Mr Kos Sclavos, National President, Pharmacy Guild of Australia, stated, “It is very exciting to see this vital project progressing so well.
Achieving an Australia-wide electronic prescription platform will be a real milestone for the Australian health system and for patient care.
eRx Script Exchange is an example of how innovations in e-health can lead to better coordination of care between GPs and pharmacists, generating the best health outcomes for all Australians.”
“The official launch at the Australian Pharmacy Professional Conference in April means the project is meeting key timelines and I am certain the pharmacy and medical professions are ready to embrace the change and explain the significant benefits to patients,” said Mr Sclavos.
Graham Cunningham, Chairman, eRx Script Exchange, says “Electronic prescribing is one of the fundamentals in improving medication accuracy and efficiency, leading to better patient care and safety. Importantly, for pharmacists, efficient accurate dispensing means that they can spend more time with their patients.”
Electronic prescriptions will enable better coordination of patient care across providers. In addition, key benefits of electronic prescribing include:
For pharmacists
* Reducing the likelihood of keying errors
* Strengthening dispensing accuracy
* Accurate retrieval of prescription data
* Faster retrieval of external repeats with scanning of one barcode
* Efficient and safe coordination of new scripts request and emergency supply of medications
For GPs and medical specialists
* Improving patient safety, as a result of reducing the risk of prescribing and administration errors
* Notification of dispenses can strengthen confidence that patients are receiving medication that they need
* Efficient management of new prescription requests and emergency medicine supply
Visit www.erx.com.au to register for updates about eRx Script Exchange.
To view demonstrations of the electronic prescription process, visit the eRx Script Exchange stand at APP on the Gold Coast from 2-5 April 2009
(stands 145,151)
The release can be found here:
http://www.erx.com.au/PDF/eRx_Media_Release_12_March_2009.pdf
More details – in the form of a Frequently Asked Questions (FAQ) document can be found here:
http://www.erx.com.au/PDF/eRx-FAQ.pdf
Note this document is current as of 12/03/2009.
Let me be quite clear here. As far as I am concerned an appropriate, open, private, secure e-prescribing messaging system would be a good thing for Australia for a range of the reasons outlined in the release above.
The evidence for this – or at least part of it – is summarised in this KPMG report on “Electronic Prescribing” done for the Department of Health.
See here:
There are however some implementation issues that I am very concerned about.
The first relates to the management and control of the core messaging hub on which the system is based. While I can see all sorts of arguments to permit the erx.com.au proposal to proceed as it is innovative and so on I do not believe this is appropriate infrastructure to be in private hands.
I do not see any problem with private providers being fully involved in provision of prescribing and dispensing clients, network communication and so on. The hub through which all the prescription data is to flow is different in my view and should be managed and controlled by a stakeholder representative driven Board – (with DoHA providing a secretariat). The actual operation of the hub can be undertaken by any competent entity – under the governance rules determined by the Board.
Let us be quite clear – the hub is a piece of core national e-health infrastructure and should be treated as such.
I believe the use of a secure store and forward hub is a reasonable architectural design approach for an e-prescribing network in Australia but I am not anywhere near as worried about direct transmission to pharmacies as the Pharmacy Guild – which is just horrified by the possibility. (It seems to work OK in the US). If we are to have such a hub, not only must it be open technically – but is must also be open from a managerial and privacy perspective.
A second key issue is around control of data that flows through any hub and the policies that are applied to its use. It needs to be appreciated that there are two parties with an interest in the prescription – the doctor and the patient – and that each of these has serious interests.
Ominously the FAQ says:
“The sale or supply of bulk de-identified patient data is restricted”
Note there is no comment I can see on sale or supply of doctor prescribing data and that the sentence does not rule out sale of patient data. There must be no sale or supply of any data from the hub in my view.
Third we have the comment in the FAQ:
“What messaging standards will eRx adopt?
eRx will adopt messaging standards when possible. eRx will however not let standards, or a lack of standards, further slow the implementation of this vital piece of the e-health infrastructure.”
This is a prescription for all sorts of issues down the track – and really is just not acceptable. Let’s do this once and do it right!
Overall I take the view that if eRx is planning to provide a piece of national e-health infrastructure it needs to be subject to the disciplines and review that befits that sort of plan. In my view there needs to be.
1. A review by NEHTA / DoHA of the appropriateness of and public interest in accepting further development of the planned initiative.
2. A full Privacy Impact Assessment of the eRx proposal
3. An assessment of any legislative / regulatory requirements to prevent any possible sale or leakage of patient or doctor information.
4. An assessment of the long term commercial viability and reliability of having infrastructure of this importance provided in this way. Once the service begins it will clearly, quite quickly, become hard to do without.
5. An assessment of the wisdom of having such a basic function in the hands of only one of the affected professions – and indeed one that does not seem to be operating all that professionally.
See:
Bitter pill for 'uncaring' pharmacists
- Mark Metherell
- March 6, 2009
SUBURBAN pharmacies sheltered from supermarket competition routinely failed to live up to their claims of being caring professionals, according to the consumer organisation, Choice.
The consumer group has seized on fresh research that says pharmacies are failing to give customers advice on drugs. It wants consumers to have a voice in the secretive negotiations between the Pharmacy Guild and the Government over the billions of taxpayer dollars paid to pharmacists to provide dispensing services.
University of South Australia researchers have found that nearly half the customers surveyed said they rarely got advice on drugs from pharmacists.
This was despite the $5.44 pharmacists receive from the Government each time they dispensed a prescription, in addition to their retail mark-up.
More here:
http://www.smh.com.au/national/bitter-pill-for-uncaring-pharmacists-20090305-8q1f.html
6. An assessment of where this proposal fits in the broader national e-Health Architecture and Strategy.
7. A clear set of published understandings about how any prescribing or dispensing system can seamlessly interact with the proposed infrastructure (standards, terminologies, protocols etc)
I am very aware of the fact that this proposal has come up largely as a result of profound Federal Government inaction on the e-prescribing space over many years – and understand their frustration etc – but I really believe we need to get this right. (I wrote my first report to DoHA about this in 1996!)
This should only go ahead if all these issues are satisfactorily – in the view of all stakeholders – properly addressed.
David.
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