As mentioned a week or so ago there has been an update to the viewable NEHRS / PCEHR.
See here for the blog.
A few days ago the professional FAQ for the PCEHR was updated.
This is found here:
This section I found interesting among others. It explains what the intent of the new Medication View of the PCEHR is and it now becomes clear it is a broader implementation of the MedView Wave Site program conducted by the Pharmacy Computing Company FRED IT I believe.
MedView has been renamed the NPDR.
Here is what we learn.
What is the National Prescription and Dispense Repository (NPDR)?
New functionality has been added to Australia’s eHealth record system to make, over time, the prescribing and dispensing of medication a safer, more effective part of health care.
The National Prescription and Dispense Repository provides for the creation of an online medication history (not retrospective) for patients with an eHealth record based on information collected at the point of prescription and the point of dispense.
A new Prescription and Dispense View has been added to the eHealth record system that displays information entered by participating healthcare providers relating to the medications prescribed and dispensed to patients with an eHealth record.
The new Prescription and Dispense View displays the name and date a medication has been prescribed (both the brand and generic name), the strength or dose of the medication (e.g. 2mg, 20mg, etc), the direction for consumption (e.g. take one capsule daily) and the form of the medication prescribed (e.g. capsule, tablet, inhaler, etc). Similar information is also displayed as medications are dispensed.
For healthcare professionals participating in the eHealth record system, this gives a better view of the medications that has been prescribed and dispensed to a patient, which, over time, will help support better clinical decisions.
While the new prescribe and dispense function is now available, benefits will only be realised over time as more people – consumers and healthcare provider organisations alike – register and participate in Australia’s eHealth record system. The new Prescription and Dispense View should not be wholly relied upon to be complete record of prescribed and dispensed medicines.
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Very useful information is also found from the FRED IT website. The discussion shows how the PCEHR can be accessed and viewed from the Dispensing System.
See here:
Very interestingly it seems the Pharmacist can access the Shared Health Summary and most other documents, including Advanced Care Directives , presumably with the default security settings in place. (I would have thought such access might have been made ‘opt-in’ - but there you go).
Another wrinkle in all this was raised a month or two back:
MediSecure announces RACGP Protocol Implementation for e-Prescriptions
Published on: 7th March, 2013
Earlier this week, MediSecure met with RACGP to discuss potentially significant issues in relation to the dispense notifications provided to general practitioners through the electronic transfer of prescriptions (eTP). These RACGP concerns impact both prescription exchange services.
Under current privacy legislation, GPs are required to obtain patient consent to receive and read Dispense Notifications in their clinical system. The RACGP advises that receiving Dispense Notifications may also impact on the GP’s duty of care.
The RACGP has requested that MediSecure provide an option to both not install, and remove the dispense notification function from the practice’s clinical information system and the practitioner’s view.
MediSecure has agreed to this. Accordingly we have disabled all Dispense Notifications in the MediSecure eTP system, effective from 8 March 2013.
Any new MediSecure® installation or an existing installation will not be able to access the Dispense Notification service from this time. Over the coming weeks MediSecure will develop and deploy a new client adaptor to remove the Dispense Notification menu option from your desktop.
In summary:
The immediate fix to this patient consent and doctor medico-legal risk issue is to disable Dispense Notifications. No MediSecure® user can access Dispense Notifications from 8 March 2013. Over the next two months, MediSecure will contact your practice to update your existing MediSecure client to remove Dispense Notifications as a menu option.
You are referred to Friday Facts for the RACGP advice in relation to dispense notifications.
Future New Dispense Notification Service
For those practices and clinicians that wish to access the Dispense Notification data after 8 March, we advise that MediSecure will release a new ehealth service as a specific opt-in Dispense Notification service with a separate Licence. Details of how to enrol for this service will be released around 15 March 2013.
For any GP or practice that decides to adopt the new Dispense Notification service after 15 March 2013, MediSecure and RACGP recommend that GPs obtain and record consent from the patient to receive dispense notifications.
More information on an appropriate Consent Protocol will be released at the time of announcement of the new service.
See here:
The eRx Script Exchange responded similarly.
The way the RACGP saw things is here:
Electronic transfer of prescriptions – update to Medisecure and eRX users
The RACGP supports electronic transfer of prescriptions (eTP) as a prescribing process to reduce transcription errors and increase medicine safety for the community. However, the College has become aware of potentially significant issues in relation to the dispense notifications provided to general practitioners by the two proprietary eTP vendors (Medisecure and eRX). The receiving of dispense notifications is a departure from current clinical practice whereby GPs are generally unaware as to whether or not a prescription has been dispensed, unless advised by the patient at a subsequent visit. Whilst GPs may find it useful to know whether their prescriptions have been dispensed, it requires patient consent to receive or read such notification; this may impact on a GPs duty of care.
This week, the RACGP met with both vendors to request that they review the current consent and product installation processes and terms of use. The College has requested advice from both vendors about the feasibility of modifying their system to not install, and remove the dispense notification function (where already installed) from the practice’s clinical information system and the practitioner’s view. In response to our request, Medisecure has advised that dispense notification functionality will be disabled effective Friday 8 March 2013. Medisecure will provide more detailed information directly to its users. When information is available from eRX, GPs will be advised in a future edition of Fridayfacts.
See here:
In my view what we have happening here is a total failure of the observance of basic system design and implementation approaches.
First we have introduction of functionality into the PCEHR and e-prescribing systems which the GPs are not at all happy with to say nothing of the whole thing being obvious scope crepe - like the planned ACD addition and the Child Care Section.
Second we have the nonsense of there now being two sources of information regarding medications in the same patient’s PCEHR which are neither synchronised or obviously related. What ever happened to the single source of information for this sort of data. Multiple differing sources are just a joke.
Why this happened was all due to the haste with which the program has been conducted and the nonsense of multiple Wave sites conducting non-integrated pilots and development and a rather obvious effort to get as much stuff as possible out there before the looming Federal Election.
It is really amazing a single patient record can have 3 different sources of medication information (Shared Summary, Medicare and the NPDR) each of which has a different delay and almost certainly different information.
What is more is that you still can't have your prescription sent to the pharmacy of your choice and the functionality overseas experience shows is liked by patients in a PHR are still not present.
It is really amazing a single patient record can have 3 different sources of medication information (Shared Summary, Medicare and the NPDR) each of which has a different delay and almost certainly different information.
What is more is that you still can't have your prescription sent to the pharmacy of your choice and the functionality overseas experience shows is liked by patients in a PHR are still not present.
What we have now looks pretty amateurish and really confusing for the average patient.
David.
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