This is the most logical use of electronic records with significant
potential gains.
There are a number of issues as you say, but I am sure they are not
insurmountable. It still relies on the patient presenting for their
script, which presumably means they are still responsible. The data will
be useful - I would suggest the govt retains close control of this
element, or makes it publicly available in an agregated form. The next
step is to link it with diagnoses and hospital admissions
R
Aus HIT Man wrote:
Your humble scribe had another of those “choking on his Wheaties”
experiences this week. Suddenly’ out of a clear blue sky’ it was
announced following the recent Australian Health Ministers Advisory
Council (AHMAC) meeting that there was to be an end to paper
prescriptions and we were to move to full electronic prescribing with
electronic transmission of the prescription to pharmacists. The
pharmacist is to obtain an electronic copy of the patient’s
prescription by swiping the patient’s Medicare Card. (One imagines
that ultimately Mr Hockey’s Access Smartcard will provide the same –
but rather more secure – functionality).
This is hardly a new idea. Way back in 1996 your scribe and a
colleague wrote a report for the Commonwealth Government recommending
planning for such a system commence as we found there was a compelling
business case to implement e-prescribing even then. Some notice seems
to have been taken of the suggestion and early this centaury we saw
the Medi/Connect/ trails in Tasmania and Victoria. These trials showed
e-prescribing could be done but that further work was required to make
it all work well and to achieve widespread adoption. There were also
some issues around the potential costs of a national implementation
being seen as quite high – as an isolated program.
It is noted, in passing that e-prescribing is being widely trialled
and implemented globally with much activity in the US,UK, Canada and
Europe.
Here is the text of the announcement.
“*Electronic Prescribing and Dispensing of Medicines.*
Australians are set to receive improved healthcare following agreement
today by all Australian Health Ministers to remove the legislative
barriers to electronic prescribing and dispensing of medicines.
From 1 March 2007 the amendments will allow for all stages of the
prescribing process to be completed electronically and provide an
alternative to the present paper prescriptions system. Scripts will be
able to be initiated electronically by prescribers, electronically
signed, then transmitted securely and uploaded into the dispenser’s
system without the need for re-keying. This will ease the burden
created by paper-based prescription processes and allow healthcare
professionals to spend more time with patients and their needs.
There are an estimated 400,000 adverse drug incidents that occur in
Australia each year according to the Australian Council for Safety and
Quality in Health Care's Second National Report on Patient Safety.
Electronic prescribing and dispensing will help eliminate those
incidents that occur due to poorly handwritten paper prescriptions and
transcription errors.
The regulatory amendments to provide for electronic prescribing and
dispensing will become effective on 1 March 2007. This gives all
States and Territories sufficient time to make their own consistent
legislative and regulatory amendments.”
This description makes it clear that what is envisaged is a national
“store and forward” network where the doctor creates the prescription,
sends it to a central repository from where it is retrieved by the
pharmacist into their dispensing computer. Presumably the patient will
also be given a written prescription (hopefully with a barcode
containing all the prescription information is scannable form) as a
back up and to handle the situation of the computer repository being
unavailable.
The number of questions this raises are legion. Among them are the
following:
Who is going to own and operate what will be this rather large
national network? (Will it be Medicare, another part of Mr Hockey’s
empire or will it be outsourced?)
What standard(s) are to be used for secure messaging and prescription
transmission and are there currently any GP systems with such capability?
What terminologies will be used, given the Australian Medicines
Terminology is still in an embryonic stage of development – not due
for at least 12-18 months?
What levels and capability of electronic decision support will be
offered at the prescribing point and at the central repository to
reduce prescribing errors? (The reduction in error rates, and possibly
the ability to bias towards the use of generic medication, is the key
justification for introduction of e-prescribing).
Where will the Government be sourcing the needed guideline and
prescribing databases to ensure the prescribers get the most current
and evidence based information?
Is the Government (or some agency) going to undertake certification
and proof of functionality testing of GP client systems to ensure they
work as safely as possible and have up-to-date drug reference
databases etc?
How are prescriptions which are transmitted but not collected to be
handled? (e.g. the situation where the patient decides not to pay for
the drug, or is given the prescription on the basis of “if you get
worse’ get it filled).
Who will have access to the commercially invaluable prescribing
data-base the system will create and under what circumstances?
Where do NEHTA, the medical colleges, the pharmacists and their Guild
and consumers fit in all this. Have they been consulted?
Are hospitals expected to produce discharge prescriptions electronically?
What review has been undertaken of all the work done here and overseas
to ensure we get the safest and most secure system possible from end
to end (i.e. from the doctor developing the prescription all the way
to be patient being handed their medication and appropriate clinical
and safety advice)?
I suppose I could go on but in the absence of the AHMAC providing
publicly available detailed minutes there seems little point. All we
have – from the Government and AHMAC - what is provided above.
Before wrapping up, I must say I think a properly developed and
considered national e-prescribing implementation would be a very good
thing and would save a significant number of injuries, indeed lives.
It does of course need to be undertaken in the context of that
National e-Health Plan we have all yet to see.
However, it seems to this observer however that, despite some rumours
to the contrary, this hare has a good deal further to run and a good
deal more work to be undertaken before something useful makes it to
the light of day. Pity that. It all seems way to “spur of the moment’
to be real.
David.
--
Posted by Aus HIT Man to Australian Health Information Technology
<http://aushealthit.blogspot.com/2006/07/e-prescribing-in-australia-is-there.html>
at 7/30/2006 03:09:00 PM
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