Wednesday, April 25, 2012

Somehow A Good Idea Is Getting To Be Really Messy. Policy Seems To Be Off Track Again.

The following appeared over the weekend.

Plibersek defends script alert system

  • by: Karen Dearne, IT writer
  • From: The Australian
  • April 21, 2012 12:00AM
HEALTH Minister Tanya Plibersek has dismissed a Victorian coroner's concerns that a proposed $5 million electronic system to alert doctors and pharmacists to prescription-shoppers is flawed.
This is despite the fact that e-prescription software and exchange services offered by independent providers such as MediSecure and Pharmacy Guild-owned eRX can provide instant reporting.
Earlier this year, Plibersek promised to establish a national electronic recording and reporting of controlled drugs system to combat abuse of prescription medications.
Her department selected a system originally developed by the Tasmanian government as the state's Drugs and Poisons Information System (DAPIS), together with a web-based application, DAPIS Online Remote Access (DORA), to be available nationwide from July.
As reported in Weekend Health last week, Victorian coroner John Olle has described a tragic rise in deaths among painkiller addicts as a public health issue. He also called on the state's Health Department to introduce a real-time monitoring and alert system within 12 months.
But this week Plibersek's spokesman told Weekend Health that the DORA system would meet Olle's specifications.
"The decision to use the software was taken after a worldwide expression of interest was advertised through AusTender," he said.
"The Tasmanian system provided the best scalable solution to deliver real-time reporting as soon as possible, and the software is the best platform for building a nationally consistent system."
Weekend Health understands DORA does not interface with doctors' desktop prescribing systems; nor does it provide alerts about patients who have obtained S8 scripts from other doctors.
More here:
This was a follow up of this report:

Electronic alert to end abuse

THE suicide of James - from an overdose of prescription morphine and diazepam he obtained during daily runs to various GPs and pharmacies - proved one tragic death too many for Victorian coroner John Olle.
Unusually, Olle has used his powers to recommend the state introduce a real-time prescription monitoring and alert system within 12 months to reduce the deaths and harm caused by such doctor-hopping or prescription-shopping by vulnerable patients.
At present, state and territory governments rely on monthly submissions of paper-based records of controlled (Schedule 8) drugs prescribed by doctors and dispensed by pharmacists. A move from manual to electronic recording, and then real-time reporting, will give providers the information needed to make clinically appropriate prescribing decisions.
But some critics fear a national alert system being developed by the Gillard government may not deliver the desired outcomes.
Meanwhile, courts must deal with cases like that of James, a 24-year-old Essendon man suffering from depression, anxiety and insomnia. He obtained scripts for S8 drugs from 19 doctors and picked up the medications from 32 pharmacies in the three years before his death in 2009.
"James developed an addiction to prescription painkillers he was unable to satisfy or overcome," Olle said in his inquest findings, delivered last February.
"His former partner recalls a normal day for James would involve prescription-shopping for several hours ...
"James would then attend work, return home and consume large quantities of medication during the late evening.
"James's family and friends were aware of his addiction, which resulted in several episodes of violent behaviour, relationship breakdown and job loss."
Olle found James actively tried to minimise the harm, storing his drugs overnight in a cabinet that was locked by a trusted friend, and attending residential drug and alcohol programs.
James was found dead in bed after his father asked police to conduct a welfare check. The young man had left notes indicating his decision to end his life and expressing love for his former partner and family members.
Olle found the issue is a public health problem, not a matter for law enforcement. The problem is such patients conceal the fact they doctor-hop and drug-shop.
"The medical practitioners whom James consulted were denied an opportunity to exercise clinical judgment with the benefit of the complete picture," he said.
Lots more here:
The issue attempted to be addressed here is how to make a prescriber aware when an individual has been receiving more than a reasonable amount of potentially addictive or dangerous medication provided by different prescribers (who are unaware of what their colleagues have prescribed).
The problem is conceptually very easy to address - all you need is a prescription database that can be searched by individual patient. With the internet and modern data-base tools there are no serious technical barriers - the devil is of course in the detail of addressing all the issues of consent, integration with work flow and prescribing and dispensing workstations, security of information, maintenance of privacy and so it goes on.
It is interesting that this problem is faced all over the world.
On Friday last week we even had it discussed in the US.
Friday, April 20, 2012

Ky. Lawmakers Consider Expanding Access to Rx Drug Tracking System

The Kentucky Senate is gearing up to vote on a bill (HB 1) that aims to crack down on prescription painkiller misuse by restricting ownership of pain clinics and increasing access to the state's prescription drug tracking database, the Wall Street Journal reports.
About the Database
Kentucky's database includes information about prescribers, recipients and dispensers of certain prescription drugs. The state's Cabinet for Health and Family Services and Board of Medical Licensure currently oversee the database.
Law enforcement officials seeking to obtain information from the database must submit a request to the Cabinet for Health and Family Services and prove that the information request is part of an active investigation.
About the Bill
Under the bill, oversight of the prescription tracking database would shift to the state attorney general's office. The change would provide the AG's office and local prosecutors with better access to the prescription drug tracking system, but police officers still would need to submit requests to obtain information from the database.
The proposed legislation also would require physicians to consult the database before prescribing certain painkillers.
More here:
From the articles above we see the Federal Government seems to want to extend a Tasmanian system which operates only in the hospital sector. The pros and cons of all this was discussed here:
The 13 comments are pretty interesting and revealing.
Reading the two articles above there is clearly concerns this - on the cheap - approach has a range of flaws.
An alternative being tried as one of the Wave 2 projects is Medview from Fred IT - a major provider of pharmacy dispensing software. You can read all about this here:
What is interesting about this project - being conducted in the area around Geelong - is that it uses just one of the two private prescription exchanges and on the web site there is hardly a mention of either NEHTA (except for the funny little e-Health logo) or the PCEHR (Just a 467 Million Govt. Program). In the background the Pharmacy Guild - who are a major sponsor of the eRX exchange - are strongly supporting this program for their own reasons.
As a tool to manage doctor shopping it has one rather large flaw. You have to consent to your data being uploaded and what seeker after pills is going to be silly enough to do that?
It also is claimed by the other prescription exchange they can provide a useful data base to do similar things.
Clearly what is needed is a strategic, standardised approach that builds on what is being done with both prescription exchanges, GP and Pharmacy Desktop Software and the relevant messaging providers to have something useful emerge in a co-ordinated and practical way.
It is not hard to do - but again there needs to be quality leadership and governance put in place to make the vision a working reality. Fragmented approaches too often fail.
p.s. Since this was prepared more coverage interesting has appeared here:

Delayed choice for prescription alert platform

HEALTH Minister Tanya Plibersek's $5 million plan to crack-down on prescription painkiller abuse, which was announced in February, was originally funded under the fifth community pharmacy agreement with the Pharmacy Guild in 2010. 
The Brownian Motion around all this is just amazing and silly!


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