E-Prescribing in Australia – Is there a New Plan?

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 which recommended that planning for such a system commence. We had concluded there was a compelling business case to implement e-prescribing even then. Some notice seems to have been taken of the suggestion as early this century we saw the commencement of the MediConnect trials in Tasmania and Victoria. These trials showed that e-prescribing could be done but that further work was required to make it all work well in order 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 elsewhere in the world 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 in scannable form) as a back up and to handle the situation of the computer repository being unavailable.

The number of questions this AHMAC announcement raises are legion. Among them are the following:

Who is going to own and operate what will prove to be a 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 that 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 the introduction of e-prescribing).

Where will the Government be sourcing the required guidelines and prescribing databases to ensure the prescribers get the most current 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 valuable prescribing data-base the system will create and under what circumstances?

Where do NEHTA, the medical colleges, the pharmacists, the Pharmacy 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 the 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 – is that which has been provided in the above announcement.

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 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 about that. It all seems far to “spur of the moment’ to be real.

David.