E-Prescribing - Part 2

Just when I thought the e-prescribing initiative was settling down for a few weeks, a very useful contribution to knowledge and the state of play comes from the Commonwealth Department of Health and Aging (DoHA).

A statement was circulated today clarifying last week's AHMAC announcement. It said (in full).

“Electronic Prescribing of Medicines

Last week in Brisbane, Health Ministers signalled their intent to remove legislative barriers to electronic prescribing.

Commonwealth Minister for Health and Ageing, Tony Abbott told the Health Ministers meeting on 27 July 2006 that his Government would amend the National Health (Pharmaceutical Benefits) Regulation 1960 to remove a requirement that Pharmaceutical Benefits can only be paid for prescriptions that carry a doctor's signature.

The amendments, which will come into effect on 1 March 2007 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 created electronically by prescribers, electronically signed, then transmitted securely and uploaded into the pharmacist's system without the need for re-keying. This will ease the burden created by paper-based prescription processes, allow healthcare professionals to spend more time with patients and reduce the risks of errors and lost prescriptions.

According to the Australian Council for Safety and Quality in Health Care's Second National Report on Patient Safety an estimated 400,000 adverse drug incidents occur in Australia each year. Electronic prescribing will help eliminate those incidents that occur due to poorly handwritten paper prescriptions and transcription errors. It will also support longer term moves to reduce waste in the PBS and improve patient safety stemming from duplicate prescriptions and adverse interactions between different medicines.

While the changes announced last week remove one of the main barriers to electronic prescribing, there are a number of additional steps that will need to be taken before the vision becomes a reality.

States and Territories will first need to examine their own legislation and make any amendments that are necessary to bring it into line with the amended National Health (Pharmaceutical Benefits) Regulation 1960.

Then, governments will need to work with Medicare Australia, the National E-Health Transition Authority, IT suppliers and professional bodies representing doctors and pharmacists to put in place arrangements to ensure the successful operation of electronic prescribing. Key considerations to be addressed will include:-
• the need to ensure security of prescribing information and protect patient confidentiality;
• procedures to validate the identity of prescribers;
• mechanisms to allow patients choice over where and when they have their medicines dispensed;
• integration with doctors' and pharmacists' existing computer systems; and
• arrangements for secure archiving of prescription details.

Given the scale and nature of the practical challenges in any large-scale move to electronic prescribing it may be some time before it is widely adopted. Nevertheless, last week's announcement by the Federal Health Minister is an important move which will yield substantial long-term benefits to patients and health professionals throughout Australia.

Regards

Tam Shepherd
Assistant Secretary
eHealth Branch
Australian Government Department of Health and Ageing”

As far as this goes this is excellent and recognises – as mentioned in my initial comments – that there is considerable work to be done in a range of areas before this can all come to fruition.

However it is also important to note what is not covered in this briefing.

First the strategic and e-health context in which the planning for e-prescribing is to be undertaken remains vague if not totally opaque.

Second there is no target time-line (except a long one) of any sort provided – leading to at least some scepticism about just how serious this actually is.

Third there are a number of Standards related issues that NEHTA is yet to address, as well as the need for consultation with the all relevant stakeholders to see just where this fits in the overall e-health priority list.

Fourth – yet again - the issue of quality of GP and Specialist prescribing decision support and its importance (and indeed the issue of the quality of the GP computer systems in general) is not recognised. To contemplate e-prescribing without fully and carefully addressing this area is folly. I believe that unless we have certified systems with current knowledge bases that provide consistent, evidence based, interactive, point of care advice the business case to e-prescribing is hard to build.

Fifth it is important to note that prescribing information data bases are presently a significant issue with the SA HealthConnect SEHR initiative choosing not to use the database sponsored by NEHTA according to their web-site.

The bottom line is that prescribing error in the absence of quality information is much more of a risk than transcription errors for the patient.

I look forward to further refinement of the e-prescribing plans and indeed a clear outline of the overarching e-health framework into which this initiative fits.

David.