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Thursday, November 05, 2009

Electronic Prescription Transfer and E-Prescribing - What Happens Elsewhere?

I came upon this slide the other day from NEHTA.

eMM National Development Roadmap

Progressive releases from 2008 – 2013

Release 1: Electronic Transfer of Prescription

Release 2: Adherence Monitoring

Release 3: Current Medication List

Release 4: Community Medication Review

Release 5: Decision Support and Secondary uses

Source: Andy Bond Presentation – June 2009.

From this we can be sure we are all going to be waiting a good while for eMM (Electronic Medication Management) to become a reality in Australia.

What is happening elsewhere? Just for reference let’s look at the US and UK.

United States of America

I think this provides the flavour:

ALEXANDRIA, Va. and ST. PAUL, Minn. – April 22, 2009 – Surescripts®, which operates the country’s largest national electronic prescribing network, today announced that more than 100,000 prescribers are now routing prescriptions electronically in the U.S. What’s more, the use of three critical components of e-prescribing – electronic prescription benefit, history and routing – jumped 61 percent in the first quarter of 2009, resulting in more than 134 million e-prescribing messages being exchanged among prescribers, payers and pharmacies.

“In the past two years, the U.S. has gone from 19,000 to 103,000 prescribers routing prescriptions electronically – punctuated by 39 percent sequential growth in prescriber adoption in the first quarter of this year,” said Harry Totonis, president and CEO of Surescripts. “The past two years have also witnessed a sevenfold increase in the use of e-prescribing. And while this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing.”

Today’s announcement features the release of the annual National Progress Report on EPrescribing. Based on the operations of the Surescripts network, the Report features statistics and graphics detailing the status of e-prescribing adoption and use in the U.S. from 2006 through 2008. For a downloadable copy of the National Progress Report on E-Prescribing, go to www.surescripts.com/report.



The network is standardised as can be seen from this report:

Surescripts Preparing for New Rx Standard

HDM Breaking News, October 20, 2009

Electronic prescribing network vendor Surescripts anticipates in May enabling software vendors, pharmacies, pharmacy management benefit plans, and insurers to begin the process of certifying their systems to support version 10.6 of the NCPDP SCRIPT standard electronic prescription.

The Centers for Medicare and Medicaid Services is expected soon to issue an interim final rule adopting the new version, mandated under the Medicare Modernization Act. Capabilities within the new version also are included in recommended meaningful use criteria the HIT Policy Committee has sent to federal officials.

More here:


The standards are also mature and usable for the US:

See this from John Halamka a few days ago.(CIO Mass General)

“ePrescribing - we have a mature standard (NCPDP Script 8.x) that is being enhanced to support new features (NCPDP Script 10.x) on a reasonable timeframe with minimal burden. We have test harnesses, middleware and clearinghouses that will accelerate adoption. We have an ecosystem of application developers. There is work to do to encourage more transactions to flow, but we're in generally good shape.”


So full adoption is now really the issue and the specific US payment incentives for e-prescribing (from the Obama stimulus package)are likely to have that happening really quickly in the next 2 years.

United Kingdom

Seems some has got it organised in Scotland!

Scotland delivers e-prescription service

14 Jul 2009

Scotland has announced that it has become the first country in the UK to deliver an electronic prescription service, with more than 90% of prescriptions now submitted electronically.

Scottish health secretary Nicola Sturgeon said the electronic Acute Medication Service (eAMS) was the first national system of its kind to go live anywhere in the UK and was now enabled in 99% of Scottish GP practices and pharmacies.

The eAMS prints a barcode on prescriptions at a GP surgery and sends a message to Scotland’s ePharmacy Message Store.

When a patient presents at a pharmacy with their barcoded prescription, the pharmacist can scan the barcode to pull down the prescription and dispense the medicine.

Dispensing a prescription triggers the creation of an electronic claim message to NHS National Services Scotland (NSS).

The Scottish government said eAMS cuts the risk of errors between GPs and pharmacists, delivers improvements such as the use of universal codes for virtually all medicines, and boosts efficiency.

Sturgeon added: “With eAMS we are now seeing more than 90% of prescriptions submitted electronically. This shows the demand among GPs and pharmacists to work together to make the best use of the latest technology to improve services for patients.”

More here:


Note Scotland does have a population of over 5 million so this is not a tiny effort. It is an already working and coded implementation!

It seems England is being a bit slower – but are planning real SNOMED CT based decision support as part of their UK NHS implementation.

Lots about what they are up to:


The bottom line to me is that NEHTA has – as I said previously – seems to have been happy to go with a less than developed proposal and to really compromise more than I would like just because of still embryonic commercial offerings. A roadmap going onto 2013 hardly fills anyone with confidence.

The issue for me with all this is the total lack of coherent governance with DoHA seemingly having just vacated the field and everyone else pursing agendas which do not convince me have the national interest at heart.

Maybe someone should get all the players and stakeholders in a room and have them agree a single appropriate national approach that everyone can support and then we can get on with this. This festinatory Brownian Motion is just not good enough and no good will come of it I believe.


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