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Sunday, June 25, 2017

I Believe They Are Getting A Little Ahead Of Themselves With This One. Needs A Bit More Planning.

This article appeared a day or so ago.

GP support for mandatory 'paperless' prescriptions

| 23 June, 2017
A call to phase out paper-based prescriptions has been backed by one of the RACGP's e-Health experts.
Integrated electronic prescriptions should become mandatory for “any prescriber of a PBS-listed medicine, any pharmacist wishing to dispense a PBS-listed medicine”, according to a Federal Government review of the pharmacy industry.
In its interim report, released on Thursday, the review says the current paper-based system is outdated and inconvenient, and increases the risk of adverse medical events.
Instead, paper prescriptions should no longer be the "version of record", and pharmacists should be able to retrieve the electronic prescription without sighting a paper version.
Dr Oliver Frank, a member of the RACGP expert committee for e-Health and Practice Systems, says many GPs are uploading electronic prescriptions to exchange software such as eRx or MediSecure already.
 “If it makes the system better and saves paper, do it."
He says the only difference in moving to a completely paperless system would be to the legal significance of the paper prescription.
At the moment, pharmacists must still scan a paper barcode to access the electronic prescription, which downloads the prescription information to the pharmacist’s dispensing software.
More Information:
The full article is found here:
Now it is hard to suggest that in principle this is not a great idea. A lot of paper does get shuffled around and much of that is surely un-necessary.
There are however a few practicalities around issues like needing access to a computer system at difficult moments such a home visits at 3 a.m. and so on. There are also security issues that would need careful review if ‘on the move’ prescribing was to be agreed.
However the real issue is going to be to have the pharmacists be confident the doctor can’t direct a script to a particular pharmacy – so called ‘script-channeling’.  The way this is prevented at present is by handing the paper script to the patient – and having the patient decide where to take it for dispensing. The paper has a barcode which allows the pharmacist to access a script exchange to avoid typing and to provide accuracy.
The parallel system we have now seems to be the way to keep pharmacists happy while ensuring accuracy, ease of use etc.
Frankly I would like the doc to be able to ask the patient where they want to pick up the medicine and then to have the script go there with no paper. It can also be ready as soon as you go to pick it up – as in the USA. Great idea but the pharmacists hate it – and they are a powerful lobby!
I suspect the present system works well enough to ensure that change will be very slow to come!


Anonymous said...

Hi David and readers
I was wondering if you have given any thought to persuading ADHA to respond to the results of your most recent polls.
I note also the recent PulseIT ones also seem to suggest that there is much concern over any future for My Health Record.
It seems that such a guest post would be excellent and help us understand where the clinical benefit is for such a large expenditure.
If clinicians must be paid to use it – one has to wonder its relevance to clinical care – perhaps Tim Kelsey could explain that.

Dr David G More MB PhD said...

Asked two months ago. No response to date.



Anonymous said...

Not surprised David, the ADHA has for sometime crawled inside an insulated bubble and refuse to engage in discussion outside the collective cheerleaders.

I have noticed two things; the community seems more devised that previously, your readership seems to have sky rocketed as a result. I guess the ADHA position might be, if they are talking about us then at least they are not talking to us.

The board has a long way to go Ian afraid.

Oliver Frank said...

What I told the journalist was that it is time that we *can* prescribe without using paper. I did not know that this would be reported as saying that we *must* prescribe without using paper.

I told the journalist that we have nearly all of the technical elements for this is in place, with one remaining issue being how we will sign the fully electronic prescriptions. Previous clumsy attempts by government to issue and have us use individual digital certificates have failed. I have told the Australian Digital Health Agency that this issue, as well as how we will sign other electronic documents, needs to be sorted out as a priority.

Andrew McIntyre said...

The previous individual PKI keys did not fail, we had it all working, including a standard to describe it and after a bit of back and forth managed to get the bugs fixed in the HIC PKI library. What failed was the resolve and understanding from the department. Somehow they were convinced it was to hard even though we could demonstrate it working fully. Understanding the technology is not a strong point for the DOHA.

Bernard Robertson-Dunn said...

How about someone does some analysis to identify all the use cases and how they should work?

How would people who travel get a script filled if it is with a particular pharmacist?

How would repeat scripts work?

If drug interactions were part of the system - how would that work? How would the system know what a person was actually taking as opposed to has been prescribed? Patients may be told to take drugs in a particular order or only in particular circumstances.

What's the fall back when the technology fails?

What's the process for correcting errors and other exceptions?

What does "pharmacists should be able to retrieve the electronic prescription" mean? Retrieve from where? What happens to the data when a script has been retrieved? Will the system record who has collected the script (carer, representative etc)?

What are the privacy issues of any proposed solution? How would they be addressed?

Unless a rigorous and comprehensive analysis phase is undertaken and agreed with all parties, then everyone will have a different idea of how the system is supposed to work and what gets built will be full of problems - a bit like MyHR.

As usual, the devil is in the detail. Unless the details are thought through there is a major and significant risk of failure. And failure of health systems can result in harm or even death.

Anonymous said...

10.58 AM Sorry to disappoint but the Board has no way to go the have been 'there' since day one. They are well paid, as are all committee members, and they all gratefully take 'their' money whilst all happily nodding in unison as and when required. It was the same with NEHTA. It's the way the system operates - they've never done it any other way - it's policy and procedures that constipates the everything.

Anonymous said...

You need to be a little more realistic Oliver. You need to tell Mr Kelsey it’s a lot harder than he thinks. Medisecure and the eRx scriptexchanges will be whistling in the wind for a long time to come.

eScripts in the cloud are one thing – the script exchange vendors have been doing that now successfully for quite a few years. But the scripts are not being retrieved from the ether – the pharmacists aren’t scanning to the degree that they should and not all doctors are sending the escripts through a script exchange.

Of course, this suits the government and the ADHA and will until they can work out how to secure control over all the processes involved in transmitting escripts and updating a person’s medicines record by integrating everything with the MyHR, including the obvious extensions into the domains of the Electronic Recording and Reporting of Controlled Drugs (ERRCD) and Real Time Prescription Monitoring (RTPM).

Investors in the script exchanges have easily burnt upwards of $20 to $30 million or more so far. They must be wondering to what end, will they ever see a return on their investment. They should ask the Government.

Bernard Robertson-Dunn said...

What do MyHR, the Government's intervention in the NT problem of abuse of Indigenous children, the Lifetime Health Cover loading initiative and the national framework for maternity services have in common?

The Department of Health and a failure to live up to expectations?


Does the following sound familiar?

"The federal government has dumped a new national framework for maternity services, which obstetricians and GPs have slammed as an “ominshambles” and a wasted opportunity to improve maternity care.

A draft report released in March drew scathing criticism, with rural doctors and city specialists united in calls for it to be scrapped and the work to start again with input from medical practitioners in the field.

Dr Steve Robson, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), told The Medical Republic that the effort had been an “omnishambles” and was comprehensively mismanaged from the start.

The working committee included no obstetricians or GPs among its 12 members, and RANZCOG did not even know work was under way until six months after it had been commissioned by the Council of Australian Governments health ministers, he said.

“It’s just been a monumental missed opportunity,” Dr Robson said. “An extraordinary opportunity to do something positive has been turned into a heap of motherhood statements."

Anonymous said...

You have to wonder if COAG needs an overhaul, how many things do they sign off without proper checks and balances, the MyHR cop-out is a good example. Clearly buried in the footnotes on some minutes and BANG becomes a de facto mandate. I think the system is having the Micky taken out of it. Perhaps a royal commission might serve the people well.