Over the last six months or so the ADHA has been out there saying what a fabulous job they are doing with the introduction of Electronic Prescribing (EP).
Here is a typical release:
Media release - Technology delivers social distancing for healthcare in fight against COVID-19
8 April 2020: Technology is poised to further help Australians during the COVID-19 pandemic through electronic prescriptions that will allow people convenient access to their medicines to people practising social distancing and self-isolation. This new development will complement the My Health Record which is already making critical health information available when it’s most needed.
In Australia, evidence shows there are more than 250,000 hospital admissions annually as a result of medication related problems. Many of these are associated with poor availability of medicines information especially at transitions of care. My Health Record is improving this access to medicines information and is an integrated record of what medicines patients are taking to ensure the most safe and effective care.
The My Health Record system has 1.81 billion documents in it including: prescription and dispense information, Pharmacist Shared Medicines Lists, medical history, allergies, pathology and diagnostic imaging test results and immunisations, as well as hospital discharge summaries.
More technology is on its way. Under the Australian Government’s National Health Plan for COVID-19, electronic prescriptions are now being fast-tracked to allow patients to receive vital healthcare services while maintaining physical distancing and, where necessary, isolation.
Electronic prescriptions are an alternative to paper prescriptions, and the solution being fast-tracked will see a unique QR barcode ‘token’ sent via an app (if they have one), SMS or email to the patient. This will allow people in self-isolation convenient access to their medicines and will lessen the risk of infection being spread in general practice waiting rooms and at community pharmacies.
This initiative is designed to support telehealth and will allow a doctor to generate an electronic prescription that patients can then share with a pharmacy.
A significant amount of work had already been done to ensure that necessary upgrades to both pharmacy and prescriber software can be done quickly and electronic prescriptions are expected to be progressively available from the end of May.
Ms Bettina McMahon interim CEO says, “the use of technology in healthcare has never been more critical, and Australia is in a better position than many other countries when it comes to digital health. Electronic prescriptions are another vital tool that will help to create a connected healthcare system for Australia.
“Australians should take comfort that governments and healthcare providers have made significant investment in healthcare technology over the past 10 years. We are now able to fast-track adoption of this tech to respond to this pandemic in a 21st Century way.”
The Agency is launching a new community communications campaign next week to help people understand the benefits of technology in healthcare and the need to ensure the health system is connected to provide better health outcomes for all Australians.
The campaign features Dr Andrew Rochford, a Medical Practitioner with an Undergraduate Degree in Medical Science, Majoring in Anatomy and Neuroscience, Post Graduate degree from University of Sydney Medical School, Bachelor of Surgery with Honours.
Medically, he’s trained in emergency medicine, having held Registrar positions at major teaching hospitals around Australia, including Royal North Shore Hospital in Sydney, Princess Alexandra Hospital in Brisbane and is currently working at the Northern Beaches Hospital.
Dr Rochford is a digital health expert with his own organisation ‘Docta’ which builds customised mobile smart clinics equipped with telemedicine and digital healthcare technology to improve access to healthcare resources and knowledge for people in remote areas round the world. The campaign will feature in radio, online (including catch up TV) and in social media.
Also we have had press releases announcing the first use of EP in a number of States, rather surprisingly, in just the last month or so.
Thus it was starting to feel the ADHA has got ahead of itself on just how the ramp up and implementation.
Now we have this article from late last week.
GP scripts rejected amid confusion over e-prescribing
Pharmacists say they are sending patients back to their doctor for paper scripts
6th August 2020
Widespread confusion over the rollout of the national e-script system is resulting in GPs issuing electronic prescriptions that can’t be dispensed, it has emerged.
The Australian Digital Health Agency has been running TV and social media advertising since April promising to “connect Australia to a healthier future” with electronic scripts.
The campaign followed promises by Minister for Health Greg Hunt to fast-track a national system for GPs and pharmacies as part of the Federal Government’s coronavirus response.
But despite officials initially saying the technology would be ready Australia-wide from May, e-scripts are currently only available at trial sites involving 22 GP practices servicing 24 communities.
The national rollout is not expected until the end of the year.
The Pharmacy Guild of Australia says pharmacies outside the trials are dealing with patients turning up with electronic tokens (usually a unique web link sent via SMS to the patient’s phone) for scripts which cannot be dispensed because pharmacy e-script software is not yet up and running.
In all cases, either the pharmacist or patient goes back to the GP for a paper script, the guild says.
Dr Rob Hosking, chair of the RACGP’s practice technology and management expert committee, says the contradictory statements from the Federal Government have sown confusion.
“Firstly, they tell everyone — the GPs, pharmacists and the public — that this program is being fast-tracked and it will be ready by late May,” he said.
“This doesn’t happen and so the program changes from a Big Bang approach to rolling it out in 24 small areas dubbed ‘communities of interest’.
More here:
https://www.ausdoc.com.au/news/gp-scripts-rejected-amid-confusion-over-eprescribing
So we have an ill-timed advertising program running ahead of the truth and just confusing the public!
Well done team! The swaggering stethoscope does not look quite so smart now!
David.
86 comments:
Is anyone really surprised?
Just add it to the list of disasters that pour out from Health/NEHTA/ADHA.
What a gift to the new CEO. My Health Record that nobody is interested in, COVIDSafe that doesn't work, the train wreck that is e-scripts that will just keep on giving.
A someone said the Feds are an incompetent bunch
In happy and more plentiful times you might forgive this level of incompetence going through to the keeper but not currently with the costs of COVID mounting.
You might even botch this event up to the Chief Digital Officer being a bit out of his depth and lacking experience, you cannot excuse those around him such as the acting CEO, the Acting COO and the now acting CMO, they at least on paper should have been well aware of the direction this was heading.
I am sure they all have contributions to make, just not in high-profile decision-making roles.
Sack-em I believe is the technical term.
That is a bit of a change in direction. Are we sure ADHA is at fault here? Perhaps the CEO of MSIA has not proven to be as useful as thought? Those acting have some criticism to suck up but they are not solely responsible for the bad show.
This will go unreported sadly, Covidsafe is back in the spotlight. Government medical advisor now saying the new updates makes it a powerful tool and encourages everyone to start using it. This seems to fly in the face of user reports, some of which are the most recent on the Apple App Store.
So much for listening to your customer base.
Not Being Open And Transparent Always Catches Up With You If You Try To Distort RealitY - could not have summed things up better David. One wonders if this was a driver for the mass exodus? Or am I being to generous?
I cannot help but be reminded of a trick my father explained to me when he served in the forces
In general liars will construct their stories as linear narratives that flow like a tape-recording, well rehearsed, simple and in one direction. Human experience are stored in memory - different parts may be accessed directly and quickly. Jumping backward through the story is thus relatively easy for the truthful person as they skip in reverse through the scenes and easily access real memories.
The liar, however, has more work as they jump back then play the story forward to get to the point in question - you see this extra work as the attempt to spin their way out. This is true for planning, when they make it up on the fly it is hard to reverse engineer the path trodden.
This method is popular with police and military services who need to get truthful accounts from perpetrators, victims and witnesses alike.
I was going to let this one go through to the keeper, but decided it needed a response. Whilst I agree that the ADHA deserves a lot of the criticism it receives, most generally in this forum, the e-script project has demonstrated that given the right opportunity, the software industry and the Govt. can work together to deliver a real benefit to the population in a timely manner.
Under normal circumstances, the e-script project would have taken a lot longer to deliver. Following normal project management guidelines, it would have included a structured deployment strategy that would have ensured that prescribing software and dispensing software were made e-script capable at close to the same time, in the same local area, so that any patient inconvenience was minimised (there will always be some).
But these are not normal circumstances. Yes, some patients have been inconvenienced, but a great many more have benefited from the functionality and from what I have read, a significant number of these have been older patients
It will become more seamless as more facilities become e-script enabled.
And 7:12am, what have you got against the MSIA? For decades they have helped to drag the medical profession into the world of e-health, in spite of significant initial push back from the medical profession.
And I ask those of you who hide under the cloak of anonymity and gripe about the state of play in e-health in Australia, what have you done lately to improve things?
Re COVIDSafe.
It took about a week to register 4million people (not downloads; people who have registered).
It's taken about 14 weeks to get to 7million.
If you look at the app stores and the details of each version, they are still fixing bugs. The comments are also worth looking at. Not exactly pretty.
The COVIDSafe curve has been flattened. IMHO, the government has hit peak trust. There's little they can do to fix that, not in a hurry.
Tony,
Maybe I was not as clear as I should have been. My criticism is that the ADHA has been spruiking a wonderful success that has yet to be delivered and in the process has misled the public. It was not that e-scripts was not a very good and worthy project, that is definitely on its way to success.
Bluntly it is not there yet but I am sure six to 12 months from now it will be. This all reminds me of the Treasurer and his 'Back in Black' coffee mugs! You claim success when you have actually delivered not before.
The ADHA has a serious problem with exaggerated spin IMVHO and needs to be called out for it.
I note the current MSIA President and ADHA Board member is also concerned that someone would call spin out.
See here:
http://medicalrepublic.com.au/griping-few-shouldnt-rain-on-e-scripts-parade/32786
10 August 2020
Griping few shouldn’t rain on e-scripts’ parade
Posted by Emma Hossack
Success in national digital health programs is rare. It should be celebrated in these gloomy times.
The prescience of Health Minister Greg Hunt in funding e-prescriptions in the 2018 Budget was remarkable. It enabled the health software industry to create foundations for seamless access to medications by consumers in the pandemic.
So what about the reports of confusion over e-prescribing. Is it a real concern? Or is it a small gripe in what is an exemplary collaboration between the health software industry, peak bodies Medical Software Industry Association, PGA, ACRRM PSA, RACGP and the commonwealth and state governments?
In ordinary times, software deployments roll out beta sites to settle inevitable user and environmental issues. That was the plan. But these are extraordinary times – just like the bushfire period in December, when pharmacies and dispensing software companies worked with their peak bodies the PGA and MSIA over Christmas to enable continuous dispensing in just a week for bushfire victims. Not ideal, but necessary. And it worked.
----
David.
@9:36 Under normal circumstances, the e-script project would have taken a lot longer to deliver.
9 women can't have a baby in one month.
@Tony 9:36 AM
You used the term e-health. Is that different from Digital Health?
"The prescience of Health Minister Greg Hunt in funding e-prescriptions in the 2018 Budget was remarkable ... "
Please, please, Emma, spare us such drivel. Is it self-serving, is it genuine or is it simply a distortion of history for political expediency?
Where has your objectivity gone. Look at the facts over the last decade and the impact of bureaucratic ineptitude and obstruction on achieving progress in this domain, not just with eScripts but with RTPM which is closely related.
Digging into Emma's article, it starts with: Success in national digital health programs is rare - which suggests that it has succeeded
Buried further down it says:
This program is being carried out by the most intelligent, trusted and respected professionals in Australia. Consumers want it. The technology is largely ready. Where it is not ready, there are existing supply protocols including phone calls. Image-based prescribing was a practical interim measure with potential privacy and security issues. It is scheduled to finish on 30 September and so it should.
The enhancements to e-prescribing will continue with Active Script List. It will just get better and better. Let’s focus on helping all parties to get up and running with e-prescribing.
I get the feeling that everyone is being a bit presumptuous. It might be a success, but it ain't yet. Like so much of digital health, promise seems to precede reality, sometimes by a long way.
@Bernard 11:14am
I've been doing this stuff for 30 years. Old habits dies hard ;-)
One problem with this over promise under deliver cycle is it takes the shine off events when they are delivered and success obtained. Rather than receiving the “job well done” it’s, oh really wasn’t that suppose to have been completed two years ago?
I have nothing personally against the MSIA guild. I simply question some people’s effectiveness and it’s value as demonstrated here. If it sits on ADHA board, which is simply a Westminster style program board, it has all these vendor members who could easily provide rollout timelines for software releases and engage their customer base to confirm all this. I question what the hell do we as tax payers pay you lot to do. Seems the transaction is all one way. When a call to arms is needed the perception does not meet the challenge. I look forward to the excuse.
I remain anon because it is to easy to be someone escape goat in this space which I serve but others are happy to exploit and push people under buses“old habits die hard”
@Tony. Just to clarify, some must remain Anon. The public service does not promote engaging on social platforms. Even Twitter is carefully handled and most filtered through comms teams. Many of us enjoy sites like this even if occasionally it hits a raw nerve.
It surprise me when Nehta was merged into a Commonwealth Government entity, it lost some freedoms. It is neither a policy house nor can it ever be an innovation house. It is lost because of the chains it must wear.
@7:37 AM "It is lost because of the chains it must wear."
It is lost because it had no understanding of the real problem it was meant to be trying to solve. The chains to which you refer were self-imposed due to inadequate leadership, no clear strategy, deficient alignment with industry, and an inability to think differently and creatively, unfettered by the constraints imposed by long-standing ingrained politics, policies and procedures.
I am so tired of the criticisms of Emma Hossack – a lawyer, CEO and exceptional professional who has advocated passionately for digital health for years. I have heard some dreadfully patronising and sexist criticisms of her over the years, and I think we – as the digital health community – should be better than that. I am certainly not suggesting that you have contributed to those, David, but can we celebrate or appreciate some efforts in the sector sometimes, instead of knocking them down?
Mmm Fast-track - well I never! "The campaign followed promises by Minister for Health Greg Hunt to fast-track a national system for GPs and pharmacies as part of the Federal Government’s coronavirus response."
There is nothing prescient about that.
It is reported that "The Australian Digital Health Agency (ADHA) has asked GP software vendors to suspend access to ePrescribing functionality in their systems while a plan is worked out to scale the new capability nationally"
Gee, the ADHA hasn't even got a plan yet? Did ePrescribing come as a surprise to ADHA? It was in all the papers. Did the MISA raise this as an outstanding issue?
It would appear that the ADHA's planning capability is as good as the Department of Health's when it comes to aged care.
@10:32 AM Well blow me down, what a surprise. Who, in the ADHA, asked GP software vendors to suspend access? And, who, in the ADHA, is overseeing ePrescribing?
Finally, would one describe ADHAs decision to request a suspending of access as "prescient"?
It would be helpful if the MSIA strongly supported the ADHAs request to suspend access to eprescribing functionality to reinforce the ADHAs credibility on this matter. MSIA, being an expert peak vendor representative body, should clarify the ADHAs request and specify the timeline to be covered "while a plan is worked out to scale the new capability nationally".
Oh no. Surely not. It can't be possible. Scaling it nationally! What an extraordinary idea, so creative! Whoever thought of that? Promote that person.
The ADHA announcement shouldn't have been a surprise to the MSIA as their CEO is very involved with the ADHA!
Further to my question "what is Digital Health Doing to address the problems with evidence based medicine?", here's another.
"What is Digital Health Doing to address the problem of bias in clinical medicine?"
Here is some information about the problems of gender bias (there are many other biases):
One in 10 women are affected by endometriosis. So why does it take so long to diagnose?
https://www.themandarin.com.au/137185-one-in-10-women-are-affected-by-endometriosis-so-why-does-it-take-so-long-to-diagnose/
Gender Bias and the Ongoing Need to Acknowledge Women’s Pain
https://www.practicalpainmanagement.com/gender-bias-ongoing-need-acknowledge-women-pain
The Heart of the Matter: Disparities in Cardiac Health for Women (2019)
https://swhr.org/the-heart-of-the-matter-disparities-in-cardiac-health-for-women/
The Lancet in May 2019 did a whole series on on gender equality, norms, and health
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30985-7/fulltext
A few recent books.
Invisible Women: Data Bias in a World Designed for Men (2019)
Caroline Criado Perez
Doing harm: the truth about how bad medicine and lazy science leave women dismissed, misdiagnosed, and sick (2017)
Maya Dusenbery
Pain and Prejudice (2019)
Gabrielle Jackson
It's not exactly a minor, or niche issue; I'm told about half the people in the world are women.
It's not hard to identify the major problems in current clinical medicine; what is harder is to identify what Digital Health is doing about them. Not one of the above references even mentions the topics of Health Records, Telehealth or e-prescribing.
Funny that.
@3:42 PM All good stuff. Now that we graduate approx. 50% of doctors being women, we will continue to see steady progress in rebalancing gender bias in medical diagnoses.
Are there better ways of doing so? Probably not. Digital Health? Probably not.
Gender bias! Isn't that all rather academic?
Is it attitudes and culture you seek to change or something a bit more pragmatic like clinical workflow practices and produres
.... read .. procedures.
3;42 PM and 4:42 PM same old story, lost in the weeds again.Stay focussed and prioritised.
Thanks for the references. Good academic research but lacking clinical insight.
@10:51 PM Perhaps you should read today's article in the Medical Republic for some enlightenment!
David, Tony, Emma, Bernard, whoever, coulease clarify where the eScript exchanges (eRx and MediSecure) fit in the electronic prescription picture.
The reason I ask is that nowhere in the media coverage, including today's Medical Republic article, does there seem to be any mention / acknowledgement that the script exchanges have a place in eprescriptions. I hope I'm wrong about that. Thanks.
@4:17 PM. Interesting observation, it raises two questions - How does a medical practice direct an ePrescription to a specific pharmacy of the patient's choice?, and, Is channeling, once vehemently objected to by the Pharmacy Guild, now an acceptable practice?
Maybe the ADHA or the Department has built a Directory of all pharmacies which a practice can use to direct the eScript to the pharmacy of the patient's choice.
Q: "Which pharmacy would you like me to send your script to?"
R: "Oh! That's a long way from here. I don't know that pharmacy".
R: "No probs doc. I'm flying from Adelaide to Maroochydore for a holiday so I'll get your eScript dispensed when I get there."
And when there's an emergency, like, oh, I don't know, a bushfire and many pharmacies are closed, or people are in self isolation away from their normal pharmacy for some strange reason, what happens then?
If you are going to automate something you have to deal with all the exceptions from the start.
I do hope they have thought through all the business scenarios/use cases.
That's not the way things are done today. Just get it developed and roll it out as fast as possible, any problems with the last 10% to 20% can be sorted and fixed later. QLD payroll s yt stem is a good example of how to develop and deploy quickly.
Rather like COVIDSafe. Get it out the door, start fixing bugs, loose the initial impetus which leaves most people who have it with a non-working system and those who don't want it won't download it whatever the government says because they are now not trusted. Yep. SNAFU.
Here's an interesting report
Summary of RFI responses on the future of the national infrastructure managed or operated by the Australian Digital Health Agency
https://conversation.digitalhealth.gov.au/industry-briefing
There is endless motherhood and stating the obvious.
What is missing from the RFI and the responses is, IMHO, any assessment of the existing environment, either if it achieved its original objective (which we know it didn't, either technically or in terms of benefits to the health budget) or the usefulness of the existing environment (which has never been demonstrated).
There is a golden rule in problem solving. You have to own your problem; it's yours, you can't outsource it. You can ask others about potential solutions but only you can determine if the solution will solve your problem.
Apart from the vague "reduce the fragmentation of health data" (which the current myhr patently doesn't) there is no evidence that the ADHA, the Department of Health or even the medical profession knows exactly what problem this infrastructure is supposed to be solving.
The fact that so many states and territories are investing time and money in their own EMR systems speaks volumes about the value they see in myhr. They pay lip service to the thing because that keeps the Federal department of health off their backs.
The Forward to the report is by Ronan O'Connor and includes:
"The feedback received has been extremely valuable and provides great insight into the areas that should be considered as we move forward, particularly with respect to future design considerations, technology focus areas, priorities for the future, capabilities that might be required and considerations that influence further
development. Reinforced by the feedback received, a focus on consumer use and uptake remains at the front of government and stakeholders’ minds when considering the national infrastructure.
We will continue to align our work to the National Digital Health Strategy and build on the success of the creation of My Health Records for more than 90% of Australians.
I look forward to working with all our stakeholders to deliver the digital health products and services this country needs, while promoting a culture of continuous improvement and innovation."
More motherhood.
If the feedback is valuable to ADHA, then IMHO, it strongly suggests they are out of their depth. There is nothing new, innovative or of benefit to anyone with even a modicum of experience in designing and building large scale government IT systems.
The careful use of words here: "the success of the creation of My Health Records for more than 90% of Australians." is telling. That number is well below 89% according to current ABS and ADHA data.
The bit about "I look forward to working with all our stakeholders ...." rings a bit hollow, now he's off to greener pastures.
The value of the report to Ronan seems to have been so great that he got out as quick as he could.
I do not understand WHY the roll-out of eScripts has failed and why there is so much confusion.
Surely to goodness if eRx and Medisecure are responsible for deploying their script exchange(s), and as they already have an agreed 'process in place' for interchanging scripts between their respective script exchanges, then the deployment should proceed fairly smoothly.
Unless for some reason they are being interfered with by some other party intent on disrupting their rollout activity.
Yes it builds upon eRX and Medisecure platforms. ADHA wanted to restrict it to a handful of "communities of interest" until most of the pharmacies around the country upgraded their software, but a certain GP vendor against their wishes allowed other sites to upgrade ahead of schedule, which has meant some patients have been inconvenienced when their pharmacy couldn't dispense. As usual the media have blown the issues out of proportion and overall the roll out is going well.
That is good Anon, shame the army of communication elves the ADHA employs could not muster up a few stories to address technical and implementation concerns and misunderstandings.
We just did in the previous comment. You people are never pleased, always looking at achievements with cynicism. It is why you are ignored and we extend no effort in communicating with you.
The ADHA has never achieved anything. NEHTA achieved some things such as the Healthcare Identifier services, but they failed at interoperability and NASH.
All ADHA has done is register lots of people for a MyHR. They haven't persuaded many to use it.
I suspect we will only be pleased if and when they do something useful, rather than just spend money on doubtful PR pretending they've achieved something.
Anon @7:11 PM seems to have answered my question @10:56 PM. In doing so Anon infers that the problems encountered during the rollout were due to a “certain GP vendor” pushing ahead too fast, instead of waiting “until most of the pharmacies around the country upgraded their software”.
This suggests that pretty well all GP vendors have upgraded their software and by association that the two script exchange platforms (eRx and MediSecure) are also ready. That being so it seems valid to conclude that the problems (obstacles) to a nation-wide rollout lie with the pharmacy software vendors!
Now surely the ADHA, the PGA, and the small number of pharmacy vendors, are capable of ensuring the nation’s 5,000 pharmacies “upgrade their software” immediately.
Or is there perhaps a deeper underlying problem yet to be illuminated?
@ 6:27 PM "Or is there perhaps a deeper underlying problem yet to be illuminated?"
Anon @7:11PM should have no difficulty answering that.
What if the Guild and the pharmacy software vendor(s) they control thought the timing not quite right to keep to the agreed timetable and quickly push forward with eScripts? What might they want to have ready to fully capitalise at the expense of the competition? Those are questions to ponder...
@9:37 PM Perhaps it has something to do with the following comment at August 12, 2020 10:32 AM
Anonymous said...
It is reported that "The Australian Digital Health Agency (ADHA) has asked GP software vendors to suspend access to ePrescribing functionality in their systems while a plan is worked out to scale the new capability nationally"
Might this have anything to do with who owns eRx and Fred (Telstra and PGA are joint owners)?
or, might it have to do with the 10 cent per script incentive subsidy paid by government to the two script exchange vendors?
Once eScripts are widely deployed the incentive payments can be discontinued and another deal put in place which will benefit the holy trinity - PGA, TELSTRA, GOVT. If that undermines Medisecure's viability, no matter, it can quite easily be absorbed by the holy trinity, resulting in one Exchange envisaged by government for almost 15 years.
David,do you understand what is meant by ".... electronic tokens (usually a unique web link sent via SMS to the patient’s phone) ....)?
What does the 'token' actually do? By that I mean: What does the unique web link actually do? Presumably it links something to something. Is that something an escript? If it is where is the escript held?
And as the escript is meant to be dispensed by the patient's nominated pharmacist how does the token ensure no other pharmacist can dispense the escript?
And, as the patient's prescribing doctor how do I nominate the patient's preferred pharmacist when it might be someone further afield whom I've never heard of? Do I have to check a database somewhere and if so how do I do that and who ensures it is kept current and accurate?
Hopefully someone can clarify all this for your readers!
The ADAH publishes a variety of documents on its website.
The electronic prescribing ones are here:
https://developer.digitalhealth.gov.au/topic/electronic-prescribing
You have to register, but there are no conditions or requirements.
The document you want is this one:
Electronic Prescribing - Solution Architecture v2.0
https://developer.digitalhealth.gov.au/specifications/ehealth-foundations/ep-3175-2020/dh-2988-2019
"In a joint communique, ADHA, the RACGP and the Guild released a list of steps for practices and pharmacies to take to ready themselves for eScripts.
Step 1 is to contact software vendors and ask them to activate ePrescribing functionality. Step 2 is to communicate with local general practices and pharmacies to ensure everyone is ready to write and dispense an electronic prescription.
Step 3 is to stay informed by attending webinars and education sessions provided by ADHA and the peak bodies."
That seems pretty clear - doesn't it!?
Hopefully as they scale this starts to get embedded and workflows normalise. One bit from the ADHA version worries me:
“through an electronic prescription providing patients with a safe and secure way of obtaining medicines remotely”
This does not allow you to obtain medicines remotely?? It is only a digital purchase order?
A quibble? Maybe, but it exposes that yet again the ADHA has not checks and balances or understanding. Really is just not up to the standards of the professions they want to change.
This is what the ADHA has to say about itself:
"Tasked with improving health outcomes for Australians through the delivery of digital healthcare systems and the national digital health strategy for Australia, the Australian Digital Health Agency (the Agency) commenced operations on 1 July 2016.
The Agency is responsible for national digital health services and systems, with a focus on engagement, innovation and clinical quality and safety. Our focus is on putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them."
https://www.digitalhealth.gov.au/about-the-agency
The ADHA is responsible for the electronic prescribing technology solution and its implementation.
Could someone please explain to me how anybody can justify voting for anything but The ADHA in this week's poll?
And how the answer to "Are we sure ADHA is at fault here?" - @August 10, 2020 7:12 AM
can be anything but Yes?
@10:49 PM The ADHA, RACGP and GUILD communique doesn't seem all that clear to me.
For example:
Step 1: Presumably the software vendor (pharmacy and medical) has already installed the necessary 'updated' software in all of its client's installations through a routine software update. Presumably switching the software over to become functional involves a one-step 'secure verification code' action. Or, have they made it more complex than that?
Step 2: "is to communicate with" .... who is to communicate with whom? Does every pharmacy communicate with every practice or does every practice communicate with every pharmacy or does everyone communicate with everyone, and in the 'communities of interest' across Metropolitan Melbourne is there any delineation of boundaries or is it all just one big amorphous 'pond', and do patient's need to know whether they can go here but not go there or can they go anywhere? Or, is it a lot simpler than that?
Step 3: Who has to stay informed? Doctors and pharmacists? Everyone? How much training and education is needed? Isn't the software seamless and intuitive? Do the ADHA and Peak Bodies need to provide training and education? Why can't this be done by the software providers? Are these reasonable questions or am I just being difficult?
What do others think about Step 1, Step 2, and Step 3?
Here are all the answers:
https://developer.digitalhealth.gov.au/resources/faqs/electronic-prescribing-frequently-asked-questions
except it doesn't say much about the implementation process.
What is a prescription token?
RTFM
Token
An electronic prescription token refers to the barcode and associated Delivery Service Provider ID (DSPID). A Token may or may not be provided with other prescription information. The Token itself is not the legal electronic prescription.
https://developer.digitalhealth.gov.au/resources/faqs/electronic-prescribing-frequently-asked-questions
"except it doesn't say much about the implementation process."
Isn't the implementation process a critically important part of the whole escript exercise? Is the implementation process something that has to be worked out along the way, like "oh, that didn't work but it seemed like a good idea at the time; let's try another approach and see what happens."
Is that the way implementation is done in these fast-moving modern times?
It's the part of the project plan that comes at the end TAMH (Then A Miracle Happens).
myhr had one of them. They are still waiting. They've tried to make the miracle easier by registering everyone they could, but expecting Australian's to take their health care seriously is a big hope.
@2:09 PM Yes, having a 'token' (via an SMS, email or on a 'piece' of paper) is all well and good, but is the token tied (linked) to the patient's preferred pharmacy or can it be taken to any pharmacy?
Why do we need a "community of interest"? What is the difference today from what has been happening now for many years - ie. a script with a barcode is printed by the doctor and given to the patient. It seems to me that if all pharmacy's software was enabled to read the barcode (surely that must be the highest priority) then escipts can be rolled out overnight! - can't they?
I think you meant "big hope" and not "Bob Hope" which might have been more appropriate (ha ha).
@August 19, 2020 2:59 PM
The architecture is more of a technical design document, it's a bit short on standard architecture artifacts, specifically a data flow diagram. This is my interpretation, I may have got some things wrong:
The architecture says:
"The “Location” of an Electronic Prescription
In a community context, the electronic prescription issued from the GP system (e.g.) resides in an Open Prescription Delivery Service (Open PDS) where it is housed pending retrieval by an authorised dispenser. In order to be considered an electronic prescription, it must contain all the data elements as specified in the National Health Act (PBS Regulations), together with additional data as may be required by State and Territory Regulation. These data elements specifically include the Conformance ID of the Prescribing System, Dispensing System and Open PDS, together with the Globally Unique Prescription ID (unique PBS electronic prescription number).
When it is retrieved from the Open PDS, the electronic prescription is resident in the Dispensing system where it may be processed. It is no longer available for retrieval from the Open PDS as this would permit multiple dispensing from the same prescription. If the Dispense is abandoned (does not complete) the electronic prescription in the Open PDS becomes available again for retrieval. In effect, it is “returned” from the Dispense System back to the Open PDS."
As far as I can tell, any Dispensing system can fill the prescription. There are several ways of filling the script. These include- the subject of care can take a paper copy of their script, they can ask the pharmacist to do a search (using their ID), or they can have sent a token to the pharmacist.
IMHO, there are so many options and procedures that the biggest implementation task is not technology readiness, but the education of millions of people and thousands of GPs and their admin staff and Pharmacists.
@4:36PM This is very interesting. It does raise a couple of other questions.
(1) Who maintains the Open Prescription Delivery Service (Open PDS)?
(2) Before the eScript is prescribed does it pass through the Real Time Prescription Monitoring System (RTPM)?
(3) When the eScript is dispensed it must update the patient's Medication Record. Is that Medication Record part of the RTPM System?
@August 19, 2020 7:05 PM
Re Maintenance of the Open PDS. The architecture doesn't say. It does say there are multiple Open PDS operators. The Open PDS does more than just deliver prescriptions, it holds them in encrypted form until requested to deliver. The Active Script List Registry play a big part in keeping track of where a script is held and who can see it. Open PDS operators are forbidden from seeing the encrypted content or a prescription.
Re RTPM or patient's medication record, there is no mention of either in the architecture
Anyone know if there have been end-to-end threat and risk assessment or privacy impact assessments undertaken and published? ADHAis federal, I would expect IRAP at the minimum.
@7:05PM Very illuminating indeed. That's the clarification I have long been seeking. It seems a lot more deeper sharper thinking into the system design and architecture is needed.
I am still bothered about the details, modus operandi workflow processes to do with the Active Script List Registry.
Where is the patient's complete, current, medication record held? Is it relevant to the RTPMs intent to target doctor shopping?
@7:05 PM "There are multiple Open PDS operators". Why must there be multiple operators?
OR, put another way - Why can't there be ONE PPRESCRIPTION EXCHANGE which all the PDS operators use? Surely the objective from a technology and political perspective is to Keep It Simple!
We blew the budget on communications and marketing so had to drop the ‘keep it simple’ we managed to fund the ‘stupid’ though
RTPM seems to be run out of Dept Health (maybe they don't trust ADHA)
https://www.health.gov.au/initiatives-and-programs/national-real-time-prescription-monitoring-rtpm
They claim to have already implemented a National Data Exchange in December 2018, so the thing must be ready to go about now.
Why don't you ask the Program officer
RTPMImplementation@health.gov.au
The pivotal question is: Why can't there be ONE Prescription Exchange?
@9:54 AM It's nothing to do with whether on not the Department trusts the ADHA.
It's simply a matter of Left hand not coordinating with Right hand, lack of leadership, a need by bureaucrats to feel relevant and to exercise control.
@12:02PM Yes, that make a lot of sense. One script exchange would simplify everything.
Aren't there two commercial script exchanges in the market place? Having one would mean making a choice and probably killing the one not chosen. MISA wouldn't like that. Do we have a complex solution because of commercial pressure?
Wouldn't it make sense for the Active Script List Registry to be an integral part of the RTPM system?
And wouldn't it also make sense to have one (not multiple) script exchange through which all eScripts pass?
@August 20, 2020 11:08 PM
Not when some dumb politician makes a decision to fast track the thing. It happens all the time with government.
When you see the PM respond to the Aged Care disgrace, is it any wonder?
@10:48 PM "MSIA wouldn't like that". !
This is the sort of narrow-minded stupidity that that undermines the total integrity of developing a comprehensive, integrated, solution to a wicked problem.
I do not think MSIA would object to ONE prescription exchange if that strengthened and simplified the overall solutions of eScripts, RTPM, and Medication Record Management.
Merging the two script exchanges would be of enormous benefit to everyone; pharmacists, doctors, consumers, and government, and no-one party including the two script exchanges need to be disadvantaged.
@9:09am
"Merging the two script exchanges would be of enormous benefit"
That would have meant extra time, work and cost and they wouldn't have been able to meet the end of May goal.
Oh. They didn't anyway, Now they've made themselves a bigger problem.
@9:09AM Hear, hear, well said. .... and the reason the concept of one National Script Exchange is so strongly resisted is (?) - - self-serving, vested interests exercising political power at the expense of the national interest.
The model for deploying and operating one national script exchange is a relatively straightforward concept. It accommodates and maximises the best interests of all stakeholders, it obviates against any stakeholder exercising any more influence than any other stakeholder, it enables all stakeholders to share equally in all the benefits that flow from such involvement, including financial.
One script exchange operated by the same RTPM operator? Yep, a good outcome for all stakeholders. But wait........ wouldn't that deny bureaucrats the apparent God-given right to delay, obfuscate, prevaricate and generally shilly-shally? Yep, business as usual.
wouldn't that deny bureaucrats the apparent God-given right to delay, obfuscate, prevaricate and generally shilly-shally?
To be fair, they don't set out to do that. it's just what they always end up doing.
They never learn from their hubris.
@3:01 PM No, the business model underpinning the one Script Exchange would neither deny or grant bureaucrats the right or the ability to do as you are suggesting they do.
.... in other words, whichever way they might want to cut it the business model and rules of engagement renders them impotent.
Pretty much...
Quite so, they never learn from their hubris. But that isn't the eszence of the problem. It's wrong also to paint them as prevaricating, shill-shallying, obfuscators.
The root of their shortcomings is their apparent reluctance and failure to enquire.
This blog has some commentators who clearly could help the bureaucrats lift themselves up and find new ways to go forward. They have nothing to lose by talking, they have much to gain.
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