All The Wrinkles Are Not Quite Out Of ePrescribing Just Yet. Stay Alert For Issues!

This appeared last week:

26 April 2021

Active ingredient prescribing prone to dangerous errors

By Holly Payne

Just three months after active ingredient legislation kicked into action, GPs say hazardous blind spots in the system are becoming apparent.

Now, no matter what brand name is typed into the computer end of the prescription software, it will print with only the generic name.

Although GPs are still able to check a no-substitutions box when creating the prescription – which will then allow the brand name to be listed – Sydney GP Dr Ruth Ratner told The Medical Republic that this was a less-than-ideal workaround.

“The only way to get the brand name back [on the medication list] for somebody who has been on a drug for a long time is to delete it, re-write it and tick that box,” she said.

“But when there are 10 different drugs to do that with, it is exceptionally onerous.”

Dr Ratner has further concern that when a drug is deleted and re-added to the medication list, it could give the false impression that the date it was changed was the date it was originally prescribed.

When a patient with an egg allergy presented for a flu vaccination, however, Dr Ratner found a hole in the system far more serious than wasted time.

After Dr Ratner wrote a prescription for the egg-free version of the vaccine, the patient collected it from a pharmacy and returned for immunisation.

Having forgotten to tick the no-substitutions box, the doctor did not realise the script printout had requested a generic flu vaccine – which the pharmacist had then dispensed – until she was close to delivering the injection.

“Should I have double-checked the paper script I handed out? Yes, I should have,” Dr Ratner told TMR.

“But I would have been medico-legally responsible [if that patient had an adverse event].”

More here:

https://medicalrepublic.com.au/active-ingredient-prescribing-prone-to-dangerous-errors/44427

This does not seem like progress to me. The prescribing system should always ask for a brand name which can then be inserted for extra certainty that the patient will actually get what is intended by the clinician. The nudge to generics becomes a bit more than that as it presently works it seems.

Also this week we have:

April 30, 2021 8:40 am AEST

Integrating electronic prescriptions into pharmacy operations

The rollout of electronic prescriptions has expanded significantly over the past few months, with 97 per cent of all PBS-approved pharmacies now dispensing electronic prescription tokens.

The next phase in the rollout of electronic prescriptions is the Active Script List (ASL) in which a patient’s electronic prescriptions are consolidated in a digital list and can be accessed at any pharmacy without the need for tokens.

The ASL has multiple benefits for patients and pharmacists, particularly for those who take multiple medications.

The ASL framework has progressed through beta testing and will be available to pharmacies over the coming months, depending on their location and dispensary software provider.

Guild Learning and Development has collaborated with the Australian Digital Health Agency to create an online module titled Integrating electronic prescriptions into your pharmacy operations.

The module discusses the practical implementation of electronic prescriptions, with a focus on workflow considerations, privacy and consent considerations related to the ASL, as well as electronic prescription troubleshooting advice.

To enrol in this course please visit guilded.guild.org.au

More here:

https://www.miragenews.com/integrating-electronic-prescriptions-into-552102/

And here:

Keeping to the script

Chris Brooker 29/04/2021

One year on from the launch of electronic prescriptions in Australia where are we at now? And what are the next steps?

Was it only a year ago that Australia’s first paperless electronic prescription in primary care was successfully prescribed and dispensed?

Amazingly, it was on Wednesday 6 May 2020 that an e-script—which used the “token” model—was prescribed by Dr David Corbet at Anglesea Medical in Victoria and dispensed by pharmacist Jason Bratuskins at Anglesea Pharmacy.

From this simple beginning only a year ago, the use of ePrescriptions has skyrocketed, helped no doubt by the COVID-inspired growth of all things electronic and remote in healthcare.

According to the Australian Digital Health Agency, there have now (as of 9 April) been more than six million ePrescriptions issued to Australians.

This includes 3.5 million original ePrescriptions from prescribers and 2.5 million ePrescriptions as repeat scripts issued by pharmacies.

Almost all pharmacies around the nation have dispensed an electronic prescription.

“The majority of Australians can now choose an electronic prescription as an alternative to a paper prescription from their doctor when needing medicines,” Andrew Matthews, director, Medicines Safety Program at the Australian Digital Health Agency told the AJP.

“At least 97% of PBS approved pharmacies have dispensed ePrescriptions. Prescribers can be confident that if a patient prefers an electronic prescription from their doctor over a paper prescription, they will be able to get this dispensed at their local community pharmacy.”

Getting active

Most experts say the next step in the evolution of Australia’s ePrescription program will come with the full national availability of the new Active Script List program, expected to occur by the end of 2021.

Active Script List (ASL) is a list of all active prescriptions and repeats available to be dispensed for a patient. It is a pharmacy-assisted service for accessing patient ePrescriptions for the supply of medicines.

The list has been trialled at 10 sites with 280 patients, Mr Matthews told delegates at the E-medication Management Conference in Sydney in late March. It will become “progressively more available” from April onwards, he said.

The patient can register for the list and can set options for which health professionals they wish to see or access this information.

“Pharmacy is the conduit through which a patient will manage their ASL, with pharmacy’s role including offering assisted registration for patients,” he said.

An example of how the system could work is if a patient is on holiday and needed to obtain a repeat prescription.

“They could elect to allow a pharmacy that is not their regular pharmacy to access their ASL information for one or two days so their prescription could be dispensed,” Mr Matthews said.

“After that date, the nominated pharmacy would no longer be able to access this information.”
The dispensing pharmacy “can access an electronic prescription for a patient from an ASL following proof of identity.”

The patient also has the capacity to instruct a prescriber to withhold scripts from the ASL.
One advantage of the system was that it removed the need for the patient to receive their tokens via SMS or email and retain their tokens, Mr Matthews said.

ADHA data indicated that currently around 85% of ePrescriptions are sent via SMS, he added.

Managing the workload

There were concerns expressed by pharmacists about the impact on workflows, which he believed had been addressed during testing on its integrating into day to day practice.

Full system functionality should be achieved “soon”, Andrew Matthews said, while the privacy framework was also being finalised “at the moment”.

He also noted there are currently three apps (MedAdvisor, Medmate and GuildLink) that are conformant for ePrescribing and offering a token management solution.

In addition, the agency has reported generally good collaboration between professions during the initial development and growth process.

“Feedback to the Agency through clinical peak bodies has been that communication between local general practices and community pharmacies about readiness to write and dispense electronic prescriptions has been another good example of the collaboration between community pharmacy and general practice,” said Mr Matthews.

For more on this article, see our May AJP magazine or e-magazine

https://ajp.com.au/features/keeping-to-the-script-2/

It is well worth reading this article carefully. Frankly I am a little worried that the complexity of the patient interaction with the pharmacist may mean all sorts of issues emerge as the roll-out continues. There seems to be a real set of privacy and security issues come to notice as the roll out continues.

I look forward to feedback from the field regarding glitches emerging as we move forward!

As you can see from this article the technology is still very new!

First active script list launched in Australia

Sheshtyn Paola 26/04/2021

My Script List provides pharmacies with a complete digital list of a patient’s current prescriptions and repeats

Fred IT Group has launched Australia’s first digital script list, called My Script List, beginning with pharmacies across Tasmania.

My Script List was activated in all Tasmanian pharmacies on Thursday, and is expected to roll out to remaining states and territories over the coming weeks.

It is Australia’s first iteration of a Department of Health conformant Active Script List (ASL), providing an alternative to the token model which launched in May last year.

More than 6.5 million electronic prescriptions were created and 4.2 million dispensed in the first six months since the launch of the token model.

“We think ASL will be the predominant model over time, for convenience and utility particularly for patients,” David Freemantle, General Manager of eHealth at Fred IT Group told AJP.

The token model can become difficult to juggle for patients who are on multiple medications as it generates a separate token for each prescription and repeat, he explained.

Meanwhile My Script List combines the patient’s electronic prescriptions in one digital list.

“The target market is patients for whom pharmacists keep their scripts on file,” said Mr Freemantle. However he hopes that as more patients learn about it, use of My Script List “should become ubiquitous”.

“If your phone becomes flat or lost you can’t access the token, but if [your prescription] is on the My Script List then you can still access it,” he said. “We think it really makes e-scripts make sense.”

Paul Naismith, pharmacist and CEO of the Fred IT Group, added that My Script List will substantially reduce the administrative burden associated with managing and dispensing prescriptions.

“This is extremely important for pharmacies that are supporting patients with multiple prescriptions and chronic health conditions,” said Mr Naismith.

“It means that pharmacists can therefore spend time where they need to – supporting the health care needs of their patients.”

Fred IT Group has been running eight pilot sites for three months, ramping up to 12 sites over the past few weeks.

On Thursday 22 April, Tasmanian pharmacies were the first to receive access to My Script List outside of these pilot sites.

“My Script List has provided us with better visibility of our patients’ current prescriptions,” said Joseph O’Malley, pharmacist and proprietor of Westside Pharmacy in Ulverstone, Tasmania, and PDL Director.

“This helps us to reduce the pressure that patients experience, as they no longer need to worry about remembering their scripts or sorting through tokens on their phone.

“Instead, they simply come in and talk to us and let us manage their prescriptions. My Script List has also removed the need to keep scripts on file, so is much easier to manage than printing and filling paper prescriptions.”

Patients can choose to access My Script List once it becomes available in their state or territory by contacting their pharmacist or GP and providing their consent.

This patient-controlled access can be ongoing or for a short period of time. Once granted access to this list, a pharmacy may dispense the items requested by the patient.

Similarly doctors and third-party intermediaries, with patient consent, can view the active list of scripts. 

More here:

https://ajp.com.au/news/first-active-script-list-launched-in-australia/

Lots to consider!

David.