I Wonder How Typical This Is In Reaction To Evolving Digital Health?

This appeared last week.

I don’t have time for telehealth and e-script admin crap

Dr Craig Lilienthal

Dr Lilienthal is a GP and medicolegal adviser in Sydney, NSW.

30th June 2021

I am heartily pissed off with the ever-changing and confusing requirements for COVID-19 telehealth and e-prescribing.

Here is an example of a typical, time wasting, administrative shemozzle we GPs have to deal with. I am sure there are many other similar scenarios.

The situation:

While doing a telehealth consultation early one evening, with a young mother - non rebatable because, thanks to COVID-19, we hadn’t had a face-to-face consultation for more than 12 months – she asked me for an urgent repeat prescription for her son.

It was for a medication originally prescribed by a paediatrician to whom I had referred the young teenager.

Now, because I hadn’t seen the son for more than 12 months, I couldn’t offer the mother a rebatable consultation for this either and because neither of them had had their electronic medical records ‘enabled’ for consent to communicate electronically, I couldn’t send them e-scripts.

Oh yes, I do have the skills to do this and send e-scrips – providing the patients’ Medicare numbers are up to date – and in this case of course, they weren’t. Thank you again, Mr Covid.

And as I was working from home without a fax machine, I couldn’t fax the script to the chemist and as it was late in the day, the reception staff at my surgery had gone home so I couldn’t ask them to print off the script and fax it to the chemist.

Of course, I was taking the next day off and wouldn’t be in the practice again until after the long weekend. Too long a delay by far for this important medication? The customer is always right.

My attempt to help:

So, while discussing the situation with her, my patient’s husband went on line and miraculously found the email address of their chemist.

I printed out the prescription and using a previously acquired app called Genius Scan, photographed the prescription using my smartphone and sent it by email to the pharmacy with a cc to the mother.

My advice was that to make sure everything went smoothly she should print out the prescription on her home printer and take it with her when she went to the chemist.

This system has worked successfully many times before.

Oh yeah:

The next morning, at the beginning of what I thought was going to be a relaxing, long weekend, I receive a call from the husband who was at the chemist. There were a few problems.

Firstly, as I had been working from the mother’s electronic medical record, the name on the prescription was the mother’s and the pharmacist wanted verbal permission to change the name on the document to that of their son.

“Yes, of course”.

Next, the chemist asked me to send the hard, original, prescription to her.

“But the mother has just given you a hard copy printout of the prescription bearing my clear signature,” I reply.

“Not good enough,” says the pharmacist. “The only time we don’t need the original is when the prescription is sent as an e-script and we can work off a QR code.”

“Are you sure about that?” says me. “I thought you only needed originals for certain, mainly Schedule 4, drugs.”

“No” says the chemist. “That’s changed.”

“Has it? Surely you don’t need an original prescription for long-acting melatonin preparation, prescribed privately and for an off-licence purpose, to help an ADHD teenager on prescribed amphetamines, to get some sleep and save his parents from going mad?”

“Yes, we do”, says the chemist.

So, I authorised the prescription over the phone and made a note to myself that when I am next in the surgery, I need to find out the snail mail address of the pharmacy and send an original, hard copy of the prescription to the chemist.

I don’t need this administration crap.

The solution:

Yes, I could have insisted the patients come to the surgery for face-to-face consultations and to formally enable (aka consent), their records to allow the practice to send them e-scripts and SMSs - and be able to bulk bill them for telehealth consultations and all this time wasting and stuffing around – when they had upgraded their Medicare cards.

But they live in the burbs and again, thanks to COVID-19, I have few reasons to visit the CBD where I work and the quickest way to piss off your patients is to play hard ball with them - especially in a perceived emergency situation.

Afterall, they had run out of Circadin!

https://www.ausdoc.com.au/opinion/i-dont-have-time-telehealth-and-escript-admin-crap

Clearly a man with a lot to get off his chest.

Judging by the 20+ comments on the article he is not the only one! We clearly need to work a bit harder to smooth out the experience!

David.