Real-time prescription monitoring needs to get real

Queensland's new 10-year digital health strategy, a sneak peek at the new Monash Children's Hospital, the establishment of a diagnostic imaging program and a strong opinion piece by HIMAA CEO Richard Lawrance on the shaky state of the health information management professions were all popular stories this week, but one that caught our attention concerned a topic we have been following closely for some years now: real-time monitoring of prescription drugs.

While the Pharmacy Guild's MedsASSIST system was set up as part of a multi-pronged strategy to resist the rescheduling of pharmacy-only (S3) medicines containing codeine to prescription-only (S4), the development of the system showed what could be done if there was a will and a way. As everyone in the healthcare industry knows, the Guild is a force to be reckoned with and the power of its lobbying strength puts almost any other industry association to shame, and while it ultimately lost the battle to keep sales of codeine-containing analgesics over the counter, the speed with which it designed, built and rolled out MedsASSIST showed what it can do when it sets its mind to it.

The Guild announced it was pulling the plug on MedsASSIST on Wednesday but put it back in again on Thursday, after an apparent intervention by Health Minister Greg Hunt. It seems the system will continue to be used, at least until next February, when codeine disappears from pharmacy shelves and into the dispensary.

Since its launch at the Guild's APP conference in March 2016, to date 70 per cent of pharmacists were using the system, and while the Guild argued that its voluntary nature and the lack of a mandate from authorities to use it were strikes against the system, 70 per cent penetration in one year is quite an achievement. It also brings to mind the long, slow, drawn-out saga of the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system that we have been reporting on for years.

ERRCD is meant to monitor in real time both prescriptions for and sales of schedule 8 drugs of addiction such as opioids, although many believe it should take in S4s such as benzodiazepines and low-dose opioids like codeine as well. Whereas the US is currently seeing an absolute epidemic of overdose deaths mainly from opioids such as oxycodone and fentanyl – according to the US CDC, more than 15,000 Americans died from overdoses involving prescription opioids in 2015 alone – in Australia, many overdose deaths are from combinations of S8 opioids mixed with codeine and benzos.

Real-time prescription monitoring at both the prescribing and dispensing end would help solve a lot of these issues, but for one reason or another (cough, cough **money**) the states haven't got around to implementing it yet, barring Tasmania. It seems strange that Victoria sees it as necessary to spend $30 million over three years to tackle its prescription drug problem while WA is spending $1 million, but that's our glorious federation for you.

As we await the implementation of ERRCD, other systems such as Dr Shop or Medicare's prescription shopping hotline can help from the prescriber's end. For dispensers, the development of new medications reconciliation platforms like Fred IT's MedView might be part of the answer. Meanwhile, the coroners keep calling for RTPM, people keep dying from accidental overdoses and not even the might of the Guild can get the states to move a bit faster.

Our poll last week asked: Will you opt out of the My Health Record? While fewer than two per cent of people in the trial regions opted out, it's a different matter for the eHealth community, it seems. While the majority (66.5 per cent) said no, one in three (33.5 per cent) said yes, they would opt out.


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