RTPM and NCSR swirl in an acronym soup

We were vaguely amused this week when, among the voluminous coverage of Victoria's draft regulations for its SafeScript real-time prescription monitoring system, we discovered that federal Health Minister Greg Hunt was threatening to write a sternly worded letter to all the other states and territories to ask them to get a move on with the federal RTPM system that he has championed to the tune of $16 million.

Amused because this is exactly what one of his predecessors, Peter Dutton, did way back in 2014 and no one paid him any attention then either. Four years on from those sternly worded letters, here we are, with Victoria giving up on the feds and building its own system and the ACT government only just announcing last week that it will legislate to give prescribers and pharmacists real-time access to its existing monitoring system by March 2019.

You'll forgive us for banging on about this yet again but we've been covering this in depth for six years – our headline back in February 2012 optimistically read Real-time access to controlled drugs data from July – and very little has changed in that time. We've been through three health ministers, millions of dollars and innumerable coroners' reports, and still we dither on saving people's lives. It's a tragedy.

That said, we were talking to one of our friends in the drug and alcohol field this week and there is a real concern in Victoria in particular that there is all of this money going towards building a system, hosting it, maintaining it and preparing health professionals for how to use it, but little if anything is said about what will happen to the people it identifies as having a problem. Whizz bang technology is all very sexy but if there's no extra money for support services for these people then it's not much use to anyone.

Speaking of which, federal parliament had an absolutely smashing time debasing its reputation even further this week, but while we were all otherwise engaged a parliamentary joint committee was yet again poking at the carcass that is all that remains of Telstra Health's hopes for the smooth roll-out of the National Cancer Screening Register project. The Department of Health's Bettina Konti did the honours on the rack this time as usual suspect Paul Madden is on long-service leave, and poor Ms Konti suffered a severe roasting at the hands of Labor MP Julian Hill on Wednesday morning.

You'd think Mr Hill was playing very dirty politics when he demanded to know how many women were likely to have developed cervical cancer between May 2017, the original date when the NCSR was supposed to be up and running, and December 1, when it finally went into action. Labor is still absolutely furious about being told in 2016 by then Health Minister Sussan Ley that questions over the awarding of the contract to Telstra Health, which could have held up the passage of legislation enabling the register to go into action, could cost women's lives.

Greens leader Richard Di Natale had similar gripes last year and neither party is going to be forget the aspersions cast upon them. But almost lost among the lingering nastiness was the fact that despite Mr Madden's “high level of confidence” that the full capabilities would be in place by mid-January, Ms Konti announced that it might stretch to March or April.

One of our insiders reckons it could even be June and speculated that there might need to be a release 1b. Where that leaves plans for bowel cancer screening we don't know. We think, however, that whatever high hopes Telstra had for earning a juicy profit from the $220 million contract have all but disappeared.

That brings us to our poll for this week: Has the NCSR saga damaged Telstra Health's reputation irreparably?

To vote in our weekly polls, sign up for our weekend edition or leave your comments below.

Our poll last week asked: Do you think clinical software vendors come in for unfair criticism? This one was close: 55 per cent said yes, 45 per cent said no. Thank you to all of the software vendors who took the time to vote!

Comments   

# Glenn Rosendahl 2018-02-17 12:50
As I have read the Victorian govt press release (cited on another blog) it appears that the 'pop up' disclosing past recent S8 prescribing appears once the button is pushed for the script to be printed. Does that mean the information is released as or after the script is printed? And the patient demands - 'sign it, and give it to me now' - and walks out the door? That would be a most undesired confrontation.

If this information is to be safely disclosed, every patient requesting a narcotic script - including those for whom it is indicated, reasonable and appropriate - needs to be aware of, and consenting to a process by which the press of the button is to initiate the 'pop-up' process, and the prescription cannot be printed until the pop-up is delivered - and reviewed.

The initiation of this process will need to be considered with care. Or there will be a significant number of S8 dependent patients who will find their quasi-legal source of supply is abruptly terminated. No one will supply them. No duplicity will work. A proportion of these will also be ICE users, and are likely to become irrationally and unpredictably violent. Do the States have sufficient detox and rehab services spread throughout their domains to provide us GPs with an immediate referral resource? The answer is - unequivocally - NO. The hospital ER services will not want them, and the police will not wish to fill up their Watch-houses with them. Nor will GPs want them.

My suspicion is that, until now - and even beyond - the State and Territories have quietly applauded GPs providing inappropriate S8 scripts. The cost of the drugs, the prescribing and dispensing has been entirely on the Federal government. The States have not had to expend their budgets on clinical care: detox and rehab (facilities and staff); on police investigation, looking for illicit narcotic distribution; on expensive litigation and criminal proceedings; and on the incarceration of convicted criminals. Instead there has been a covert, unofficial, unauthorised program of 'harm minimisation' funded by the Federal government.

What will happen if this abruptly stops?
# Kate McDonald 2018-02-17 13:45
Hi Glenn. I'm not sure what that other blog is but it sounds like it is referring to the way the two existing script exchanges eRX and MediSecure work when printing a script. MediSecure had a system called Dr Shop that had that sort of functionality, but it was a voluntary system and restricted to GPs using MediSecure, so pharmacists and GPs using eRX couldn't use it.

Victoria's new system is still being built but my understanding is it will be a comprehensive system, not just a prescription exchange. Fred IT, which owns eRX, has been given more than $6m to build it, and the Western Victorian PHN has been given money to develop the educational material to help GPs and pharmacists use the new system.

Unfortunately, the Victorian Department of Health and Human Services has been less than forthcoming with information on the technical aspects of the new system. I'm still trying to get this information.
# Glenn Rosendahl 2018-02-18 23:41
I have read the Victorian govt press release. It states:
“Clinicians will receive pop-up notifications from their desktops within seconds when a prescription has been issued or dispensed which will prompt clinicians if a review of the records in SafeScript is necessary. The notification will also provide a direct link to the patient's record.”
see:
https://www2.health.vic.gov.au/public-health/drugs-and-poisons/safescript

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