MediSecure disables dispense notifications over duty of care fears

UPDATED: Electronic prescription exchange vendor MediSecure has disabled the function that allows doctors to receive automatic notifications that a prescription has been dispensed, following concerns raised over duty of care by the RACGP.

Both MediSecure and competitor eRx attended a meeting last week with RACGP officials in which they were both requested to disable the function. eRx general manager David Freemantle said the functionality would be turned off from tomorrow, March 13.

In her Friday Facts newsletter last week, RACGP president Liz Marles said there were concerns over patient privacy and consent, and that the ability to receive automatic dispense notifications “may impact on a GP's duty of care”.

Several industry sources have told Pulse+IT the concerns relate to the recent case of a morbidly obese man who sued his GP, Emmanuel Varipatis, for failing to refer him to a weight-loss clinic or for bariatric surgery.

The patient, Luis Almario, has terminal liver cancer. Last month, he was awarded $364,000 by the Supreme Court of NSW, which ruled that Dr Varipatis was legally responsible for the consequences of Mr Almario's pre-existing liver disease progressing to cirrhosis, liver failure and cancer.

Dr Varipatis and his medical defence organisation, Avant, are appealing the decision.

Pulse+IT understands that the precedent set by the case has alarmed MDOs, as it could potentially mean that doctors will be expected to follow up every patient to ensure they are correctly following instructions.

One source called it a “completely ludicrous” position but that a precedent had now been set and the bar for duty of care had been raised.

In the past, a doctor had no way of knowing if a prescription had been filled, but with automatic dispense notification capability, GPs can easily find out, another source said.

“There is an argument that because a GP could credibly identify whether a patient did or didn't pick up their pills, it could be argued by a patient's lawyer that the GP should be held liable if the patient didn't pick up pills and something happened as a result,” the source said.

“However, it's a bit of a weak argument as just picking up pills doesn't mean the patient actually takes them.”

RACGP spokesman on eHealth, Nathan Pinskier, said the recent case had added to concerns about duty of care, but it was in addition to the college's concerns over automatic notifications.

“[The case] certainly added to the concerns,” Dr Pinskier said. “It in itself is probably not the prime driver but it is a complicating factor in the currently confused environment.”

MediSecure CEO Philip Shepherd said that AMA and RACGP concerns over duty of care had been taken into account when designing the MediSecure system. MediSecure allows dispense notifications to be received and interrogated individually by the prescribing doctor on the desktop, but that information was not incorporated into the patient's clinical file.

eRx, on the other hand, does allow the information to be written into the patient's file. Mr Freemantle said a notification that the functionality will be disabled would be sent to customers tomorrow.

"It will be turned off at the gateway so the messages won't be sent," he said. "We are turning it off at the request of the RACGP and we are looking at how we can make the functionality an optional add-on for GPs at a later date."

MediSecure turned off the functionality last Friday, so its users can no longer access dispense notifications.

"MediSecure ePrescription service now does not deliver any information back to the doctor about what has happened to the prescription," Mr Shepherd said.

In a letter to customers, the company said it will deploy a new client adaptor to remove the dispense notification menu option from the GP's desktop.

However, for those practices and clinicians who still wish to access dispense notification data, a new service will be created as a specific opt-in with a separate licence. “Details of how to enrol for this service will be released around 15 March 2013,” it said.

Avant has been approached for more information.

This story has been updated to include comments from eRx and the RACGP. Click here for more.

Posted in Australian eHealth


0 # Sidney Crout 2013-03-12 11:48
Had to check that the date wasn't April 1 when I first read this piece of nonsense! If a GP has a legal duty of care to check that every patient collects (and takes?) their prescribed medications there will be an exodus from the profession and drug company profits will plummet.

I would also suggest that someone introduces Avant to the defence of contributory negligence.
0 # Concerned 2013-03-12 13:13
I am confused as to how failing to refer to a service, is the same as failing to follow up on a patients action in regards to a referral or prescription.

These are two very different things.

Perhaps we should withdraw the use of Telehealth in case it is considered to confer additional responsibility for followup care that was previously impractical.
0 # Paul 2013-03-12 13:25
What about when these systems are pushing prescribe and dispense data to the PCEHR, which will happen sometime in the future? Will the dispense record not then be in the patients PCEHR record (unless the specifically opt out for that transaction)? If the duty of care argument can be used here, why not for the information contained in the patients summary record.
0 # dave 2013-03-13 09:56
as a patient who embraces the ehealth and PCER system ethos I think it's wrong to expect a GP to have to follow-up if I've taken their advice. Surely if I'm stupid enough to ignore medical advice it's on my head not the GP's?
This is taking GP responsibility far beyond where it needs to be. I'm all for the dispensing of scripts info to be fed back somewhere but to the DoHA PCERS rather than the GP makes much more sense.
GPs are there for primary healthcare not secondary surveillance & monitoring

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