Pharmacy in the 'getting ready' stage for PCEHR

While the community pharmacy sector has long prided itself on its early adoption of dispensing software and the development of electronic transfer of prescription capability, it has not yet been on the priority list for other eHealth developments such as the PCEHR.

That all appears to be changing now, with Medicare Locals moving into a wider engagement program to evaluate the readiness of the sector for participating in the PCEHR.

The recent launch of the National Prescription and Dispense Repository (NPDR), which is understood to now be available to over 180 pharmacies around the country, is one sign that the change and adoption program is moving beyond the initial focus of general practice into the wider primary and allied health sectors.

Grant Kardachi, president of the Pharmaceutical Society of Australia (PSA), said his feeling was that there was a general awareness of the PCEHR throughout the sector, but that it was still in the “getting ready” phase for eHealth.

“Pharmacy some years ago got on the front foot in terms of software for dispensing and we were probably ahead of general practice at one stage, but as everything is becoming more sophisticated, there is probably a lot more that pharmacy needs to do,” Mr Kardachi said.

“At the moment we are trying to get pharmacists to increase their uptake of the electronic prescriptions, which has been varied, and then I think there is still work to be done around things like secure messaging and privacy so that pharmacy is fully prepared for what is an important step before we jump into the PCEHR. It is a readiness thing.”

Mr Kardachi said Medicare Locals are being funded to drive eHealth awareness throughout pharmacy as well as general practice. Medicare Locals are currently surveying the pharmacy sector to evaluate what the general state of readiness is at the moment.

“I understand it's a collation of data at the moment in terms of where everybody is and where they are placed, and therefore what needs to be put in place to activate it,” Mr Kardachi said.

“The dispensing software side of things is good but moving to this new world is where we need to move our profession forward. There is an ePIP payment for GPs and and this would be a good incentive for pharmacists, and as with anything if you receive an incentive you are far more likely to get with it and do it. That is fundamental to a quick uptake of the whole process.”

Mr Kardachi believes that models such as the non-dispensing pharmacist, which the PSA is encouraging through a trial in 15 pharmacies around the country, can only be helped by improvements in IT such as electronic transfer of prescriptions, which may free up pharmacists’ time to focus more on the delivery of professional services.

“We are putting forward a model of a non-dispensing pharmacist who stands in the front of the dispensary and talks to people about their medicines, about complementary medicines, about wound care,” he said.

“Some pharmacists have embraced this model because it is rewarding for the pharmacist but it's also rewarding on the bottom line to the pharmacy and also to the consumer. They are getting much better advice and much better outcomes. We've got to get pharmacists out the front.”

Another move being supported by developments in IT is the medications chart pilot currently being undertaken in NSW, supported by the Department of Health and Ageing and the Australian Commission on Safety and Quality in Health Care.

This trial is developing a paper-based National Residential Medication Chart (NRMC), which when the design is agreed upon will be transferred to an electronic system that will enable pharmacists supplying nursing homes to use the drug chart rather than requiring a paper prescription.

Medical practitioners will be able to use a standard NRMC to prescribe most PBS medicines to patients in nursing homes instead of a traditional PBS prescription, and pharmacists will also be able to use a copy of the NRMC to supply and claim the medicines.

“What has happened historically is that supplying medicines in an aged care facility has happened much like in the community,” Mr Kardachi said. “We would supply medicines on a daily basis to the facility, but then we'd have to chase the prescription from the GP. If we'd run out and the patient needed next week's dosage of medicine, what do you do? Generally you'd supply it but then have to chase the prescription from the GP.

“So we had a big owing script situation in aged care – pharmacists basically breaking the law, but through continuity of care you supplied the medicine and then tried to fix up the paperwork behind the scenes. Now there is a new system with the pilot happening in NSW where a drug chart is being developed.

“The pharmacist is paid from the drug chart and in most cases you won't have this historical situation of pharmacists needed a physical prescription to match up the medicines you have supplied to aged care.”

A nationwide roll out of the drug chart model will take some time as it requires every state and territory to amend legislation, but eventually dispensing software will be upgraded by software vendors to accommodate the new chart arrangements.

Barcoding of medications for the right dosage and the right patient is also beginning to happen in aged care, Mr Kardachi said. “That sophistication will ensure the minimisation of errors in aged care. We are looking at better communication, better functioning of the supply of medication into aged care, barcodes being more sophisticated to ensure the right patient gets the right medication at the right time.”

Regarding the recent concern over changes to the PBS listing of certain multi-active medications, in which the move to list ingredients alphabetically has raised the potential that dispensing errors will occur, Mr Kardachi said it did catch the pharmacy sector by surprise but that there was a bit of an alarmist reaction to the situation.

“By changing to alphabetical listing it changed things around on some combination packs and that certainly does carry an increased risk potentially in prescribing, in dispensing and in consumer outcomes. We all recognise that, but I've also got to say that as a result, we went out fairly quickly to our members alerting them to that and reminding them to let other health professionals and colleagues know about it and be vigilant when dispensing.

“But for pharmacists, this is what we do day to day. We have a number of mental checks in our dispensing process anyway, but until we can resolve this and come to a conclusion that everyone is happy with, we are advising that pharmacists and prescribers be a bit more vigilant with these combination products.

“If you are not sure about something, go back to the GP – contact the prescriber and clarify that it is correct. It is all about responsible care from the pharmacist's perspective and at this point in time, until we have what we believe is an appropriate consultation, just be more vigilant.”

Posted in Allied Health


0 # Steve Wilson 2013-07-04 13:12
I'm really surprised to see people unselfconscious ly using language like "mental checks" in relation to the quality and integrity of community pharmacy processes only weeks after the wrong e-prescriptions were uploaded on multiple occasions to PCEHR.

I have yet to see yet any satisfactory commentary about how to prevent this from happening again. Equally, I haven't seen many people in policy join the dots from those mishaps back to IHI. Total mismatch between patient and e-health message was supposed to the concern of IHI. It's amazing that we have an IHI and it's not being used. When will it be used? And until such time as IHI is fully integrated into community pharmacy, I would think the idea of "mental check" would be taboo.
0 # peter macisaac 2013-07-04 20:56
Comments such as " This trial is developing a paper-based National Residential Medication Chart (NRMC), which when the design is agreed upon will be transferred to an electronic system that will enable pharmacists supplying nursing homes to use the drug chart rather than requiring a paper prescription."
represent an overly simplistic view of the process - yes a careful study of requirements and trial on paper systems will help with the ultimate definition of requirements for an IT system, however it is simplistic to talk then about a "transfer to electronic systems" as many other issues need to be addressed in advance such as standard drug codes, workflow, how to engage industry who will have to implement this, integration with existing systems, current and emerging health IT standards - if this is left to be done "later" then it will not happen in any time soon. If legislation or regulation needs to be changed then incorporating the "electronic" applicable rules needs to be done upfront as any legislative change is also a slow affair and better to do it with one bite of the cherry.
0 # peter macisaac 2013-07-04 21:00
Steve, understand your angst about stuff ups in the PCEHR.
however Mr Kararchi is referring to the checks Pharmacist do when dispensing scripts - just like we should do when signing scripts - right patient, right drug, right dose etc. Could your comments be a bit harsh?

The addition of new functions eg update to PCEHR will require additonal checks to ensure that we dont have GIGO
0 # Steve Wilson 2013-07-04 21:32
Sorry if it wasn't clear but my harshness is reserved for IHI. I have no problem with mental checks per se: they're part and parcel of professionalism . But it's ironic isn't it that mental checks are proffered as a safeguard against making errors in a new electronic health process? In another area of community pharmacy, the combined electronic-huma n processes failed spectacularly when the wrong scripts were uploaded multiple times to PCEHR. I say "spectacular" advisedly, in the context of many tens of millions of dollars spent on health identification systems that were expressly intended to prevent mismatched records. I appreciate that NPDR and IHI are different components but I want to segue from one to the other. In the context of "pharmacy getting ready for PCEHR" I suggest that the failure to integrate IHI into community pharmacy is a serious shortcoming that seems to have gone more or less unremarked.

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