MediSecure to launch real-time prescription monitoring
Electronic prescription exchange service MediSecure is currently trialling new software that could provide a simple and inexpensive way to introduce a real-time prescription monitoring (RTPM) system to crack down on prescription or doctor shopping.
Called Dr Shop, the software uses the existing capabilities of the MediSecure prescription exchange and will allow information on specific drug molecules prescribed to a patient in the last 90 days to be relayed back to GPs in real time at the point of care.
The development of the system has been driven in part by yet another recommendation from a Victorian coroner for the introduction of real-time prescription monitoring following the accidental death of a patient from a combination of prescription drugs, as well as the slow pace of the roll-out of the proposed national Electronic Reporting and Recording of Controlled Drugs (ERRCD) system.
ERRCD was developed in Tasmania based on its DORA technology and a licence for it was purchased by the federal government on behalf of the states in 2012. However, as reported by Pulse+IT, NSW, Queensland and Western Australia are still laying the groundwork for its potential implementation, while in Victoria a business case has been presented to government but no decision has been made.
Victoria's former Coalition government did promise funds for the system as part of its election platform, but this promise was not matched by Labor.
In the meantime, the Victorian Coroners Court has held another inquiry into the death of a patient from a combination of prescription drugs. This patient had a previous heroin addiction and a history of schizophrenia, anxiety, depression and chronic pain. The coroner found she died from the combined effects of tramadol, methadone, diazepam, codeine, alprazolam, risperidone, doxepin and metoclopramide.
A search of her PBS records showed she was repeatedly prescribed the same analgesic, anti-anxiety and antidepressant medications from seven different GPs. One GP had treated her for anxiety and depression but was unaware she was also on methadone, which the patient obtained from another GP.
At the inquest into her death, the chief officer for drugs and poisons regulation at the Victorian Department of Health, Matthew McCrone, told the coroner that the implementation of a RTPM system like ERRCD or DORA was complex and likely to be costly. He also said that while most Tasmanian community pharmacists had access to DORA, less than 50 per cent of GPs could use it, and that pharmacists had proven to be reluctant to take on the gatekeeper role.
The coroner also heard evidence from MediSecure CEO Phillip Shepherd and the general manager of competitor system eRx, David Freemantle, that it was technically possible to instead use existing technology to highlight previous prescriptions of not just Schedule 8 drugs, which ERRCD is limited to, but Schedule 4 drugs as well.
Of the drugs the patient in this case was taking, only methadone was Schedule 8 (alprazolam was later rescheduled) and the others were all Schedule 4.
Mr Shepherd told the coroner that the actual cost of adapting existing technology like MediSecure would be minimal, with the main cost related to training and developing protocols for GPs on how to deal with potential doctor shoppers at the point of care.
MediSecure is now set to introduce such a system for its GP users, with a trial currently underway to integrate it with the Best Practice clinical and practice management software, according to MediSecure's chief of strategy and marketing, Vladimir Finn.
Mr Finn said Dr Shop used the MediSecure electronic prescription exchange, which captures details of the prescription and sends it to a central repository where it can then be downloaded by the pharmacist when the patient presents with the barcoded paper script.
“That information is highly protected and encrypted, as you would imagine, but what we can do is track a very narrow segment of the data, which can provide real-time monitoring of certain elements,” Mr Finn said.
“These elements are the molecules of addiction in dangerous drugs. For those what we can do is provide in real time back to the GP, when they are prescribing medications with those molecules, the last 90 days of prescriptions containing those molecules.”
Unlike ERRCD or DORA, MediSecure can pinpoint Schedule 4 drugs that may have been recently prescribed. It will not tell the GP who has prescribed them, but provide a warning that there may be a contraindication or that the patient is potentially shopping around. This capability will also protect patient privacy, he said.
“Our system gives it back in real time without breaking any user privileges. You can't track all of the prescriptions of an individual and you can't do a search on it. It is only in the time when the clinician is prescribing for this very narrow subset of the molecules that we can provide back what that individual has had in the last 90 days. That will allow the clinician to say that you might have a problem and we can help you with that.”
As the coroner heard, one of the main problems that the states are finding in implementing ERRCD is the question of patient privacy. MediSecure believes it can overcome this problem by informing all patients that the practice is monitoring prescriptions at the point of care.
“The patient knows that this GP is using a real-time tool to make sure that they are not prescribing certain medications that are dangerous,” Mr Finn said. “That way everyone is covered with consent and everyone knows where they stand.
“It's very important to protect privacy and we've gone through a lot of legal advice. We've consulted with the RACGP in a lot of detail and we also presented this program to the AMA in Western Australia as well as the Department of Health in WA as a solution.”
At the moment, the system will only be available to general practitioners using MediSecure. Mr Finn believes it is more likely that GPs will take it up rather than pharmacists as the real-time monitoring element happens at the point of prescribing, not dispensing.
This is also a failing of the ERRCD system, as it requires the pharmacist to interrupt their workflow and do a search, he said.
Mr Finn said MediSecure had decided to introduce the software now rather than wait for funding from governments, and would provide it free to GPs.
While the long-standing rivalry between MediSecure and eRx is no secret to the industry, Mr Finn said he hoped that eRx would also adopt the technology, which should be relatively easy as both systems are interoperable.
“In the meantime we need to start with something, something that doesn't cost the taxpayer a truckload of cash,” he said.
MediSecure is trialling it first with Best Practice and then some of the smaller vendors. The company has also been in early talks with the market leader, MedicalDirector, Mr Finn said.
He said the system had received overwhelming support when it was recently demonstrated at the Australian Association of Practice Managers (AAPM) conference, and would hopefully be available early in the new year.
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