RACGP calls for urgent national roll-out of ERRCD
The Royal Australian College of General Practitioners (RACGP) has released a discussion paper outlining the computerised systems currently available that can assist doctors with monitoring of potential prescription or doctor 'shoppers', but has ultimately supported the national roll-out and expansion of the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system.
The ERRCD aims to provide a real-time monitoring system for both prescribers and dispensers, and is currently in use in Tasmania with plans to roll it out in other states and territories. The Victorian and South Australian branches of the Australian Medical Association (AMA) have also been vociferous in their calls for action.
So far, however, the implementation has been slow. While the federal government purchased a license to use the system for all states and territories almost three years ago, most jurisdictions are still in the planning stage.
In a letter to stakeholders asking for submissions of support, the RACGP national standing committee for health information systems chair, Nathan Pinskier, and the chair of its drug and alcohol committee, Michael Aufgang, say efforts to prevent deaths from overdoses of prescription drugs are being hampered by a lack of a national system that is available to all prescribers, dispensers and regulators.
“The RACGP strongly supports the urgent implementation of the ERRCD,” they write. “Although this system currently only allows viewing of Schedule 8 drug dispensing information, the RACGP believes the system should be expanded to include all drugs, including other drugs of dependence such as benzodiazepines.”
The discussion paper outlines existing systems that could potentially be used but also details their failings. These include the PCEHR, which receives medications information through the National Prescription and Dispense Repository, but this functionality is still in its infancy.
The PCEHR also captures PBS information, but this is not in real time. Few GPs or pharmacists are actively using the PCEHR, and it is also an opt-in system, with only two million consumers registered.
GPs and pharmacists also have access to information through the prescription exchange services that many use. One of those services, MediSecure, is soon to release software called Dr Shop that will allow GPs to be notified if certain Schedule 8 and Schedule 4 drugs have been prescribed in the last 90 days.
As the college points out, however, electronic transfer of prescriptions either by MediSecure or eRx is not used by all GPs and pharmacists, and it will not provide a full medications list.
Dr Pinskier said he could definitely see a role for Dr Shop as an interim measure until a full national system can be implemented.
He also said Medicare's Prescription Shopping Information Service (PSIS) was available to GPs. This service operates a telephone inquiry line 24 hours a day and also allows GPs to request a full report on a particular patient online through HPOS.
Through this service, GPs are provided with a statement as to whether the person meets the criteria of a prescription shopper, with patient summary reports available on those who do. A prescription shopper is defined as anyone who, within a three-month period, has been supplied with PBS items prescribed by six or more different prescribers or a total of 25 or more target PBS items.
“The Medicare doctor shopping site is really good and the statements they provide now, either directly or through HPOS, are really comprehensive,” Dr Pinskier said.
“But GPs generally don't know about it. We did some research and people had differing understandings of what was available. They can provide a statement that covers everything ... but you have to be registered.”
Medicare's Prescription Shopping Program (PSP) also has a mail out program to alert a doctor if they have prescribed to a patient of concern, but again, this information is sent out after the prescribing event and is not in real time.
What the Victorian Coroners Court has repeatedly requested over the last few years, and which the RACGP supports, is a real-time system. As far as the RACGP is aware, the ERRCD is the only system available that can provide this service to both prescribers and pharmacists nationally, and can also be used to track prescriptions written by hospital-based physicians that are filled in community pharmacies.
It has its drawbacks – at present, it is only available through a web browser and is not integrated into either GP or pharmacy desktop software, considered essential for GP and pharmacist workflow, and it only tracks Schedule 8 or controlled drugs.
In most of the recent cases reported by state coroners it is the combination of a Schedule 8 drug with prescription or Schedule 4 drugs that has led to the fatalities.
Despite its current limitations, Dr Pinskier said the college was supporting the ERRCD because the coroners are supporting it. “It appears to be the only national solution that could be implemented, noting that it has significant limitations in its current form,” he said.
“Other than expanding it to include more than just Schedule 8 drugs, it needs to be integrated into existing desktop products. If they could agree on a standard approach and a way of integrating it through a B2B interface, that's what we need.
“However, that doesn't preclude eRx or Dr Shop or any other vendor from providing ERRCD with additional data.”
Pharmacy Guild national president George Tambassis said the Guild also supports the ERRCD as it will save lives.
“We negotiated funding for the development of it in the Fifth Community Pharmacy Agreement, five years ago,” Mr Tambassis said.
“We support one national system, with the privacy and governance controlled and maintained by government.
“We don’t support a multiplicity of systems run and operated by multiple private companies, especially if they exclude pharmacy.”
Posted in Australian eHealth