Real-time access to controlled drugs data from July

The components of the electronic recording and reporting of controlled drugs system announced by Health Minister Tanya Plibersek last week are still being worked out but will be based on an existing system designed by Hobart-based XVT Solutions under contract to the Tasmanian Department of Health and Human Services (DHHS).

XVT Solutions was contracted to develop a suite of applications that collectively record, monitor and provide real-time reporting on controlled drugs dispensed from pharmacies and health facilities.

The company has developed three applications for the system, including Real Time Reporting (RTR), an integrated set of web applications that record, monitor, analyse and report on pharmacy dispensing in real time.

The company also designed a Drugs and Poisons Information System (DAPIS) that is linked to RTR and which manages all patient, drug, prescriber, practice, and pharmacy information, including authority management and poisons licensing.

Linked to this is DAPIS Online Remote Access (DORA), a web application that provides GPs and other registered health professionals with information on patients receiving controlled drugs.

A DHHS spokesperson said DORA gives prescribers appropriate information to support their decision to prescribe a controlled drug in real time. The information only relates to the patient being treated, not third party information.

The spokesperson said the system dates back to 2008 when DHHS received funding from the Commonwealth's Health Connect program to develop and introduce a real-time reporting system.

“Reporting of dispensing is initiated in real time – when dispensing occurs,” the spokesperson said. “Dispensing creates a report that shows patient name, drug, strength, prescriber, date and pharmacy. This action does not involve any further action on part of the dispensing pharmacist.

“Patients are not registered – dispensing the medication must be reported under poisons regulations and the patient dispensing history results from that reporting.”

It is understood that the new reporting system will not be linked to other eHealth initiatives such as the PCEHR, as patients do not and will not have access to the information.

Pulse+IT understands that while the Tasmanian system is currently being rolled out to some community pharmacies, it is predominantly hospital pharmacists who are using it at the moment.

Lawrence Howson, managing director of XVT Solutions, said the system has been designed around a secure website, but more work will need to be done by the Department of Health and Ageing (DoHA) to determine how it will be rolled out to the rest of the country.

It is understood that all of the components will be made available to the states and territories for implementation on July 1. As Schedule 8 drugs are controlled by state and health territory health departments, it will be up to each jurisdiction to begin implementation.

It is also understood that no extra software will be required by pharmacists or doctors and the system will interface with existing systems such as Medicare and the PBS.

Mr Howson said the system would only be accessible by authorised users using existing capability such as Medicare's public key infrastructure (PKI) procedures and infrastructure.

“It is also secured by a specific IP addresses as well,” he said. “There are multiple levels of security.”

Mr Howson said if prescribers or dispensers suspect there may be a problem with a particular client, they can look up the client's prescribing history.

“It raises an alert if there has been multiple prescribing,” he said.

The system was promised as part of the Fifth Community Pharmacy Agreement (5CPA), enacted in July 2010, with a tender opened in April 2011 for the hosting and development of the system. Tasmania's system was subsequently chosen and the federal government has now licensed it from DHHS.

Legislation to enable two other programs under the 5CPA – the ability for pharmacists to continue dispensing the oral contraceptive and statins without a prescription in defined circumstances and the supply and PBS claiming from a medication chart in residential aged care facilities – were passed by the lower house last week.

The 5CPA included $5 million to develop a system to collect and report data relating to controlled or Schedule 8 drugs to address the problems of forgery, abuse and doctor shopping.

Currently, prescriptions of Schedule 8 drugs must be registered on a controlled drugs register (or dangerous drugs registers, known as DD Books) in each state and territory, which includes the quantity, strength and balance of each controlled drug, the patient name and address and prescriber details as well as date of supply and prescription number.

These registers are manually recorded and maintained within the pharmacy and, in most jurisdictions, copies of the prescriptions are sent to state and territory health departments at regular intervals. The registers must be available for inspection by health departments and the police.

At the moment, this is done manually and faxed or posted to the relevant health authorities. According to a consultation paper on the new system published in March last year, when data is analysed up to six to eight weeks after an event, as may currently occur in some jurisdictions, the clinical significance of the intervention is compromised.

“The best time for intervention is when a prescriber is about to write a prescription or a pharmacist is about to dispense a controlled drug,” the paper stated.

“Wherever possible this system will be designed to interface with any existing state or territory health department monitoring and reporting systems.

“The system will enable real-time, secure reporting of controlled drugs within each jurisdiction … Currently it is a legislative requirement to record all stock movements for controlled drugs (including receipt from supplier), balances and reconciliation of controlled drugs including in section 90 (community) and section 94 (public hospital and private hospital) pharmacies.”

According to the paper, the system will need to seamlessly interface with existing dispensing software to enable real-time reporting.

“In those states and territories that do not yet have an electronic register, the system will provide this, assisting pharmacists to more easily meet their statutory obligations to maintain records of controlled drugs. The electronic register will also assist in identifying errors or omissions.

“The system will allow notification to pharmacies of stolen prescription stationery, cancelled prescriptions, expired authorisations, and prescribers with limited prescribing rights.”

Another part of the system is a real-time electronic decision support tool for prescribers of controlled drugs, where the prescriber is able to voluntarily access a secure database to view the dispensing history for patients.

“The system will automatically create an audit trail for all records viewed, without the need for prescribers and pharmacists to record details,” the paper states.

“A real-time electronic decision support tool will assist the pharmacist to confirm the authenticity and patient history when presented with a prescription for a controlled drug.

“The system will be integrated into all prescribing and dispensing software packages. Current technology available in pharmacies will allow the system to operate in all dispensary software packages without major modifications to current dispensing software programs.”

Posted in Australian eHealth

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