Plumbing in place: the evolution of ePrescriptions
So what is electronic transmission of prescriptions? ETP is the secure transmission of prescription information between doctors and pharmacists with the key benefits being:
- Improved quality and safety of medication provision
- Improved efficiency, particularly in pharmacy dispensing workflow
- Reduced potential for errors of transcription
- Creating a foundation essential to the wider eHealth system.
ETP has been resounding proof that the medical software industry can work together to quickly deliver quality outcomes, with all of the major doctor and pharmacy vendors having integrated to ETP.
The creation of an integrated healthcare platform connecting doctors and pharmacists creates great potential to further enhance the communication between these members of a patient’s care team. The ETP platform has established a national infrastructure integrating health professionals in every corner of the nation to better communicate and share clinical information for the benefit of the patient.
Australia’s first prescription exchange service, eRx Script Exchange, was officially launched in 2009 and has grown steadily since that point. With approximately 83 per cent of pharmacies and 65 per cent of doctors across Australia using the service, eRx is now transacting an average of five million medications transactions per week or over 220 million original and repeat prescription dispensing messages per annum.
There are currently two prescription exchanges active in the Australian ETP market: eRx Script Exchange and MediSecure. With the push towards an integrated eHealth environment, the development of a model of interoperability between the two prescription exchange services was an important step.
Released in December 2012, the interoperability model allows for ePrescriptions sent to either prescription exchange service to be dispensed no matter which system the pharmacy uses where the patient presents.
With the ETP infrastructure well established, there is enormous potential over time to support future eHealth concepts such as a paperless prescription process. In given scenarios, paperless prescribing is considered a significant driver of efficiency gains and clinical benefits.
With the introduction of these eHealth technologies, as is repeatedly seen in eHealth, the change management implications for the users of the systems continue to be complex. Ongoing change management activities involve such things as:
- Demonstrating clear benefits to both pharmacists and doctors involved
- Demonstrating the safety benefits for patients as a key driver for doctors and pharmacists to use ETP
- Working closely with pharmacists to adapt their dispensing workflows to scan the barcodes on the scripts presented
- Investigating value adding processes utilising the ETP infrastructure as a means of further demonstrating the importance of widespread usage.
One of the key findings from the development and deployment of ETP over the last five years is that there are no short cuts to changing behaviours and driving uptake requires taking a long-term view and significant patience. Success requires approaching such projects as a significant change management exercise where the technical, procedural, legal, administrative, stakeholder incentives and political components of the project all need to be aligned.
Significant and effective investment in change management will more often than not be the determining factor in whether or not such systems are utilised effectively.
Incentives for use
Two key user initiatives to help drive ETP usage include the ETP being established as one of five requirements for GPs to receive their Electronic Practice Incentive Payment (ePIP) and the recent announcement by the Pharmacy Guild of Australia and the Department of Health of the Electronic Prescription Scanning Incentive Scheme (ePSI).
ePSI will be paid to pharmacies based on achieving particular rates of scanning ePrescription barcodes. These incentives continue to drive positive results in terms of both user numbers and scan rates.
Whilst ETP provides both clinical and efficiency benefits, it is also becoming a key platform for the delivery of effective electronic management of medications (eMM) programs. eMM has long been seen as a vital service within the primary, acute care and aged care sectors.
With the establishment of prescription exchange services over recent years, particularly within the community care setting, the ability to provide consolidated medications histories for consenting patients is fast becoming a reality.
As one of the PCEHR Wave 2 projects, Fred IT Group was contracted to build MedView to provide medications histories for consenting patients. It was based initially on eRx Script Exchange and the Geelong Hospital (Barwon Health) providing prescription and dispense records.
Focused initially in the Barwon region of Victoria, medications information was consolidated into patient histories from pharmacies, medical clinics and Barwon Health for the first time. This information is then viewable by authorised health providers including community pharmacists and doctors, hospital pharmacists and doctors and health practitioners within associated aged care facilities.
Fred was later contracted to transition this concept to the PCEHR under the name of the National Prescription and Dispense Repository (NPDR). The rollout of the NPDR continues with recruitment of pharmacies being undertaken by Medicare Locals.
The current PCEHR review findings will be eagerly awaited by many as the outcome will determine future roll-out and implementation plans. What is certain is that the significance of the national eHealth infrastructure that is now in place should not be lost on anyone. One thing is for sure: there are wide and varying views on what has been built and how it was built, but fundamentally the infrastructure or “plumbing” is now in place.
Moving ahead, significant benefits could be gained from the PCEHR and other eHealth infrastructure. To further enhance these benefits, developing the ability of end-point systems such as prescribing and dispensing systems to use PCEHR atomic data for effective and real-time decision support would be game changing.
Relatively simple tools to enable automated alerts for interactions and allergies could be within reach and the associated development of curation tools to provide a level of analysis of the data presented could add significant benefit to individuals and the health system by providing better quality of care.
Electronic medications management was identified in the original PCEHR business case as the source of approximately 60 per cent of the financial benefits from the PCEHR. These benefits come primarily from the reduction of hospitalisations and deaths due to medications misadventure.
A 2010 study by Booz & Co, titled Optimising eHealth Value, came up with this startling finding: in Australia, 138,000 hospital admissions every year are a result of adverse drug events and it has been estimated that up to 18,000 die as a direct result.
eMM can be a major part of delivering enormous social, clinical and financial benefits to the health system and the Australian community and whilst this certainly isn’t an instant fix, great progress has been made and will continue in the future.
ETP has achieved great results and continues to gather momentum. This success will help to enable the journey towards paperless prescriptions and effective electronic medications management, further cementing medications at the centre of Australia’s eHealth future.
General manager, enterprise solutions
Fred IT Group
David Freemantle is general manager for enterprise solutions at Fred IT Group, which developed and operates eRx Script Exchange. David was also responsible for managing the development of the National Prescription and Dispense Repository (NPDR), which is being rolled out throughout the country.
Posted in Allied Health