PCEHR needs seamless medications curation: review panel

More work needs to be done on linking clinical software systems and the PCEHR to enable a seamless method to curate medications lists and add real clinical value to the system, the PCEHR review recommends.

While the opt-out model, a change of name and clinical usability are the headline recommendations of the review, the panel has also made a number of recommendations about improving electronic medications management, along with bringing medical specialists, allied health professionals and private hospitals into the system.

The review states that medication management and the sharing of pathology and radiology results needs to be properly addressed to provide much richer functionality to the PCEHR. The system should also enable the inclusion of data from medication management services provided to patients by community pharmacists.

A list of current medications and adverse events should be one of four essential pieces of data added to the “minimum composite of records” that the panel recommends be implemented to allow a transition to an opt-out model by January next year, which the panel says will dramatically improve the value proposition for clinicians to regularly turn to the PCEHR.

Medications management is touted to be the greatest individual driver of benefits of a properly functioning eHealth system, representing up to $3.2 billion or 39 per cent of gross benefits, the panel says.

This is a theme Health Minister Peter Dutton mentioned when releasing the report earlier this week. “Every year about two to three per cent of hospital admissions are medication related, with up to half of these potentially avoidable,” Mr Dutton said.

“Providing healthcare providers with a simple, clear picture of the patient’s medications is critical in reducing the number of avoidable admissions.”

On the PCEHR as it currently stands, data on medications can be found through shared health summaries, PBS information, discharge summaries and in the National Prescription and Dispense Repository (NPDR). However, the panel wants to find a simple way to bring this disparate data together to provide a simple overview.

“Currently there are multiple sources of medication lists available to the PCEHR with varying levels of clinical utility and functionality,” the review says. “From some sources there is an image of the current medication list, from some sources the current medication list is available as text, from some sources the information is coded …

“[If] the functionality existed, [it] would allow for import and export into and out of clinical systems as well as transmission by secure messaging from health care provider to health care provider.”

The panel also emphasised the importance of adding information on over the counter (OTC) medicines to provide a full picture, saying data on OTCs was essential to detecting such issues as poor compliance with treatment, potential side effects with prescription-only medicines and to allow for monitoring and support for drug dependency.

“The two main sources of data are complementary and neither can do the job of the other,” the panel says. “The curated current medications list together with adverse events, could be sourced from the GP, specialist, hospital or aged care facility clinical information system”, and along with public and private discharge summaries, “would be immediately clinically useful and save time for the clinician on the receiving end”.

“It is imperative that further work be done on software systems to make the process of import and export and medication curation as seamless as possible to fit in to and streamline current workflow,” the panel says.

It also wants to expand the Australian Medications Terminologies (AMT) data set – which is not widely used – to include a set of over the counter (OTC) medicines. OTC medicines should also be added to the NPDR, it says.

The panel says that when widely adopted, the NPDR will add another dimension allowing clinicians, particularly pharmacists, to track compliance and interactions with over the counter medication. However, the panel says the NPDR “does not readily or rapidly allow clinicians to track a current medications list”.

Mr Dutton said the NPDR was a positive of the system in its capacity for prescription and dispensing information to be added to the record.

“The goal is to make prescribing and dispensing information a safer and effective part of healthcare via a eHealth system,” he said. “But the full benefits can’t be realised unless the patient has a record and the prescriber and dispensing pharmacy are registered to use the PCEHR and have access to the necessary information.”

The review also highlights that the NPDR needs prescriptions to be written and scanned electronically and that work must be done to improve electronic transfer of prescriptions (ETP) adoption. GPs must use ETP to qualify for the eHealth practice incentive payments, and in its submission to the review panel, the Pharmacy Guild urges that the fully funded Electronic Prescription Scanning Incentive announced by the previous government be confirmed as soon as possible by the new government.

Posted in Allied Health

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