Pharmacy error probable cause of PCEHR problem
Further investigations into how two incorrect prescriptions were added to the PBS section of a Pulse+IT journalist's PCEHR have shown that it was most probably an error at a local pharmacy, one that has since been compounded when repeat scripts were dispensed from a different pharmacy a month later.
As we reported recently, I discovered that two prescriptions had been added to my PCEHR in February. The prescriptions were for drugs that had never been prescribed for me, and were for medical conditions I do not have.
The prescriptions were written on March 12, 2012, and came with a number of repeats for each drug. Two of those repeat scripts were dispensed from my local pharmacy on January 4, 2013, and the details then found their way onto the PBS section of my PCEHR in February, although there were no corresponding MBS items on my record showing that a consultation had taken place.
After publishing the story, I was contacted by the eHealth team from the Department of Human Services (DHS), who told me they were investigating the problem as a matter of urgency. I had also reported that I had been unable to rectify the problem through the PCEHR help desk, which could not verify my identity over the phone.
The DHS representatives told me that the two prescriptions had been dispensed from my regular pharmacy, and encouraged me to approach it to investigate further. I did so, and the pharmacist in question cancelled those prescriptions on my patient file.
The cancellation flowed quickly to the PBS, and the erroneous scripts were deleted from my PCHER within a day. However, on Wednesday last week, I received another call from the eHealth team, who informed me that the same two prescriptions had been dispensed again on February 13, this time from a different pharmacy.
The second pharmacy was one I had never attended and was in a suburb I had not been to for several years. That raised the possibility that the error may not have arisen at the first pharmacy but perhaps from the prescribing doctor or were a far more serious matter of potential identity theft.
DHS recommended that I approach the second pharmacy to investigate further, which I agreed to do. First, however, I dropped in on my local GP, the only medical practice of any kind that I have attended in the last decade.
The very helpful practice manager checked my file and found no record of my having attended since September 2010, as correctly shown on my PCEHR, or having had those drugs prescribed for me. He also checked other patients with a similar name to mine, searched the database to rule out the potential my Medicare number had been duplicated, and even checked all people with the same date of birth as mine.
He could find nothing that indicated those prescriptions ever came from the practice.
Having informed DHS of my progress, the eHealth team then spoke to the PBS section, which came up with the probable solution: the original prescriptions both came with a number of repeats. When they were erroneously dispensed using my name and Medicare number from the first pharmacy, those details were then probably added to the patient's repeat script, which was then dispensed from the second pharmacy under my name.
It is not definite that this is the case, but it is the most likely. The second lot of repeats have been cancelled in the PBS and have not made their way to my PCEHR.
The case is probably closed, although I have given DHS permission to keep monitoring the situation. However, the experience does raise a number of questions, not the least of which is the potential for danger had I had an accident and any resulting diagnosis or treatment was affected by the incorrect information.
In all likelihood no clinician would have acted only on those small pieces of information in my PCEHR, and DHS reminds both patients and healthcare practitioners that PBS data is administrative only, and is certainly not clinical data.
In a positive light, the error would never have come to attention without the PCEHR, and it certainly reinforces the benefits of patient engagement with their medical information. Then again, the error wouldn't have been magnified if the PCEHR didn't exist and it would have just been a matter between the pharmacist and the government.
On a negative note, one suspects that had I not been a journalist, it is doubtful that the problem would have been escalated so quickly, and I did have to do a lot of the legwork myself, which could prove too much of a burden for other patients.
Several readers also commented on the difficulties I faced with my first point of call for assistance – the PCEHR help desk. The requirement for identity verification is so extreme that despite me providing my full name, date of birth, IHI, Medicare card number and expiry date, and the details of my last visit to a doctor and that doctor's name, it still was not enough to allow the help desk to actually help me.
Perhaps the Department of Health and Ageing, as the system operator, could look into instituting Paypal's method for identifying users over the phone, which involves a one-off code. With more than 150,000 people registered for the PCEHR and that number growing, without doubt errors are going to appear more frequently.
The development of a streamlined system for correcting those errors would seem the best way forward.
Posted in Australian eHealth