Another call for urgent implementation of RTPM

A Victorian coroner has added to the growing pressure on the state government to act on doctor shopping as a matter of urgency following an inquiry into another death involving prescription drugs, one of a growing list including both Schedule 8 and Schedule 4 medicines.

In handing down her report on December 17, Coroner Jacinta Heffey called on the Victorian Department of Health to implement a real-time prescription monitoring system following the death of 38-year-old Paul Kanis, who died from pneumonia in the setting of drug use, including methadone and benzodiazepines.

Mr Kanis was treated predominantly by two GPs, one authorised to prescribe opioid replacement therapy (OTR) and another who treated him for long-standing mental health problems. While each GP was aware that he was being treated by the other, they relied on Mr Kanis to describe what medications he was on.

As in the case of Anne Christine Brain, who died from the combined effects of opioids, anti-depressants and axiolytics and whose inquest report was released last October, the coroner called for the introduction of a real-time prescription monitoring system such as the planned national Electronic Reporting and Recording of Controlled Drugs (ERRCD) system.

Unlike the coroner in Ms Brain's case, Ms Heffey has called for the system to capture information at the point of dispensing rather prescribing. She also called for the system to monitor all Schedule 4 drugs of dependence. At this stage, ERRCD is planned to only monitor Schedule 8 drugs.

“As a matter of urgency, the Victorian Department of Health must implement a real-time prescription monitoring system that records information on dispensing of all Schedule 8 drugs and all Schedule 4 drugs of dependence in Victoria and makes this information available to all Victorian pharmaceutical drug prescribers and dispensers, so they can use the information to inform their clinical practice and reduce the harms and deaths associated with pharmaceutical drugs,” Ms Heffey wrote.

“I take this opportunity to draw the new Minister for Health's attention to the ongoing issue of pharmaceutical drug overdose in Victoria and the vital – and universally acknowledged – need for an RTPM system to reduce the harms and deaths associated with pharmaceutical drugs.”

She said the overdose deaths data shows clearly that Schedule 4 drugs are “tremendous contributors” to overdose deaths in Victoria, with diazepam (Valium) the predominant contributing drug overall.

The Commonwealth Department of Health had floated the idea of rescheduling all benzodiazepines from Schedule 4 to 8 last year, but this idea was discarded as it would have ruled out most GPs and hospital-based doctors from prescribing them. Instead, only alprazolam (Xanax) was rescheduled.

The former Victorian government had committed $7 million to introducing the system as part of its election campaign. However, as The Age reported this week, new Health Minister Jill Hennessy is still receiving advice on the issue.

As Pulse+IT has reported in the past, the implementation of ERRCD is a complex one, involving changes to legislation to allow an electronic version of dangerous drugs books to be kept by pharmacists and the data transferred to state health departments and in some cases the police electronically.

Some states are also looking at the privacy implications of the system. The Royal Australian College of General Practitioners recently released a discussion paper on the issue.

Posted in Australian eHealth


0 # Phil 2015-01-14 12:00
Lets stop talking about this and do it. Australian's are dying unnecessarily while we worry about privacy and other side issues. Ask the familes devestated by the loss of a loved one what they think about privacy if access to the information could have saved their loved ones life! The new Labour government has an opportunity to put Victoria back on the front foot in terms of health IT for the first time in a least 5 years. Grasp the nettle and fund a Victorian implementation. There are vendors out there with solutions for Victoria! And don't let the bureaucrats in the department tell you why it cant be done or how hard it is. Show the leadership we expect from our government.
0 # Maureen Jackson 2015-01-14 13:10
Another reporting tool or capturing tool.
How about risk management at the point of consult.
PCEHR the health information platform, a risk management tool that is under valued by patients in understanding why a practitioner requires the "critically important" health information thus ensuring patient safety be it diagnostic or prescribing.
0 # Terry hannan 2015-01-14 13:40
A strong argument for STANDARDISATION and INTEROPERABILIT Y across ALL health system on Oz.
For many years (>30) in the Regenstrief system which covers 16 hospitals in Indianapolis the e-system permits only ONE clinician to order certain drugs (or all) and if that person is absent then SHE/HE must AUTHORISE another prescriber to be able to write the prescription(s) . I believe this has had a dramatic effect on "doctor-shoppin g" for medications.
0 # Niki Sheldon 2015-01-27 21:30
Yes Terry,
The UK still insists patients register with one practice. This instantly stops the hopping, and can promote continue unity of care. We'd also be able to monitor prescribing habits of the GPs too.
Just another way to tackle the issue. E health is still a long way away.

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