Healthy growth in eScripts but large gap remains

The companies behind Australia's two electronic prescription platforms say transactions are up by several magnitudes from the same time last year, although many GPs and pharmacists are not yet using the technology.

eRx Script Exchange has seen overall dispense transactions grow by 40 per cent in 2011, while MediSecure Script Vault has seen an increase of 287 per cent in original scripts to the end of November 2011.

While final numbers are not yet available, eRx said it expected to pass previous records and handle more than 4.2 million dispensing transactions in a single week in the week leading up to Christmas, traditionally the busiest time of the year for dispensing.

The 4.2 million dispense transactions include originals and repeats dispensed manually as well as those scanned using the eRx barcode that are sent to eRx. according to David Freemantle, general manager for Health at the Fred IT Group, which led the development of eRx.

It achieved one milestone by handling 750,000 transactions in one day in the lead up to Christmas, he said.

Mr Freemantle said eRx does approximately 3.2 million scripts for an average week, which is equivalent to approximately 160 million dispense transactions per year.

“This includes PBS, under co-payment and private scripts,” he said. “The best estimate we have is that there are approximately 260 million items dispensed per year across those three categories of scripts, so we are achieving a fraction over 60 per cent of those dispense records in eRx.”

MediSecure does not provide information on repeat scripts so a comparison is difficult. Mr Shepherd said his most recent figures show that in October 2011, MediSecure handled about 12 per cent of all original prescriptions written by doctors.

While the two don't agree on total numbers, they do agree that the uptake of electronic prescriptions in pharmacies has been higher than in general practice and that engaging more doctors to use eScripts is the key.

“We know that we have somewhere around 36 per cent of general practices signed to licences but we know that less than half of those are actually doing it,” Mr Shepherd said.

“By and large, this sort of sophisticated technology is more being ignored than being used. Most doctors and pharmacists don't take the process seriously.

“I would estimate that across the board, less than 40 per cent of doctors – probably closer to 30 per cent – are actually using electronic prescriptions in a conscious, informed way.”

He said there were three main reasons why this was so. Remuneration is one sticking point for doctors, with pharmacists reimbursed by the government for using eScripts. (Both eRx and MediSecure charge pharmacists a transaction fee that matches the 15c incentive payment under the Fifth Community Pharmacy Agreement.)

“The second issue is that it's not compulsory yet and they say 'I'm not going to do it',” Mr Shepherd said.

“And the third issue is that there are a few doctors who still hold the view that all of this electronic stuff is a bit of a fad and it's probably going to go away.”

Mr Shepherd said that to encourage a higher uptake of eScripts, the government needs to send clear signals that ePrescribing is the future, particularly for safety reasons.

“We have argued for a long time that the government should come out and say on this day the electronic prescription will become the legal document,” he said.

“A doctor might write something up and give it to your patient, but that has no legal standing. We've suggested that the government give the industry and the professions 12 months or 18 months' notice of that – we think that is what is necessary to make the signal crystal clear.”

Mr Freemantle said his preferred option would be that the government ensure fully electronic eScripts, including going paperless, are trialled in the aged care sector, where significant problems currently exist. He also agreed with Mr Shepherd that primary care doctors were not yet seeing the full benefits of the technology.

“Yes, I agree with Phillip,” he said. “GPs see the benefit as being at the pharmacy end. The problem isn't technical but there are three key barriers to greater uptake. The first is legislative, the second is the Medicare payment process which is incredibly slow to change, and third is the need for a comprehensive long-term change management and training program for all Australians.”

In 2011, MediSecure added a “owing script” functionality to its platform, allowing doctors and pharmacists to overcome the ongoing miscommunication between the two professions over scripts already dispensed but not yet written and authorised.

eRx too is planning to add owing scripts functionality to Script Exchange this year. It also plans to integrate Script Exchange with Medtech32 in the first quarter of this year, joining Medical Director, Best Practice, Zedmed and Stat Health to cover approximately 90-95 per cent of all GPs, along with pharmacy software such as Fred Dispense, Corum, Minfos, Simple Aquarius Dispense and Pharmacy Pro.

Posted in Australian eHealth

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