Keeping to the script

One year on from the launch of electronic prescriptions in Australia where are we at now? And what are the next steps?

Was it only a year ago that Australia’s first paperless electronic prescription in primary care was successfully prescribed and dispensed?

Amazingly, it was on Wednesday 6 May 2020 that an e-script—which used the “token” model—was prescribed by Dr David Corbet at Anglesea Medical in Victoria and dispensed by pharmacist Jason Bratuskins at Anglesea Pharmacy.

From this simple beginning only a year ago, the use of ePrescriptions has skyrocketed, helped no doubt by the COVID-inspired growth of all things electronic and remote in healthcare.

According to the Australian Digital Health Agency, there have now (as of 9 April) been more than six million ePrescriptions issued to Australians.

This includes 3.5 million original ePrescriptions from prescribers and 2.5 million ePrescriptions as repeat scripts issued by pharmacies.

Almost all pharmacies around the nation have dispensed an electronic prescription.

“The majority of Australians can now choose an electronic prescription as an alternative to a paper prescription from their doctor when needing medicines,” Andrew Matthews, director, Medicines Safety Program at the Australian Digital Health Agency told the AJP.

“At least 97% of PBS approved pharmacies have dispensed ePrescriptions. Prescribers can be confident that if a patient prefers an electronic prescription from their doctor over a paper prescription, they will be able to get this dispensed at their local community pharmacy.”

Anglesea Pharmacy in Victoria was the location for Australia’s first e-script dispensing in 2020

Getting active

Most experts say the next step in the evolution of Australia’s ePrescription program will come with the full national availability of the new Active Script List program, expected to occur by the end of 2021.

Active Script List (ASL) is a list of all active prescriptions and repeats available to be dispensed for a patient. It is a pharmacy-assisted service for accessing patient ePrescriptions for the supply of medicines.

The list has been trialled at 10 sites with 280 patients, Mr Matthews told delegates at the E-medication Management Conference in Sydney in late March. It will become “progressively more available” from April onwards, he said.

The patient can register for the list and can set options for which health professionals they wish to see or access this information.

“Pharmacy is the conduit through which a patient will manage their ASL, with pharmacy’s role including offering assisted registration for patients,” he said.

An example of how the system could work is if a patient is on holiday and needed to obtain a repeat prescription.

“They could elect to allow a pharmacy that is not their regular pharmacy to access their ASL information for one or two days so their prescription could be dispensed,” Mr Matthews said.

“After that date, the nominated pharmacy would no longer be able to access this information.”
The dispensing pharmacy “can access an electronic prescription for a patient from an ASL following proof of identity.”

The patient also has the capacity to instruct a prescriber to withhold scripts from the ASL.
One advantage of the system was that it removed the need for the patient to receive their tokens via SMS or email and retain their tokens, Mr Matthews said.

ADHA data indicated that currently around 85% of ePrescriptions are sent via SMS, he added.

Managing the workload

There were concerns expressed by pharmacists about the impact on workflows, which he believed had been addressed during testing on its integrating into day to day practice.

Full system functionality should be achieved “soon”, Andrew Matthews said, while the privacy framework was also being finalised “at the moment”.

He also noted there are currently three apps (MedAdvisor, Medmate and GuildLink) that are conformant for ePrescribing and offering a token management solution.

In addition, the agency has reported generally good collaboration between professions during the initial development and growth process.

“Feedback to the Agency through clinical peak bodies has been that communication between local general practices and community pharmacies about readiness to write and dispense electronic prescriptions has been another good example of the collaboration between community pharmacy and general practice,” said Mr Matthews.

Becoming part of the framework

Although ePrescriptions may not be embedded in workflows, they have already accounted for around 5% of total prescriptions for the 12 month period to 30 June 2021, said pharmacist Ben Wilkins, director of ehealth coach, a specialist pharmacy digital health training and advice organisation.

“It is already becoming an integral part of prescriber’s workflow with 50% of GPs generating an original ePrescription token—mainly sent to patients via SMS. In fact, SMS occurs 85% of the time as the preferred mechanism”.

Since the beginning of February, and the implementation of active ingredient prescribing, 600 to 1,000 new prescribers of ePrescriptions are coming on board each week, Mr Wilkins said.

“Prescribers can feel confident that their patients are supported because 5,600+ pharmacies across our nation have successfully dispensed ePrescriptions. That is a massive adoption by pharmacists and their staff over a relatively short period of time and is another good news story demonstrating pharmacy’s agility.

“So, dispensing an ePrescription is almost ‘old’ news, as it is already widely occurring and gaining momentum every week, every month.”

What the holiday season showed us

As an example of ePrescriptions becoming standard, Mr Wilkins described the experience of a pharmacist colleague, working in a tourist region, whose pharmacy saw a quarter of their scripts arriving in electronic form during the holiday season.

“This pharmacist, who dispenses in excess of 250 prescriptions daily, reported that some days in February achieved a mix with 25% of script volume via tokens,” he said.

“Apart from the local surgery being proactive, many Sydney tourists had utilised telehealth consultations with their regular GP and were sent ePresription tokens.”

The ehealth coach network of pharmacists reported many similar stories where patients arrived on holiday with no medicines and no access to a local GP, and where the pharmacist gained visibility of medicines via My Health Record*, he said.

“There follows a counselling discussion to provide prescriptions via either continued dispensing or guiding the patient to a telehealth consultation to progress their medicine requirements as an ePrescription,” Mr Wilkins said.

“This is saving patients’ time and frustration, and ensures the pharmacist meets their obligations in an effective and efficient manner utilising the advantages of digital health, without the phone and fax run-around that has been the norm for decades!”

* It is relevant to note that programs like ePrescriptions and My Health Record are separate—however, can overlap in pharmacist’s workflow, Mr Wilkins added.

The security issue

The rapid growth of e-prescribing has highlighted the need to raise the importance of good cyber security processes and systems overall in pharmacies, said Andrew McManus, general manager, Managed Services with Fred IT Group.

Positively, it has meant all pharmacies have had to go through the government process to be certified, he said.

“Like many other online services it highlights the need to be cyber secure—what needs to be done has always been the same, simply the sheer volume of online services means you must invest in your people, process and technology.”

The Pharmacy Guild of Australia told the AJP it had yet to receive a report of any risk to the security of patient data in regard to the introduction of electronic prescriptions in Australia.

Further resources

The Australian Digital Health Agency has made available a number of additional resources in preparation for ASL via its webpage:

These resources include:

  • An ASL explainer video
  • New podcasts, webinars and eLearning—click on the ‘Training and resources’ tab.
  • New ASL assets included in the Agency’s Electronic Prescriptions Toolkit.

The toolkit includes a range of resources free of charge, such as printed (posters, tent cards, window decals) and digital assets (social media tiles, email graphics, email wording) to order and print or download. The Agency covers printing and delivery costs.

The assets are designed for pharmacies to share with patients or display in their pharmacy.

To access the toolkit click on the ‘Training and resources’ tab which will provide a link to the ‘Electronic Prescriptions Toolkit’.

To order or download resources from the Toolkit use Username: pharmacy Password: digitalhealth.
Updated technical documents, available from April, will guide clinical software providers on further enhanced ePrescription functionality.

“When software products become conformant to these specifications in the second half of 2021, health professionals and patients will have even more useability and convenience, especially for the Active Script List”, said Andrew Matthews.

For more on this article, see our May AJP magazine or e-magazine

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