Pharmacy needs to get several elements right to be truly ready for ePrescriptions, writes Paul Jones
As a community pharmacist working on a daily basis, electronic prescriptions (ePrescriptions) are one of the most exciting developments to come out of the National Digital Health Strategy, and the encouraging signs coming through the Community of Interest testing hubs are showing that the benefits can be realised for prescribers, patients and pharmacies.
However, there are still a number of hurdles I see that we all will have to jump over in both the running of a community pharmacy, and in the daily practice as a pharmacist to be able to deliver and realise the benefits of ePrescriptions.
Being ‘ePrescription ready’, particularly for community pharmacy, means a lot more than simply activating your new software. There are a number of elements that need to be in place to not only be ready for ePrescriptions but to ensure your pharmacy’s ‘digital health’ as well. These elements can be divided into two areas of readiness – digital and practice.
Patient personal identifiers – have you been systematically collecting the unique patient identifiers required for digital health?
Individual pharmacist HPI-I your pharmacy’s HPI-O – have all your pharmacists got a HPI-I, and has the pharmacy registered and got their PI-O?
Business registration – with the impending expiry of your pharmacy’s NASH PKI certificates, and needing to move to PRODA (Provider Digital Access). This registration process is complex and can be time consuming.
Even with experience it is still a process that can several days and even weeks to complete and most pharmacists would have no insight about how to do it. We have a consultant to help us, but that isn’t a necessity; even with a consultant the process will take some time.
Pharmacy mobile number – has your dispensary software provider allocated your pharmacy a mobile number to receive the token from patients for the token model?
QR Code scanners – are your scanners able to read QR codes?
Practice readiness – workflow integration requirements
Workflow – have you thought about how you will manage your new ePrescription workflow? Do you have a QR code scanner on your ‘Scripts-in’ counter where you will be accepting the ePrescription token? Many community pharmacies only have scanners located within the dispensary, where the public aren’t allowed to go.
Dual system – with both paper and electronic prescriptions, have you got a plan for how you will manage the ePrescription tokens as they are presented, and dispense them in order to ensure the integration of your ePrescription queuing system continues to meet the expectations of your waiting patients?
Computer/IT hardware – with checking an ePrescription, it will need to appear as the legal document onscreen. How will this occur and are you going to need a dual monitor system for each dispense station?
Fax and emails – will some GP’s think that sending a prescription via fax or email is an electronic prescription? Discuss the introduction of ePrescriptions with your local prescribers.
Staff training – as Pharmacy Assistants are key to the smooth running of a pharmacy, they will need to be educated on your new ePrescription workflow and its integration with the existing workflow.
Patient identification – just as you do with paper prescriptions, you are going to have to identify patients, get their unique identifiers (IHI-I), as well as their contact mobile number and email address to allow the ePrescription to be pulled down from PES and repeat token(s) to be issued back to the patient.
COVID-19 and scanning a mobile phone – is there an expectation that pharmacy staff are going to want to spend additional time near patients while COVID-19 restrictions are in place? And if so, will they require PPE to do this?
No internet – what is the contingency plan when the internet and mobile network goes down. Think of what happened in the recent bushfires. Talk to both your software provider and internet providers about contingency plans.
Additional personal information – DOB, gender, mobile number, email. Patients are going to want to know why you are collecting this information and this is why comprehensive education is required. What happens when a carer, friend, relative presents with the patient’s token?
Medication management and adherence apps – these will give patients the option of viewing and, to a certain extent, managing their ePrescription tokens. Patients will need to sign-up and consent, download and activate their app and who will help them do this? Most likely it will be their community pharmacy that will have to support their patients’ transition to ePrescriptions.
Education of patients – will the GP’s do this before they send their patients on with their ePrescription token(s), or will the pharmacy be left to try and sort it out for the patient when they present at the pharmacy? How will the patient manage this when they are at home, and trying to send a text message or email with a token to their pharmacy?
General Practice experience – patients have relied on the reassurance of a piece of paper in their hand when they leave the GP surgery and GP’s may find that patients will still want a printed version of the token when they leave the surgery – this may be an understandable transitional step for the patient that is not completely ready to trust the digital world.
Lost tokens – what is the patient going to do when they accidently delete their token(s), and can’t find it or recover it on their mobile phone? Or worse still, the phone is flat or they’ve lost it?
Paper prescriptions – yes, they will still be available and should continue to be used in the context of patient safety and the patient’s access to their prescribed medicines – an ePrescription may not be the answer for everyone.
Social distancing – pharmacy staff don’t want to be any closer for any unnecessary time during COVID-19, and the introduction of ePrescriptions into the COVID-19 environment may present a greater transmission risk to pharmacy staff.
Mobile Phones – with the mouth being possibly the dirtiest part of the human body, I don’t really want to be going near a patient’s mobile phone; having to share a mobile phone with a patient when assisting them to scan their token is not a safe health practice during COVID-19.
The token model will not be suitable for the chronically ill on multiple medications, including many elderly patients. It has the real potential to cause confusion, and make it harder for these patients to manage their medications, as they will have multiple tokens via text messages or emails, and there is a real risk that they won’t know which SMS token belongs to which medication.
A patient on 12 different meds will require 12 different tokens. Therefore, the best and only practical solution for these patients will be the Active Script List – so the sooner it is tested and rolled out the better.
Overall, the initial roll-out of ePrescriptions will be a once-in-a-generation change to community pharmacy and will require significant change management.
Some pharmacies and pharmacists are raring to go and will be early adopters, and there are others who will be a bit more cautious, and wait for the early adopters to deal with the teething problems, and have the software companies sort them out.
And there will be the people who find the whole change all too difficult, and just only want paper prescriptions, and these will need to be dragged reluctantly into a digital world.
Ultimately, if you fall at the first couple of hurdles, you are going to have to pick yourself up, and continue the race to ePrescriptions.
Paul Jones is a Bathurst, NSW community pharmacist, and a National Councillor of the Pharmacy Guild of Australia. He is also the Guild representative on the ADHA medicines safety advisory committee.