RTPM: Where are we now?


health professional at computer with magnifying glass

Pharmacist Dimi Hoppe provides a detailed overview of real time prescription monitoring across Australia

While all Australian states and territories have agreed to participate in a national real time prescription solution, they are at varied stages of development and implementation.

This article provides an overview of the current situation and progress towards national real time prescription monitoring across each Australian state and territory.

National

In 2018, all Australian jurisdictions agreed to participate in the implementation of a federalised real time prescription monitoring (RTPM) system that is based on the Victorian SafeScript model. All states and territories will integrate and provide data to the National Data Exchange (NDE).

The NDE collects patient, prescriber and pharmacist information related to supply of controlled medicines and uses it to generate real time alerts. The Commonwealth will not have access to the personal information in the NDE.

It is anticipated that all states and territories will be integrated into the NDE by mid-2021.

The national system will provide patient medication histories for the previous 12 months in real time. Monitored medicines include Schedule 8 (S8) controlled medicines such as morphine, oxycodone, fentanyl, dexamphetamine and alprazolam, and other high-risk medicines including all Schedule 4 (S4) benzodiazepines such as diazepam.

State and territory prescribers, pharmacists and regulators will have access to RTPM information and use is mandated at point of care for health professionals prescribing or dispensing monitored medicines.

RTPM similarities across jurisdictions

Overall, the goals of the national system are that RTPM supports the identification of patients at risk of harm due to dependence or misuse of controlled medicines, diversion, “prescription shopping” and provides each state or territory with data to detect prescribers who are not complying with regulations.

RTPM access is limited to prescribers and pharmacists providing direct patient care and approved regulators. The systems do not determine whether a medicine can be prescribed or dispensed. This remains the responsibility of the clinician in conjunction with the application of a patient centred focus on the patient.

RTPM data supports clinical decision making by providing up-to-date and accurate information and assists the clinician to determine risk, coordinate care and support the safe and effective supply of medicines. Clinical treatment and management decisions are the responsibility of the healthcare practitioner and the principles of the quality use of medicines apply.

Patients are not able to opt-out of RTPM systems or restrict medication history information.

The decision to include medicines to be monitored by RTPM systems is informed by ongoing research and analysis of prescribing trends that may vary across jurisdictions.

RTPM systems are designed to integrate with prescribing and dispensing software, however, they can also be accessed via secure web-based portals.

The administrator of the RTPM system is the relevant Commonwealth, state or territory health departments.

RTPM differences across jurisdictions

While the national RTPM program provides a traffic light alert system, each state or territory is responsible for the format of the alert that is generated.

Regulation of controlled medicines (including systems that manage permits and authorities) and which controlled medicines are monitored are state-specific responsibilities.

In addition, regulatory requirements for integration with the NDE are administered by the state or territory.

RTPM progress by jurisdiction

Australian Capital Territory

ACT Health are working on replacing the current voluntary-use RTPM website, DAPIS Online Remote Access (DORA), with Canberra Script. Prior to March 2019, all ACT pharmacies were required to manually submit weekly reports containing information on supplies of controlled substances to ACT Health.

Since the Commonwealth agreement, DORA was integrated with the NDE and real time data is now available.

DORA is available to prescribers (doctors, nurses, dentists, interns) and pharmacists (including intern pharmacists). Other healthcare professionals, including those outside the ACT, can apply to the ACT Chief Health Officer for authorisation to access DORA as long as use is consistent with the purpose of use.

DORA monitors S8 controlled medicines including those that have been dispensed interstate for ACT residents. It can display cautionary prompts for healthcare providers and ACT CHO prescriber approvals. Canberra Script will also monitor benzodiazepines, codeine and gabapentin.

Canberra Script forms part of the national RTPM system and its implementation commences from late 2021 with full release in early 2022.

New South Wales

A consultation process regarding regulatory amendments to support RTPM implementation was undertaken with submissions due to close in February 2021, and enabling legislation was passed in March 2021.

Northern Territory

Since 1983, pharmacies have provided weekly reports of dispensed S8 medicines to the NT Chief Health Officer (CHO). This data was only available to CHO approved regulators and patient S8 histories were provided to their medical practitioners by email or phone when requested.

In July 2020, NT Health signed the Commonwealth agreement and prepared to replace their existing database with a NDE conformant RTMP system called NTScript. Users will include prescribers (doctors, dentists, nurse practitioners, endorsed midwives, podiatrists) and pharmacists, with permitted access by CHO-approved regulators.

NT Health also states that patients can submit a Freedom of Information request to gain access to their records.

Monitored medicines will initially include only S8 controlled drugs and at a later (unspecified) date S4 medicines including benzodiazepines, zolpidem, zopiclone, quetiapine, gabapentin, pregabalin, codeine combination products and tramadol.

NTScript will generate alerts based on the patient’s risk profile and pop-up notifications will appear at the time of prescribing and dispensing to highlight that NTScript information is available.

Queensland

Currently a prescription drug monitoring program (PDMP) collects information on dispensed Schedule 8 medicines on a weekly basis and provides a telephone service for prescriber queries. The PDMP is not in real time and is not automatically accessible to clinicians.

Queensland Health signed an agreement in October 2019 to develop the mandated RTPM system QScript. Users will include prescribers (medical practitioners, nurse practitioners, endorsed midwives, dentists, podiatrists) and pharmacists in hospital, aged care, prison and other health services settings.

Medicines recommended for monitoring include all S8 controlled drugs, all S4 benzodiazepines, all codeine-containing medicines, gabapentin, pregabalin, zolpidem, zopiclone, quetiapine and tramadol.

QScript delivers alerts and notifications using a traffic light system: red notification means potentially high-risk circumstances; ambers means that patient data is available; green notification means that no patient data currently exists in the database.

QScript reduces the requirement for prescribers to seek prescribing approvals and pharmacists will no longer need to manually send S8 prescriptions to the Monitored Medicines Unit.

South Australia

In addition to the overall national goals, SA Health emphasise that ScriptCheckSA is a tool that supports prescribers and pharmacists to make informed clinical decisions about the supply of monitored medications and does not prevent patients from accessing medicines where there is a clinical need. Furthermore, they affirm the key principle of risk and harm minimisation.

ScriptCheckSA was released to all prescribers and pharmacists across South Australia on 31 March 2021 on a voluntary basis and it is anticipated that it will transition to mandatory use after a period of at least 12 months.

Prior to legislative changes being made to make the use of ScriptCheckSA mandatory, full public consultation and a formal evaluation of the implementation of ScriptCheckSA will occur.

Health practitioners who have access to ScriptCheckSA include pharmacists and intern pharmacists and prescribers including medical and nurse practitioners, dentists, midwives and podiatrists who hold an endorsement to prescribe scheduled medicines.

Other users include authorised officers of the Drugs of Dependence Unit who are responsible for monitoring and regulating the prescription and supply of drugs of dependence in South Australia.

Medicines monitored by ScriptCheck SA include all S8 controlled drugs, all S4 benzodiazepines, all codeine-containing medicines, gabapentin, pregabalin, zolpidem, zopiclone, quetiapine and tramadol.

Tasmania

Tasmania implemented the first RTPM system in Australia in 2009. The website-based system DAPIS Online Remote Access (DORA) was made available to prescribers and pharmacists in 2011.

DORA is a voluntary system accessible to Ahpra-registered prescribers (doctors, dentists, nurse practitioners, intern doctors) and pharmacists (including intern pharmacists). DORA provides information on all dispensed S8 medicines and S4 opioids as well as prescriber approvals.

The Tasmanian Department of Health is currently collaborating with the Commonwealth regarding its integration with the NDE.

Victoria

Victoria’s mandated RTPM system SafeScript was implemented in April 2020. Access to SafeScript is available for prescribers (doctors, nurse practitioners), pharmacists and authorised Department of Health and Human Services staff who have a regulatory role in ensuring the safe supply of medicines in the community.

Monitored medicines include all S8 controlled medicines, S4 benzodiazepines, zolpidem, zopiclone, ketamine, quetiapine, and codeine-containing products. Work is currently underway to include prescribing and dispensing information on medicines supplied in the hospital outpatient and discharge settings into SafeScript.

SafeScript provides users with clinical alerts using a traffic light system based on the patient’s prescribing and dispensing history, for example, multiple provider episodes, opioid dose threshold and specific drug combinations. Many integrated software programs also support activation of SafeScript’s pop-up notifications.

Western Australia

Since the late 1990s, WA Health has used the PDMP Monitoring of Drugs of Dependence System (MODDS) to collect S8 medicines dispensing data from community pharmacies. The data is available to health practitioners via a telephone service. The data is limited in access and not in real time.

WA Health committed to the Commonwealth RTPM in 2018 and work is currently underway to update platforms and integrate with the federal system. MODDS was replaced earlier this year and use of the current database Electronic Recording and Reporting of Controlled Drugs (ERRCD) commenced in February 2021.

Jurisdiction

RTPM name

Implementation date

Resources/Training

(on Government website)

Mandated

National

not currently available

end-2021

not currently available

ACT

DORA transition to Canberra Script

March 2019 (DORA) to late-2021/early-2022 (Canberra Script)

 

New South Wales

pending

pending

not currently available

 

Northern Territory

NTScript

pending

not currently available

Queensland

Current PDMP transition to

QScript

pending

South Australia

ScriptCheckSA

April 2021

pending

Tasmania

DORA

2011

 

Victoria

SafeScript

April 2020

Western Australia

MODDS transition to ERRDC

late-1990s (MODDS) to February 2021 (ERRDC)

 

More information:

Jurisdiction

Website

National

https://www.health.gov.au/initiatives-and-programs/national-real-time-prescription-monitoring-rtpm

ACT

https://www.health.act.gov.au/health-professionals/pharmaceutical-services/real-time-prescription-monitoring

New South Wales

https://www.health.nsw.gov.au/legislation/Pages/regulations.aspx

Northern Territory

https://health.nt.gov.au/professionals/medicines-and-poisons-control2/ntscript-information-for-health-professionals

Queensland

https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/medicines/real-time-reporting

South Australia

https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/medicines+and+drugs/drugs+of+dependence/ScriptCheckSA+real+time+prescription+monitoring+in+South+Australia

Tasmania

https://www.dhhs.tas.gov.au/psbtas/real_time_prescription_monitoring

Victoria

https://www2.health.vic.gov.au/public-health/drugs-and-poisons/safescript

Western Australia

https://ww2.health.wa.gov.au/Articles/N_R/Prescription-monitoring-in-Western-Australia

Dimi Hoppe is a consultant pharmacist with experience in military, hospital and community pharmacy.

She is an educator with the intern training program and is currently completing a PhD professional doctorate in public health.

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1 Comment

  1. Michael Scavone
    24/06/2021

    2018? Not bad. Colin Trevena (Amfac Computers) and I first started to discuss this project with the Victorian Health Department in 1988. Michael Scavone (now retired).

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