Electronic prescribing enters testing phase ahead of rollout

‘On 6 May 2020, Australia transmitted its first electronic prescription in primary care – end to end, from the doctor to the patient – using a digital token via an encrypted digital exchange to be dispensed by the pharmacist, and then claimed through Services Australia at the other end.
 
‘It was a great outcome.
 
‘There are real live electronic prescriptions taking place in Australia at the moment.’
 
That is Andrew Matthews, director of the Medicines Safety Program at the Australian Digital Health Agency (ADHA), who has worked on Australia’s accelerated push to electronic prescribing.
 
That first electronic prescription took place between Anglesea Medical and Anglesea Pharmacy in Victoria.
 
The GP who prescribed the first electronic prescription, Dr David Corbet, has described the process as simple as writing a prescription as per usual and choosing the delivery method as electronic. 
 
The pharmacist who dispensed it, Jason Bratuskins, said he was ‘pleased to see that this could sit comfortably alongside our existing processes’.
 
Like telehealth, electronic prescribing was fast-tracked early on in the COVID-19 pandemic in a bid to keep people safe by reducing the need to attend their healthcare providers in person.
 
But while telehealth is able to take place over existing phone or video call services, electronic prescribing has involved building a safe digital communication channel for prescriptions, as well as changing Pharmaceutical Benefits Scheme (PBS) regulations and regulations governing drugs and poisons in every state and territory.
 
The development and planning process has been under way since last year to meet a late-2020 implementation timeframe, but COVID-19 has supercharged these efforts. Though timelines have slipped a little, the largely unseen work behind the scenes is starting to pay off.
 
‘It’s been really satisfying over the last month to get genuine runs on the board,’ Mr Matthews told newsGP. ‘It is complex, but it is happening.
 
‘The pharmacy sector has delivered five years’ progress on digitisation in a matter of weeks, according to some commentators.’
 
On 11 March, the Federal Government announced it would accelerate electronic prescribing, building on work done in 2019.
 
Instead of implementing the new electronic prescribing system over six to 12 months as planned, the new goal for rollout was set for less than 10 weeks. The first electronic prescription was sent nine weeks later.
 
‘It’s been a challenging 18 months, but now we’re seeing some success,’ Mr Mathews said.
 
He estimates the project is now six months ahead of the curve.
 
‘We had the opportunity to capitalise on the work we did last year. To send the first prescription on 6 May is a credit to the peak bodies and software providers involved,’ Mr Matthews said.
 
‘The software providers have worked collegiately – even though they are competitors – to push this forward.’
 
All states and territories, with the exception of Queensland, have now passed their regulatory changes necessary to recognise the form of an electronic prescription as the legal document permitting a medicine to be supplied.
 
A Queensland Health spokesperson told newsGP the changes are currently being finalised. 
 
Community-based testing has begun
ADHA and the Department of Health (DoH) are now evaluating electronic prescribing in a number of communities of interest around Australia, testing how it works for GPs, at the script exchange, and at pharmacies. 
 
To avoid patients taking their electronic prescription outside of one of these trial communities, only doctors participating in these communities should be prescribing an electronic script.
 
‘These have been established to ensure any technical or workflow issues can be addressed on a smaller scale before broader national rollout,’ Mr Matthews said. 
 
Australia’s health agencies have been building towards full electronic prescribing for several years. GPs have long been able to use the previous technology – electronic transfer of prescriptions (eTP) – though a paper copy had to be sent to the pharmacy alongside the electronic transfer.
 
The Federal Government authorised a special arrangement during the first wave of the coronavirus outbreak in March, allowing GPs to take an image of a prescription and send it to the pharmacy.
 
This was only ever an interim arrangement, but it gave GPs the use case to see how electronic prescribing will work in practice, and how convenient it is.
 
‘Electronic prescriptions mean GPs don’t have to print the prescription; it goes directly to the consumer in the form of an electronic token,’ Mr Matthews said.  
 
‘If they are doing telehealth, that gives them the opportunity to be in completely different locations and have the prescription token sent safely and securely to the consumer, who can forward it to the pharmacy for home delivery, if they are self-isolating.’  
 
The system is expected to be popular from a consumer point of view, given that a prescription being sent directly to a phone or email avoids having to look after a piece of paper.
 
Under the new model, once a GP prescribes medication the patient receives a notification on their phone via SMS or email with a link to a QR code. Patients present the QR code at the pharmacy to be scanned.
 
‘The first principle of electronic prescribing is that the consumer has a choice and should be able to take the script anywhere they want,’ Mr Matthews said. ‘Most consumers prefer their regular community pharmacy who often provide home delivery, but it does allow for more flexibility in how you can get medicine, and opens up new flexible models for pharmacy.
 
‘Electronic prescribing can potentially enable new innovations.’
 
It must be noted that paper prescriptions will not go away. Both paper and electronic prescriptions will continue to be available for the foreseeable future.
 
‘We do think people will transition relatively quickly. If doctors or patients prefer paper, that can continue,’ Mr Matthew said.
 
‘The extra safety and security of electronic prescriptions is a key part of the work of our medicines safety program to address mistakes made with prescriptions.’
 
What do GPs and medical software providers think?  
Dr David Adams has represented the RACGP on the ADHA’s electronic prescribing technical working group. He told newsGP that electronic prescribing will make life much easier for on-call work, in particular.
 
‘The real change is going to be in those situations where you’re doing nursing home work or telehealth,’ he said. ‘It’s going to revolutionise my on-call work.
 
‘In my practice we do a lot of on-call work, seeing patients remotely or having nurses call us at 5.00 pm on a Saturday to get a prescription for someone who’s not in front of you. That can take up to 30 minutes of ringing, posting or faxing.
 
‘Doctors have been champing at the bit to get access to this. They all want to be in the trial group.’
 
Dr Adams predicts that within a year, electronic prescribing will find its place as a key part of healthcare.


Dr David Adams believes electronic prescribing will make life much easier for on-call work, in particular.

Medical software providers have backed the community-based testing approach.
 
MedicalDirector CEO Matthew Bardsley told newsGP it is important that the rollout takes place as part of a coordinated deployment by industry.
 
‘We’ve all been busy making software ready to deploy to ensure doctors, pharmacists and patients are coordinated,’ he said. 
 
Mr Bardsley said he supports the ADHA approach of initially testing the new system in targeted communities.
 
‘This is a measured way to get the change into the market and we are supportive of that approach,’ he said.
 
MedicalDirector Chief Medical Officer Dr Charlotte Middleton has previously warned against treating the rollout as a race. 
 
‘There has been a lot of discussion about ePrescribing, at least in the GP networks I am part of, and I’ve noticed a worrying tendency to think of the rollout as a competition to see who can be ready first,’ she wrote.
 
‘If it’s going to work properly, ePrescribing really needs to be a whole-of-industry initiative.
 
‘Instead of thinking of it as a sprint, let’s think of it more as a relay where GPs, pharmacists and patients all need to be in position before the starting gun goes off. It might take more time in the beginning, but it’ll save us all a lot of fumbling down the track.
 
‘Yes, GP software platforms need to have the tech ready and enabled. However, GPs also need to know how and when to provide an ePrescription, pharmacies need to have the tech enabled to receive ePrescriptions, and patients need to be educated so they feel comfortable and confident about the changes.’
 
Best Practice CEO Dr Frank Pyefinch told newsGP the rapid progress on electronic prescribing represents ‘quite an achievement’.
 
‘The fact is that in March we didn’t have electronic prescribing and now we do,’ he said.
 
Dr Pyefinch said electronic prescriptions will prove to be safe and secure.
 
‘It’s probably more difficult to produce a forged electronic prescription than paper. People used to steal paper prescribing pads from surgeries,’ he said.
 
‘With electronic prescribing, doctors have to have a password to get in, and the prescription is encrypted locally with a key before it’s sent to the exchange. At the other end, it’s downloaded at the pharmacy, which has the key to decrypt it.
 
‘So it’s encrypted all the way from clinic to dispensing pharmacist.’
 
What is next?
After trials conclude in the communities of interest, the focus will shift to ensuring clinical software updates are rolled out to prescribers and pharmacies.
 
An ADHA timeline document states that as ‘significant numbers of community pharmacies are able to accept electronic prescriptions, prescribers can be encouraged to issue these to patients where appropriate’.
 
The ADHA is planning for a full release of electronic prescribing between October and December.

Looking ahead, the ADHA is working on the rollout of a complementary active script model in which patients can choose to have a list of their available prescriptions kept in the cloud for easier and safer access by pharmacists.
 
‘The active script model has been a lot more complex for software providers to build. We’re expecting launch for that in October,’ Mr Matthews said.
 
‘Under this model, if the consumer consents, the pharmacist – or any healthcare professional who can prescribe or dispense – can see their list of available prescriptions. If you can assert your identity to the pharmacist, you can get your prescription.
 
‘You can’t lose your script under this model, as the legal script is sitting in the cloud in an encrypted prescription delivery service.’
 
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