Image-based prescribing has ‘served its purpose’ for general practice

It was at the start of the pandemic that the National Health (COVID-19 Supply of Pharmaceutical Benefits) Special Arrangement 2020 – also known as ‘image-based prescribing’ – was introduced as a temporary service to support telehealth consultations until electronic prescriptions became widely available and fully functional.
 
In the interim, a number of extensions have been applied to the use of image-based prescribing, the most recent announced in December 2021, which is due to end on 31 March.
 
After this date, the service will only be available for use in a hospital setting, following a Department of Health (DoH) announcement that the service will be extended until 31 March 2023.
 
While image-based prescribing arrangements will cease in the community setting, healthcare providers will ‘continue to have options that existed before image-based prescribing [in addition to electronic prescribing] to enable remote support to their patients’, the DoH stated.
 
The decision is partly in line with feedback provided by the RACGP in November 2021, on the future  of image-based prescribing.
 
At the time, RACGP President Dr Karen Price said that previous extensions had been supported by the college as necessary to provide an opportunity for broader uptake of token-based electronic prescribing – but that further extensions were unnecessary.
 
‘The need to email, text or fax a digital image of a paper script to a patient’s pharmacy has dramatically reduced from a general practice perspective,’ Dr Price wrote.
 
‘Therefore, we do not believe there is a need to extend imaged-based prescribing.’
 
But even though the college has advocated for an end to image-based prescribing, Dr David Adam, a representative from the RACGP’s Expert Committee – Practice Technology and Management (REC−PTM), says doing so while extending for hospitals may result in confusion among patients and should be on GPs’ radar.
 
‘The continuation of image-based prescribing in hospital settings reflects the complexity of rolling out new systems in hospitals,’ he told newsGP.
 
‘And I think it will probably need to be extended further for them.
 
‘Patients may have the same expectations for GPs and might be confused or disappointed about the two different systems.’
 
Electronic prescriptions has been rapidly adopted by general practices and pharmacies across Australia, with the majority of clinics adopting the service through updated software.
 
According to the DoH, more than 39 million electronic prescriptions were generated in mid-February 2022, with more than 89% of individual prescribers and over 98% of community pharmacies using the technology.
 
But while uptake has risen dramatically, the college believes ending imaged-based prescribing is an opportunity to further drive electronic prescribing uptake across the healthcare sector more broadly.
 
‘This would be a positive step forward as part of the overall digital health strategy,’ Dr Price wrote.
 
Dr Steven Kaye, Deputy Chair of the REC−PTM, told newsGP while the community safety achieved by the transition to electronic prescribing ‘cannot be understated’, there are some risks with continuing image-based prescribing in hospitals.
 
‘[It] is now an unsafe process with limited confidentiality and should be discontinued,’ he said.
 
‘Regrettably, some hospital EMRs [electronic medical records] have been slow to achieve compliance with the rigorous security levels required for electronic prescribing.
 
‘Thus, image-based prescribing continues to be used, primarily to avoid patient inconvenience, although revealing security and safety concerns.’
 
Dr Kaye is concerned that although visualisation of electronic scripts in the PBS log in My Health Record is ‘a wonderful addition’ to the patient information stream, image-based prescriptions will struggle to be recorded in the patient My Health Record or Active Script List (ASL).
 
This limitation further exposes patients to an ‘unnecessary safety risk of medicine error’, he said.
 
Despite being wary of the confusion possibly created by the now two-tier system, Dr Adam agrees that image-based prescribing has served its purpose for general practice.
 
‘Image-based prescribing was an important step during the early stages of the pandemic, coupled with initiatives like continued dispensing arrangements,’ he said.
 
‘However, its time has largely passed thanks to the widespread availability of electronic prescriptions.
 
‘All major GP software packages can generate electronic prescriptions, and most GPs are comfortable with the concept.’
 
For patients who are unable to receive an electronic prescription directly, there is still the option to generate this prescription and send the token to the patient’s chosen pharmacy.
 
‘The eventual implementation of the ASL will make life easier for patients, prescribers, and dispensers, by removing many steps in the process,’ Dr Adam said.
 
‘Unfortunately, that is taking a long time.’
 
To minimise the impact of image-based prescribing coming to an end, the RACGP is calling for the ASL to be progressed as a key feature of electronic prescribing, to improve the way patients and GPs manage multiple electronic prescriptions without incurring SMS fees.
 
‘The ASL is yet to be implemented widely and it needs urgent wider rollout through pharmacies to support the end of image-based prescribing,’ Dr Price wrote.
 
‘We recommend providing support for prescribers to email electronic prescribing tokens directly to pharmacy to assist patients who do not use smart phones, have limited digital literacy or are isolating at home.
 
‘This would further reduce the need for the continuance of imaged-based prescribing.’
 
Fact sheets on the supply of prescriptions via telehealth for prescribers are available on the DoH website.
 
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