Image-based prescriptions to end 30 September

In response to the COVID-19 pandemic and subsequent stay-at-home restrictions and lockdowns in early 2020, the introduction and widespread expansion of telehealth brought a number of innovative digital health models.
 
Among those is electronic prescribing, including Federal Government-subsidised SMS prescription tokens − recently extended until June 2022 – and image-based prescriptions.
 
Image-based prescribing commenced March 2020 to coincide with the rollout of COVID-related telehealth options, and allowed prescribers to email, text or fax a digital image of a paper script to the patient’s pharmacy following a telehealth consult.
 
However, the special arrangement in place for image-based prescriptions is due to end on 30 September 2021 and members of the RACGP Expert Committee − Practice Technology and Management (REC−PTM) are concerned that the service is being wound up too early.
 
‘I can’t see legitimate reasons at this point of time as to why image-based prescribing is being phased out so soon, given that there are so many subscribers that don’t have electronic prescribing,’ Melbourne GP and REC−PTM member Dr Nathan Pinskier told newsGP.
 
Despite the high uptake of electronic prescribing, widespread adoption of the Active Script List (ASL) is yet to be established.
 
‘The challenge is that there are still a number of practices that have not adopted the new token-based prescription system,’ Dr Pinskier said.
 
‘Then if you move into the rest of the sector, adoption outside general practice, [such as] specialists and other prescribers will be very low. That would be my assumption [because] you have to have clinical software to be able to do electronic prescribing, and lots of providers don’t.
 
‘So until there’s a bigger uptake of that, it’s premature to take it [image-based prescribing] away. It’s risky and likely to cause unforeseen problems that could be avoided.’
 
With emphasis being placed on encouraging prescribers to adopt electronic solutions, Dr Pinskier said this should apply not just for general practice but across the whole prescribing industry, including other specialists, dentists and allied healthcare providers.
 
‘That solution might involve the development of low-cost technologies that just allow for prescribing,’ he said. ‘At the moment there are barriers [where] for some it’s probably not warranted to go to the extent of having an electronic medical record or clinical information system.
 
‘So we need low-cost solutions where it’s easy to generate an electronic token.’
 
The cessation of image-based prescribing next month not only presents potential issues for prescribers, but for patients, according to Dr Pinskier.
 
‘It’s not so much a disadvantage for GPs [and other prescribers] – it’s a disadvantage for patients who will be forced to go in for a face-to-face consultation to obtain a prescription, and in the current environment where we’re seeing continuous lockdowns,’ he said.
 
‘The issue around social distancing and COVID safety, that will cause a problem because you’re exposing them to a requirement to go in and sit in a waiting room or walk through a shopping centre. And that creates a risk.
 
‘It may mean that they actually don’t get that prescription. And that might lead to problems with medicines compliance or a delay in prescriptions − it will just lead to unexpected consequences.’
 
While increased uptake of ASL tokens has been floated as one way of addressing the removal of image-based prescriptions, Dr Pinskier said a broader, longer-term solution is yet to be reached.
 
‘I think probably this is a policy question and needs to be more broadly canvased with the peak bodies, including the [RACGP],’ he said.
 
‘Sometimes rushing towards what is the perfect solution, because perfect is the enemy of good, requires a more nuanced conversation.
 
‘How do we get to that point where we turn off paper-based prescribing? Because it’s not just about image-based prescribing, it’s also about paper-based prescribing, and at some point we are probably going to move away from that.
 
‘So what’s the end game? What does it look like?’
 
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digital health electronic prescribing image-based prescribing