What GPs should watch out for when ePrescribing

Doug Hendrie

2/12/2020 4:29:47 PM

GPs have called for careful uptake of electronic prescriptions due to privacy concerns and the complexities for patients with multiple medications.

Graphic representing ePrescriptions.
Electronic prescribing holds promise – but there are areas to watch for, experts say.

Electronic prescriptions (ePrescriptions) are surging in popularity, with GPs and pharmacists lining up to switch to a faster system.
More than 800,000 ePrescriptions have been generated since May, but Adelaide GP Dr Danny Byrne has warned GPs to be absolutely certain they are sending scripts to the correct mobile phone number.
‘Think before you click e-script to ensure the mobile number is the correct one,’ he told newsGP. ‘If not, it’s an indefensible breach of privacy, or even a legal case and payout by your medical defence organisation.’
South Australia is the latest state to have the functionality rolled out as part of a staggered introduction, with GPs and pharmacies now able to use the system.
Dr Byrne, who is also the RACGP SA/NT Provost, has been an early adopter of electronic prescribing (ePrescribing) under the Australian Digital Health Agency’s (ADHA) trial rollout. He has sent more than 300 ePrescriptions since July and recently ran a webinar on their growing use.
‘The biggest issue is teenagers,’ he said. ‘Imagine you have a 14-year-old teenage girl who has been coming to your practice since she was three.
‘She wants to go on the pill, and gets an ePrescription – but it gets sent to her mum’s mobile, as that’s the one in the system.’
Dr Byrne also warned that the system as it stands can be too confusing for older patients on many different medications.
‘If you have a patient on 10 medications with multiple repeats, don’t do [ePrescriptions] for them,’ he said.
‘It’s too confusing, since each prescription is a separate text message. They can’t handle 10 messages.’
The ADHA is working on the Active Script List as a longer-term solution for patients with many medications.
‘This will be the solution for complex patients on multiple medications. Until then, use paper,’ Dr Byrne said. 
Other possible issues Dr Byrne flagged include: 

  • situations where a couple share one mobile phone, meaning one partner could see a sensitive script
  • if GPs delete prescriptions from the patient’s record, it can prevent the ePrescription from working when the patient visits their pharmacy if it hasn’t yet been dispensed
  • the need to confirm patients have received the script by text message
  • repeats will usually come back to the original patient’s phone, even if they have forwarded the SMS to a third party to pick up the item for them.
‘We are very good with the uptake of technology but we do have to stop and think and double check – especially with teenagers,’ he said. 
Dr Byrne said that ePrescriptions have proven their worth for simple, one-off scripts in conjunction with telehealth, as well as dramatically simplified his workload of bulk repeat scripts for aged care home residents.
‘They are fantastic for one-off prescriptions. The beauty of e-scripts is when you’re doing a telehealth consultation on their mobile, you can confirm they receive the script while they’re on the phone to you,’ he said.  
‘They don’t have to come to the surgery to pick up the script, we don’t have to fax it to the chemist. It’s literally a three second process – and the majority of patients are just loving it.
‘I’ve had huge interest and been overwhelmed with inquiries. Pharmacists are signing up hand over fist. They want to provide this service to patients.
‘A pharmacy that says they don’t take ePrescriptions won’t survive – this will be the new normal.’
Dr Rob Hosking, Chair of the RACGP Expert Committee – Practice Technology and Management (REC–PTM), told newsGP that ePrescribing is turning out to be ‘really good.’
But, like Dr Byrne, he stressed the importance of being mindful of inadvertent breaches of patient privacy possible under the new system.
He gave other possible scenarios, such as a family where the parents have separated, and the script was sent to a different parent.
Dr Hosking said that while some GPs are emailing scripts directly to pharmacies, the ADHA ‘frowned on’ this practice as it could lead to pharmacies being overwhelmed.
‘The preferred way is to send it to the patient,’ he said.
Dr Hosking agrees paper is probably best for patients with many medications until the Active Script List launches next year – unless it proves convenient in conjunction with telehealth – and said apps such as MedAdvisor and GuildCare can help patients manage the tokens associated with multiple ePrescriptions.
‘Another trick is that when patients receive a repeat from the pharmacy as an SMS, that they save the number as “Scripts” in their phone so it’s easier to find later,’ he said.
Dr Hosking said the most important thing when starting is to know which pharmacies have the process enabled.
‘It’s very easy for GPs – we just get a software update,’ he said. ‘But pharmacists have to change their business processes and way they receive prescriptions, as well as putting a scanning device at the front counter. So it can take longer for pharmacies.’  
Dr Hosking said that many lessons have already been learned from the rollout across Melbourne, and later, Victoria, during the state’s challenging second COVID wave.
‘We did Melbourne and Victoria as a result of us stirring things along. We pushed very hard, with agreement from the Pharmacy Guild and others to roll this out during lockdown and assist with the public health effort,’ he said.
‘The goal was to reduce patient contact at the pharmacy and with GPs, and to support telehealth.’
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Dr Henry Arthur Berenson   3/12/2020 5:47:09 PM

It's nice to see someone is using it. Telehealth would be a lot easier if it was running in Canberra.