Why has a national real-time prescription monitoring system been delayed?

On 3 May last year, Federal Health Minister Greg Hunt told the Australia Pharmacy Professional Conference that a national real-time monitoring system would be delivered in the coming months.
 
‘What we see is that there is a real focus now to deliver real-time prescription monitoring by the end of the year,’ he said.
 
‘We’re funding it for $16 million and only two weeks ago all of the states agreed at the Council of Australian Governments health meeting to sign up to be part of real-time prescription monitoring.’
 
While the Federal Government’s National Data Exchange (NDE) component – which will receive and distribute dispensing information across all states and territories – rolled out in December 2018, the full system has not met the ambitious timetable.
 
Bee Mohamed, the chief executive officer of prescription drug misuse advocacy group ScriptWise, has called on the Government to push for a clear timeline at a state level.
 
‘Things are moving, but not as quickly as they should be,’ she told newsGP.
 
Ms Mohamed said the matter is becoming more and more urgent, with the numbers of deaths from prescription drug misuse (2177 in 2016) now far outstripping the road toll (1293).
 
Funding and planning is required from each of the states, coming after a compromise agreement in April last year that allowed states to use different systems as long as they were interoperable with a national system.
 
A Department of Health spokesman said the NDE was completed on time and made available to all states and territories in December.
 
‘The Commonwealth is urging all state and territories to integrate with the NDE as soon as possible,’ he said.
 
‘The Commonwealth is currently working with all states and territories to ensure integration of the NDE with jurisdiction-specific regulatory systems as soon as possible. However, the timeline for implementation within individual jurisdictions is a matter for that state [or] territory.’
 
A key issue for the states is choosing which software system to implement. The Commonwealth has made its system, the Electronic Recording and Reporting of Controlled Drugs (ERRCD), available to states since 2013.
 
By contrast, Victoria went it alone to build its own more comprehensive $30 million system, SafeScript, which is now being trialled across western Victoria ahead of a state-wide rollout in April.
 
Pharmacy software developer Fred IT – which built SafeScript – was also given the contract to build the NDE, which was designed to make state systems interoperable.
 
But newsGP has learned that an effort to trial a cross-border monitoring system between western Victoria and the southern coast of South Australia was abandoned ahead of the expected national system.
 
A spokesman for the Victorian Department of Health and Human Services said SafeScript had gone live with an initial focus on the Western Victoria PHN catchment.
 
‘This catchment shares a border with South Australia. This national system is expected to be made available to jurisdictions later this year,’ he said.
 
A South Australian health spokeswoman said the department is assessing the suitability of available software.
 
‘SA Health is assessing the suitability of the available real-time prescription monitoring solutions and is committed to implementing a national real-time prescription monitoring solution within three years,’ she said.

ScriptWise CEO Bee Mohamed has called on the Government to push for a clear timeline at a state level.
 
ScriptWise has long called for a national real-time prescription monitoring system to end the deaths and damage from prescription drug misuse. According to Ms Mohamed, many other Australian states are adopting a watch-and-see approach to see how Victoria’s new system fares.
 
‘We’re waiting for two states to be connected. We want to be able to show the value of having a system that works across borders. That’s the only way to progress,’ she said.  
 
Ms Mohamed said the goal of rolling out a national system quickly was based on a misunderstanding.
 
‘The Federal Government committed money to have national real-time monitoring in place, but the misconception there was [assuming] it can happen without each of the states and territories actually committing to their own system first,’ she said.
 
‘Unfortunately at this stage, it’s a matter of the remaining states and territories committing funding. The solutions are obvious and possible – it’s just how we get to them, that’s the difficult part.’
 
After Victoria, the Australian Capital Territory will be next to roll out its own system, with launch set for March. New South Wales has a version of ERRCD in place, but is exploring SafeScript as an alternative.
 
One emerging issue is that Victoria’s SafeScript system monitors both Schedule 8 controlled drugs, such as oxycodone and fentanyl, as well as prescription-only Schedule 4 drugs, which includes most benzodiazepines.
 
By contrast, the proposed national system will only include Schedule 8 drugs, as will the ACT’s new system. Tasmania’s existing opt-in real-time prescription monitoring system, DORA (Drugs and Poisons Information System Online Remote Access), also only includes Schedule 8 drugs.
 
That situation, Ms Mohamed said, is a major problem given many preventable deaths have occurred through mixing Schedule 8 with Schedule 4 drugs, such as combining oxycodone with benzodiazepines.
 
‘For us, combination users are a huge issue,’ she said.
 
‘So even though these are real-time monitoring systems, it’s not [entirely covering] what should be monitored.’
 
Fred IT eHealth general manager David Freemantle told newsGP the NDE his company developed would act as a repository of monitored drug prescriptions.
 
‘It’s now about getting each of the jurisdictions to integrate to the NDE,’ he said. ‘[State] borders are the basis of the need for the national system. There’s a need for data-sharing between jurisdictions.
 
‘Fundamentally, this is a national pool of data which can be viewed by practitioners in each state.’
 
Mr Freemantle said the NDE was built on very similar intellectual property (IP) to Victoria’s SafeScript, which Fred IT also developed.
 
‘It’s fundamentally the same IP that came out of the Victorian project, but more varied by jurisdiction,’ he explained.
 
The RACGP has long called for a national real-time prescription monitoring system, and believes the system ‘should be expanded to include all drugs, including other drugs of dependence such as benzodiazepines’.

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