The emergence of electronic prescribing and real-time prescription monitoring.

Can technology enhance your practice?  It probably does already, whether through an electronic clinical records system, email and SMS, or easy access to electronic MIMS during consultation.

When it comes to medication prescribing and dispensing, technology has developed more slowly.

Your electronic record system might generate a prescription, but it is still a paper copy usually taken to a pharmacist to dispense.  You can access your electronic records to see medications your practice colleague prescribed, but it is harder to find out who else may have prescribed medication to your patient, or whether they have filled the prescriptions given to them.

MIGA is conscious that technology is not the panacea for all the challenges you face in practice.  Current systems often work well.  New initiatives can bring unforeseen drawbacks.  However, the right eHealth initiatives can bring very significant benefits to healthcare.  That is why we’ve been advocating on these issues and other prescribing reforms with decision-makers and regulators to ensure they are clinician-led in development and deployment, and that their regulation and operation are sensible, practical and fair.

Two initiatives, underway for some time but only now gathering steam across the country, have significant potential to enhance healthcare – electronic prescribing and real-time prescription monitoring.

Electronic prescribing – so close, and not so far? 
Electronic prescribing has been in the works for some time but it the COVID-19 pandemic has accelerated its development.

Digital image prescribing – the temporary fix 
The move to widespread telehealth use at the beginning of the pandemic meant there was a need for a straightforward mechanism for telehealth prescriptions to be sent to a pharmacist.  This led to the introduction of digital image prescribing, now in place across the country.

Digital image prescribing involves the sending of a digital copy of a prescription (usually via email) to a pharmacist for dispensing.  Unfortunately, how it can be used is not consistent across the country (e.g. which medications can be prescribed, methods for sending a prescription to a pharmacy).  It is meant to be a temporary fix until electronic prescribing can be widely used.

More information about digital image prescribing, including state and territory differences, is available on MIGA’s COVID-19 Q&A – www.miga.com.au/coronavirus – ‘How can I use digital image prescribing?’

Electronic prescribing – now being trialled in certain areas 
Over the past few months, electronic prescribing has been introduced in metropolitan Melbourne (to help during its Stage 4 restrictions) and elsewhere in ‘communities of interest’.¹

The first phase of electronic prescribing involves the Token model.  A unique QR barcode (token) is sent by the prescribing doctor via app, SMS or email to a patient, who then sends it to or takes it into a pharmacy for dispensing.

The second phase involves the Active Script List (ASL) model.  An ASL contains a patient’s active prescriptions, accessible by prescribers and pharmacies.  Prescriptions are dispensed when ‘active’ (i.e. issued by the prescribing doctor).  Patients will need to register for an ASL in order for you to use it.

More information on the Token and ASL models, including timing for roll-out and a free online learning course, is available from the Australian Digital Health Agency.²

More information about electronic prescribing is available on MIGA’s COVID-19 Q&A – www.miga.com.au/coronavirus – ‘When will electronic prescribing become available?’

Real-time prescription monitoring – some places, but not others
The introduction of real-time prescription monitoring (RTPM) systems has been fuelled by concerns about the risks posed by prescription medication misuse, particularly opioids.

Tasmania was the first to introduce a RTPM system, DORA, almost a decade ago.³  It is a voluntary system where prescribers and pharmacists can access information about Schedule 4 opioids and Schedule 8 medications dispensed from pharmacies in the State.  Last year the ACT also introduced DORA.⁴ In time, it is intended that DORA will connect other RTPM systems across the country.⁵

Other states are progressively introducing RTPM systems which require mandatory checking of the system by prescribers before prescriptions are given for certain medications.  MIGA has been closely involved in consultations around the development of these systems in South Australia, Victoria and Queensland.

From April 2020, Victorian prescribers have been required to check its RTPM system, SafeScript, before prescribing Schedule 8 or certain Schedule 4 medications for their patients.⁶

Over the coming months, the RTPM systems of ScriptCheckSA for South Australia⁷ and QScript for Queensland⁸ are expected to be introduced, initially on a voluntary basis before becoming mandatory after an implementation period.  This will monitor a similar range of medications to SafeScript in Victoria, but with some differences around Schedule 4 medications included.

MIGA is conscious that these systems can be complex.  We encourage you to take the time before they are introduced to learn about how to use them in your practice.

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