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    Issue 14

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    The introduction of electronic prescribing

     
    Rocky Ruperto Headshot

    Rocky Ruperto

    LLM, LLB (Hons), BSc (Psych)

    Legal and Policy Officer - Advocacy, Education and Research, Avant

     
    new script

    Like other industries, digital transformation in healthcare has great potential to change the way we approach patient care and enhance the overall quality of care. Electronic prescribing is the latest development to be fast-tracked from its planned launch in late 2020 due to the COVID-19 pandemic.

    The Department of Health states electronic prescribing aims to provide convenience and choice to patients, while improving prescribing efficiencies, compliance and drug safety. It has been progressively rolling out since 30 May 2020.

    It allows the prescribing, dispensing, and claiming of medicines, without a paper prescription. This should not only mitigate against prescribing and dispensing errors but will also help, in the short term to protect people most at-risk from COVID-19.

    More options for doctors and patients

    With tight social distancing restrictions in place, telehealth consultations have become common practice, and many doctors are already providing prescriptions, under interim arrangements, to their patients via telehealth.

    Electronic prescribing will complement telehealth services by allowing you, the prescriber, to deliver a complete service because you can now send prescriptions directly to a patient’s mobile device. It provides another way to protect against exposure to COVID-19 and other infectious diseases for you and your patients.

    Electronic prescriptions are not a substitute for paper, but an alternative. Prescribers and patients now have more choice and control over their prescriptions, and patients can still choose which pharmacy they go to.

    How does electronic prescribing work?

    There is no specific 'opt-in' or 'opt-out'. Your patients will choose at the point of prescription whether they would like a paper prescription or an electronic prescription. The only requirement is that they have an Individual Healthcare Identifier (IHI). If they are eligible for Medicare, or for a Department of Veterans’ Affairs pension, they will automatically have an IHI assigned.

    If you choose to offer electronic prescriptions, you will need the capability built into your clinical information system, and the Australian Digital Health Agency provides information on how to prepare your practice.

    Only new prescriptions can be issued electronically, and current paper ones cannot be converted.

    Tokens and Active Script List

    There are two ways to use electronic prescribing. The Token Model was the first phase introduced. It’s a relatively simple system and is beneficial for your patients who require a one-off prescription or repeats for one or two medications.

    When generating the prescription for your patient, you will be prompted to ask how they would like to receive the token. They can choose to receive it via mobile app, by SMS or email.

    A unique one time use QR code, ‘token’, will be generated for each medication, with the number of repeats noted, and sent to the patients’ device.

    The token itself is not the legal prescription and contains very little information.

    Your patient can take or send the token(s) to a pharmacy of their choice that is set up to receive electronic prescriptions. The pharmacy will scan the barcode, similar to an airline boarding pass. Repeats will be issued by the pharmacist directly to the patient at the time of dispensing.

    The Active Script List Model is set to be ready for late 2020 and will be particularly valuable for your patients who require multiple medications and on-going prescription management.

    Your patient will have to register for an active script list. The mobile app will allow patients to set it up and manage who has access.

    They will also be able to register for an active script list through you or their pharmacist. An SMS will be sent to your patient, generated through the prescribing or dispensing software. Your patient will give their consent to have an active script list established.

    Once set up they can grant you and the pharmacist access, and you will have visibility over the scripts which have not been dispensed yet.

    Figure 1 – Electronic prescribing process from the Australian Digital Health Agency

    Electronic prescribing

    Managing the medico-legal risks

    Protecting patients’ privacy is very much a part of the healthcare service you provide. Electronic prescribing will not change your existing prescribing processes. Keeping your patients’ contact details (mobile phone number and e-mail address) up to date will be key to ensuring their information is not compromised.

    The Token Model was implemented so that prescriptions are fully encrypted. The patient’s sensitive health information is only available when the QR code is scanned by a pharmacist. The token acts as a key to unlock the prescription from an encrypted and secure electronic prescription delivery service.

    Electronic prescribing does not change the prescribing of restricted or addictive medications process. You are still required to follow the same protocols, including receiving prior authority or a permit from your relevant state or territory health authority.

    A consistent national approach

    The Department of Health is working closely with all states and territories to make sure a national electronic prescribing framework is in place. A consistent approach and availability will be key to ensuring that the benefits of electronic prescribing are realised.

    Useful resources

    Reference

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    Advocacy at Avant
    Advocacy at Avant