24 March 2020

E-scripts for isolated patients will happen sooner not later, says MSIA and government

Informatics Patient Management Systems

A fully operational token based e-script system could be up in less than eight weeks, albeit, likely only for about 60% of GPs, according to the CEO of the Medical Software  Industry Association (MSIA) of Australia, Emma Hossack.

This flies in the face of recent speculation that the eight-week time frame being pushed by the Australian Digital Health Agency (ADHA) with the major patient management system  and dispensing vendors was neither logistically nor financially feasible given other issues during the current COVID-19 crisis.

However, Ms Hossack told The Medical Republic this morning that some vendors were a lot more advanced than others, and the timeframe that was being dismissed by many a week ago as a pipedream,  is a lot closer for some vendors than many people think.

“Where companies are not ready to go, the good news is that they will have work arounds until their fully fledged release is ready,” Hossack said.

“Every company wants to co-operate and help.”

The e-script project is a paperless and secure cloud and mobile solution for patients, doctors and pharmacists, driven by a token system which exchanges between the PMS and dispensing vendors and the existing Rx exchanges, eRx and Medisecure.  If it was running then patients in isolation would  not need to leave home to get scripts.

The project was meant  to take another 12 months in order to give all the software vendors involved the time and cashflow to make it happen however given the COVID-19 crisis, the ADHA  and Department of Health, which are working on the timetable escalation. According to Hossck, the government has e agreed to provide additional assistance to enable companies to get going quicker.

Some vendors, mainly PMS providers,   reacted immediately to the initial push by the ADHA, saying they didn’t have the time, money or focus to drop everything and get the system running in that time frame. They pointed out, like representatives from the RACGP have, that the simple solution to helping isolated patients get a script to a pharmacist without seeing a doctor or a pharmacist in person was to get the doctor to scan or photograph the bar code that is currently generated on their PMS  systems and send it by email to a patient. Though technically illegal, there are plenty of precedents now in Australia and overseas of relaxing legislation in order to expedite sensible new operational procedures during the COVID-19 crisis.

Lots of pharmacists and GPs are already practising this and other work arounds to help patients in isolation , ‘in good faith’, for which their are provisions in legislation.

This interim work around is currently being pitched to the Australian Health Protection Principal Committee (AHPPC).

But  Hossack says the interim workaround needs to have risks and benefits balanced.

“If they have risks they need to be superseded as quickly as possible by software which works through prescription exchange systems,” she said.

“This ensures monitoring of medications consistent with the real time prescription monitoring supported by Scriptwise in Victoria and being followed elsewhere.

“It also avoids a multiplicity of points of failure if there is more transparency about what is being prescribed and dispensed – both for clinical reasons and transparency of the PBS system”.

Hossack conceded that interim workarounds are welcome in emergencies until more robust software is released which is more consistent with digitally enabled clinicians existing workflow.

” Racooning  is where people are being sent pictures of racoon emojis during this ciris, to put them on notice that they were distracting others by creating too many different threads of communication for example using Whats App when others were using Hangouts or Skype.

“Having a multiplicity of different sources coming thick and fast in health – via text, email, skype, phone, secure messaging etc would have to qualify as being a pretty big racoon -particularly when doctors are under pressure. Its our job to make health professionals lives easier, and that is exactly what all companies involved in this project are doing.”

“We need a system up quickly where we there is good process and governance to ensure the best efficiency and  patient and clinician  experience.”

Hossack also said that as in US and Taiwan during this crisis, some of the usual enforcement to ensure best privacy practice may need relaxation.  Once in 100 years crises demand exceptional responses  – this one is a balancing act which is being handled very sensibly by co-design between industry and the ADHA.

that is centralised and able to be monitored, in order that things are kept in control, and to provide vital data back to the government on patients working from home.

“The interim workaround is fine for now, but offers to0 many points of failure over a longer time period, and it will add too much to a doctors workflow given they are currently under enormous pressure”, she told TMR.

“We need a system up quickly where we there is good process and governance and we can monitor what is going on”.

Ms Hossack also said that we should be looking carefully at how we can safely relax some security and privacy laws in order to be sharing data better electronically in the health system to help manage the crisis, as has been done so effectively by Taiwan.

Apparently most of the dispensing vendors are ready to go with installation and testing now. FRED IT, a Telstra Health company, which controls the majority of the dispensing market was heavily involved in the e-script project so has prepared their systems in advance. FRED IT is apparently ready to go on the dispensing side.

Most of the issue is with the time and cost of PMS vendors, although some look to be far more advanced than others.

What we might be witnessing is a big departure in the strategies and commercial positions of our two major vendors, MedicalDirector and Best Practice.

MedicalDirector is amid a sales process and getting its cloud-based product Helix working properly is a major focus for that group at the moment. Whereas BP has stated it will take its time to work on its cloud version, Titanium, with a view expressed that appropriate time is needed in order to properly get GPs to accept the new technology.

BP is apparently far more willing and advanced in the process of developing the modules for its existing desktop version, for e-scripts to work. ZedMed is said to be more advanced as well at this stage.

This means that it’s feasible that in six to eight weeks, 60% of doctors might have a PMS which is able to interact with the new e-script token system. The remaining GPs would likely have to continue with the interim workaround (should the government approve it) until MedicalDirector and other vendors caught up.

On the specialist side, Genie Solutions, which controls some 60% of the market, is reporting it can be ready in the ADHA specified timeframe.

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