ePrescriptions: Taking Australian eHealth Forward

On 6 May 2020, Anglesea Medical Clinic and Anglesea Pharmacy were involved in the first electronic prescription in Australian history.

With the lack of face-to-face consultations occurring in response to the COVID-19 pandemic, it became clear that there was a service gap in prescribing medication as patients were no longer in the doctor’s room to receive the printed script.

Enter: Electronic Prescribing

Electronic prescriptions, or ePrescriptions, are an alternative to paper prescriptions. Previously, only a paper prescription signed by a prescriber has been the legal form by which medicines could be supplied. Now, instead of printing the prescription, the prescriber can send it via SMS or email to the patient as a link to a secure repository with a QR code. This acts as a token they can take to the pharmacist who will scan it to access the electronic prescription (the Token model). A token is not a legal prescription, but it can be used by an authorised pharmacy to retrieve the legal prescription.

According to the Australian Digital Health Agency, patients will eventually be able to access electronic prescriptions with proof of identity rather than via the presentation of a token using the ‘Active Script List’ model. An online database will house an ‘Active Script List’ for the patient where prescriptions will be uploaded to by the doctor if the patient has signed up for it. Then the patient will be able to go to any pharmacy that has these services available, identify themselves and the pharmacy will be able to look them up in the system to access their active scripts and dispense them directly.

“The ePrescription initiative is one of those significant leaps forward in eHealth that will profoundly change the way patients, doctors and pharmacies manage their prescriptions.”

The integration and testing of ePrescription technology was accelerated as telehealth rapidly became a common method of client consultation during the pandemic.

A few months on from the first ePrescription, we decided to check-in with Dr David Corbet (GP from Anglesea Medical) and Jason Bratuskins (Pharmacist from Anglesea Pharmacy) to see how ePrescription technology has changed the way they deliver best practice primary health care.

How does it feel to be the first prescriber and dispenser of an ePrescription in Australia, respectively?

Dr Corbet: “I feel quite proud our clinic was involved in a significant event in Australian medical history, for getting involved and stepping up to try out a new system which will hopefully benefit a lot of people, doctors, patients and pharmacists.”

Mr Bratuskins: “It was a privilege for Anglesea to be involved in the first ePrescription in Australia, and for me it’s amazing to be able to process prescriptions in this way. The ePrescription initiative is one of those significant leaps forward in eHealth that will profoundly change the way patients, doctors and pharmacies manage their prescriptions.”

How are you finding ePrescriptions compared to traditional prescriptions, in terms of ease of use and accessibility?

Dr Corbet: “The PES that our practice uses is closely integrated with our medical software, and is very quick to use with just a click of a button required to send the script. The tricky part is everyone getting used to the electronic side of this, with some patients having trouble if they don’t have data or reception on their phones, meaning they haven’t been able to access the QR code. Fortunately, there is also an option at the moment to print the QR code on to paper for those people who don’t have access to a mobile phone or email, which ensures the ePrescription is still more secure than a traditional script in terms of safety and potential forgery. It’s well protected and secure and would be difficult for people to electronically forge scripts. It’s made my workflow during telehealth particularly a whole lot better.”

“A good relationship between general practitioners and pharmacists is vital for good health, with each playing a different role. Pharmacists have expertise in one area, and we as GPs have expertise in another, and so working together is the best way to help people in primary care.”

Mr Bratuskins: “The process of handling ePrescriptions is certainly different for all involved, but quite easy once you’ve seen it in action. In the pharmacy, we now have a better understanding of how ePrescription tokens are presented and how to integrate these into our normal prescription workflow. Once the Active Script List model becomes available, the use of ePrescriptions will be even easier for everyone involved.”

Does the technology improve the link between GP and pharmacist?

Dr Corbet: “Being in the one practice, one pharmacy town of Anglesea, our clinic has good rapport and two-way communications with Anglesea Pharmacy about patients. Being a test site for electronic prescribing, we’ve had a lot of interaction with the pharmacy about how it works, any problems we’ve come across and troubleshooting them. We’ve needed to communicate frequently on how to change and adapt processes for the betterment of the community.”

Mr Bratuskins: “Being part of the trial, we’ve inherently been in contact with the Anglesea Medical Clinic more as we all learn the process. Ultimately, ePrescriptions will make the handling of prescriptions easier for general practices and pharmacies in particular, especially when the Active Script List becomes available.”

What are the benefits of the technology for GPs and Pharmacists?

Dr Corbet: “Eventually it will benefit the doctor more when we reach the endgame of having Active Script Lists, particularly for webster pack prescriptions, but currently it is beneficial in speeding up workflow in telehealth by reducing the need to email or fax scanned printed scripts. The Australian Digital Health Agency have really worked hard in pressing this through in the last couple of months (in response to the pandemic). I love how easily it fits into a standard workflow of a consult.”

“An Active Script List will be a much better way to manage all their prescriptions with their local pharmacy, and if they are travelling, a way to access their prescriptions wherever they are in Australia.”

Mr Bratuskins: “For pharmacists and pharmacies it means that there is no paper involved – so nothing for the patient to sign, no paper to store and eventually destroy, no need for repeats to be printed and, ultimately, an increase in efficiency of the entire prescription dispensing process.”

How do you think the technology benefits the patient?

Dr Corbet: “This kind of technology is what we expect these days. I expect to be able to communicate electronically with my bank to transfer money, so really, I expect to be able to, as a patient, get a script on my phone and take it to the pharmacy. It’s important to know that this isn’t new around the world, it’s only new in Australia, so this is a step in the right direction for eHealth in Australia to bring us up-to-date with global technological standards.”

Mr Bratuskins: “For patients it means that there’s no paper prescription to look after and nothing to lose under the seat of the car! An Active Script List will be a much better way to manage all their prescriptions with their local pharmacy, and if they are travelling, a way to access their prescriptions wherever they are in Australia.”

Any advice for GPs and Pharmacists looking to integrate the technology into their workplace?

Dr Corbet: “I’d encourage GPs to take up ePrescription technology for the convenience of the patient, while also for the sake of the environment in using less paper and ink for printing traditional prescriptions. I also encourage GPs and pharmacists to prepare their software for the updates that will be needed for ePrescription technology. Upgrading now to the latest software means that you’re ready to go when the technology is more widely available. For practice managers, educating your staff and doctors around how this works and having signage up in the clinic or on your website is useful. Ensuring that patient details are confirmed and correct with a valid IHI in the medical software should make things easier for the doctors when prescribing. Most importantly, ask your IT and medical software providers for support!”

Mr Bratuskins: “Start to read up on ePrescriptions to get an idea of what it means for pharmacy. Use information from your dispensary software provider to ensure you have the right hardware to cater for incoming ePrescriptions and what the changes are in the software. If you don’t have the Health Identifier service running today, then start the process of getting that activated now. Finally, think about any potential changes to your internal processes and prescription flow that need to happen to cater for your first ePrescription.”

More Information

Electronic prescriptions will not be mandatory, with patients and prescribers being able to choose between a paper prescription and electronic prescription.

For more information on ePrescriptions for prescribers and dispensers including Frequently Asked Questions, please see the Australian Digital Health Agency’s Electronic Prescribing webpage.