Sustaining change in electronic prescribing

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eHealthNews.nz editor Rebecca McBeth

Canterbury has expanded use of its eReferral service under Covid-19 lockdown to allow GPs, hospitals and other providers to send electronic prescriptions directly to pharmacies. Now it’s working on integrations and making the change sustainable.

Electronic ordering and prescribing have become critical to the ability of health providers to continue to provide care during the Covid-19 pandemic.

In order to stem the spread of the virus and keep people safe at home, general practices and other community services have rapidly switched to a digital first approach when caring for patients.

Hospital outpatient appointments have also engaged with telehealth in numbers never seen previously.

But implementing telehealth is not simply about choosing a video conferencing tool, to be effective it needs essential services such as ordering tests and writing prescriptions to also be available online.

The Covid-19 lockdown has driven a huge increase in the use of electronic ordering for lab tests, as well as use of the NZ Electronic Prescription Service (NZePS) by GPs.

In March, the Director-General of Health temporarily waived the requirement for physical signatures on prescriptions for non-controlled drugs for settings where NZePS is not currently an option, such as hospital discharge and outpatient prescribing.

This has led to a spike in electronic prescribing between secondary care and pharmacies, which DHB leaders, such as Canterbury DHB executive director planning and funding Carolyn Gullery, hope to make permanent.

Canterbury expands ERMS

Clinical Pharmacology, the DHB’s Information Services Group and the Electronic Request Management Service (ERMS) team based at Pegasus Health have expanded ERMS to allow prescriptions to be sent electronically to pharmacists from both GPs and secondary care services in the region.

GPs are familiar with the tool as they already use it for eReferrals into the DHB and it is integrated into their practice management systems. Patients nominate the local pharmacy they want their script sent to.

More than 20,000 GP prescriptions have now been sent using the service and 2000 from secondary and tertiary services within the DHB.

Gullery says ERMS was developed in 2008 as a way to integrate the health system by providing a central point for messages to pass through from one point to another.

It has already connected previously siloed services such as general practices, community providers, private hospitals and even schools.

It was on the roadmap to connect pharmacies and general practice using ERMS, but Covid-19 meant it was done much more rapidly as uptake of electronic prescribing skyrocketed due to GPs having to work and deliver care remotely.

Gullery says the idea came up on March 25 and the system was live by April 5.

The benefit of the system is that it also connects the hospital to pharmacies so doctors in ED can now send a script electronically to a patient’s community pharmacy.

Doctors use a dropbox to select a pharmacy and can see if the medication was dispensed, closing the communication loop.

“It enables us to keep an eye on that gap between prescribing and dispensing, which people have been trying to close for a while,” she says.

The system is also available online meaning people who don't have a PMS, such as some allied health providers, can also connect.

Future plans

This month, ERMS has been integrated with pharmacy software providers Toniq and RxOne in a testing environment, which will allow scripts to be sent directly into pharmacy systems.

By June, it will also be integrated into the South Island’s clinical portal, Health Connect South, making the system smoother for hospital clinicians.

ERMS is available across the South Island and Gullery says the initiative could easily be rolled out to other DHBs if they wanted to take advantage of it.

She hopes these integrations will make the system more appealing to other South Island DHBs.

The temporary waiver, issued in March, will expire when the Epidemic Preparedness Notice 2020 is revoked or expires.

Canterubry DHB plans to ask for an ongoing waiver for hospital services using ERMS, which is a completely secure transfer of information.

“We’re working at the moment to see if there’s some way to make it sustainable for secondary care,” she explains.

Silver linings

Gullery says the upside of a disaster such as Covid-19 is that “people's barriers to change drop quite quickly”, and the new electronic service has benefits that will last way beyond the current Covid-19 crisis.

The connection now established between GPs and pharmacies could develop in a number of ways to help support vulnerable populations and help ensure patients pick up and take their medication correctly.

“This opens up the door to a whole lot of new interdisciplinary teamwork,” she says.

“Often face-to-face consultation is necessary or beneficial, but for other times during the patient journey, enabling parts of that process to be done online is safer - especially if it avoids the potential for passing on an infectious disease.”

If you would like to provide feedback on the above feature article, please contact the editor Rebecca McBeth.

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