Hospitals roll-out outpatient ePrescribing as waiver deadline looms

eHealthNews.nz: Clinical Software

Hospitals roll-out outpatient ePrescribing as waiver deadline looms

Monday, 16 August 2021

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Book My Vaccine Four Northern DHBs are using an NZ ePrescription Service (NZePS) compliant system for outpatient prescribing and 3DHB is starting its roll-out in two to three months.

A temporary waiver allowing hospitals to use non-NZePS integrated systems is due to expire in September.

“If the waiver is not extended, DHBs without NZePS integrated systems for outpatient prescribing will have to revert to their pre-waiver process that may include paper-based prescription as they work towards integration,” a Ministry of Health spokesperson says.

In March, the Director-General of Health temporarily waived the requirement for physical signatures on prescriptions for non-controlled drugs that are generated or sent by a system that is not integrated with NZePS.

NZePS enables a prescription to be generated by the prescriber, transmitted to the NZePS health information exchange broker, and downloaded electronically at a community pharmacy.

All DHBs made use of the waiver and this led to a spike in electronic prescribing between secondary care and pharmacies

A Ministry of Health spokesperson says the waiver was introduced in response to Covid-19 to make it easier to provide virtual care during lockdowns.

“The waiver was extended because we continue to be in Covid-19 response mode and should there be a community outbreak there would be a need to support non-NZePS integrated signature exempted prescriptions,” the spokesperson says.

However, this will not be a permanent exemption and “DHBs will have to ultimately use an NZePS integrated system,” the spokesperson says.

The Ministry will engage with the DHBs to understand their state of compliance with NZePS integration ahead of the waiver’s current expiry date of 24 September 2021.

All four Northern region DHBs (Counties Manukau, Waitematā, Northland and Auckland) went live with indici for outpatient electronic prescribing in June 2020 and 4,500 prescriptions were sent via the service in July 2021.

Karl Cole, chief clinical information officer at healthAlliance, says the new system replaced what was largely a paper and fax-based process. Clinician sign-on provides more robust security than a written signature and removes the need for printing and faxing.

“The signatureless feature of the new system has been fantastic,” he says.

“It revolutionises the interaction with the patient, makes it very neat and clean as to who is doing what, and facilitates remote healthcare, which is a real bonus for patients.”

Kole says another advantage is that the shared database means medication prescribed from one DHB is visible and able to be repeated at another DHB, allowing clinicians to prescribe with better knowledge of what a patient is getting from other DHB clinicians.

Community pharmacist and clinical informatician at 3DHB, Annie Joe, says a pilot using indici for outpatient prescribing at Capital and Coast DHB is due to start in 8-12 weeks.

“Covid-19 pushed this project forward: we are starting small, then will do a wider roll-out,” she explains.

Moving from a mostly paper-based system to a digital one will ensure prescriptions are always legible, saving time for pharmacists and also minimising errors.

“It will save time for hospital administrative staff who won’t have to look for copies of scripts in folders,” says Joe.

“If a prescriber is offsite, they’ll be able to log in and check what’s been prescribed and if it’s been dispensed at the pharmacy, so it gives them a lot more information.”

The new system also tells prescribers what medications are subsidised or need a special authority number.

Across 3DHB there are around 1000 prescribers and the electronic system will create an auditable, trackable record of what is being prescribed, improving safety.

Joe engages with clinicians to map out their processes so when the new system is rolled out it does not involve huge change and any changes have already been identified.