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Electronic Transfer of Prescriptions in Australia (eTP)

Electronic Transfer of Prescriptions (eTP) or e-prescribing is also referred to as electronic-prescribing in North America. In Australia, eTP refers to a secure prescription information exchange between general practitioners and pharmacies.

This information exchange occurs through the general practitioner’s clinical prescribing software, the secure prescription exchange service and the pharmacy’s dispense system software.

When a general practitioner writes a prescription, a barcode is printed on the paper prescription. A copy of that prescription is encrypted and sent electronically to the general practitioner’s Prescription Exchange Service (PES). When the patient visits their pharmacy, the pharmacist scans the barcode, and the electronic prescription is downloaded from the secure PES.

History

In 2008 the Australian Health Ministers’ Advisory Council (AHMAC) sought external advice from Deloitte in developing a strategic framework regarding e-health. E-health is “the electronic management of health information to deliver safer, more efficient, better quality healthcare” and is designed to benefit all Australians through information sharing.

In September 2008 Deloitte produced the National E-Health Strategy to progress and develop e-health initiatives in Australia. The National E-Health Strategy recommended establishing and implementing electronic prescription services as a priority solution. In December 2008 the Australian Health Ministers’ Conference (AHMC), released a Summary endorsing the Deloitte National E-Health Strategy. The summary identified electronic information sharing, including the use of electronic prescriptions as a ‘high priority’, for E-Health solutions in Australia.

To establish effective governance, the Summary also recommended the establishment of a National E-Health entity to oversee and coordinate the National E-health Strategy. This responsibility was delegated to National E-Health Transition Authority (NEHTA), an existing eHealth body. NEHTA was established in July 2005 to “identify and develop the necessary foundations of eHealth” and has continued to support healthcare enhancement through the national eHealth agenda.

Service Providers

There are currently two Australian eTP services – MediSecure and eRx Script Exchange.

Incentives

To incentivise the use of eTP in Australia, the Commonwealth government introduced the eHealth Practice Incentive Programme (ePIP) payment for general practices. For more information regarding the Practice Incentive Programme visit the Department of Human Services.

Pharmacists are encouraged to scan barcodes on electronic prescriptions with funding provided under the Fifth Community Pharmacy Agreement (5CPA) for the Electronic Prescription Scanning Incentive (ePSI). Funding for the 5CPA will cease on 30 June 2015 and at the time of writing this article the Sixth Community Pharmacy Agreement is still being negotiated with the Federal Government.

Please note: This is a work in progress the remainder of the article will not have this content copied below. I am just learning the formatting code. Thanks

High-level dataflow diagram outlining the roles and processes involved in electronic prescribing

The basic components of an electronic prescribing system are the:

1. Prescriber - typically a physician
2. Transaction hub
3. Pharmacy with implemented electronic prescribing software
4. Pharmacy Benefit Manager (PBM)

The PBM and transaction hub work closely together. The PBM works as an intermediate actor to ensure accuracy of information, although other models may not include this to streamline the communication process.

Prescriber

The prescriber, generally a clinician or health care staff, are defined as the electronic prescribing system user and sign into the system through a verification process to authenticate their identity.

The prescriber searches through the database of patient records by using patient-specific information such as first and last name, date of birth, current address etc. Once the correct patient file has been accessed, the prescriber reviews the current medical information and uploads or updates new prescription information to the medical file.

Transaction hub

The transaction hub provides the common link between all actors (prescriber, pharmacy benefit manager, and pharmacy). It stores and maintains a master patient index for quick access to their medical information as well as a list of pharmacies.

When the prescriber uploads new prescription information to the patient file, this is sent to the transaction hub. The transaction hub will verify against the patient index. This will automatically send information about this transaction to the PBM, who will respond to the hub with information on patient eligibility, formulary, and medication history back to the transaction hub. The transaction hub then sends this information to the prescriber to improve patient management and care by completing and authorizing the prescription. Upon which, the prescription information is sent to the pharmacy that the patient primarily goes to.

Pharmacy

When the pharmacy receives the prescription information from the transaction hub, it will send a confirmation message. The pharmacy also has the ability to communicate to the prescriber that the prescription order has been filled through the system. Further system development will soon allow different messages such as a patient not picking up their medication or is late to pick up medication to improve patient management.