Why does Toniq not consume the NZePS script directly? Aren’t they in virtually all community pharmacies in NZ?
This seems a little crazy; hopefully it is a WIP that will soon be implemented / rolled out widely.
Can anyone from @pharmacists shed some light? Or maybe someone from Toniq?
Not sure as I have only worked at the coal face side of it. The number of types of electronic versions of prescriptions we get is actually quite irritating considering the end result is still the same-they still just get printed off, essentially filled out manually then checked, signed off and sent away in big bundles every three months to be stored in a giant warehouse wasting space. At the pharmacy end its honestly just made things MORE difficult than when things just popped off the fax machine.
Technology may have advanced but the old antiquated law and regulations may still apply where pharmacy is required to send in physical prescriptions for claiming/payment purposes and retain physical rx on premise for controlled drugs - I may be wrong so please feel free to correct me.
Is Toniq and RxOne ready for this interoperability? It would be awesome if the pms vendors are working on this already.
I agree with Sarah that dispensing can and should be automated! We need to move away from rx based pharmacy model to value based pharmacy
Hi guys. Working currenlty with NZePS from an emeds and end user perspective. There are clearly different areas and phases of development of NZePS.
Initially NZePS has been bringing the data of prescribing and dispensing actions from a data repository perspective to the end user for viewing, not for actioning functionality. Could potentially/safely say that prior to COVID19, This development was slow going and not a priority. Clearly the need during COVID helped display the practicality and needs for a paperless and a secure process.
I reached out to a colleague who has been working with NZePs since 2018…just to ensure I didnt get my wires crossed!
" Yes this is being worked on by both community pharmacy vendors Toniq & RXOne. Because things have changed in this landscape by MoH /HNZ in the last year or so, they will consume from the MDR (medicine data repository) which NZePS feeds into.
Things are happening in this space, it just taking a bit of time. Plan will also be hospital discharge medicine changes summary /Meds list, the GP Current List of meds and all other prescribers will also feed in and out of this repository as well either via NZePS for scripts or the MDR for Med lists"…
Hope this helps.
Oh its definitely a legal thing. I’m not sure if any of these regulations are being addressed in the Therapeutic Products Amendment bill but fingers crossed. I’m really hoping when it happens though that we will be “one and done”-there have been a lot of new technology changes lately and there is definitely a lot of Clinician fatigue with keeping pace of the changes…the CIR alone seems to change weekly.
Contact Trevor Lloyd at Digital & Data, he’s a treasure trove of information on the latest developments on all things escripts, electronic CD registers etc
A good bloke too.
Wonderful news! MDR - yet another abbreviation we’ll all need to learn, eh?
He keeps a low profile online! Google can’t seem to find him.
Would you mind inviting him to the eHealth Forum (and this Topic) so we can all benefit from his thoughts? You can just send him the link to your post i.e.
https://ehealthforum.nz/t/emeds-not-working-at-the-nzeps-pharmacy-interface/29089/6
and ask him to join (he’ll be taken straight to it once signed up).
I was part of an early eRx workflow prototype for paperless dispensing with Trevor and others back in 2020-2021. Representing the RxOne pharmacy, I found that they were not able to effectively utilize the information sent through NZePS.
Ultimately, nothing came of it as far as I was aware- there was issues with how to annotate, dispense and check prescriptions. Other nuances that go along with dispensing prescriptions such as differed/held prescriptions and partially dispensing prescriptions while allowing the other part of the Rx to be dispensed at other pharmacies presented other issues too. The generic substitutions of medicines also did not utilize the NZULM as far as I was aware. In terms of consuming data generated from eRxs, apparently GPs at the practice next door to where I work have been attempting to leave notes for us, but RxOne was not able to present this information to us.
Changing one of the mainstay processes in pharmacies presents a huge workflow problem that I think needs many revisions before we get it right and also involves massive changes to our regular dispensary layout. I think transition from paper to paperless ends up being an unexpectedly large change in terms of dispensing compared to prescribing.
I recall reading about a Nordic country utilizing a cloud-based e-prescribing system where once a patient was prescribed a medicine, any pharmacy would be able to look a patient up on their dispensing software and dispense as many or as few items as the patient would like. It sounded like a cool implementation of e-prescribing and dispensing. From the cloud repository, it showed a visual representation of the prescription information on one side of the screen with the other side being the dispensing software to compare against. Unfortunately, I am not easily able to dig up that journal article- might try to find it eventually!
I’m also happy to share more about what we attempted to do if you would like!
@jjeremylee the Nordic country was Denmark. Other European countries seem to be doing something similar. I googled (in Scholar) “denmark e-prescription” and there were some pretty interesting articles. Try this one out (there is one in the list that says that Denmark was doing e-prescriptions since the early 1990s, which puts us to shame).
Aldughayfiq, B., & Sampalli, S. (2021). Digital health in physicians’ and pharmacists’ office: a comparative study of e-prescription systems’ architecture and digital security in eight countries. Omics: a journal of integrative biology , 25 (2), 102-122.
I found the article I was referring to :
Rahimi, B., & Timpka, T. (2011). Pharmacists’ views on integrated electronic prescribing systems: associations between usefulness, pharmacological safety, and barriers to technology use. European journal of clinical pharmacology, 67, 179-184.
Sweden’s national pharmaceutical information infrastructure allows a clear workflow process from prescribing to dispensing and this article has quite good illustrations around it. Their ‘three-level human-computer interface’ is quite interesting and could form the basis of future development here as it has been proven to be effective.
Kia Ora Nathan and team,
I lead the medicines digital strategy team in Data & Digital Te Whatu Ora and I have just been notified on this discussion - i will try and catch up on the comments and respond back to the questions. Cheer Vidhya
Historically, GP PMS systems were not NZePS complaint and therefore the pharmacies were using the paper script to create the dispense record in NZePS in what is called as the 1SCID( only the dispense record exists with a script(SC) Identifier(ID) as legislatively only NZePS scripts were signature exempt.
With Covid, we saw an increase in GP PMS creating an electronic script, but also sending an image of the paper script via email of other means ( e.g. ReScript) to pharmacy of patient choice - this means that NZePS data was still downloaded and matched against the script image received.
Also the paper until now has been deemed as the source of truth and had to be then sent to Wanganui where it is held for claiming, audit and retention purposes.
We also had the added complication of PMS systems allowing the override of the medication description - ie the prescriber might have selected a NZULM code but updated the description making the script different from the NZePS held data and therefore the check was critical between the paper script and NZePS at the pharmacy end.
We have been moving technology and legislation towards paperless dispensing and the key for this to resolve any risks ( compliance gaps in generating the NZePS eScript) and also generating a script image using the NZePS data and then holding this image as the source of truth for claiming, audit and retention purposes.
With these changes, NZePS will become the channel to transmit prescription images from prescriber to pharmacy and once this is complete we will start to focus our efforts on removing paper from the dispensing process. Switching to the NZePS channel for transmitting prescription images will also introduce the change from the PDF format to XHTML for the prescription image. XHTML images are immutable and compressible and as the image is constructed using the NZePS data it will ensure that image will always aligns with what downloads into the pharmacy systems, which has not always been the case with the PDF / paper format.
MDR ( Medicines Data Repository) is now operational and will make available the NZePS held data for an NHI with the ultimate aim of creating a current list of medicines ( not just GP prescribed).
The team have also been focused on rolling out NZePS to other prescribers e.g. maternity and also one of our key focus working with Taryn and others in the hospital space is getting discharge scripts into NZePS.
Happy to answer any further questions
I would love to dispense meds off a script on an iPad or similar. Same feel as using a paper script, but I could use my finger print to sign off each item as its checked and an electronic pen to annotate. signing is time consuming. Each pharmacist would need their own iPad login so only they could sign things off. Would be great if we could then use our ipads to recall the script to dispense a repeat. Legally you are meant to check repeats against the original script but in practice very few pharmacies do this as its a lot of extra work digging out the original script. That would obviously be much easier to do with electronic scripts. It would improve patient safety if all pharmacists did check against originals like we are supposed to as I have seen plenty of errors that I have picked up when dispensing a repeat off an original script. I can’t see pharmacies stumping up the money to roll out iPads to staff however.
Hi Nathan,
Toniq is working with Te Whatu Ora to enable NZePS prescriptions to be sent from prescriber directly into the Toniq Inbox. The mechanism is NZePS (not MDR) however it does require a technical uplift to enable this new feature, meaning there is a fair bit of work involved. We are currently aiming to have this live in 2023. It is also important to note that this will require Prescribing systems to do some work to enable the prescriber to send the prescription to the specified pharmacy via NZePS not email.
Once we have the prescriptions coming into Toniq we will look to leverage the electronic prescription to enable paperless workflows (legislation permitting).
In regard to the MDR, this will also open further opportunities for pharmacy as a way to surface a complete dispensing record from any pharmacy (with medicine to medicine interaction checking), automatic subsidy card counts and more.
Happy to answer any Toniq related questions.
Thanks
Luke @ Toniq
Thanks for your korero, enjoyed reading that.
What will this paperless dispensing process look like or what are the proposed ideas for this or is it to soon to say?
I think it sounds like a great idea, however thoughts about how these new ideas are resourced needs to be kept in mind. The individual Pharmacies or Pharmacists having to self-fund the electronic resources e.g. iPad, tablet etc. won’t be warmly welcomed, I’d imagine.
Will there be standard prescribing abbreviations implemented across the motu in the future? The way NZePs prescriptions instructions are often written using abbreviations/shorthand known to the prescriber, but the dispensing software doesn’t recognize it or uses different abbreviations when scanned in. Which often means you have to delete the medication instructions that pulls through form the electronic script in the dispensing software and start again, and have to refer back to the physical script to type it back in.
Rx0ne is working with PMS vendors to enable scripts to be delivered electronically to the RxOne basket by all PMS systems
Also we do use NZULM to select generic dispensing when we are allowed to. Unfortunately a lot of PMS systems send us the Trade NZULM and we are obliged to use that drug even if it isn’t funded.
The new requirements for paperless scripts require the PMS to dispense generically except in specific cases.
In regard to annotations, we have had the ability to annotate in RxOne for some time, however this is awaiting legal approval.
There are several steps still required before all systems can go live safely. RxOne and Toniq are working with the PMS systems to test and ensure the solution is workable.
Considerations include pharmacies needing timely notifications (5 minutes is too slow) to receive a notification that an image was sent to them. Especially if they are a co-located pharmacy.
Once these problems have been solved by the PMS systems and Te Whatu Ora, RxOne and Toniq will switch to paperless scripts within the legal framework.