NZePS problem

Discussions
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Mōrena CiLNers

Hope yesterday afternoons refreshments were pleasant, nice to meet “the” group, unfortunately I had to zip back to Northland (very similar to Wairarapa, feel free to substitute when it’s needed, (the fishing is better).

We have a digital challenge in Primary Care, and I’d suggest Secondary Care Land.

Electronic Prescribing, a dog or a winner???

From a Community Pharmacy point of view (87% of NZ Community Pharmacies are connected) it’s a winner, secure, encrypted prescribing, no more sending original faxed scripts (time & money saving for GP’s & Community Pharmacy).
Backed up by Whanau Tahi and Testsafe in the Northern and Auckland Metro area, a very, very handy tool for knowing who’s prescribed what, where and what’s been dispensed where and when, how much etc.

The problem? Barriers to uptake, no roadshows, no support and no direct financial benefit (investment) but rather a cost to GP’s.

So 87 vs 26, great score line for a RWC if this was in the AB’s favour (not!) but disabling and an ”Archilles heel” for secure digital prescribing, at present.

I’d be interested as to why this platform is not being adopted/tested in Hospitals, what a win that would be, what a connection, from my planet.

All and any thoughts appreciated, these will be fed back to the MOH lead Clare Kirk and her Team.

Kia Ora

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The majority of Aged Care services are now utilising electronic prescribing through Medimap services with a decrease in related medication errors. Not sure if 1Chart has been approved for electronic prescribing yet. kind regards - Gillian

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Hi Shane, 100% agree with those comments. The NZePS system has a lot of potential, as do e-charts. The tipping point for GPs will be usefulness; eg efficiency, improved patient centred care - which is where future development should focus to encourage uptake. It is also needed in some areas where the old fax machine is no longer an option from a cabling point of view! I also think there is opportunity for GPs to utilise pharmacy within their triage system - as it stands we triage 100s of patients and refer, by asking the patient to walk out our door and phone the medical centre (or other care provider). Patient centred care would be much improved if we shared the referral information with Medical centres in a way that’s useful to them, and to the patient eg tapped into a shared triage system. Lots of easy small wins within the integration space.

Its a pity that each DHB has its own IT strategy and platform (eg Testsafe Auckland whereas CCDHB has no system for primary care) which ultimately could end in inequity, each with its own different pros and cons. The biggest benefit is safe transition of care, whether between pharmacy or medical, or medical to medical.
A good example of these platforms power became evident during the chch earthquake where pharmacists were able to access prescriber information and provide emergency supplies, without running blind so that the medical teams could focus on urgent healthcare needs. It was possibly one of the most effective examples of a working primary care system NZ has ever seen, but sadly it took a disaster to demonstrate. CCDHB has no platform, and CCDHB will not be able to achieve what Christchurch did with the same efficacy when the big ones hits…

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Thanks Gill

Those platforms have been fantastic but unfortunately are not connected to GP’s PMS, so a double entry is needed, a real dog for GP’s.

Community Pharmacy is at present looking to delve into Rest Home PMS, for Medicine Reconciliation purposes, hopefully this will help with connection and improved care through both medicine optimisation and avoidance of interactions and side effects.

Thanks

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HCSL software provides aged care services with their Electronic health records from community based services to EOL, along with national benchmarking, quality and risk management systems software which has interoperability with Medimap. Also looking to get interoperability with InterRai assessment processes with discussions underway currently to link for the sharing of information.

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Yes

Couldn’t say it any better if clearer.

Hopefully sense prevails, otherwise continual messaging and encouragement/front footing, as I’m currently doing in Northland will be my default.

Attempting to remove the $$ barrier and improve the upside to GP’s is one of my missions at present, with Clare, Rommel and Andi Shirtcliffe.

Thanks for your thoughts on the digital patient charts, it’s frustrating that it’s half an answer but not the whole, which is why CiLN is so important.

Ngā mihi nui

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Hi,
Electronic prescribing is a problem in hospitals, at least in part because Medchart became the MOH preferred supplier 10y or more ago, and appears to have promptly lost all interest in continuous development. It’s a beautiful system for the early 2000s, and there are now other products streets ahead of it. It also doesn’t export any data … doh.

There are other alternatives out there, and hopefully the MOH will see the light sooner rather than later. In the meantime, the DHBs are having to look at something more clunky than paper- difficult to do, but demonstrably possible.

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Interesting

Thanks for the inside information.

I hear similar stories in many healthcare settings.

I hear there are standards in place to attempt to ensure connectivity, which at least gives me hope for the next generation.

Cheers

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Definitely a winner, but we have a long way to go before we realise all the potential benefits. In most digitisations this takes 20 years (!). Personally, I’d like to do some leapfrogging.

MedChart solves the legibility problem for ward prescribing in hospitals very competently. Unfortunately the other problems remain unsolved. There are much better products out there now - but the bugbear remains data sharing.

The only solution that I have seen thusfar which addresses most of the problems (and makes a start on the others) is OPENeP. It is modern, with a nice UI, and built on OpenEHR - the only open source data platform designed to defeat the interoperability problem once and for all (eventually, if enough sign up).

This is being rolled out in a couple of places in the UK right now; our UK visit dropped by Plymouth to check it out. @lara, @damon, @lance.elder, @bev, and @mike.collins will all have useful opinions on it.

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I’m with you

Leap frogging, that’s good.

My concern remains with inadequate change management investment, cost prohibitive merchandising, leading to dismal take up, or what could be a game changer

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Interesting point re a cost to GPs as user @richard.medlicott told me he has seen savings of $1500 a month compared with a cost of $120 since implementation https://www.hinz.org.nz/news/443209/e-Prescription-service-takes-step-towards-paperless-future.htm
“Not having to do triplicate controlled-drug forms is a particular timesaver.”

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Kia Ora Rebecca

I’ve tried to sell that to a number of GP’s whom I’m friendly with, but the “con’s” keep hogging the limelight unfortunately.

Ngā mihi

Shane Heswall
Kensington Pharmacy Ltd

Mb 027 524 0543

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Posted by Jon Herries on behalf of Rommel Anthony (Medication Management Digital Services Lead - Data & Digital) contact: rommel.anthony@health.govt.nz

Thank you Shane. You are right. We can and must do better than 29% (as of Nov 19) of GPs on NZePS compared to 90% of pharmacies that are actively using NZePS.

Clare Kirk and the team are adding about 10 new practices each month and are keen to up that rate by making the workflow and experience of prescribing and dispensing more efficient. The team are doing this in a couple of ways. First off, we’re working with several of the vendors and some pharmacies on some proof of concepts aimed at improving the workflow that, if successful, we’d hope could be more widely adopted. These include signature exempt prescribing, and use of an electronic medication chart instead of prescribing in Aged Residential Care facilities. We are also working on updating the specifications for the NZePS to provide guide vendors to implement NZePS more consistently and to find solutions to support cyclic processing (repeat prescriptions) and managing pharmacy/dispensing changes to scripts.
Cost is seen as a barrier for some. Some, not all, PMS systems charge an additional fee to GPs for electronic prescribing. There’s work going on with some of these vendors to bring those costs down eg MedTech are working with BPAC to integrate the BPAC prescribing module with the NZ Formulary. GPs using NZePS have also reported efficiency gains that they believe compensate for the added costs including :

  • eliminating the need to complete the triplicate forms for Controlled Drug prescribing
  • no longer sending the original signed scripts for non-controlled drugs to pharmacies after the prescription has been faxed or securely emailed
  • prescriber being able to write a comment for a pharmacist when prescribing reducing time on phone for both pharmacist and prescriber

See attached document on the Benefits to NZePS prescribers for more detail on the benefits including an attempt to quantify the efficiency gains at general practices.

The team work closely with the PMS vendors to resolve issues with the NZePS that GPs and Pharmacy vendors raise. Would be keen to listen to you and others on how the Ministry and the vendors can provide more responsive support for the NZePS and on ideas you may have to increase uptake.

Our goal is to have all prescriptions that are dispensed in the community go through the NZePS including public and private hospital discharge and outpatient prescribing, and other community prescribers such as optometrists and dentists. Some of the DHBs are currently in the midst of upgrading their electronic prescribing systems with versions that include community prescribing, and we’ll be engaging with them to integrate with the NZePS. We’ve also started talking to some groups of private specialists on the prospects of integrating.

What are the benefits of NZePS Prescriber perspective July 2015.pdf (301.4 KB)

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Kia Ora Jon/Rommel

I have been thoroughly impressed by Clare and her Team, top notch, no issues from me as a Community Pharmacist’s, any issues I’ve had have been explained or rapidly sorted.

A pleasure to have such an easy, open and honest working relationship between MOH and Community Pharmacy.

To be honest, from the GP’s I’ve spoken to, both utilising NZePS and not, the early adopters enjoy the successes and wins, while the barriers appear multiple, and often informed by negative perception, which is hard to remedy, once the “rumour mill” has got rolling.

I like the plan of proof of concept, to run out official “pros”, what’s needed to be successful etc, and we have discussed this as a possibility in Northland, employing both the DHB & PHE Digital Teams.

Always happy to offer further thoughts via Zoom, or in person if possible (face to face I find are my most enjoyable dialogues).

Thanks for your thoughts and thorough feedback.

Ngā mihi nui

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