Hi Richard, I wonder if I can get your comment - I’ve been wondering how we can prepare for nationwide Point to point paperless prescribing dispensing and delivery to reduce risk between GPs, Pharmacists and patients - some of who may be at home in isolation.
Pharmacy is working on the low exposure home delivery bit.
In terms of paperless prescribing there is a trial at the moment via MOH and “my practice” (I think?) with signature exempt functionality, that can be directly forwarded to the pharmacy, rather than via the patient (except CDs). This would also be faster and less work for GPs /nurse practitioners who are working remotely or at home. This is meant to be available at end of April (too long to wait!) but also requires medical practices to be on NZePS which many are not. Have you any comments on if this capability is positive, how we can get it set up earlier and encourage early use ?
increases efficiency of the dispensing process – script is electronic, no need for paper copies
removes the ability for transcription error (pharmacist doesn’t need to decipher prescriber handwriting) and or type the medicine and patient (hopefully correctly) into their system
removes the need for CD triplicate prescriptions and faxed prescriptions and the significant issues that delivery of the original creates
captures everything that is prescribed, rather than everything that is dispensed (patients can elect not to have items dispensed)
reduces the ability for prescription fraud, lost prescriptions and prescription theft
Is a useful data source for capturing prescribed medicines and dispensed medicines, that can be used to integrate with other IT systems.
Excellent for using as a source of data for analysis.
Can be used eventually to track adherence – patient script pick up vs what was prescribed.
As far as trying an e-consult system……Waikato DHB tried HealthTap/ SmartHealth. There were/are lots of good features with this system, including remote symptom checking ability (weight/ BP/ skin), teleconsultations, messaging, bulletins, patient info leaflets…however, didn’t end up going as well as expected.
Many yrs back I was part of the original concept team for NZePS along with Shayne Hunter. We presented it at a breakfast meeting at HINZ from memory.
Despite this I have now talked to 2 community pharmacists and both state that NZePS is less efficient than just dispensing from the script in most cases.
There are still database issues (MIMS vs NZULM)and selection is required. NZePS data is stored in CDA documents and there is no FHIR interface.
As a GP you are required to “clean up all regular scripts” to make it hum.
So I am not sure, unless one has a lot of controlled scripts, are you better to Jump. Numbers for the South Island suggests no??
FWIW there are plans to create a FHIR interface to access the data - at least for reading summaries (not the actual transactional part of the process AFAIK). Given the enormous amount of work - and cost - to get this far, I don’t imagine that the transactional part will move away from CDA any time soon.
My advice would be to work with the current system and resolve the issues within the current technology. There seems little doubt that it’s worth persisting with the electronic approach over a manual one…
We are successfully using NZePS and after a few teething issues for GP getting used to it it is now normal business in our practice. With recent announcement from MOH around faxes being defunct the missing part of closing loop is the ongoing requirement for GP practice to print hard copy for patient to present to Pharmacy. In current environment of COVID19 I remain confused why the electronic script which is now resident on cloud for Pharmacist cannot be authorised by patient attendance at physical pharmacy or alternatively available via an app or email with barcode on patient phone or computer. What is sense in having an open loop in modern day . Surely not rocket science to complete the final step in the loop
Grahame
I very much disagree Martin. One of the reasons for slow uptake has been leaders not recognising what a phenomenal time saving system it is. I’d never go back.
Controleld drug management so much easier. Time savings +++.
Also quite useful to see within your PMS in seconds if something has been dispensed or not.
Its been humming for us for ages now. 2 years? Not sure. Time and motion studies would suggest we would have saved at least $100000.
I don’t care about the underlying tech from a user point of view.
As I said from a GP perspective it depends on how many controlled drugs a HCP prescribes.
I virtually never prescribe controlled drugs.
As to the pharmacy end I am pretty much obliged to accept the pharmacists opinion as they download the scripts. Are there any other
pharmacy views on discourse? I would be interested to hear.
We in the SI of course have had a dispensed view for 5 years odd in HealthOne and can do that when we wish. Can’t say for me that is
every often. Mainly when I am looking at compliance with a patient.
Not caring about the underlying tech is your prerogative but it simply means when we do MLOM in the South Island we will be using HealthOne
not NZePS and the FHIR store for the list. We are now within striking distance of this long anticipated target. It is the underlying infrastructure that will make that possible.
Great to have your perspective and to hear from you Richard.
Well as user the tech doen;t worry me, but as someone with ahealth tech hat on of course it does!
Medtech finally about to be live with hte new formulary based on NZF. That is the NZ standard for medicines - what are other systems using?
I’m not big on CDs either Martin, but if I have to do one then I really resent it! If a practice is doing it properly then its walk to the cupboard, unlock it, get the pad out from the safe, write the script number on back of pad, take it to consult room fill it out by paper. Monthly the nurses go through the pad lists and numbers and sign them off against the CD script ledger! You don’t have to do many to see the time savings.
Of course not having to post a faxed script a huge money saving at the front desk. (Though to go back up the thread why are we still faxing…)
Again dispensing lookup not common, but useful at time (Patient ‘losing’ the script)
Our practice is using ePS but we are paying for the privilege. As “early adopters” we paid a reasonable upfront fee to MedTech and I still think there is an on-going cost. If the Ministry wants an increase in uptake them removing financial barriers is a no-brainer. However, like Richard, the advantages of ePS just on CDs has been enough time saving and angst to make the investment worthwhile. Alterations or amendments to scripts is time consuming in ePS- often requiring cancellations and re-writes. Knowing the active/dispensed status of scripts is really useful. I’m very nervous of shifting from MIMS to NZF until someone can reassure me I haven’t got hours of unravelling to do.
Yep , us too. I tink it was $400 up front and ongoing cost is it $120 a month? Ceraitnly cost wqay less than the benfits
NZePS will be free with the NZF module from what I understand. I’ve had a look at the Beta of that a while ago and it looked good… The work with the switch will be around medication alerts… Getting onto Stockleys interaction engine will be a relief after the MIMMS ‘alert anything’ system. (Same as on www.nzf.org.nz ) Might actually have to start paying attention to the alerts as they will be rare but real!
I recently talked to MT (assume you are using that?) and they said NZePS was now “free”. Ie covered in the monthly fees.
They also said they had a conversion program MIMS to NZULM and some tools. Without these it will be a big job and I fear the average
GP or HCP won’t see the benefits realisation of a single medicines classification across the NZ health system.
Many years ago when I wore a different hat pushing for adoption of electronic systems for medicines within Canterbury DHB I would’ve agreed with you. Now from a community pharmacist perspective, ePS doesn’t get rid of the need for paper because we still receive barcoded prescriptions via fax which is scanned to download the information from the CDS. The original prescription copy doesn’t need to be sent to the pharmacy (unless it’s for a class B Controlled Drug) which saves on postage.
With respect to the dispensing process, most GP prescriptions are computer generated so legibility hasn’t been a problem for some time. With ePS scripts, quite often the wrong product is picked (e.g. discontinued brand, non-funded brand, pack-size etc) so it often adds time to the processing time. Also, the abbreviations used by prescribers are not standard and if used, then these often have to be re-typed.
There are some benefits of having ePS but all the selling points that were used to promote it are yet to be realised. To make those a reality would require a bit more improvement.
I believe it is less of an issue for a hospital as they don’t have ongoing medicines lists for every patient
(and favourites) like primary care. Medchart comes with NZULM I believe.
Good points. We don’t see this practical side of things, working in hospital. What we do see is the fantastic benefits of having the NZePS database available to our prescribers and pharmacists so that they can check what a patient has been dispensed in community. Plus really useful for post-discharge audit of who picks up what post dx. (Ethics approved studies only).
