2014 NATIONAL PROGRESS REPORT
AUSTRALIA’S FIRST NATIONAL PRESCRIPTION EXCHANGE – MAKING THE RIGHT CONNECTIONS Australian healthcare experienced a quiet revolution in patient safety over the past six years. Through eRx, the electronic transfer of prescriptions (ETP) is now a mature process used by 87% of pharmacies and 72% of doctors.
782 MILLION ePRESCRIPTIONS DISPENSED SINCE LAUNCH
Today, eRx is Australia’s largest and most clinically significant health information exchange. More than 80% of all prescriptions in community pharmacy are dispensed with the support of eRx.
In 2008 Fred IT embarked on the significant step of developing Australia’s first national system for the electronic transfer of prescriptions, based on a vision of connecting GPs and pharmacists to achieve safer and more efficient health care.
In 2013, the eRx Express app was added to the network, allowing patients to pre-order their prescription medicines by smartphone.
eRx Script Exchange, a subsidiary of Fred IT, was launched in 2009, forged on collaboration with Australia’s major medical and pharmacy IT vendors so as to provide universal access.
ePRESCRIPTIONS DISPENSED AS AT SEPTEMBER 2014:
EVOLUTION OF eRx
EVOLUTION OF INDUSTRY
• Fred IT announced eRx in September • Fred began engaging partners within software vendors and the medical profession
• eRx launched at Australian Pharmacy Professional Conference 2009 • Best Practice first GP vendor • All major dispensing software connects to eRx • Anglesea Medical Clinic prescribes first ePrescription • Anglesea Pharmacy dispenses first ePrescription • eRx receives Victorian iAwards health award • 7 million ePrescriptions • 814 doctors & pharmacists
• Launch of Australia’s national eHealth strategy • Northern Territory trial of ETP • Pharmacy Guild of Australia endorses eRx and purchases 10.6 million transactions for its members
• Australian Friendly Societies Pharmacies Association endorses eRx and purchases 500,000 transactions for its members • Society of Hospital Pharmacists of Australia endorses eRx
PER SECOND PEAK
• • • •
4,857 doctors 2,748 pharmacists 97 million ePrescriptions eRx achieves security and privacy accreditation in August
2010 • The Fifth Community Pharmacy Agreement (5CPA, 2010-2015) includes eHealth initiatives to support ETP growth
FIGHTING AGAINST PRESCRIPTION FORGERY eScripts are proving invaluable in the fight against prescription fraud, as a busy Mackay pharmacy in Queensland has discovered. Karalyn Huxhagen, pharmacist of the year (2010), was on duty when the fraud attempt occurred. She describes, “This was a sophisticated forgery. If you were quite busy you would never have picked it up, as it was so expertly forged over a legitimate prescription.”
The paper script looked completely authentic, without any sign of forgery. The Pharmacy Guild of Australia has even begun using it as a training example of how sophisticated prescription fraud can be. The key was in having a fast, secure means of verifying what the doctor had prescribed. The pharmacist noticed that the drug information downloaded via eRx was different from that on the printed prescription, prompting a telephone call to the doctor to double check.
FORGERIES Just how good was this forgery? The Pharmacy Guild showed the forged Oxycontin prescription to a group of pharmacists in recent training. Pharmacists were asked if they would dispense it, and the majority said, yes, they would. The trainer then said that the prescription was forged – using Photoshop of an image from a previously dispensed prescription. When the pharmacist scanned the eRx barcode, Amoxicillin medication information came up, which didn’t match the prescription detail. The pharmacist was suspicious, and rang the Doctor to confirm. The fraud was exposed, thanks in no small part to eRx.
5,362 doctors 3,075 pharmacists 152 million ePrescriptions 4.2 million dispensing transactions in one week • Fred and eRx become a lead site (MedView) for the $467 million electronic health records project
• 8,238 doctors • 3,200 pharmacists • 162 million ePrescriptions dispensed • MedView transitioning into the National Prescription and Dispense Repository for electronic health records
• eScripts integrated into PBS Online • Australia’s two prescription exchange services become interoperable • Stage 1 of MedView national medicines repository completed • Australian Association Practice Managers endorses eRx
• eRx de-activates dispense notifications at the request of RACGP • ePIP (Practice Incentive Program eHealth) requires that GPs send the majority of prescriptions to ETP • ePSI 1 (Electronic Prescription Scanning Incentive) requires that pharmacies scan 15% of original prescriptions • Royal Australian College of General Practitioners recognises eRx
• • • •
• Pharmaceutical Defence Limited endorses eRx
• Launch of eRx Express smartphone app • 16,065 doctors • 4,233 pharmacists • 200 million ePrescriptions dispensed
• eRx Express wins ICT Innovation Award • Fred IT named on BRW’s 50 Most Innovative Companies List 2014 • 18,908 doctors • 4,628 pharmacies • 229 million ePrescriptions dispensed each year
2014 • ePSI 2 (Electronic Prescription Scanning Incentive) requires that pharmacies scan 30% of original prescriptions
BENEFITS OF ETP
ELECTRONIC TRANSFER OF PRESCRIPTIONS
Australia’s development of a national approach to ETP is a prime example of the fact that different parts of the health sector – even competitors – can work together to deliver positive health outcomes.
IT’S CONVENIENT Electronic dispensing reduces queuing time and creates opportunities for people to take greater control of their medicines
TOWARDS COLLABORATIVE CARE A better health care experience for patients depends upon improved coordination and management of care between doctors, pharmacists and patients. ETP is a key foundation for this to occur
IMPROVED PATIENT SAFETY The most important benefit of electronic prescriptions is that they reduce potential dispensing errors, as prescriptions no longer need to be transcribed. Instead, patient and medication data is pulled directly into dispensing software, just as the doctor prescribed
IT’S FASTER Electronic dispensing is more efficient than paper-based dispensing – which means pharmacists can spend more time taking care of patients
CONNECTING THE HEALTH INDUSTRY ETP is the avenue through which medications information from Australia’s many different prescribing settings comes together – making it a vital underpinning to electronic health records
PARTNERSHIPS IN ACTION Australia’s eHealth system has been carved out in partnership between government, health practitioners, and IT specialists. Fred and eRx have been part of the team leading these transformations, with the successful development of the MedView Wave 2 site and the National Prescribing and Dispense Repository (NPDR).
A MEDICINES REPOSITORY
MedView was a secure, standards-based, consent-driven, conformant repository. It used eRx and hospital clinical systems to transfer data between healthcare providers, and deliver this valuable information to the repository. Leading industry members and software vendors came together for the project: Best Practice Software, Zedmed, Fred Health, Simple Retail, eRx Script Exchange, BossNet, Pharmhos, and iCare. Industry partners included Barwon Health, Barwon Medicare Local, and Monash University.
MedView was a groundbreaking medicines repository that brought together patient records (prescribed and dispensed) across community, hospital and aged care settings. For the first time, GPs and pharmacists were able to see a combined list of a patient’s prescribed and dispensed medications, no matter how many doctors and pharmacists they had visited. The community, hospital and aged care history was available on one screen at the touch of a button in existing software.
• Led by Fred IT • Powered by eRx • Trialled in the Barwon Region of Victoria as a Wave 2 eHealth site for the Personally Controlled Electronic Health Records (PCEHR) • Transitioned into the national infrastructure of the PCEHR • First major implementation of HL7 CDA (Clinical Document Architecture) in Australia • Data encrypted using Medicare PKI technologies, with patients identified electronically using Individual Health Identifier (IHI) via the Medicare Health Identifier Service
Building on the very successful first phase, Fred IT was commissioned to build the NPDR on behalf of the government of Australia.
BUILDING A NATIONAL REPOSITORY
eRx has been a key enabler in delivering instant medications information to a patient’s electronic health record - building and powering the national repository on behalf of the Australian government.
consumer portals and on conformant software. As a result, healthcare professionals have a fuller patient medications history, enabling them to make more informed decisions about their patient’s treatment and care.
The NPDR is part of the backbone of the national eHealth record system. The repository allows the PCEHR to generate prescription and dispense views on provider and
The NPDR is delivering efficiency in healthcare services as well as increased access to healthcare information.
REMARKABLE GROWTH 2
Five years of remarkable growth in the network of health professionals connected by eRx.
* = estimated
TOTAL ePRESCRIPTIONS DISPENSED
2009 2010 2011 2012 2013 2014*
2009 2010 2011 2012 2013 2014*
2009 2010 2011 2012 2013 2014*
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WHAT USERS SAY ABOUT eRx… whole system has been “ This s. extremely beneficial to our busines ed. end mm reco ly High ” John K Chris Walsh Pharmacy Drysdale VIC
d commercial 'mus t have'. It's as big a technological chan ge as computerised dispensing. Get with it!
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We were hesitant about introducing eRx into our “ perce pharmacy as we ived little benefit. We were wrong ! It is a welcome advance in the workflow for our dispensary, in fact the script s that don't have eRx barcodes now slow the workflow more .
Partner, Chesterville Pharmacy, Vic
nefits for our significant be eRx provides been using practice has patients. Our as very easy w It time now. e m so r fo x eR negative we’ve had no our to set-up and of e performance s only impact on th ha ct pa e. The im ar ftw so al ic clin been positive. rson Brett McPhe IC e, ical Centr V Collins St Med
eRx EXPRESS Order prescriptions on your phone eRx Express is a free app which allows people to order their prescription medicines via their smartphone or tablet, and to then collect them at a time that suits. It’s free, it’s convenient, and it makes life easier for everybody: • Helping people keep track of their prescriptions medicines and when they need to be taken • Putting patients in control of their medications • Less waiting time for prescriptions
BENEFITS FOR PHARMACIES: • Dispensing ahead of time means pharmacists can spend more time helping customers with their health needs • Specialist and high-value medicines can be ordered in as patients need them • The number of people waiting in-store is reduced • Customers are provided with new ways to engage with pharmacy • Customer loyalty is strengthened The pharmacies with the highest number of customers pre-ordering prescriptions have helped their customers get on board, talking to them about eRx Express while their medications are being dispensed and downloading the app for them on the spot so that they can see how to use it.
• 12,900 downloads and regular users • 10% of Australian pharmacies dispensing via eRx Express • 30,000 dispenses since launch
I LOVE eRx Express. I am having lots of “ fun with it!! Have just had my 83-year-old customer send me her 7 scripts from her iphone!
Express creates loyalty “ eRx with customers helping
them return to us rather than have scripts dispensed elsewhere.
Fiona Wailes Kofoeds Pharmacy
really love it. We mention it “ toOurourcustomers customers while they are waiting for
Steve Speirs Exhibition Pharmacy
scripts, and we show them how to download the app. WE all love it.
What users are saying… use the app when we’re “ Igetting low on medications and I can just scan it any time of the day and night, nominate when I want to pick it up, and it’s all done for me.
” Vicky, Tenambit
have about ten scripts a “ Imonth, which is a lot to juggle. With this app, I can go back and check which ones I have. There’s no more waiting to get your script done, no more waiting in line. I love it.
It’s made my life easier “ knowing that I can scan them and my pharmacist will always have them ready for me.
“ It’s made life pretty easy for me.” John
INNOVATION AND LEADERSHIP eRx is owned by the Fred IT Group, Australia’s leading provider of IT services to pharmacy. Fred was launched in 1992 to create pharmacy-friendly dispensing software. The company has since grown from its original staff of 2 to a team of 205, consistently exploring new ways for IT to improve the way pharmacy does business and improve patient health and safety.
In the last decade, Fred has taken a leadership role in eHealth, including the rollout of PBS Online, developing the first national platform for ETP, increasing scaffolding for national medication records, and launching a patient phone app to link in to eRx ePrescriptions.
In 2013, Fred entered a new chapter, with Telstra becoming a significant investor and strategic business partner. This partnership is based on a shared vision of connecting health professionals and users to deliver better health care.
BRW’S 50 MOST INNOVATIVE COMPANIES 2014
INNOVATION AWARDS Awards since eRx was launched in 2009
The Fred IT Group’s leadership and development in eHealth has seen the company named on the 2014 BRW 50 Most Innovative Companies List, coming in at number 25. The List recognises companies with a culture of innovation across all areas of their business, from ideas through to reality. Fred IT was named specifically for its innovation in relation to eRx, eRx Express, and Fred NXT, which is the first and only full-functionality, cloud-based software service for Australian pharmacies.
TWO iAWARDS VICTORIAN INNOVATION AWARDS FOR HEALTH (2009, 2014) The iAwards are Australia’s premier annual awards recognising innovations by Australian ITC companies. The Australian Information Industry Association hosts these to recognise cutting edge developments in technology and to reward innovations that can positively impact on the community. eRx received the awards in recognition of its technological leadership and its partnership model for a national roll out that was secure and sustainable whilst also quickly reaching as many users as possible.
MICROSOFT PARTNER AWARD Fred Health won the Microsoft Partner of the Year Award for Health in 2009 in recognition of the eRx Script Exchange ETP solution.
BOOSTING SCAN RATES Boosting scan rates is one of many vital changes needed to share the efficiency and safety benefits of ePrescriptions as widely as possible. With all eHealth changes, big and small, there is a need to manage processes of change carefully. eRx Script Exchange has found that the keys to managing change are to: • Demonstrate clear benefits to all involved – pharmacists and doctors • Demonstrate the safety benefits – patient safety is the number one driver for doctors and pharmacists to use ETP • Work closely with stakeholders on designing the process – working closely with pharmacists to incorporate scanning of barcodes into dispensing workflows • Look for value-adds – how could widespread ETP infrastructure create additional benefits? • Keep engaging with vendor partners to maintain cooperative interoperability There are no short cuts. Introducing new tools and systems requires a long-term vision together with significant patience. But success is more likely if you approach such projects as a major exercise in change management, and invest time and effort into ensuring that the many different aspects of the project align (technical, procedural, legal, administrative, stakeholder, and political).
• Turning on electronic prescribing and dispensing is easy and doctors and pharmacists can start using it immediately • Electronic prescribing and dispensing are built into the software that GPs and pharmacists already use, which makes it intuitive and removes the need for additional training
A TRUE PARTNERSHIP
• eRx software updates are part of regular software updates, so that doctors and pharmacists receive eRx upgrades without having to do anything extra
Medical and pharmacy IT vendors throughout Australia have partnered with eRx in ensuring that all doctors and pharmacists around Australia have ETP access. Over the past 6 years, this has been an impressive undertaking, built on constructive relationships, rigorous quality control, and a shared vision of improving outcomes for patients and professionals, regardless of competitor or industry perspectives.
This means that doctors and pharmacists can access ETP quickly and easily, whilst pharmacists gain notable improvements in workflow.
As a result eRx is built into the medical and dispensing software used by 99% of community based doctors and pharmacists in Australia.
eRx is also the only ETP platform supported by every leading medical and dispensing software vendor in Australia, including every member of NEHTA’s GP and Pharmacy Vendor Panels.
PHARMACY SOFTWARE PARTNERS 12 April 2009 Fred Dispense www.fred.com.au
10 November 2009 Corum – LOTS www.corumhealth.com.au
7 December 2009 minfos www.minfos.com.au
18 December 2009 PharmacyPro www.pharmacypro.com.au
28 October 2009 Simple Retail – Aquarius www.simpleretail.com.au
23 December 2009 Corum – Amfac Windows Dispense www.corumhealth.com.auu
1 August 2011 Z Software www.zsoftware.com.au
4 August 2014 MountainTop Dispense www.mtntop.com.au
eRx is also the only ETP platform supported by every leading medical and dispensing software vendor in Australia
MEDICAL SOFTWARE PARTNERS 12 April 2009 Best Practice www.bpsoftware.com.au
16 December 2009 Medical Director (MD3) www.hcn.com.au
1 December 2010 Zedmed www.zedmed.com.au
15 November 2011 Stat www.stathealth.com.au
1 June 2012 Medtech32 www.medtechglobal.com
8 January 2013 Communicare www.communicaresystems.com.au
16 January 2013 GPComplete www.pmsc.com.au
21 June 2013 Smart Clinics www.smartclinics.com.au
30 March 2013 Houston Medical www.houstonmedical.net
23 August 2013 Totalcare www.totalcare.net.au
21 August 2013 HTR www.htrsolutions.com.au
25 January 2013 Intrahealth www.intrahealth.com
7 March 2013 Visual Outcomes www.visualoutcomes.com
31 January 2013 Genie www.geniesolutions.com.au
25 January 2013 Practix â€“ iSoft/CSC www.isofthealth.com
VISUAL VIS UAL OUTCOMES OU TCOMES
CL CLIENT IENTt CLINIC SOFTWARE SOFT WA ARE
DELIVERING ON IMPROVED PATIENT SAFETY Scanning the barcode is the key to activating improved care and safety outcomes for patients. Scanning pulls the electronic record into dispensing software, improving safety and efficiency at the same time that it feeds the record into the eHealth network (for patients who have given their consent). A staggering 133% increase in the proportion of original ePrescriptions dispensed (out of all potential originals) in the past twelve months provides insight into the significant changes in pharmacy practice that have occurred as barcode scanning becomes standard. It also shows the degree to which the benefits of improved patient safety are extending throughout the community, building the level of patient data available for health records, and leading to improved health outcomes. This table shows the number of ePrescriptions dispensed versus those prescribed, highlighting those locations dispensing the greatest proportion of ePrescriptions.
ePRESCRIPTIONS DISPENSED SEP 2013
IT ALL STARTS WITH A CODE... The eRx barcode and QR code both activate the improved outcomes in patient safety and dispensing efficiency, as shown here.
THE PAPERLESS PATH Bringing our systems fully into the 21st century with paperless prescriptions is the next chapter of innovation in health. Despite the real advances of the past five years, doctors and pharmacists in Australia still spend significant amounts of time dealing with handwritten prescriptions, causing ongoing inefficiencies and double handling. A paperless system has the potential to unlock millions of dollars of clinical and administrative savings throughout health, including: • creating more time for health professionals to spend with their patients • managing adverse interactions • minimising errors • strengthening patient confidentiality • reducing the potential for fraud
SUCCESS BUILT ON POLICY, ADVOCACY AND INCENTIVES The ETP story stands up as one of the health industry’s most successful examples of advances in the last decade. The driving force behind this success has been the fundamental support of Government, the Pharmacy Guild of Australia, and industry. This support has included three vital aspects: • Advocating for and fostering ETP as standard practice in Australian health care • Innovative financial models and incentives to support the widespread uptake of ETP – effectively making it no cost for GPs and pharmacies • Linking ETP into other mechanisms of standard practice, such as PBS Online.
• Australian government launches national eHealth policy • Pharmacy Guild of Australia purchases 10.6 million eRx Script Exchange transactions to provide free ePrescriptions for members • Australian Friendly Societies Pharmacies Association Inc purchases 500,000 transactions to provide free ePrescriptions to Friendly Society Pharmacies
• 5CPA negotiated by Federal government and Pharmacy Guild introduces incentive payments to drive ETP as standard practice for health care in Australia • eRx announces its zero cost policy and lowers its prices to match 5CPA
• Australian Government introduces new round of ePIP (Practice Incentive Program eHealth) linking GP incentives with eHealth advances • ETP becomes integrated into PBS online making administration easier for pharmacies • The Guild ran 35 professional training sessions about the role of ETP in Australian healthcare
• Federal government introduces incentives to increase pharmacy ETP rates, called Electronic Prescription Scanning Incentives (ePSI) • First ePSI target applies to pharmacies scanning 15% of all prescriptions dispensed • Second ePSI target applies to pharmacies scanning 30% of all prescriptions dispensed
The Fifth Community Pharmacy Agreement (20102015) between the Australian Government and the Pharmacy Guild of Australia was key to this process. The agreement covered initiatives such as professional training and an Electronic Prescription Fee to support the uptake of ePrescriptions.
Pharmacies begin using ETP immediately – experiencing the safety and efficiency benefits of electronic prescriptions
Pharmacy use of ETP increases dramatically – and GPs also begin to turn on ePrescribing
The number of GPs ePrescribing jumps dramatically – extending the safety and efficiency benefits to the Australian public
Scanning of ePrescriptions jumps – delivering real change in work practices and embedding ETP as standard health care practice
MEDICAL SOFTWARE PARTNERS
VISUAL VISUAL OUTCOMES OUTCOMES
CLIENT CLIENTt CLINIC SOFTWARE SOFT WARE
PHARMACY SOFTWARE PARTNERS
eRx Script Exchange Pty Ltd 20 Trenerry Crescent, Abbotsford VIC 3067 1300 700 921 www.eRx.com.au