Initiatives to support medicines safety webinar

Brit Harper (BH): Welcome everybody. You're joining us for another session from the RACGP’s Practice Essentials Webinar Series. This webinar is ‘Initiatives to support medicine safety’. My name is Brit and I'm a project coordinator with the RACGP’s Practice Technology and Management team. I'll be with you for the presentation today.

I'm joined by Dr David Adam, who will be your GP host. Dr Adam graduated from the University of Western Australia in 2010 and undertook general practice training in outer urban and rural WA. He currently works part-time in general Practice in Lockridge, as well as being a hospice doctor with the Home Hospice Service. He's particularly interested in children's health and medical education. Dr Adam is a member of the Practice Technology and Management RACGP Expert Committee and presented workshops as a ‘Digital Champion’ to members as part of the 2018 My Health Record education awareness program. David, welcome to the webinar. 

Dr David Adam (DA): Thanks Brit and I have to say that my isolation haircut is even shaggier than the picture given on screen there. So you'll just have to imagine that.

BH: It’s a good thing I'm not on camera that moment, David! Thanks a lot and thanks to everyone listening for taking time out of your busy schedules to attend this session.

Before we begin our webinar, I'd like to acknowledge the Traditional Owners of the respective lands on which we're meeting today, and pay my respects to Elders past, present and emerging. I'd also like to acknowledge any Aboriginal and Torres Strait Islander people attending the session.

This education activity is delivered in collaboration with the Australian Digital Health Agency.

We're going to take a minute now to discuss the features of GoToWebinar. If you've joined us for webinars in the past, you will notice that your screen looks a little different this time. Your control panel is on the left hand side. Here, you can see our contact details the chat box and the handout section that is circled in red here. Normally we would send you links to resources and other support material to supplement the presentation throughout the webinar. Now all the links and resources will be available in the handout section for you to view to view at any time.

You may have noticed that you cannot pause, rewind, or fast-forward this webinar, even though it is not a live recording. If you need to stop, you can quit and return later. Click the link you were given at registration when you are ready to return, and you'll be taken to the slide where you left the session. This education activity is accredited for two points under the RACGP’s 2020 to 2022 CPD triennium. To collect these you do need to watch the whole webinar.

Another feature I want to show you is the chat box. Press the speech bubble icon in your control panel, and it will open click it again, and it will close to talk to us type a message here and click send. These messages will be sent directly to us, and we'll email you back a response within two business days. Now, I'd like to hand over to David to begin the presentation.

DA: Excellent. Sorry, thank you very much, Brit. So today's session is really around medicines safety as you know, and we'll talk about the care cycle of medicines safety and where problems can arise. We’ll look at four different initiatives to support medicines safety and what you can do in the practice to implement processes to ensure that correct use of mandatory digital initiatives will support medicine safety, and also the general patient safety in your practice. So on the agenda we will talk briefly about medicines safety as a concept. and then we've got four different initiatives to talk about today. And as Brit said, this material is presented in conjunction with the Australian Digital Health Agency so this is things that they've been working on with groups like the RACGP and with many other industry groups. 

So when we talk about medicines safety what we mean is try to minimize problems with the prescribing, dispensing, and monitoring of medicines, and so any step on that whole cycle of medication and medicines that are taken by our patients, and all the areas that can impact on that.

So problems can occur anywhere along that spectrum, and I'm sure you can read the examples on screen and we've all seen examples of these in our own practice or with our own patients. So inappropriate and effective or irrational prescribing, either under- or over-dosing. Problems with writing the prescription and that's things like legibility, which thankfully with the advent of computerized prescribing is less of an issue than that has been. Things can go wrong with the dispensing point: the wrong drug, the wrong formulation, the wrong label can be applied. And then I think the thing that particular worries us with some of our patients is the administration and the taking of medications, and that's around accidental and sometimes even deliberate misuse. So poor compliance, taking the wrong dose the wrong way, at the wrong times or for the wrong period of time, or in fact whether the patient is fact taking it all or not taking it. And then although drug monitoring is relatively uncommon, there can be issues with appropriate monitoring of therapy, failure to respond to changes in serum levels or in fact altering things when they don't need altering, and my favourite example of that is particularly our new registrars monitoring our patients’ warfarin tend to be quite twitchy when it comes to even slight deviations from the target range, which we know actually probably involves a lot of running around, times when times when the drug dose could be left alone. They might say that I probably failed to alter therapy when required – I'm sure we could have a robust discussion about that!

So medicine safety certainly has the potential to cause problems in Australia and some statistics here from the Pharmaceutical Society of Australia and from the ABS. Like all of these things, these are largely extrapolated numbers and so it's difficult to be clear exactly what… exactly what cost some of these things have but I think the one that really stands out for me is that statistic about 98% of Residential Aged Care Facility residents having one or more medicine-related problems. And I think all of us who look after patients in aged care have really struggled with that in the past year and the managing of adverse outcomes… the cost-benefit, risk-benefit balance that has to be taken in aged care, particularly knowing that the medicine that they take can be quite limited or can be affected by carers and systems issues.

So I guess that's why we as a College and we as practitioners are interested in supporting medicine safety, and there's lots of different ways to do that. Today we're going to focus on four initiatives that are being supported by the Digital Health Agency. We're going to look at what the benefits of those things are. Some of these things will be new to you, some of these things hopefully you've heard of before and so I will say that we're just going to give a fairly high-level overview of these specific initiatives. There is always lots of information made available about them, and if you have specific questions don't hesitate to shoot them through to the team here and we will try to get back to you. 

So the first thing I want to talk about is real-time prescription monitoring. When we use this term what we mean is a digital system which provides information about a patient's use of particular high-risk medications to the prescribing doctor (so that's us) and the dispensing pharmacist… and that information comes at the time that we are making the decision about prescribing or dispensing. So that's what the ‘real time’ refers to. That stands in comparison to certainly what used to happen here in Western Australia and in fact still does happen here in Western Australia, which is that, you know, three months later, you might get a letter from the Poisons Department saying ‘oh look did you know that you prescribed Oxycontin and the patient had 6,000 tablets in the last three months?’ That is obviously much less useful information a long way down the track. Real-time prescription monitoring allows you to support that the choices that you're making at the time that you're making those choices. 

So most people would be aware that real-time prescription monitoring covers Schedule 8 drugs. So: oxycodone, morphine, fentanyl, methadone, buprenorphine. Real-time prescription monitoring can sometimes cover high-risk Schedule 4 drugs as well. So: benzodiazepines, codeine, pregabalin, quetiapine, tramadol, and other non-Schedule 8 drugs which are at risk for misuse or abuse or diversion

The benefits of real-time prescription monitoring are really around identifying patients who are at risk of harm, either due to dependence or misuse of high-risk medical medicines. It can help us to identify inappropriate requests for drugs dependence, so identifying what we used to call ‘doctor shopping’ behaviours, but being aware that those requests are made for a variety of reasons. And of course it can help detect prescribers and dispensers who are not complying with regulations, so I think there are unfortunately some of us out there who treat the Poisons Act as a bit more of a suggestion than as legislation! And the feeling is from government that this will be one method for helping them to keep more up-to-date with this rather than getting data 3-6-12 months down the line, when the harm has already been done.

A number of states and territories have, or are building, systems for real-time prescription monitoring, and each state is at a different stage of development and readiness. Unfortunately, one of the issues we see, particularly in medicines safety, and you’ll hear me say this a few times in the webinar, is that every jurisdiction does do things slightly differently because of the control of poisons at a state level rather than at a federal level.

So in the ACT and Tasmania, there's a web-based information system that's been running for nearly 10 years now, so since 2011 in Tasmania and that's called DORA or the Drugs and poisons information system Online Remote Access, and that looks at clinical information and dispensing data around Schedule 4 and Schedule 8 drugs. You need to apply to gain access to that and it's use is not mandatory in those states and territories. In Queensland they’re working on a system called QScript, which I believe is planned to be released in the second half of 2020. In Victoria, they’ve got a system called SafeScript and that was rolled out in 2019. We're going to look at that a little bit more.

Other states and territories do have monitoring and reporting systems in place, but not real-time prescription monitoring. So again, if you're with me in Western Australia, you'll be aware that there is a monitoring program run by the Medicines and Poisons Regulation Branch, but that it is it is very much after the fact, and in fact, I understand that they'll often get data from dispensing several months after the after the event has occurred. 

So let's talk about SafeScript in particular. This is computer-based software that allows prescription records of all Schedule 8 and some Schedule 4 drugs to be transmitted to a centralised database, where it can be accessed by prescribers and dispensing pharmacists when consulting with the patient. The idea behind SafeScript is that no data entry is required. So it's all hooked up to the infrastructure and connectivity of the Prescription Exchange Services, which is how you get those little barcodes on the top of your computer-generated scripts. So you don't have to enter it into another system and likewise the pharmacists just have to scan the script, scan the barcode, and their dispensing software will submit the dispense notifications automatically. It's designed to be quick and easy to use and not interrupt the clinical workflow too much, although I know there's always been some complaints about the speed at which it works. The idea behind SafeScript is that you receive a pop-up notification whenever you issue or dispense a prescription, so that prompts you to review the patient record in SafeScript if required, and you can just click that notification and you'll be taken directly to the patient record.

In Victoria, the use of SafeScript is now mandatory for prescribers and dispensing pharmacists after an 18-month introductory period. and so I think the Victorian GPs in our audience will already be well familiar with it. Certainly it seems it’s been pretty popular to become registered with safe script even before it was mandatory. There are some exemptions around hospitals, prisons, aged care and palliative care. SafeScript doesn't tell you that you can't do something, or you know, it doesn't make the decisions for you: the decisions about supply and prescribing is still with the practitioner. But at the idea is to provide you with the most up-to-date, relevant information when you're making a prescribing decision. 

So the triggers that you'll see look like this. These are pop-ups from the system tray. So again Victorian people, this should be familiar to you. You can see that a red notification might indicate that the practitioners – sorry, that a patient has visited four more providers in the last 90 days, or has a high-risk combination recorded in the last 90 days, or when the total morphine dose will give them exceeds that 100 milligrams morphine equivalent daily threshold. The amber notification and the green notification there are also useful in the sense that that's the information they give you can see the description of what those thresholds are there on the screen.

As I say, the jurisdictions all do slightly different things around real-time prescription monitoring, and in 2018 there was agreement from all the State and Territory Health Ministers that they would work on a federated model, and that accommodates for jurisdictional differences in regulatory requirements, so the fact that our threshold in Western Australia is 90 milligrams of morphine equivalent while in other states it's 100, and so on. It also means that there will be a national system in place, so that those people that live close to borders – I have to admit that doesn't bother us too much here in most of WA – but for those of you in Queensland, New South Wales and Victoria, particularly rural areas, you'll know that some people attend clinics across borders. There will be federation of that information, sharing of that information, so that cross-border issues are picked up appropriately as well.

The national system will have a National Data Exchange to sort of capture all that information from the local regulatory systems, prescribing and dispensing software, and other data sources and that was actually released in 2018. So that's running, but the current uploading of information is still state-dependent. So that federated model is kind of designed around SafeScript’s architecture, and SafeScriptt will be able to feed directly into that and hopefully once QScript comes online that will also be able to feed straight into the national system.

So, yeah, so real-time prescription monitoring I think is something that doctors have been hoping for for many years. And I know many of you have communicated with your Members of Parliament to encourage them to take it up. I know many governments have identified it as a real priority for preventing medicine related harm and I'm looking forward to it coming to my practice and hopefully to your soon as well. 

Alright, the second initiative we're going to talk about today is electronic prescribing. Electronic prescribing is essentially being able to write prescriptions without having to use a piece of paper. Now, I could talk a lot about electronic prescribing. In fact, I am going to talk a lot about electronic prescribing in our next webinar, which will be later in May 2020 at this stage. So I'm just going to give a bit of a high level overview today.

EP has been in the works for some years now and in fact the legislative and technical infrastructure at a national level was enabled in October of last year, with the impetus then on our clinical software vendors to implement the requirements for electronic prescribing. That has taken a little while, but with the current COVID-19 pandemic situation, many of them in conjunction with the Australian Government have been funded or are working more on this and in fact, I think it has been tested this week for the first time or I read some information about that recently. So the regulatory requirements are still in place and that we are looking to have what's called a token model, and I'll go into more detail about this in a second. The token models will be available towards the end of this month, May 2020, and hopefully the Active Script List systems will be available later this year.

So in brief, the process looks like this: you will generate a prescription using compatible software. So that's the software that you're already using, your clinical information system, and that prescription is then transmitted in an encrypted format to a prescription delivery exchange service. And these are run by the same people that run the current Electronic Transfer of Prescription technology exchange services. When we talk about electronic prescribing a lot of people say, well, you know, don't we have that already? Isn't that what's on top of the… isn’t that the barcode on top of the script? That's something called eTP or electronic transfer of prescriptions, and I guess the important difference is that you still need the physical prescription… the legal act of prescribing is when you generate piece of paper and so a lot of the regulatory change has been around sort of changing the language around that, and changing the legal act of prescribing or legal instrument to being the electronic data.

So once that prescription is transmitted, there are two ways for it to get to the pharmacy and the simplest way is what's called the token model. Basically, the token is a barcode or a QR code that will be sent to the patient by SMS, by email, or even printed out on a bit of paper which they can then present the dispensing pharmacist to access that legal document for dispensing. And the thinking behind the token model is that it really is a minimal change initially from what patients are used to now. So for example, you got to the doctor, you say like, you know, I need to talk to you about my hypertension. You know, we decide to prescribe you something, then you come away with something, now that might be a physical piece of paper, it won’t look like a PBS prescription, but it will still have a barcode on it. It might be a SMS sent to your phone, it might be an email sent to your email address, and you can then take that to the pharmacy and they will be able to access the prescription using that token.

As you can imagine, one of the problems with paper that we'd like to avoid with electronic prescribing is it getting lost, it being hard to move around, and hard to share with patient carers or so on, and so development has been done on a system called an Active Script List. This is something that people have to enrol for as patients and they will be asked to authorise relevant pharmacies and doctors and carers or third-party intermediaries. So they'll have access to a list of active scripts ready for dispensing. So I guess the key thing is that's not available yet and that will be an opt-in process. You will have to sign up for an Active Script List and you'll have to authorise certain doctors and certain pharmacies to access it. It certainly doesn't replace any of the existing systems around active medications. So for example, once you fill a medication, it will no longer appear on the Active Script List. It's not useful as a medication reconciliation service; that will be coming in the future and there's some interesting work being done around the consent for that. So for example, you know you turn up to a new pharmacy and you say, I'd like you to access my Active Script List please, what will probably happen is that you'll get a text saying, reply ‘1’ to allow your pharmacy to have access, reply ‘2’ to let them have access for 24 hours… and so that is coming. Once the pharmacist can access that prescription, they just need the medication as they would under the existing processes. I want to be clear that paper prescriptions are still available. This is simply providing patients with a choice around when they want to get a paper prescription, standard PBS paper prescription, or whether they want to access electronic prescribing. You will not be required to take part in the electronic prescribing system, although you may find that some of your patients come to expect it. I know that there are still some GPs out there who perhaps aren't joining us today who are still entirely paper-based and don't use computerised systems at all, and this will be similar. You're not required to participate.

So at the time of this presentation, electronic prescribing is still yet to be rolled out but we are moving as we say to progress token-based electronic prescribing, particularly with the current COVID-19 pandemic crisis. In the meantime, the Australian Government's Department of Health, the Federal Government, has put into place an interim arrangement under the law that makes it easier for patients to access prescription medication while they are so isolating or practicing social distancing, physical distancing. The special arrangement started in March and what it allows is image-based supply of PBS medicines and also to temporarily allow patients to receive PBS medicines without needing to sign for them. You might have heard of this as image-based prescribing or prescriptions via telehealth, which is the official name, and basically under these interim arrangements, the prescriber will create a paper prescription like norma,l so you can print out a normal PBS script, you take an image of that and send it via email, text, or fax or similar to the patient or their nominated pharmacy, and the pharmacist can use that image to dispense the medication and deliver or post the medicines to the patient. Now, there are some there are some caveats around that; it doesn't apply to Schedule 8 or certain Schedule 4 medications, and the ones you'd expect like benzodiazepines. I guess the other really big caveat is that, like everything, this is also affected by jurisdictional restrictions. So for example in Western Australia, we are still required to send the original prescription to the pharmacist. In other states and under the PBS regulations you just have to hold on to it for two years or send it to the pharmacist. So I really encourage you to carefully check what your state regulations say about this image-based prescribing or prescriptions via telehealth. That will cease on the 30th of September 2020 unless we hear otherwise and the new electronic prescribing system will take over. 

So as I say, we will be going deeper into electronic prescribing on our next webinar on practice essentials, and I think that will be in late May/early June so you can visit the URL on there, on your screen, to register. I've been fairly heavily involved personally in electronic prescribing, and I have to say there have been times when I wasn't sure that it was going to happen at all, but I think with lots of work by government bodies, by the Australian Digital health agency, by the RACGP, pharmacy representatives and many more, I think it's going to be good when it when we finally get it.

Alright. This next initiative also falls under the banner of the Australian Government's work on electronic prescribing ,but actually applies to all computer-generated prescriptions, and what this says is active ingredient prescribing refers to new regulations that require a health practitioner issuing a PBS medication script that's computer-generated to use the name of the active ingredient, rather than the brand name or the trade name. Now this regulation came into effect late last year, although the regulations say that it will not be enforced until later this year. So I think the 1^st of November this year it will become requirement for all computer-generated prescriptions to use the name of the method the active ingredient rather trade or the brand name.

The aim of this project or the aim of this change is to increase the uptake of generic and biosimilar medications, which is good for the financial sustainability of the PBS and hopefully increase the number of prescriptions that allow for generic substitution and make patients sort of more likely to agree to generic medicines instead of their branded version when required. I think the other hope is that patients will gain a better understanding of the medicines they take through the introduction of active ingredient prescribing and being aware that it's much more about the drug than about the particular brand that's on it. I guess we'll have to wait and see whether that happens. The other benefits are that it will hopefully decrease out-of-pocket expenses – as you all know brand versions often have a brand price premium that has to be paid – and also reduce the risk of incorrect dosing, patients having multiple medications with different brand names, but they all have the same active ingredient on them. So hopefully we reduce the risk of problems in that regard.

So, of course there are times when you want a patient to have a particular brand of medication and the RACGP and other groups have always been very clear that doctors need to retain the ability to prescribe by brand in some cases. You do need to be aware that the active ingredient name will appear first on prescriptions generated by computer systems. There are some exceptions, so medicines that have four or more active ingredients in them. There are certain items that can be excluded by the Secretary of the Department of Health, and of course handwritten prescriptions or paper-based medication charts in residential aged care and hospitals are exempt from this requirement. So it's only for computer-generated prescriptions. There is some reporting that it only applies to electronic prescribing, which we talked about before, but that is not the case. The regulations in fact apply to all computer-generated prescriptions, so you will need to update or upgrade your clinical information software to be compliant by the 1^st of November. And if you're not noticing that coming out on your prescriptions yet, it might be worth talking to your vendor about when they're planning on w implementing that. The College has put it to the Department of Health that they need to work with the various vendors, the various software developers, in order to help ensure that GPs are compliant, and that's something that you and your practice will need to have a look at by the 1^st of November this year.

Alright, and finally the last initiative that we want to talk about today is the My Health Record and particularly the sources of medications and medicines information that's available in My Health Record. I hope that you're all familiar with the Shared Health Summary, which is the document that you generate in the practice that describes, among other things, the active medications that your patient is taking based on the information from your clinical information systems, from your practice software. So today we're going to focus on a new item, which is called the Pharmacist Shared Medicines List and something that has been present for a little bit longer but I think it's worth looking at a bit more closely, which is the Medicines Information view. 

So just to remind everyone the My Health Record among other things contains a series of documents. It's very much focused on the different types of those things that are available and so you'll be able to see these three different sources as separate documents in the my health record. The new one is the Pharmacist Shared Medications List – sorry – Pharmacist Shared Medicines List, and that was introduced in December 2019 and being rolled out over various settings. It's a document that's put together by a pharmacist which includes a list of all the medicines the patient is known to be taking to that pharmacist that includes prescribed, over-the-counter, and complementary or alternative medicines. It is created by a pharmacist either after completing an in-pharmacy medicine review, when they're preparing a dose administration aid such as a Webster-pak, or in a hospital pharmacy for a patient who's being discharged and I think many of you will be seeing those custom medicines lists that are sometimes prepared by the hospital pharmacists. Now at the moment they are only being uploaded by a software called Webster care, which is one of the packages used for preparing dose administration aids, and later this year there are going to be some jurisdictions that move their hospital pharmacy medicines list into the My Health Record. That will come with time, July 2020 I understand that there are some states that are planning to do that. So there will be there will be some more time before you'll be able to see that. So when that's operational, like anything in the My Health Record, you'll only be able to see it if it's be created obviously, and also if the patient has not hidden it from view, so you'll be able to see it in the Medicines Information view, which we're going to talk a bit more about in a minute. In the handouts section there is a link to a video that's been prepared by the Australian Digital Health Agency on the benefits of typical Pharmacist Shared Medicines Lists. So if you're interested more in that you can have look at that after today's session. 

So when you're looking at the My Health Record, I hope you've seen the document called the Medicines Information view. This is an unusual – or not unusual, but it's a little bit different to what you might expect from the My Health Record in that it's an automatically created, synthetic document, so it's created by the system rather than a person, from a variety of sources. So that includes prescribing and dispensing records, the most recent Shared Health Summary, hospital discharge summaries, and now the Pharmacist Shared Medicines List. You'll be able to see it if you if you're one of the few people who use the Provider Portal, which is the website to get on to the My Health Record, you'll be able to see it under the documents tab, or your clinical information system will have a different way of accessing various types of documents and you should be able to access it through that. 

So to compare these two, the Pharmacist Shared Medicines List is like the Shared Health Summary completed by a human, whereas the Medicines Information view is synthetic. It's gathered from all parts of the My Health Record. And so what that means is that one is static. When it's created, that's how it stays. Whereas the Medicines Information view can potentially be different every day that you look at it, because it's created from all those other sources of medicines.

The information in the Pharmacist Shared Medicines List only gives an account of medicines being taken at a particular point in time. Like the Shared Health Summary, it is a point-in-time document, but it is a useful reference for medicines reconciliation, particularly around transitions of care – coming out of hospital or being transferred to another care provider or something. It would be ideal that you know, if there's a significant difference between the Pharmacist Shared Medicines List and your own Shared Health Summary that you update your Shared Health Summary because that will be that will be the first place I think that most of us go to look at medicines information. The idea is that having more information will be offering you useful information, so hopefully you have time to check, well, all three sources I suppose on medicines in the My Health Record, but you know, I'm very aware that that may like anything, having too much information can be can be tricky as well. 

So the argument I guess around the benefits of using the My Health Record for medicines information are to provide multiple sources to hopefully reduce the amount of time looking across, you know, for example, different discharge summaries and so on, and that's the idea behind that synthetic view, is to try and draw together all the different sources of information automatically, like anything computer-based or suppose we probably call this artificial intelligence now, is that there are limitations on that of course. We hope that this will help GPs to make more informed decisions about prescribing and around treatment, particularly for those with complex or chronic conditions, and hopefully will reduce medicine errors particularly around medication interactions.

Like anything in the My Health Record and in fact any piece of information that we gather, it may not be complete and it may not be accurate at the time you view it, you know, things might have changed since then, so like all the information out of My Health Record or any information that you have on a patient's file, it is of course supplementary information to information that's given to you directly from the patient.

So look in summary, medicines safety is a big issue for all of us and we've touched all the four initiatives that are largely digital that we're hoping will improve medicine safety. So that's real-time prescription monitoring, electronic prescribing, active ingredient prescribing and the various sources of medicines information that's available in My Health Record. I think the other thing to reiterate is that to use these initiatives and in some cases to comply with legal requirements, you may need to update your clinical information software, so certainly electronic prescribing and active ingredient prescribing, and in some cases the My Health Record. You may need to get a newer version or access to a new version of your clinical information system.

The College has several resources related to the topic of medicine safety that you might be interested in, and these are all available to view and download at our website www.racgp.org.au. There is one on medication management and supply in general practice. Now, this is for RACGP members only, and that provides a high-level understanding of the regulatory and best practice frameworks around supplying and managing medicines in general practice, so that's for the medicines and that you might have on premises. 

There is a good fact sheet on drugs of dependence and responding to requests for drugs of dependence, and that's looking around problematic or risky use of these medicines, how to respond to those requests, the use of prescription monitoring services, and practice-wide approaches which can assist in managing requests for drugs of dependence. I think for all of us drugs of dependence cause significant heartache and anxiety, particularly for our new and our training doctors, and this fact sheet – I'm actually really been really pleased with how this has come out, particularly, you know, around… I think it's a really patient-centred resource and makes us remember that people ask for medications, sometimes appropriately and sometimes inappropriately, for a huge variety of reasons.

And then the final document there is our brief guide on the My Health Record, which is sort of a basic overview of the platform and the kinds of content that you can find in and upload to patients’ My Health Records as well as information about access controls and medico-legal matters.

Thanks for joining us today. This is part of a monthly webinar series that our team at the Practice Technology and Management Unit put together. We used to call it the eHealth webinar series, but tried to broaden it a bit to more things that are available around general practice, although as you can see we're sticking the eHealth thing the next month, which will be around electronic prescribing, so you can join and sign up for those at the RACGP website on the screen there.

BH: Thanks very much David. That's been a really useful overview of those initiatives. We are coming to the end of the webinar now and we do have some time to cover a few common questions. So David, our first question: which medicines are covered under the real-time prescription monitoring alert system?

DA: Yeah. Okay. Look as you say, this is a really common question that comes up with these systems. Unfortunately it varies between jurisdictions. So there's no federal rules around which medicines are going to be monitored at this stage. Tasmania as far as I know is the only state, and understand that Tasmania monitors all Schedule 4 – might not just be actually, I think it's just high-risk Schedule 4 medications, as well as Schedule 8 medications perhaps with the federated model. There will be more standardisation between jurisdictions, but I guess we've just got to wait and see.

BH: Terrific and our next question: do I have to switch to electronic prescribing when it becomes available? 

DA: No and thanks for reminding me about that again. Definitely not. If you want to continue using PBS scripts or even handwritten prescribing, that's fine. You may find that some of your patients prefer the convenience of ePrescribing, but there is no requirement for GPs or other prescribers to move to it. I think unfortunately for our pharmacy colleagues, there will be a much bigger market drive to take up electronic prescribing, because they are going to be required to dispense prescriptions from multiple prescribers and if you go to your pharmacy with an electronic script and they can't dispense it, well, you know, that that's obviously going to affect your desire to ever go back there. So I think our pharmacy colleagues are going to have to take it up at a much faster rate than we are. The testing that's been done and I thought I had some information around that – there are several big players in both the prescription transfer and the dispensing space, and they are all working fairly hard on getting electronic prescribing support available. So we're hoping that pharmacy will be ready pretty soon as well.

BH: Great, that's good to know. So our next question is: if a patient only understands the brand name of their medication, the brand or the trade name of their medication, can I as a prescriber continue to prescribe using that instead of the active ingredient? 

DA: Yes, there's definitely certain circumstances where you'd want to use a brand name on the prescription. The requirement is that the active ingredient must be listed on, and it must be listed first. Now this will all hopefully be handled fairly seamlessly by your clinical information systems. The reasons to use the brand name I guess are around promoting compliance with a particular brand. There are also some people who find that a particular brand works better for them than others, or that they have reactions to certain forms of the medicines, and I think a lot of that surrounds the non-active ingredients that are contained in some brands. So you can still do it. It will need the active ingredient on there and ideally your software will take that into account and handle that appropriately.

BH: Okay, and we have time for just one more question. Do I have to check the My Health Record or the Pharmacist Shared Medicines List when considering whether to prescribe?

DA: So no, it's not mandatory to check the My Health Record. Unlike Victoria's real-time prescription monitoring, which you do have to check, there's no requirement to participate in the My Health Record system, and even if you are participating, there's no requirement to look up that information. It may provide useful information that supplementary to what you already. So the example that always springs to my mind is the woman who I saw late one evening whose pharmacist was shut, who needed a new prescription for her asthma inhaler that she'd be previously been prescribed elsewhere. And so the My Health Record was how we managed to get the dose right, rather than having to wait til the next morning. So it can be extra information that you might find useful.

BH: Thanks very much for that David. We've now reached the end of our session. So thanks again David for a brilliant presentation, and thank you to everyone out there who has attended the session. We hope you found it useful. If you have a question for us that you haven't already entered in the chat box, you can email the RACGP’s Practice Technology and Management Unit at ehealth@racgp.org.au and the team will get back to you within two business days.

So we hope you found this webinar informative. Thanks for attending and hope you'll join us for a future webinar in our Practice Essentials Webinar Series. Goodbye.