SafeScript - Real time prescription monitoring for controlled drugs

SALLY: Welcome to today’s webinar, as part of our eHealth webinar series, SafeScript – Real Time Prescription Monitoring for Controlled Drugs. My name is Sally and I’m the Project Coordinator for the RACGP Practice Technology and Management Team, and I will be your host for today.

I am joined by Dr Steven Kaye, a GP based in Melbourne, who will deliver the presentation for you today. Steven has been an RACGP Expert Committee Member in eHealth Practice Technology and Management since 2016. He has previously been the Deputy Chair of the Bayside Medicare Local and Chair of the Bayside GP Network. Steven is a GP Registrar Supervisor for the Eastern Victoria GP Training, an examiner for the RACGP Fellowship, and the managing partner of his general practice in South East Melbourne. He has worked on many projects in an advisory role, including: Shaping a Health Australia Working Group, My Health Record Education Program, and the My Health Record External Assurance Committee.

Steven, welcome to the webinar.

STEVEN: Oh, thanks, Sally, and welcome everybody on a relatively, what is it tonight to you, Thursday night?

SALLY: Thursday, yes.

STEVEN: I will hopefully be able to give you some information that you’ll be able to use in your practices.

SALLY: Yes, indeed. Steven, myself, and the RACGP would like the thank everyone for taking time out of your busy schedules to participate in tonight’s webinar. We look forward to engaging you in this RACGP eHealth webinar series on SafeScript, and while you may feel like you are the only one participating at the moment, you are joined online by a number of your peers, as well as other eHealth experts, that will be available at the end of the webinar to assist Steven with any questions you may have.

Before we begin, I would like to make an acknowledgement to country. I would like to acknowledge the traditional owners of their respective lands on which we are meeting today, and pay my respects to elders past, present, and future. I would also like to acknowledge any Aboriginal and Torres Strait Islander people present.

STEVEN: Great. So, today’s presentation is for all listening nationally, to learn about SafeScript, but note that at this stage SafeScript is only being rolled out in Victoria. We’ll cover briefly, in the latter part of the talk, what’s happening in the other states and territories, but nevertheless it is a Victorian exclusive thing at this present time. So, the agenda that we’re going to run is really to try and identify for you what SafeScript is, why we’re running SafeScript, how we’re going to implement it and roll it out, which’ll allow information to be used for you, for your patient care. So, we must always say that it’s part of your patient care and not going to interrupt your general practice workflow particularly. And we’ll also identify, of course, the notifications with SafeScript, and what action is required for each of those. So, we can roll the agenda, yep. So, as I say, we want to learn a bit SafeScript, how it’s going to work, and really to understand how to interact with this particular software program, so that we have better clinical outcomes for our patients.

So, the question therefore is, what is SafeScript? So, basically, it’s a computer software program that records for certain high-risk medications, which are then transmitted in real time. So, it’s not ages ago, it’s absolutely real time, to a centralised database that can then be accessed by doctors, or nurse practitioners and pharmacists, during a consultation with the patient, so you have that interaction of what’s going on. So, the records themselves are obtained automatically through electronic transfer of prescriptions, through a prescription exchange server, the acronym is PES, which is not such a great acronym, when the prescription is issued, so when you write the prescription, or when it’s dispensed at the pharmacy, and that’s an automatic process that should be sitting at the back of your clinical software. So, it enables doctors and pharmacists to make safer clinical decisions, and identify circumstances where patients may be receiving high-risk medication, beyond their medical need. So, the system monitors prescription medicines that are causing the greatest harm to the Victorian community, so that’s all of the S8s, such as oxycodone, morphine, alprazolam, Ritalin, Xanax, dexamphetamine, and the Schedule 4 medications, including the rest of the benzodiazepines, Imovane, Stilnox, Seroquel, and codeine. So, perhaps we’ll ask a polling question now, and get a little bit of input from the folk who are listening.

SALLY: So, have there been situations where you have had to refuse the prescription of scheduled medications? Yes, no, or not applicable. We’ll just give everyone a few moments to answer that… and I’ll just close the poll off, and share that with everyone.

STEVEN: Great. And, so we can see that clearly this is a substantial issue in the general practice community, that we are confronted with, at times, where patients are asking us to prescribe medication that we’re not all that comfortable with, and there may be very good reasons for that, so that’s a conversation. So, that’s what SafeScript does, it allows us to understand what the patient’s actually doing in real time.

So, we know that medications cause a lot of problems. That the benzos and the opioids are really a major health concern, across the state, and of course replicated through the other states as well. So, the Victorian Government has taken this action of implementing SafeScript in order to allow that information to transfer. So… and it’s really not to compete with our clinical decision making, but rather to complement that. So, managing medication conditions is still the doctor and the pharmacist’s role, together, and this is just a value-add to that process. We know that dependence is high with many medications, and that’s even when they’re legitimately used for pain or anxiety or what have you. And as you can see on the slide now, we’ve got data from the Victorian Coroner, which is data collected from 2011 through to 2017, shows that the number of prescriptions medication overdoses is higher than both the illicit drug overdose and the deaths from road tolls. So, it’s a really significant problem that we are part of, that the government has now identified, and are using SafeScript to try and control, and at least give us, to empower us to have a level of input into getting it back.

So, if we go to the next slide you’ll see that annually the… we’ll see the graph tallies there… there we go. So, you can see that the graph, which is the orange one for prescription medication, is in fact increasing. So, the number of deaths, so this is deaths, it’s not admissions or bad outcomes, this actual death, is increasing progressively with prescription medications. The other graphs, as you can see, the illicit drug is increasing as well, while the road toll has somewhat stabilised. So, this is the rationale for SafeScript, of actually trying to get this stuff under control. So, there’s legislation which has, like usual the legal eagles give a very long name, The Drugs, Poisons and Controlled-Substances Amendment, Real Time Prescription Monitoring Act of 2017, which enabled the implementation of SafeScript to come into operation in July 2018. So, from that time prescribers and pharmacists are required to complete actions to ensure that data in SafeScript is complete and accurate. So, to assist with the correct patient data matching, prescribers must have the patient’s date of birth on all prescriptions for medication monitored through the system, and that’s been engaged with by the clinical software manufacturers, so Best Practice, Medical Director, etc. Pharmacies, likewise, have to have the date of birth recorded in their system. So, that wasn’t recorded in the past, so that has been a very big change for the pharmacists, their software needed to change in order to get matching dates of birth and patient names, to therefore communicate correctly. So, the identity of the patient was very important. The prescription exchange service, and most clinical software packages use one of the two prescription exchange services. They’re called eRx or MediSecure, they need to be accessed also by the pharmacies. So, the pharmacy then needs to access the same prescription exchange service as does SafeScript. So, we’ve got multiple database all communicating with each other in the background. So, this is all in the background that the clinicians and the pharmacists really know nothing about, we don’t see that at all once it’s all turned on and all the information is moving quite correctly. So, this system of SafeScript was trialled in Western Victoria, the Western Victoria PHN. So, Geelong, Portland, Colac, etc. Some of you may well have been involved in the trial, and that has now been rolled out through the rest of Victoria, on an optional basis at the moment, earlier this year. And so that’s… we can go to the next slide…

SALLY: I think we’re going to do a couple of polls here now, Steven.

STEVEN: Was there a poll there? I didn’t see the poll.

SALLY: Yes, you were going to ask…

STEVEN: Oh, there was, my apologies.

SALLY: Yes, so just want to know if your practice is registered with a PES provider, that’s a prescription exchange service provider. Yes, no, don’t know, or not applicable. And I’ll give you all a few minutes to answer... a few seconds to answer that, sorry… and, I will close that off.

STEVEN: And that’s a really interesting result. The “don’t knows”, two thirds of the audience don’t know if their system is accessing. You may have seen on your prescriptions that there’s a barcode and a QR code that now exists on the prescription. So, that barcode and QR code is, in fact, applied to the prescription when you print it out by the PES, by the prescription exchange service. So, that barcode can be scanned by the pharmacy. So, when the pharmacy gets the script they scan the barcode and then the medication appears on the pharmacist’s computer so that there’s no transcription errors. So, we’ll all remember the days of hand written scripts, where there were transcription errors, a lot of transcription errors, which again contributed to medication errors along the way. So, that’s all part of that, and the SafeScript program is leveraging off that PES program.

SALLY: Okay, and we’re just going to do another poll, and ask the audience if they’ve used SafeScript. So, yes, no, or not applicable… and I’ll just close that off now.

STEVEN: So, again we can see that a lot of the audience have, in fact, used SafeScript, but the majority have not used it yet. So, that’s great, welcome and we’re really happy to see you here in the webinar so that you can utilise the benefits of SafeScript.

SALLY: Okay.

STEVEN: Here we go. So, the rollout, as we mentioned before, is across Victoria. It’s only a Victorian system at the present time, initially, Western Victoria. It’s been rolled out, earlier this year, to the rest of Victoria. So, all Victorian doctors are enabled to access SafeScript, and importantly it will become mandatory in April 2020. So, April next year, it’s 11 months away, it will become mandatory to use. There will be exceptions. A number of the… for example, when treating inpatients in hospitals, people in prison, people in police jails, aged care, and palliative care, will be exceptions needing to use SafeScript, so the obligatory nature of SafeScript, but all of the outpatient care, so whenever we’re treating people in the community, that will be obligatory. I should mention that in April of last year, 2018, all of the health ministers agreed to a federated model for a national real time prescription monitoring system. So, that approach utilises the same design principles as SafeScript, so that is functioning on a national data exchange run by the Commonwealth. So, we’re expecting that over the next couple of years, and especially for our interstate guests, that SafeScript, or an equivalent, will be available nationally to be used, and to give us help with our prescribing. So, I think we’re going to send you a note about the rollout through the messaging service, as part of the webinar. So, as of April this year, as you can see on the screen, we’ve got substantial numbers of GPs and pharmacists who’ve been registered. We’ve got substantial numbers of items identified as risky, either for visiting multiple doctors, or excessive doses, or combinations of medications. Of course that will grow, that’s only from April when the rest of Victoria came onboard, so the numbers will continue to grow and statistics will be developed from those.

So, how to use SafeScript is an interesting concept. It should minimally interrupt your clinical workflow. So, most GPs will use software that is connected to a prescription exchanging service, even if you’re not aware of that, and what happens is that you’ll receive, if you try to prescribe a S8 or a benzodiazepine etc, that you’ll receive a popup notification through your software, that then demands that you interrogate SafeScript before making a clinical decision on prescribing or re‑prescribing a particular medication. So, there’s a differentiation between notifications and alerts. So, the notifications are on the popups, so we see the notifications in our software, and we’ll define these a little bit later, and they are traffic light symbols, red, amber, and green, to popup. The alerts, within the SafeScript portal, identify that clinical criteria hasn’t been met, and then allows us to read those reasons for the alert, to then add that to our clinical decision making process. So, the notification triggers… so, if a popup is, or the notification is green coloured, then that identifies that there’s been no prescription on the list for the past six months, and that there’s clearly no issues, from a clinical risk point of view. The amber warning is that there’s been multiple prescribers, or multiple pharmacies, and that the patient has reached an opioid dose threshold, and red is that there’s high risk drug combinations as well. So, these are well proven risks that are attached to overuse of medication, these particular medications, that then gives us that clinical information, that extra source of information, to help things along. So, just going through them. So, the red notification comes along when there’s been multiple provider episodes, and that’s defined as prescriptions from four or more prescribers or medical practices, or four or more pharmacies have been recorded in SafeScript within the last three months, so in the 90 days, or you’ll get a red notification if there’s high risk drug combinations. So, when prescriptions for certain drugs in the last 90 days have been also given. So, let’s say methadone with a benzodiazepine, or methadone with a long-acting opioid, or fentanyl, likewise with a benzodiazepine or long-acting opioid. So, when those combinations occur the system alerts the prescriber that that’s a risk, that there’s danger in that process, or potential danger in that process. The opioid dose threshold, again which we should all be quite familiar with, is the morphine equivalent dose, so again a silly acronym, MED, but the morphine equivalent dose then gets applied to the various narcotics that are used. So, whether it’s oxycodone, or fentanyl, or whichever one we happen to be using, and if that, in the red zone, if that exceeds 100 milligrams or a morphine equivalent dose over the previous 90 days, so 100 milligrams a day for 90 days, that’s considered to be a risk and that comes up as red. In the amber section, that dose is between 50 and 100 milligrams of morphine equivalent dose that will alert us to an amber notification, and likewise, if the six months prescriptions having been monitored by more than one prescriber or medical practice… and the green, obviously, where there’s not been a prescription issued or dispensed, for a monitored medicine, in the past six months, or green again where prescriptions for a monitored medicine, in the last six months, have been issued by the same prescriber and there are no alerts attached to that. So, it’s a simple system, and once we know the rules of when we get the alerts, which inevitably we’ll become quite familiar with, then it becomes quite usable within a clinical flow.

So, how to respond to the medications… we haven’t go the pop-up/screenshot one? No, that’s okay.

SALLY: Sorry, I think that’s coming in the next couple of slides. Okay.

STEVEN: Okay, it’s just a little bit out of order, that’s fine. So, what will happen is that the software will receive notification, it will then produce a pop-up, so at that stage, if it’s been identified, the SafeScript portal needs to be accessed, either directly through your web browser, or as a hyperlink through your clinical software. So, through the clinical software, I’ll show you a moment on the pop-up, you can just click a “Proceed” button and that will take you to the SafeScript website, in order to access that information, or you can go independently through the SafeScript website. So, for example, if you’re writing a paper script then that’s how you have to do it if you currently aren’t writing scripts online. So, the portal will show patient details and the monitored drugs that are being identified. So, what you can see now (sorry go back to that pop-up screen, there you go) so, what you see now, this is a zoomed in view of the pop-up, and you can see SafeScript has identified, and you can see the red triangle with the exclamation mark in the top left corner is that SafeScript has identified that this particular patient is at high risk, it says that it is red as well, so in case there’s a colour issue, the black… underneath the triangle is a black square, that’s the patient’s name, and it says “Please check SafeScript alert exists.” So, they’re asking us to attend to this particular patient. So, the choices therefore are: “More information”, “Proceed”, or “Cancel”. So, “Cancel”, clearly, disallows the prescription to be done, “More information” gives the instructions of what that means, so what the red triangle means, and “Proceed” will take you through to the SafeScript portal in order to get a view of the most recent prescriptions and dispensing of that particular patient. So, if we go to the next screen… so, this screen shows the web portal. So, this is generic, so you have to log in, there is a process, of course, through SafeScript to get access, we’ll come to that in a moment, and this then allows you to search for your particular patient using first name, surname, and date of birth. You can search with their IHI, their Individual Health Identifier number if you’re aware of those, and that will then produce a list of the medication that the patient has been on, the searched medication that’s been on. So, we can go to the next slide, Sal… here we go… so, we’ve June Jones here, you can see. So, this is the patient profile that you’ve been looking at. It looks very similar either way, so whether you get in through your software, or directly through your web browser. So, you can view the patient’s file, you can check the patient’s details, as you normally would, to make sure that you’re looking at the correct patient, and any alerts will explain the clinical risks needing your attention. For example, in this case for June Jones, you can see the red alert on the top left-hand side, or midway through on the left-hand side. In the type column, on the right-hand side, you’ll see information about the type of event. So, this tells us that a medication has been prescribed, or dispensed, or, in fact, cancelled, and that will accumulate. So, they’re the green and blue buttons that are being shown there. The top bar allows you to search for specific medications in the patient’s history, just to make it a bit easier, so you can search, and you can search by date range and previous event types. So, there’s no need to update the portal or to make direct entries into SafeScript because that’s all updated from the clinical software packages automatically via the prescription exchange service, and it is in real time. So, you can actually, if you write a script you’ll see, if you then go to SafeScript, you’ll see the script arrives a few seconds later. The S8 permits that we need to access in order to prescribe these medications can also be accessed from SafeScript. So, the Department of Health puts these authority forms into SafeScript so that we can then look at the various permits, including the start date and the expiry date, so that we have more information for our patients. So, when we’re searching, you can also see that we have… so we have the patient search section up the top, we’ve got notifications on the left-hand side, and we’ve got recently viewed as well. So, when we go into the Practitioner dashboard we can see the recent notifications and viewed patient history, and that just gives us that extra speed of accessing that particular patient instead of having to type in their name and date of birth. So, that’s a very neat little feature actually, that’s quite functional, for those that haven’t used it yet. So, we’ve got the information now, we’ve got the patient in front of us requiring a script, or requesting a script, we’ve got clinical scenarios of whatever sort and the reasons that we use that particular medication, and now we’ve got real time objective evidence of how much of any particular medication has been prescribed in the past and dispensed, and therefore that allows that loop to be secure so that we can have much better control and input into our patients’ care. So, we’ve got another polling question coming up now…

SALLY: Yes, we do. So, the question is, do you believe SafeScript would benefit you in making informed decisions in high risk circumstances? And you would expect it to be quite a high “Yes”, I would have thought, Steven?

STEVEN: It’s a bit of a Dorothy Dicks, clearly.

SALLY: Yes. So, I’ll just give it a few more seconds. And, yes, the majority “Yes”.

STEVEN: So, we can see that clearly there’s a… and you know, there’s a general of feeling that SafeScript will be valuable and beneficial for patients who are at risk of medication interactions and over usage.

So, one of the questions is when we’re involved in the patient’s care when is it appropriate to access SafeScript. So, clearly there’s lots of opportunities but it’s really when prescribing and supplying a medication to the patient, when reviewing the patient’s medication history, as part of a consultation, so that you can have real time objective evidence of what medications the patients have been on, and also when discussing the patient’s medication history with other doctors, with other registered health practitioners who are involved the patient’s medical care. So, that’s perfectly legitimate and appropriate. Clearly clinical guidance and appropriate management will be the end product of that. The legislation that was written does not allow us to review a patient’s record if we’re not involved with the patient’s medical care. So, if you’re not directly involved in taking care of the patient then you are in fact breaching the legislative requirements if you then just go and have a little snoop about the patient, and that’s in particular the purpose… so, we must question the purpose of assessing or looking at SafeScript if you’re not directly involved in the clinical management of the patient, and perhaps a marketing or perhaps some commercial purposes come in, and clearly that’s not the intent of the software, and that’s clearly not the intent of the legislation, and hence is not encouraged in any way. And that’s would be the reason when I cannot… when it’s… we’ll go to the next slide, Sal… when it’s not appropriate to access SafeScript, and that’s to viewing the patient record if you’re not involved in the patient care, and… so you’re only authorised to ensure safe prescribing and safe supply of medications to the patient, and not for any other purpose, like marketing or commercial reasons.

If you don’t access SafeScript, I guess the question is not for now, because it’s not mandatory, but after April of next year when it is mandatory, is what happens if you cannot access SafeScript? So, if you’ve taken reasonable steps to access it but have been unable, for whatever reason, then there’s no penalty, and that’s absolutely fine. The focus will be on circumstances that pose a significant risk of harm to patients, or where practitioners have repeatedly failed to comply with the mandatory requirements. The legislation does allow for penalties to be applied, and that’s part of that legislative arrangement, that if the medical practitioners are not using this system correctly then there are penalties attached, similar to those when prescribing S8 medications, applying for permits. So, that brings up the question of why SafeScript needs to be mandatory, and it really does… it works much better when it is mandatory. It maximises patient safety, we’ve got a number of monitoring system, which have been implemented already overseas, and clearly the value and the benefit to the patient cohort is much much stronger and better when it is mandated, rather than being an optional system. For inpatients, it will not be, at this stage, will not be mandatory for hospital inpatient use, and the rationale is that when patients are in the hospital they’re in a controlled environment, so they are under close observation. Hospital clinicians are very welcome to check the system, so to check SafeScript, to log in and check, which of course they are able to do and encouraged to do, but it’s not mandatory. However, when the hospital doctors, pharmacists, nurse practitioners are prescribing and dispensing for outside use, for outpatients, or in the emergency departments, then it does become mandatory for the use of SafeScript, to clear the way, to clear the deck, and make sure that everything is as good as possible. And the requirements are the same for paper-based or computer generated prescriptions, it’s the same, and the same system, of course, is used if logging in from clinical software or through a web browser directly.

So, the privacy protections are, again there are offences and strict penalties under the Drugs, Poisons and Controlled Substances Act for improper or unauthorised use of SafeScript. SafeScript will log each time a record is viewed, and that’s going to be monitored by the Victorian Department of Health and Human Services. So, if inappropriate use is detected, health professionals may face penalties under Victorian law and the matter may be referred to either the medical or the pharmacy boards for investigation, and potential disciplinary action. So, again, we really want this to work in appropriate clinical scenarios, but we need to have the legislative oversight so that improper use is minimised and controlled. The data that will be collected by the system, by SafeScript will, of course, be held in the appropriate privacy regimes, but will be the property of the Victorian Government, at this stage, whilst it’s a Victorian system. So, the storage and use of the data will be a Victorian Government responsibility. I should note at this stage, as well, that the prescription exchange services are also under very very strict privacy requirements as part of their function in the background of our computer systems.

So, consent for use of the system is presumed. So, we are, the doctors, nurse practitioners, pharmacists who provide care are therefore authorised, under law, to access the records in SafeScript, and do not need the express consent from the patients, so long as it is for the purposes of ensuring safety when prescribing or dispensing high risk prescription medications. So, that’s very important, there’s a clinical higher level that we’re applying to, and it’s just going to be so. We’ve had a computer system recently that allowed some opting out… go to the next slide, Sal… so the question therefore that pops up is, is SafeScript an opt out system, and the answer is no, it’s not. If we are going to use these types of medications then we need to use SafeScript, both us as practitioners, and the patients also need to be involved in SafeScript if they are going to need to use these medications. Patients can submit a FOI request, a Freedom of Information request to the Department of Human Services if they would like to access information held by SafeScript about them. So, of course there is availability of information for the patients if there is any issue. I’m sure we’ve all seen the public awareness campaign, broadcast across free-to-air, as well as internet, TV, and social media, predominately through Western Victoria, but of course occurring right through Victoria, and that we really aimed to raise awareness, reduce the stigma, and encourage the patients to have open conversations with us as their clinicians about concerns that they have with their medications. The campaign ideally, and I guess those who’ve seen it will know, that it really drew attention to the magnitude of this problem, that it is really incredibly difficult in large to get medication control in an appropriate space, and really that is the justification for SafeScript, as we discussed earlier. Through your practices, or perhaps individually, you should all have been given a communications pack relating to SafeScript in order to have a level of understanding of what it is, and that really dovetails into tonight’s webinar. Should you not have had that information the SafeScript system is happy to provide a new info pack for you, if you so desire.

So, preparing for SafeScript… of course there’s a legitimate log in process, so your computer system, whichever clinical computer system you happen to use, needs to be accessing SafeScript, it clearly needs to have a PES, a prescription exchange service, it needs to be turned on for SafeScript, and each individual doctor needs to be turned on to SafeScript as well. So, when you log in to your system, if you go to preferences there’s a tick box that says “Apply SafeScript or not”, that, presumably, that will become not an option after April 2020. In order to get through… accessing SafeScript identity needs be confirmed, so the clinician’s identity needs to be confirmed, so you need to make sure you’ve got your AHPRA details and they’re up-to-date, there’s a registration process to go through, and there’s a two-phase identity process, so even after you log in through the software, you then will be sent through your phone a six-digit number that you then need to put into the software in order to access SafeScript. So, it’s the same level of security as we have for out banks, or for the Tax Department, or whichever secure system that we’re using. Should you need any support for setup then the SafeScript system has a support line, and I think we’re going to let… send that through to you all in a message, so, there’s a phone number an email address for registration.

The training for SafeScript has been quite wide. Most of the face-to-face training sessions have now been concluded. They were originally, of course, in Western Victoria, and then the other five PHNs around Victoria organised a training program. I hope that some of you attended those programs, they were, in fact, very good, and this session, now, is part of that discussion of how to utilise and improve function using SafeScript. These webinars are taped so you can go through the College to listen again, if you feel inclined. There’s also, for usage of narcotics and “dangerous” medication, of course in Victoria we have the General Practitioner Clinical Advisory Service in order to get peer-to-peer advice. So, each of the PHNs across the state have been assigned two clinical advisors, who are GPs, who have been trained in the management of pain, anxiety, insomnia, addiction, and they can be contacted by telephone in order to discuss patient care and management with these particular issues.

So, registration is available for SafeScript to all clinicians with an AHPRA principle place of practice in Victoria. Whilst the legislation can only provide practitioners in Victoria with access to SafeScript, interstate practitioners can make a request for information about a Victorian patient that they’re treating, in writing, to the Medicines and Poisons Regulation Branch. So, SafeScript cannot guarantee access to interstate practitioners, at this stage, and that’s really relating to state‑based privacy legislation. Unfortunately we suffer with state systems. So, what do the other states currently have in terms of real time prescription monitoring? I hear the question loudly requested. Currently in the ACT and Tasmania they are using, those two states, are using a system called DORA, which is the Drugs and Poisons Information System Online Remote Access. It’s a web page-based access system. It give timely, secure access to the Department of Health database regarding these Schedule 4 and Schedule 8 medications, but unfortunately, unlike SafeScript, it’s being increasingly used but it’s not mandatory. So, the lack of mandatory, compulsion to use it has reduced its effect, to a degree. Queensland has only recently, in the last few weeks, announced a real time prescription monitoring legislation will be developed in 2019, and it will, as in Victoria, require pharmacists and doctors to check the monitored medicines database before supplying, with penalties imposed for non-compliance. So, the Queensland database, apparently, will leverage off the national solution being developed by the Commonwealth, the National Data Exchange, and I remind you, as we said before, that in April last year all the Health Ministers around the country were looking for a federated model for a national real time prescription monitoring system, which will accommodate for jurisdictional differences and regulatory requirements between the various states. So, that is still in a development phase, whether it’s SafeScript, or DORA, or both, is yet to be developed.

Great, so, of course there’s a million questions, I can see them popping up now, and we have, certainly the College has produced a lot of resources. They’re freely available through the College website, and the one relating to SafeScript is titled “General Practice, A Safer Place”, and really talks… it’s really a resource containing lots of information and identifying and responding to drug seeking behaviour, how to manage that clinically, and how to engage with our patients. A further fact sheet will be available later in the year regarding managing drug seeking behaviour, and as you know, the College produces lots of information that’s really clinically substantially relevant and valuable to our practices. So, SafeScript is one part of managing difficult patients with due care and consideration. I remind you all that this is one part, one webinar of many. So far this year we’ve done a number of webinars, for example, on Notifiable Data Breaches, on Medico-Legal Concerns of My Health Record, Information Security in General Practice, and now the SafeScript one, and as you can see on the slide, over the rest of the year we have a number of webinars which are going to be presented in order to bring as much of the medical community into an appropriate eHealth space. You can register for any of those at any time and, of course, they’re free, and you get some CPD points as well. So, I might leave it there, and hand back to Sally.

SALLY: Yes. Thanks, Steven. Well, that brings us to the end of the webinar, thanks for taking us through the information about SafeScript. As promised, we now have time for Q&A, so if there’s a question you had from today’s presentation, or generally about Practice Technology and Management, please send it through, and as Steven stated earlier, we will also be making a recording of this webinar available online in the coming days. One question that has come through the chat box is around palliative care patients, and if SafeScript includes palliative care patients? Steven?

STEVEN: So, SafeScript, palliative care patients are exempt from SafeScript, so we don’t need to use the SafeScript system for palliative care patients. How that evolves, the practical functionality of that is not quite clear at the moment, we’ve, in fact, got a meeting next week with the SafeScript folk, and that’s going to be very high on the question list for them, in order to try and develop that, so it’s a bit of a watch this space, but we are very confident that palliative care patients won’t need to have their practitioners accessing SafeScript.

SALLY: Okay, and what if a patient is being treated anonymously?

STEVEN: SafeScript doesn’t work in anonymous situations, so we really need to have a non-anonymous, so we need to have the details of the patient, name and date of birth, in order to access SafeScript, and hence access these medications, so use of these medications for these patients. So, that’s… you cannot prescribe these medications anonymously.

SALLY: Okay, and another question we’ve had is does SafeScript tell me if I can or cannot prescribe?

STEVEN: No, it’s… the obligation is to look at SafeScript, it’s a clinical tool, an additional clinical tool, in order to try and reduce, across Victoria, to reduce the negative impact of these dangerous drugs, but once due clinical consideration is given it’s still the practitioners clinical duty to prescribe as appropriate.

SALLY: Okay, thank you. And another one we’ve had come through is, does SafeScript include details of private and non-PBS prescriptions?

STEVEN: Yes, yes, all of the medications of which we spoke, the S4s and S8s, will be included in SafeScript, whether they’re on private scripts or on PBS-subsidised prescriptions.

SALLY: Okay, thank you. Is SafeScript the same as My Health Record?

STEVEN: Yes, this is a question which pops up a lot. My Health Record is the national repository of clinical data, SafeScript is a Victorian initiative, so the short answer is no, they’re completely different systems. Obviously they’re both related to clinical scenarios and outcomes, but, at this stage, they are most definitely separate and different.

SALLY: Okay. Another question we’ve got is, will individual practitioners if prescribing appears inappropriately excessive?

STEVEN: We understand that the prescribing practices of providers are monitored, as per the current authorisation system, so that is happening at present, and we understand that will continue to occur.

SALLY: How can we know about patients from interstate?

STEVEN: It’s very difficult, the interstate patients being treated, if an interstate patient is being treated in Victoria, by a Victorian registered GP, the GP will have access to high-risk prescription records if those records have been transferred through a prescription exchange service. So, if someone, for example, in Queensland has a medication written, it goes through eRx as a prescription exchange service, that will be visible in SafeScript. So, that is the short answer.

SALLY: Okay, thank you. And we’ve got time for one last question which is, if I can’t find the patient in SafeScript does that mean the patient hasn’t been prescribed medications?

STEVEN: In this situation it’s likely the person has not been prescribed scheduled drugs, at least since July 2018, however, if there’s a level of curiosity or suspicion that that’s not the case then researching for the patient through SafeScript would be valuable, and using the patient’s alternative names perhaps, or ideally their IHI, which is their Individual Health Identifier, which is generated through your clinical software from Medicare, so that would be certainly be valuable to research for the patient so that you can be sure of what’s going on, as best as possible.

SALLY: Okay, great. Well, that brings us to the end of today’s webinar. Thanks so much for a great presentation today, Steven, we really appreciate it.

STEVEN: Oh, thank you all for attending. I hope you’ve gained some little bit of extra knowledge and enthusiasm towards SafeScript. I sincerely believe it’s a very good program, and will help us to try and control the damage that’s being done by these types of medications across the state.

SALLY: Yes, indeed. If we did not get to your question this evening, please email the team on ehealth@racgp.org.au, and we’ll get back to you as soon as we can, and we will also be asking some questions of SafeScript when we meet with them on Tuesday. So, we’ll send out an email to all attendees of the webinar. So, we hope you’ve enjoyed the presentation. Thank you, have a great night.

STEVEN: Thank you all and good night.