BACK TO CONTENTS
FEATURE
Real-time prescription monitoring It may seem a long time coming, but WA is edging towards a mandatory real-time monitoring service.
James Knox reports. The WA Department of Health is slowly progressing towards a realtime prescription management system which will connect with other states and territories with the objective of reducing problematic prescription usage and prescribing practices of schedule eight (S8) pharmaceuticals.
who use it can see how and when S4 and S8 opioids and other controlled S8 pharmaceuticals are being prescribed.
WA currently utilises the Prescription Monitoring Program (PMP) for S8 prescriptions, which is a monthly reporting system that provides prescribers retrospective notice of problematic prescribing for a drug dependent and oversupplied person, long after the pharmaceuticals have been dispensed.
National action
As the PMP system produces monthly reports, there is inherent latency in providing clinicians with information they need to make informed, in-the-moment prescribing choices, as notices could be sent long after a prescription has been dispensed. With increasing overdoses and accidental deaths from controlled pharmaceuticals over the past 20 years in Australia, particularly S8 opioids, real-time prescription monitoring is considered a viable harm reduction strategy. Tasmania was the first state to implement RTPM with the Drugs and Poisons Information System Online Remote Access system (DORA) in use since 2012. The Australian Capital Territory began using the DORA system in 2019. Whilst using the DORA system is voluntary in both states, prescribers 26 | APRIL 2020
Victoria implemented its own RTPM system, SafeScript, in 2019 which differs from the DORA systems as it is mandatory for all prescribers and dispensers.
In 2018, the COAG Health Council agreed to a federated RTPM model, releasing a communique at the time saying: “The minsters agreed to… a federated model with jurisdictions committed to progressing development and adaptation of systems to connect to and interface with Commonwealth systems to achieve a national solution.”
It is expected that in 2020, WA will be joined by South Australia, Queensland and New South Wales in planning and implementing RTPM systems.
WA’s RTPM system will connect to the NDE, yet nationalised data sharing of prescription information comes with a multitude of state and territory agreements, along with legislative and policy changes in WA.
Each of these systems will connect to the national data exchange (NDE), a federally funded, Australia-wide system providing state and territory interconnectivity and interoperability for prescribers and pharmacists with real-time prescribing information.
How close is WA to having a functional RTPM system? How will it be implemented? And what will this mean for prescribers and dispensers? Medical Forum spoke with the WA Department of Health and WA’s Chief Pharmacist Neil Keen for the answers.
The NDE, rolled out in December 2018, is the primary architectural component for the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system, the national RTPM system, based on the Tasmanian DORA model.
Towards real-time
The ERRCD system has been made available to each state and territory by the Commonwealth since 2013 yet the ACT is the only state to take up the offer so far.
The Prescription Monitoring Program (PMP) in WA is far from perfect with notices being sent to prescribers up to three months after a script has been dispensed to potentially drug dependent and oversupplied persons, highlighting the need for RTPM in the state. The program only monitors S8s, whereas other systems scrutinise S4 opioids, such as Tramadol, as well.
Both Dora and SafeScript were developed independently to the ERRCD and national data exchange, funded by the individual states, with the Victorian system costing a reported $30m.
The WA Department of Health (WADoH) has decided to connect to the NDE rather than having a purely state and territory-based system as in Tasmania, Victoria and the ACT. This means data sharing
MEDICAL FORUM | CARDIOVASCUL AR HEALTH ISSUE
