COVID-19: E-Prescription Standards Set To Change To Meet Rise In Virtual Consultations

New Zealand’s electronic prescription standards are set to change to cope with an expected long term rise in the number of virtual consultations.

The current method of issuing a prescription is regulated under the Medicines Act and Ministry of Health guidelines which, in most cases require a signed, hard copy prescription or fax copy.

During the Level 4 lockdown, these standards were relaxed to allow for emailing of prescriptions - which is creating workflow and security issues for some pharmacists.

Health Care Providers (HCPs) say the current medicine prescription model was not designed to cope under the constraints of a pandemic and has impacted on their ability to issue hardcopy scripts during the COVID-19 pandemic.

They say an accelerated move towards digital prescriptions will help remove paper as a potential point of transmission for viruses - when passed between HCPs, patients and pharmacists.

Auckland GP Dr Stephanie Taylor says virtual consultations can come in many forms ranging from the telephone to video conferencing - depending on the patient’s condition.

She says while many GPs are able to work remotely through patient portals which allow video conferencing, the ability to send prescriptions to most pharmacies can be limited - especially as most do not have a fax machine in their home.

“Medical practices have undergone a seismic shift in the way we diagnose and treat patients.

“During the Level 4 lockdown, most patient consultations do not involve physical interaction with the patient.

“Traditionally this is the point at which a paper script would have been handed to them.

“This presents challenges for many parts of the community, particularly the elderly, in accessing treatment and medicines in their normal way,

“At the same time the impact on the continuity of GP practices and community pharmacies during this time has been significant - both of which are an essential part of healthcare infrastructure for New Zealanders,” she says.

HCP interest in an alternative, paperless prescription technology, launched to address non-adherence to medicine in New Zealand has risen by more than 500% in recent weeks according to an Auckland pharmacist.

The technology allows GPs to create a digital prescription during a consultation and send it securely to a pharmacy for fulfilment and delivery by courier. The script, which is not given to the patient, contains a single-use barcode and cannot be copied - preventing it from repeatedly being filled across multiple pharmacies.

While the infrastructure for an electronic prescription service (NZePS) is already in place, until now under the Medicines Act 1981 a printed, signed, facsimile or original of the prescription was still required.

The technology has been audited by the Ministry of Health and is able to address a number of digital security and software programming requirements. The system has been provided with an exemption from the Director-General under the Medicines Regulations 1984 - allowing them to remove the need for any hard copies of the prescriptions to be created.

Pharmacist Din Redzepagic from Zoom Pharmacy, whose company working with the MOH and PMS vendors led the development of the software, says an analysis of their prescriptions show they have had a significant lift in interest from GPs around the country as they look for alternatives to the current model.

Redzepagic says the technology integrates with medical practice software already operated by more than 95% of GPs.

David Taylor, managing director of Zoom Pharmacy says the industry is aware of the issues but the current healthcare crisis is making the development of a long term resolution more complex.

“Many pharmacies are not set up to manage the workflows with prescriptions coming from non-traditional sources such as email.

“Some of the potential issues include a proportion of emails going to spam folders and prescriptions may also be sent to the wrong pharmacy as patients don't always have the exact name of their preferred outlet to hand.

“There are also challenges around co-payment of the cost of the medicine to be resolved, the possibility that a script may be sent to a pharmacy that has been closed without the knowledge of the GP, as well as the potential for prescription fraud,”

“At the same time, we expect to see an increase in demand for virtual consultations over the coming months as many patients will adapt to the model used during the lockdown,

“It will be critical that a robust digital standard is put in place along with an investment in courier infrastructure to ensure medicines can be delivered quickly to patients in need,” he says.

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