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The first steps to ePrescribing in Ireland

With electronic health records (EHRs) and individual health identifiers (IHIs) finally in the pilot stage in Ireland, there is also increased interest in introducing electronic prescribing (ePrescribing) here.

Currently, there is a legal requirement in Ireland to produce a paper prescription for patients to present to their pharmacist, but legislation is being drafted to allow for electronic prescribing, which is currently being piloted through a couple of different models.

eScript is a pilot prescription notification service being run by Clanwilliam Group that sends a secure notification of the prescription details from the GP’s computer to the patient’s chosen pharmacy. While it does not replace the traditional signed paper prescription as it is not ePrescribing, it means that the pharmacy can start preparing the prescription before the patient gets there. The patient gets a text message from the pharmacy to confirm their prescription is ready and presents the pharmacist with the paper prescription and ID when they collect it.

Survey

While putting together the idea for eScript, Clanwilliam Group conducted research to find out Irish patients’ concerns and thoughts on prescriptions.

The survey of over 1,000 people revealed that 93 per cent of Irish consumers believe that technology makes their lives easier. Almost three-quarters (74 per cent) of those surveyed claim they found their GP’s handwriting difficult to read and 43 per cent were worried about errors that can occur between their GP and the pharmacy when given a prescription.

The majority (79 per cent) thought that the GP sending a prescription notification to the pharmacy electronically would reduce the possibility of these issues.

“As prescribing today is a paper-based process, there can often be a problem where the handwriting is illegible for the pharmacist and the pharmacist may not always ring the doctor — they might just take a guess what the prescribed medication or dosage is. So basically, patients are aware of that,” explained Mr Rory Cremin, Director of Service Delivery, Clanwilliam Group.

Other findings from the survey highlighted that 72 per cent of consumers always or regularly use the same pharmacy, while 74 per cent get prescriptions for themselves. Nearly half of those surveyed (48 per cent) would like to reduce their waiting time for medications to be dispensed in their pharmacy.

“From our discussions with the HSE, doctors and pharmacists, as well as the survey findings, it was clear there was definitely a need to address those issues and improve the patient journey between their doctor and their pharmacist when it comes to prescriptions,” Mr Cremin said.

He explained that there are a number of existing models for ePrescribing, such as the current UK NHS model, where prescriptions can be sent electronically to the pharmacy or dispenser of a patient’s choice, which he described as a ‘push’ model.

“There is an alternative to that [a ‘pull’ model] where patients can be given a print-off with a barcode on it where any pharmacist in the country can scan that and pull that prescription down and issue it to the patient. So those are the models in the UK. In Ireland, we are some way off that… There is a debate among doctors and pharmacists and ourselves, the HSE and other stakeholders as to which model might work best in the Irish context.”

While Ireland is far behind the UK in relation to ePrescribing — Mr Cremin says 80 per cent of prescriptions in the UK are now done through ePrescribing — we can learn from their experience.

Given the current legislative constraints, it was felt eScript, a ‘pull model’, would be a good model to trial in Ireland. “So eScript is not electronic prescribing; it is what we call electronic notification.  The patient still receives a paper copy of their prescription, as that is the law.”

The original eScript pilot commenced in Cork last year with a couple of GPs and pharmacists and, after some adjustments and learning from the local pilot, the service was refined and launched as a national pilot in March. There are now 167 GPs signed up to the project as well as 302 pharmacies (20 per cent of national total) and 4,352 eScripts have been sent through the system to date. The eScript system is currently free for GPs and pharmacists to use.

Advantages

The three main advantages of eScript, according to Mr Cremin, are, number one, that when the patient gets to the pharmacy their prescription is ready and they can just collect and pay for it, as opposed to having to wait.

“Advantage number two is that as it was sent electronically, they know there is no room for error or misinterpretation in what was prescribed, so there is enhanced patient safety there.

“The third advantage is that once the pharmacist dispenses the medication and hands it over to the patient, the doctor gets notification of that back to their system, so they see that what they actually prescribed was dispensed, so there is that ‘closing of the loop’ in terms of clinical care and safety.

“We see it as a first step towards electronic prescribing. At the moment, it is just notification but it is about improving the patient journey, making it more convenient for them and improving safety from both sides — from doctor to pharmacist back to doctor,” Mr Cremin commented.

It is planned that the eScript pilot will run until October/November, and then a report will be drawn up to gauge its success and learning points, and advise how to move towards actual ePrescribing in conjunction with the HSE and eHealth Ireland, he said.

“We will be looking at different models and what would work best in the Irish context and while it is not a done deal and there has been no final decision yet, it looks like pharmacies here would prefer the ‘pull’ model, where the barcode gets scanned and the prescription gets sent down, which was something that was actually piloted here as far back as 2008.”

How ePrescribing fits in with EHRs will also have to be considered Mr Cremin noted, adding that a summary care record has been launched in the UK this year. “It is not a full-blown EHR, so it won’t give you the entirety of your medical history for the last 20 years, but what it does is summarise your key medical history that someone providing you healthcare at the moment might need to know, like what medication you are on, are you allergic to anything in terms of drugs, do you have any chronic conditions.

“That summary care record is now available in the UK to any GP who is interacting with a patient, which they can look up via the GP system and we are currently integrating it into our pharmacy system in the UK, so we would definitely see down the line that kind of summary care model being available within our GP and pharmacy systems in Ireland, and prescribing data would flow into that, etc.”

For more information and to sign up to register with the eScript pilot, go to www.escript.ie.

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