Thursday, February 16, 2012

Australia’s Discombobulated E-Health Policy Governance Strikes Again! It Is Getting Really Silly.

We had a couple of press releases last Sunday.
First from Tassie:
Michelle O'Byrne, MP
Minister for Health
Sunday, 12 February 2012

Tasmanian Drug Abuse Prevention Scheme Goes National

A system developed in Tasmania to prevent the abuse of painkilling prescription drugs has been so successful it will be rolled out across Australia, Health Minister Michelle O’Byrne said today.
Ms O’Byrne said the Australian Government’s decision is a huge vote of confidence in Tasmania’s system, which provides doctors and pharmacists with real time information about a patient’s history of prescribed drugs.
“We are leading the nation with our efforts to ensure medicines are used safely and effectively and to protect patients from the growing global problem of prescription drug misuse and diversion,” she said.
“We know that medicines, including opioids, play an important role in maintaining health, preventing illness and treating disease when used properly.
“Given to the right patients, under the right conditions, in the right doses and for the right length of time, they can improve health.
“But they can be dangerous when misused or abused.
“Our scheme alerts doctors and pharmacists to the possible abuse of prescribed medication through real-time information on a patient’s history of prescribed drugs to help them prescribe appropriately.
“It shows when repeat prescriptions are being claimed in quick succession which helps to identify patients who may be taking too much medication or perhaps passing it to others.”
Ms O’Byrne said previously, prescription information was only reported retrospectively on a monthly basis, which was too slow to guide required dosing and to prevent problems and protect patients.
The misuse, overuse and abuse of opioids and other drugs of dependence, such as morphine, is a significant public health issue in Tasmania and the rest of Australia. 
“We are proud that our response to this challenge has been recognised as one that will benefit the entire nation,” Ms O’Byrne said.
“As well as promoting the proper use of opioids, our project aims to reduce some of the adverse events that arise as a result of inappropriate opioid prescribing.
“Reduction in the scale of this problem and the deaths it causes is a significant positive preventative health initiative which will save people’s lives.”
The system provides secure controlled access to appropriate information at any time for clinicians who need to prescribe drugs of dependence and are unsure of their patient’s previous clinical history relating to these drugs.
Ms O’Byrne said information provided is restricted to that needed for a clinician to make an informed decision for a patient.
“The push for a national system similar to Tasmania’s comes from key professional organisations and coroners in numerous jurisdictions.
“A national scheme will also allow for information sharing across jurisdictions so we can all work together to minimise abuse and illegal use of these substances.”
And also from The Commonwealth:

New System to Crackdown on Prescription Painkiller Abuse

The Australian Government will set up a new $5 million national electronic records system to combat abuse of controlled drugs including prescription painkillers.
12 February 2012
The Gillard Government will set up a new $5 million national electronic records system to combat abuse of controlled drugs including prescription painkillers, said Minister for Health Tanya Plibersek.
The Electronic Recording and Reporting of Controlled Drugs system will be made available to doctors, pharmacists and state and territory health authorities across Australia to monitor the prescribing and dispensing of addictive drugs in real time.
“While controlled drugs such as oxycodone, morphine and codeine play an important clinical role in managing pain, abuse of these drugs can cause enormous harm and is a growing problem in the community,” said Ms Plibersek.
“Following calls from coroners, law enforcers and consumer groups for greater control over distribution of the drugs, the Gillard Government is pleased to be making this electronic system available.”
Ms Plibersek said health professionals and administrators will be able to immediately detect people suspected, for example, of trafficking in painkillers, forging prescriptions and “doctor-shopping.”
“The new records system will be able to flag patients in real time who have repeatedly sought controlled drugs, helping to prevent people from inappropriately using the drugs or selling them to others.”
Health professionals will be able to access a centralised database over a secure computer network, which will contain prescription history records.
“If a pharmacist determines it is not clinically appropriate to dispense a medicine to a patient, it is their duty of care to restrict access to that patient.”
This information will enable state and territory health department regulators, pharmacists and prescribers to minimise the abuse of these medicines while also ensuring necessary access for consumers who have a legitimate need for these important medicines.
The amount of prescription opioids used in Australia is growing. According to the Internal Medicine Journal, the total value of Pharmaceutical Benefits Scheme opioid prescriptions increased from $2 million in 1992 to $7 million in 2007.
Ms Plibersek said the Electronic Recording and Reporting of Controlled Drugs system was first developed by the Tasmanian Government.
The Gillard Government has signed a licensing agreement with the Tasmanian Department of Health and Human Services and will make a nationalised system available to states and territories, which are responsible for monitoring controlled drugs, from July this year.
“The system has proved popular among Tasmanian health professionals where it has been operational for more than a year.”
Currently, some states use paper-based prescription records, which are slow and require significant resourcing, while electronic recording in others states is inconsistent between jurisdictions. A national electronic system will allow pharmacists to check on prescription records from other states.
Drugs that will be monitored on the system are listed under Schedule 8 of the Standard for the Uniform Scheduling of Medicines and Poisons, which is administered by the Therapeutic Goods Administration.
Abuse of controlled drugs can have severe health and economic consequences such as addiction, disruption to families, loss of work productivity, risk of blood-borne diseases for injecting drug users, depression, anxiety, overdose and even death.
---- End Release
We also had some press coverage here:

Appeal to stop drug shopping

  • by: Carl Dickens
  • From: Herald Sun
  • February 16, 2012 12:00AM
AN online monitoring system should be introduced within a year to stop "prescription shopping" for drugs, a coroner said yesterday.
Coroner John Olle said the State Government should introduce a real-time system to track all prescription medicines.
It would be available to all drug prescribers and dispensers statewide, to determine whether someone was trying to get more medication than needed.
Mr Olle made the recommendation at an inquest on a 24-year-old man who died in October 2009 from an overdose of prescribed morphine and diazepam.
The Coroner's Court heard James, whose surname has been suppressed, spent hours each day visiting doctors and pharmacists, filling multiple drug scripts.
Records show that he visited 19 doctors and 32 pharmacies in his last three years, as his prescription drug addiction claimed his job, his love life, and his finances.
Mr Olle said the monitoring system should primarily focus on public health, rather than law enforcement, and should support rather than overrule health providers' clinical decisions.
Mr Olle said all the submissions he received from governments, health advocates, and individuals, supported real-time monitoring.
More here:
As I understand it essentially this proposal is for a national database of dispensed S8 (Drugs of Addiction) medications to be established that a pharmacist can look up and see if there has been more than they desire dispensing of such medicines to catch ‘doctor shoppers’ etc.
Now all this is well and good, and well motivated, considered in isolation - the problem is that it is not in isolation. There are public (think PCEHR) and private initiatives (think Medisecure and eRx) all designed to improve medication use and patient medication information availability.
Surely an initiative of this sort should actually be integrated into the overall directions for e-Health and not be announced and implemented as some sort of minute and unconnected component of the overall flow of development. I wonder is the IHI Service being used for instance? Surely it would be highly relevant? The releases don’t mention it. I wonder is this project in any way connected to the much vaunted Project Stop? See here:
It is my view that this sort of knee jerk policy making reflects the lack of national leadership and governance we really need in the e-Health space.
This is really little more than a bit of ‘Brownian Motion’ compared with what is needed overall.
The Strategic Vacuum we seem to have in OZ is really a bit sad.
David.

13 comments:

Anonymous said...

How does this system work? Have they developed a seamless interface for us as GPs to review the medication record? Which medical software vendors have developed an interface to the system in Tasmania? How does DOHA plan to roll it out? What will it cost us? Will DOHA provide some incentives for us to use it? Is there a business plan in place? Can we see it?

Anonymous said...

All good questions..but think about it.Ask yourself shouldnt the same questions be also asked about PCEHR.Then ask yourself at this late stage do you have an answer? Then ask yourself what are your chances about about this little part of the bigger picture?!

Paul Fitzgerald said...

I am getting a sense of deja vu - the classic episode of Yes Minister and the perfect hospital with no patients.... The infection rates are very low, Minister...
or is that just my cynicism coming through again? I think I need some more "pain go bye bye juice" :-)

Anonymous said...

"It has been so successful it will be rolled out across Australia, Health Minister Michelle O’Byrne said today."

Wow, that's impressive. So DOHA is going to Taswegianise Australia with a mini MediConnect.

Anonymous said...

"Tasmania’s system provides doctors and pharmacists with real time information about a patient’s history of prescribed drugs." Does it?

Our practice in Hobart is not permitted to use it. Why?

Because we are in private practice and not employed by the State Health Department.

Anonymous said...

Ms O'Byrne said "Health professionals will be able to access a centralised database over a secure computer network, which will contain prescription history records."

How are the prescription history records kept up-to-date?

Anonymous said...

Because neither the PCEHR, Medisecure nor eRx are mandatory, they can’t be used to address these issues. Anyone abusing the system will steer well clear of them.

The data on all dispensed (PBS) medications is held by Medicare. All they need is a good business intelligence tool to slice and dice that data to extract the information they need.

We don’t need another “system”. Let’s use what we already have more intelligently!!

Anonymous said...

2/17/2012 09:17:00 AM said "We don’t need another “system”. Let’s use what we already have more intelligently!!"

From what you say it seems therefore that the most 'intelligent' thing to do is is to ensure every prescription written is sent electronically, so that it can be used to dispense the prescribed medications and then used to update a comprehensive medical record which doctors and pharmacists can refer to subsequently for prescribing and dispensing purposes.

Why doesn't the government help make that happen with what we already have instead of wasting money chasing rainbows?

Anonymous said...

Hmmmmm I don't suppose this system will have any sort of "personal controls" like the PCEHR... but heck it's 461 million dollars cheaper than the PCEHR and already up and running.

Anonymous said...

Have DOHA committed to a date when they will have the Tasmanian system rolled out nationally?

Anonymous said...

This is all I can find. Of course 'made available' could mean anything.

Health Minister Tanya Plibersek announced this week the Electronic Recording and Reporting of Controlled Drugs system developed by the Tasmanian government would be made available to doctors, pharmacists and state and territory health authorities across Australia from 1 July.

Anonymous said...

1 July? How interesting. Sounds perhaps like we might get a bundle of e-health goodies at PCEHR launch. Brilliant tactically - like getting free steak knives with your K-tel plastic thingy, the populace will feel they have got a tremendous 'bargain' for half a billion. Look at all these e-health wonders you get just for 5 payments of $5.99 per month for the next 5 years ..... Politics, Machiavelli, dark arts indeed.

Anonymous said...

It look more like a knee jerk reaction timed to counter any embarrassment arising from the Coroner's Recommendations. There is a smattering of evidence available which describes the system but nothing that I can see which would convince one it is a 'real-time online prescription monitoring system'. Perhaps DOHA sees its real use more as a propaganda tool to add to its 1 July PCEHR roll-out announcement to silence its critics. Or perhaps its just another way of telling eRx and Medisecure to go away we're not interested.