PCEHR-An untapped database of patient medication history?

After choosing to blog on this particular topic of issues around eHealth for Pharmacists, I decided to do a little investigating. I wanted to know what this PERSONALLY controlled electronic health record system was all about. Signing up for the eHealth record was quite easy, all you really need is your medicare card and to have some knowledge of your own personal details…seems reasonable. Once I had registered and looked at my own yet to be populated eHealth record, I was struck by how this system could make the entire healthcare process so much more integrated and efficient, as long as it is widely adopted. The second thing that struck me was a little sidebar of information running down the left side of the record. As the eHealth record seems to be largely administered by Medicare, all of my doctors visits and PBS prescriptions that had been dispensed over the past 3 or so years were there. I believe this to be an untapped resource.

One problem that we still have in our society is a dependence and in some cases an addiction to certain medications. The people who are addicted to these medications sometimes do drastic things to ‘beat’ the system to get them. This includes seeing multiple doctors to get prescriptions for the same items, and having these dispensed at different pharmacies so as not to be detected. Further, at a Pharmacy we only have the medication history of a patient to the extent of the medication that they have had dispensed at our pharmacy. This can prove problematic at times when we do not receive the whole medicinal history of our patients. How does this tie in to electronic health records you may ask?

The information that is collected by Medicare regarding dispensed prescriptions is already providing us with an avenue to cut down the level of medication misuse and abuse, and to gain a more complete medical history of our patients to cater more efficiently to their needs. Currently this information it is not used in this manner by Medicare. All PBS prescriptions which have been dispensed show up on that particular individuals eHealth record. A record that, if widely or universally adopted in Australia would lead to a greater benefit to society as a whole, which would provide pharmacists and other health professionals with an extra tool in their ability to treat patients effectively and provide other forms of therapy if needed.

But now we come back to the main issue for pharmacists and the Ehealth initiative. If the system is purely based on personal choice to opt-in, how will better health outcomes for patients to be reached? Can a system where compliance is not mandatory in an area as pivotal to our society as healthcare truly achieve better outcomes without a complete framework and information database to work with?

Alternatively, is an integrated Electronic Prescription Database (independent of the eHealth initiative at this time), with mandatory membership of all pharmacies a more reasonable answer at this time? The ETP is somewhat attempting to create this with efficient flow of paper-less prescriptions from doctors to pharmacies planned for the future, but is this really integrating our dispensing systems enough? An all encompassing national database would contain the information already collected through medicare and all of the patient records within individual pharmacies which would work together to help strengthen the foundations of conscientious dispensing within this country. We have the technology so why not the initiative? An inter-connected database and transfer of prescription information between all pharmacies nationally is really not all that far-fetched as an idea.

E-Health: The Australian Context

The development and introduction of an eHealth Initiative in Australia provides a new and exciting topic for discussion, thus this initial blog is an attempt to provide an outline to the topic for further investigation.

The eHealth Record in the Australian context refers to a Personally Controlled Electronic Health Record (PCEHR) System. This system comprises of an interconnected database of patient health records, providing authorised healthcare professionals access to critical patient information with relative ease and in a much less time consuming manner than is currently available. The eHealth initiative in Australia is centered around the idea of being consumer friendly with the public having to ‘opt-in’ to having an eHealth  record, and also having decision making abilities around which specific heath information can be viewed by particular health professionals. The ability to sign up for a PCEHR in Australia began in July 2012, about eight months ago, therefore at this stage the program remains in its infancy and the full potential is yet to be realised.

Some of the main components of the eHealth initiative in Australia include:

• Personally Controlled Electronic Health Record (PCEHR): The cornerstone of the eHealth program in Australia. This record will consolidate the many separate health and dispensing records that are currently held for the patient with their GP, Specialist, Pharmacy and from previous Hospital visits. More information about PCEHR for consumers and healthcare professionals can be found at http://publiclearning.ehealth.gov.au/
• Opt-in and Opt Out Function: This component applies to both patients and healthcare providers. Patients and Healthcare providers are required to voluntarily sign up to be a part of the eHealth record system. In the instance of patients they also have the power to decide to opt-out of the system if they no longer want to keep their eHealth record.
• Electronic Transfer of Prescriptions (ETP): currently being rolled out and is currently used in the majority of Australian pharmacies in the form of bar coded eRx paper prescriptions. The continuation and roll out of this initiative is a component of the 5th Community Pharmacy Agreement negotiated between the Australian Government and the Pharmacy Guild of Australia. The purpose of ETP is to make the process of dispensing medications more precise and to eliminate dispensing errors. In its full implementation, the system will do away with the need for paper prescriptions. The patients prescription details will be uploaded on to their secure eHealth record at the time of prescribing. The patient may then choose to have their initial dispensing (and all subsequent repeats) filled at any community pharmacy of their choice in Australia. All prescription transfer of information will take place over the electronic prescription exchange which is in turn linked to the individual patient record, allowing a more holistic view of medication, prescribing and dispensing history. This program will eventually deal with the problem of lost prescriptions and cut down the industries impact on the environment through the excessive need for paper. For more information about ETP check out the following interactive link http://prezi.com/vwz-csacweld/v2-etp-education-program/

There are many issues and benefits for Pharmacists that are set to arise with the rolling out of this program, hopefully we will be able to delve into some of these within this forum.

More information about the eHealth initiative and ETP can be found at http://www.ehealth.gov.au and http://www.5cpa.com.au