Electronically transmitted prescriptions fact sheet (for prescribers and pharmacists)

The advent of electronically transmitted prescriptions in Australia has the potential to improve the Quality Use of Medicines by prescribers, pharmacists and patients. This fact sheet provides information for prescribers and pharmacists regarding electronically transmitted prescriptions in Tasmania.

What are electronically transmitted prescriptions?

Electronically transmitted prescriptions are an electronically transmitted and digitally signed legal order authorising the supply of a scheduled substance. An electronically transmitted prescription is issued by a prescriber and transmitted securely for dispensing by a pharmacist, through approved software without production of a paper prescription.

Electronic Transfer of Prescriptions (ETP) involving the use of barcodes on paper prescriptions are not electronically transmitted prescriptions, as the legal order is the original paper prescription.

Paper prescriptions and electronically transmitted prescriptions are separate formats and are not interchangeable. A prescription is issued in either a paper or an electronic format, and that format will remain the same for the life of that prescription. A prescription cannot be converted from one format to the other.

What is changing?

From 1 November 2019, the Commonwealth Government introduced legislative amendments to the National Health Act 1953 (Cth). These amendments enable electronically transmitted prescriptions for scheduled substances listed on the Pharmaceutical Benefit Scheme (PBS) to be claimable for subsidy, in the same way as paper prescriptions.

As a result of the Commonwealth legislative changes, it is anticipated the uptake of electronically transmitted prescriptions will increase. Paper prescriptions and electronically transmitted prescriptions will co-exist, allowing patients to choose their preferred format where available. Software systems are required to obtain a Conformance Identification (ID) from the Australian Digital Health Agency (ADHA) after self-attestation that their system conform with the ADHA Electronic Prescribing Technical Framework (ADHA Framework).

There is significant change and adoption work being co-ordinated by the ADHA, engaging both software vendors and professional organisations regarding the implementation of electronically transmitted prescriptions.

The Tasmanian poisons legislation was amended in 2008 to allow for electronically transmitted prescriptions where approved by the Tasmanian Secretary for Health. The relevant provisions are Regulations 21 and 46 of the Poisons Regulations 2018. Any software system used in Tasmania to prescribe, transmit, or dispense electronically transmitted prescriptions requires approval in writing from the Secretary for Health.

What does this mean for prescribers and pharmacists?

As awareness increases, members of the public will likely direct questions to prescribers and pharmacists about electronically transmitted prescriptions and how they work.

The ADHA are working with professional organisations on the adoption of electronically transmitted prescriptions into practice workflows.

Prescribers and pharmacists with questions about system integration, practical implementation or technical support should contact their software vendors in the first instance, or the ADHA.

Prescribers and pharmacists who wish to implement electronically transmitted prescriptions must confirm all their connected software systems have obtained approval from the Tasmanian Secretary for Health. A list of approved software systems is available on our website.

How do approved software systems comply with Tasmanian legislation using electronically transmitted prescriptions?

The ADHA Framework has been developed to facilitate a national approach to electronically transmitted prescriptions. The ADHA Framework requires software systems to comply with relevant jurisdictional poisons legislation requirements.

Electronically transmitted prescriptions by veterinary surgeons are not included in the current ADHA Framework.

Do prescribers and pharmacists need to sign an electronically transmitted prescription?

Yes. Electronically transmitted prescriptions are digitally linked to the prescriber who issues the prescription; and to the pharmacist who dispenses each supply (original and repeats). A record of the practitioner’s name and their Healthcare Provider Identifier – Individual (HPI-I) are stored within the approved software system, as required under the ADHA Framework.

What does this change mean when prescribing or dispensing Schedule 8 and Schedule 4D substances?

Prescribing and dispensing legislative requirements aimed at protecting the public with respect to Schedule 8 (S8) or Schedule 4 declared restricted (S4D) substances have not changed in response to these Commonwealth changes. Prescribers and pharmacists will need to continue to meet their legal obligations. Software systems will not be approved in Tasmania unless they are consistent with the requirements of the Tasmanian poisons legislation.

The following requirements remain for both the paper-based and electronic format of prescriptions:

• a prescriber to be present and practising in Tasmania when issuing a S8 or S4D prescription;
• the repeat interval to be included on prescriptions for S8 and S4Ds;
• the retention of S8 repeat prescriptions at the pharmacy where first dispensed;
• compliance with Section 59E authority conditions; and
• the prescription to have a six‑month expiry.

For electronic format prescriptions where repeats are retained at the pharmacy or require staged supply under a Section 59E authority the electronic token would need to remain under the control of the practitioner, i.e. patients would not be sent a copy of the token by SMS, email, or mobile application.

Do prescribers and pharmacists need to endorse an electronically transmitted prescription with a repeat interval?

Yes. An electronically transmitted prescription issued with repeats for a S8 or S4D substance requires digital endorsement by the prescriber with a repeat interval; or digital annotation by the pharmacist with a calculated or prescriber confirmed repeat interval. This is consistent with established practice and legal requirements, ensuring safe intervals for supply of these high-risk substances.

Can approved software systems be used by pharmacists to supply a scheduled substance without an electronically transmitted prescription?

Regardless of the prescription format used (electronic or paper) a pharmacist may supply a scheduled substance only in accordance with the provisions of the Poisons Regulations 2018.

Where a prescriber provides an instruction (without a prescription) to a specific pharmacist to supply a scheduled substance, the prescriber is required to forward the original prescription, in either prescription format, to the supplying pharmacy.

The electronic token, or QR code, presented by the patient is not a prescription or an instruction from the prescriber to supply a scheduled substance. The electronic token is only a pointer to the legal electronic record.

Are there any storage and retrieval requirements for prescribers and pharmacists regarding electronically transmitted prescriptions?

The ADHA Framework requires a digital copy of an electronically transmitted prescription to be retained and securely stored in the software system by the prescriber when it is issued; and by the pharmacist each time it is dispensed.

A digital copy must be kept in a retrievable format, available upon demand by a Poisons Inspector for a period of two years consistent with the Poisons Regulations 2018.

Do I need to record dispensing events for electronic prescriptions in the narcotic register?

Yes. The recording requirements for narcotic dispensing events do not change between paper-based and electronic format prescriptions.

Are electronically transmitted prescriptions available to hospital prescribers and pharmacists?

The ADHA Framework allows electronically transmitted prescriptions to be used by hospitals with approved software systems for in-patients and for patients discharged into the community.

More information

For electronically transmitted prescription system integration, practical implementation and technical support, please contact your software vendor.

For information on the ADHA Framework for electronically transmitted prescriptions, please contact the Australian Digital Health Agency:

Web:    www.digitalhealth.gov.au

Phone: 1300 901 001

Email:   [email protected]

 

For questions regarding the poisons legislation in Tasmania please contact Pharmaceutical Services Branch on:

Phone:  (03) 6166 0400

Email:   [email protected]