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Fully electronic prescriptions significantly reduce the risk of error during the dispensing process and help minimise person-to-person contact during the Covid-19 pandemic.
Fred IT was founded by pharmacist Paul Naismith around 30 years ago with the aim of making life easier and safer for pharmacists. Pharmacists want to reduce risk and improve patient safety, and that’s what e-prescriptions do when compared with the task of re-keying handwritten or printed scripts.
Australia’s e-prescription exchange architecture was designed with input from the relevant stakeholders. Around 30 companies provide software, such as Fred IT’s eRX Script Exchange, for general practitioners (GP) and pharmacists, and interoperability is essential to gain the benefit.
The firm’s eRX Script Exchange is now used by 21,000 doctors and 95% of Australian pharmacies, and by July 2021 it had delivered more than 11 million digital prescriptions.
It works by adding a barcode to the script when it is printed by the prescribing doctor. That barcode serves as a token that allows the dispensing pharmacy’s software to retrieve the details of the prescription that were uploaded to eRx by the GP’s software.
“It’s grown to be a fairly large piece of infrastructure,” said Fred IT CEO Paul Naismith, but relying on the barcode as a token was a limitation as it meant the physical prescription was still needed.
Laws that varied between Australia’s states and territories were an obstacle to agreeing on a national all-electronic implementation, but the Covid-19 pandemic generated a sense of urgency, and the stakeholders came to an agreement over the outstanding issues.
Some eight months’ work was achieved in eight weeks as a result of governments making the project a priority, said Naismith.
The adopted approach involved the transmission of an electronic token – expressed as a QR code – from the prescribing doctor to the patient, via SMS or email. The pharmacy software reads this code from the patient’s phone and retrieves the prescription details from the exchange.
The advantage is that a paper prescription is no longer necessary. “That’s great if you were doing a teleconsultation,” said Naismith, because the prescription becomes available almost instantly, without the delays caused by posting or faxing. This process became legal in May 2020, he added.
Fred IT needed a partner to handle the SMSes, and it chose Twilio for its scalability and quality of delivery. It was “a platform we could modify in the light of experience of how people use paperless prescriptions”, said Naismith.
Twilio is a global communications platform that supports the sending and receipt of phone calls, SMSes, WhatsApp and Facebook Messenger messages, and more. It is typically integrated with other platforms – for example, Twilio is used to allow Uber customers and drivers to communicate with each other.
A key consideration is that Twilio clients use a single application programming interface (API), regardless of the communications channel or channels they want to use. Twilio is channel agnostic, said Twilio ANZ regional vice-president Kristen Pimpini, and as such is able to integrate with anything in the pursuit of providing a good user experience.
Twilio helped Fred IT with the messaging implementation, he added, noting it was already familiar with the back-end technologies that Fred IT had selected. The pandemic hit while the project was in its early stages, so what would previously have been face-to-face meetings between the companies’ staff were instead conducted via Zoom.
The roll-out of QR code tokens started in Victoria, then extended to other states. Naismith said the roll-out went very well, with some 12.5 million digital prescriptions processed, most of them sent via SMS.
But during Covid-19 lockdowns, people were discouraged from going into pharmacies, so a mechanism was needed for forwarding e-prescriptions to pharmacies for delivery. As such, Fred IT updated its pharmacy software with a new workflow engine that includes provision for delivery services such as Sherpa.
An additional problem with SMS tokens was that some people on several medications got confused when trying to manage all their tokens, especially when repeats were involved.
The Active Script List was designed as an architectural solution to both issues. It is a cloud-based token storage system that provides a single list of a patient’s active prescriptions, and – with the patient’s consent – can be accessed by health providers.
That means any doctor or pharmacy can be granted access, and then “you never lose a script again”, said Naismith, adding that the adoption of a single national arrangement was a big win.
My Script List (MySL) is the first implementation of Active Script List, and was developed by Fred IT and MediSecure, which Naismith said shares 100% of the Australian e-prescription exchange market. The roll-out began in Tasmania in April 2021.
As patients must explicitly consent to the use of Active Script List, they must enrol at a pharmacy, and must prove their identity if they are not known to the staff. MySL uses Twilio to process the consent process.
Once enrolled, patients can decide who can access the data. They typically grant ongoing access to their usual pharmacy, but temporary access can be granted for 24 hours if preferred, such as when travelling. Patients must also prove their identity, but that is still easier than remembering to carry scripts while on the move.
Another benefit for patients will come from the integration of MySL with medicine management apps such as MedAdvisor and Medmate. Any app capable of managing e-prescription tokens will be able to work with MySL, Naismith said.
The percentage of paperless prescriptions grew during the Covid-19 lockdowns, he observed, but “we’ve still got a long way to go”.
The system is great for doctors and pharmacists, but more needs to be done to make life easier for patients by providing them with greater utility and choice, Naismith said.
To that end, MySL is being integrated with WhatsApp via a Twilio-based chatbot. This provides a convenient way for a patient to choose which prescription they want dispensed, which pharmacy they want to dispense it, when it is to be dispensed, and whether it is to be collected or delivered.
The chatbot will be able to handle multiple patients’ prescriptions, such as those for different family members, through one WhatsApp account. Fred IT was able to build on its previous use of Twilio to build this functionality.
The company chose WhatsApp because of its popularity and because – unlike Facebook Messenger – it uses end-to-end encryption. That capability is supposedly coming to Facebook Messenger in 2022 at the earliest, but Naismith said there are no plans to extend the chatbot to any messaging system beyond WhatsApp.
Twilio can also be used to build interactive voice response (IVR) systems, Naismith said, adding that Fred IT will keep working to provide the best experience for users, such as providing live chat between patients and their pharmacists.
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