Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

With the increase of electronic records and their portability, new obligations exist to safeguard patient information. Privacy legislation exists in most parts of the world to protect individuals, and this legislation expands daily through precedent and experience.
In America, a new piece of legislation entitled the Health Insurance Portability and Accountability Act (HIPAA) is about to be enacted, and some aspects are sure to find their way into the Australian system eventually.

Formal privacy policies in Australian pharmacies are mostly limited to a handful of e-commerce Internet operators, who have developed basic policies to illustrate to their clients that they are serious in protecting confidentiality.
Few pharmacists have actually developed a written privacy policy.
This is not to say that Australian pharmacists do not embrace privacy concepts.
They do, and very successfully, for there has been little consumer complaint in this area.
This does not mean that privacy gaps have been eliminated---there are still a few glaring examples, particularly at the point where a patient is receiving their script, and some counselling may be in progress. I have witnessed HIV medications being placed on a bench in full view of all persons at a prescription collection point, with the patient then proceeding to receive counselling.
And all this from the outpatient department of a public hospital!

American experience in maintaining a log book in a busy pharmacy environment is similar to some Australian experiences felt in administering the Pharmaceutical Benefits Scheme (PBS). The expectations imposed by regulators, developed in their environment, do not match the practicality of the existing “coalface” of a pharmacy environment.
This translates to errors and a high rate of claims being rejected.
It further translates to a sharp increase in overheads, a loss of cash flow, and a correction workflow that is extremely costly and unproductive (as well as being personally stressful).
The process is eventually corrected through some innovative pharmacist taking time out to think through an “out of the square” solution, generally at his or her own expense.
The American experience in having to sign up patients has now been resolved through a system innovation called “E-Sign”, which has implications for Australian pharmacy.
It involves the use of an electronic keypad to overcome the problem.
It is a device where basic patient data can be captured and coupled to an encrypted electronic signature unique for each patient. There are spaces for the patient to tick that they have read privacy policy and have received counselling, and the data generated is then transmitted to the dispense program forming part of the dispense database.

The good news is that the E-Sign hardware and program is inexpensive and will interface with all popular dispense systems.

I could not help thinking how this system might speed up all the data collection required by the Health Insurance Commission (HIC) and eliminate the problem of paper-based prescriptions floating around the pharmacy awaiting patient signature.
The process looks like it could be incorporated in the Better Medication Management System (BMMS) as a very worthy addition, and the HIC would then have a very easy method of determining who signed what and where in their searchable database.
The E-Sign system could also be easily developed to cope with the Medicare numbers, Concession card numbers etc with the whole process enabling patients to verify their details while the pharmacist is dispensing their prescription unhindered.
Because all this detail can be tied to individual prescriptions and transmitted electronically in claims, it has the potential to reduce workload, claim rejections and stress, because the input can be managed through pharmacy assistants, freeing up valuable pharmacist time where previously, pharmacist intervention may have been required.
The HIPAA legislation being enacted in America involves hefty fines if signatures are not collected against a privacy policy. The E-Sign system virtually eliminates this as a potential problem.
(The old log book system allowed other patients to see what previous patients had signed for, but this is not possible with the E-Sign system.)

The E-Sign system has become so popular that some American pharmacists have coupled it with an automated dispensing unit, and the company driving most of this innovation is ScriptPro.

My only reservation is that by developing a system to solve a host of government regulation requirements, it will be targeted by future bureaucrats as a means of obtaining ever more detail about patients and their prescriptions (at pharmacist expense, of course).
Given the multi-million dollar budget of the HIC now, one has to continually question why all this detail is necessary, and does it save on cost?
I know the political reason for all this, but is it the real reason?

Last month I wrote about another innovation called TrialCard, that involved pharmacists in the ethical distribution of drug sample packs. The patient details and the drug sample details are stored on smartcards, and a claim is submitted to each manufacturer for reimbursement.
Perhaps some Australian entrepreneur can devise something similar to E-Sign that can capture data in multiple ways and provide a universal mini-gateway system to deliver information to appropriate organisations (including manufacturers,health funds and the HIC), eliminating paperwork along the way.

To read my previous articles on Australian pharmacy practice, please click on this link.