RACFs prescribing changes “an important step forward”

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In the Royal Commission on the Quality and Safety of Care for the Aged final reportRecommendation 68 calls for “universal adoption by the aged care sector of digital technology and My Health Record”.


In response, the Department of Health and Aged Care asked the Australian Healthcare Safety and Quality Commission to develop online resources to support the roll-out of Electronic National Residential Medication Table (eNRMC) services.


From July, all Residential Aged Care Services (RACF) now have the option to adopt transitional eNRMC products to better support medication management.


Under a transitional arrangement, RACF prescribers can use transitional eNRMC products for prescribing, dispensing and administering PBS medication charts, eliminating the need for medication charts or paper prescriptions.


In addition to RACFs, eNRMC products can be used by residential aged care providers in the Flexible Aged Care for National Aborigines and Torres Strait Islanders and Versatile services programs.


Members of the RACGP Expert Committee – Technology and Practice Management (REC-PTM) say the implementation is a significant change for GPs assisting patients in RACFs.


“The eNRMC is a great idea and will streamline the process between the RACF and the dispensing pharmacy,” said REC-PTM Chairman Dr. Steven Kaye. newsGP.


Frustrated at “repeatedly vocalising” the importance of this change, Dr Kaye said the ability and effectiveness of prescribers accessing the eNRMC has, to date, been “somewhat overlooked”.


“The eNRMC should be able to synchronize the list of medicines with the RACF, the pharmacy and the general practice,” he said.


“The GP should be able to effectively see the list of medications – ideally via a synchronized patient record – and have the ability to prescribe and deprescribe remotely, where appropriate. Medication information should also be visible in My Health Record in real time after dispensing.


“It’s a complex process and it’s an important step forward.”


The transitional arrangement is an interim measure to allow the use of eNRMC products until a broader e-prescribing infrastructure is established with the assistance of software vendors for nationwide deployment.


The ministry says software vendors help develop eNRMC products that meet legislative and technical requirements for e-prescribing and PBS information requirements for medication tables.


Approval of these products is expected by the end of 2022, when they are expected to be listed on the Australian Digital Health Agency’s Electronic Prescription Compliance Register. In the meantime, all RACFs and other eligible service providers have the option to adopt transitional eNRMC products.


The nominations are currently open for the first round of the eNRMC adoption grant opportunity, which is designed to increase the use of new products.


REC-PTM member Dr Rob Hosking said newsGP the implementation of the eNRMC will support general practitioners by reducing administrative burdens and the risks associated with medication errors.


“As a GP who visits aged care facilities, if implemented well it will be a game changer for us,” he said.


“Currently, if we want to make changes to a resident’s medications, we either have to physically go to the facility and handwrite on the chart, or the staff faxes a copy of the chart, we make the changes and the fax.


“It’s either extremely inconvenient, in the first scenario, or dangerous in the second scenario – with multiple copies and deterioration in the readability of scanned copies.


“Provided a GP can log into the medication chart remotely and make changes from their clinic or home, that will make things much better. If, however, the installation requires us to physically attend to make changes, it can be worse.


Another area that should be improved by the introduction of eNRMC products is the removal of the requirement to write physical prescriptions, according to Dr Hosking.


“This will remove the list of ‘due’ scripts that we currently receive from pharmacies serving RACFs,” he said.


Exceptions that will always require a paper prescription include:

• controlled substances (schedule 8 drugs)
• medicines available only under special arrangement (article 100)
• medications requiring telephone or written authorization.

Dr David Adam, also a member of the REC-PTM, said newsGP that although the change will only affect a small number of GPs in the short term, he agrees that it will help remove the administrative burden once eNRMC products are fully integrated with existing clinical software.

“Managing prescriptions and medications in RACFs is an extremely frustrating process for many GPs, and one of the reasons why some doctors choose to stop working in elderly care altogether,” said the Dr Adam.

“The national residential medication chart on paper can make a big difference, although it is only available in certain facilities.

“The shift to e-prescribing will ideally streamline this process, although it will likely only benefit GPs working in practices specializing in elderly care, as the common clinical information systems used in most practices don’t. [currently] integrate with the eNMRC.’

Dr Hosking agrees that, although currently limited, development is still important.

“It may not be needed imminently, but it would be good for GPs to know things are changing,” he said.

“Furthermore, GPs can potentially pressure the facilities they attend to adopt the new electronic medication charts.”

The Department of Health and Aged Care has developed a prescriber information file with further information.

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electronic prescription eNRMC My Health Record National Residential Medication Chart RACFs