Strategic Priorities

By 2022, the National Digital Health Strategy will deliver the essential, foundational elements of health information that can be safely accessed, easily utilised and shared.

Medicines Safety

4. Better availability and access to prescriptions and medicines information.

By delivering better availability and sharing of prescriptions and medicines information, the following will be delivered:

  • By the end of 2018, all consumers and their healthcare providers will have access to comprehensive views of their prescribed and dispensed medications dispensed the medicine.
  • By 2022, there will be digitally enabled paper-free options for all medication management in Australia. People will be able to digitally request their medications online, and all prescribers and pharmacists will have access to electronic prescribing and dispensing, increasing convenience for people filling prescriptions and improving overall safety.

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Better, safer medicines information

Medicines are part of most people’s lives, and their use is growing. In any two-week period, around seven out of ten Australians and around nine out of ten older Australians will take at least one medicine.[101]

Significant funding is allocated for medicines provision and administration. In 2012–13, $19 billion was spent on medications in Australia, an increase of 5% since 2010–11.[102] Australians are among the highest consumers of antidepressants, cholesterol-lowering drugs and antibiotics in the OECD.[103]

In Australia, health consumers’ medication histories are currently stored across a variety of paper-based and electronic systems that are often inconsistent, making consolidation into a single view highly problematic.[104]

The impact of incomplete and inaccurate medicines information can be devastating for patients and their families. There is evidence that approximately two million adverse drug events (ADEs) occur every year in Australia.[105] An estimated 230 000 ADEs lead to hospitalisation,[104] with an estimated cost to taxpayers of more than $1 billion annually. [104] Over 2000 deaths in Australia each year are related to medication errors.[106]

Medication errors have a disproportionate impact on older Australians, accounting for an estimated 20–30% of all hospital admissions in the population aged 65 years and over.[104] One study found that 40–50% of residents in aged care facilities were prescribed potentially inappropriate medications.[107]

The ability to capture a patient’s current medicines and allergy information in a structured, coded, standardised and shareable form will support improved sharing of accurate and complete information across care boundaries. It will support quality use of medicines, prevent avoidable injuries and deaths, reduce hospital admissions and give consumers the opportunity to take more control of their own health and care.[101], [108-112] It is estimated that adverse drug events could be reduced by up to 50% with an effective digitally enabled medicines management program.[113] Substantial cost savings could be attained through the reduction of medication errors, more efficient processes, improved patient outcomes and fewer patient visits.[114], [115]

At present, patients and their healthcare providers have limited access to current medications lists or medication histories. Further, information about the millions of medicines administered each year is not consistently recorded in a structured or coded form, making it very difficult to apply clinical decision support tools, or to use medicines data to support research into improving the use of and access to medicines to improve health outcomes.

Better management of medicines information was identified as a high priority among both health consumers and healthcare providers during the “Your health. Your say” consultation. Out of a range of health and care activities, Australians were most interested in using digital technologies to manage their medications, including online filling of prescriptions.[116] Nearly two-thirds of clinicians are interested in transferring prescriptions to pharmacies electronically using digital technologies.[116] A key challenge in achieving this goal is aligning relevant state and territory regulatory frameworks, and ensuring that electronic systems are easy for healthcare providers to use, co-designed in collaboration with medical professionals. This is especially critical for clinicians administering medicines in residential aged care facilities, given the common use of multiple medicines and the complex needs of aged care residents.[117]

Peak professional bodies and other key health stakeholders support the need for improved medicines management, as identified by health consumers and healthcare providers. The Royal Australian College of General Practitioners described electronic prescribing as “an urgent national priority” in their submission.

" When patients move between care settings, the absence of complete and up-to-date medication data can contribute to instances of care becoming high risk, resulting in medication misadventures and unnecessary hospital re-admissions."
- Pharmacy Guild of Australia submission

Prescription medication abuse and overdose is also a growing public health issue, with coroners calling for real-time electronic monitoring of controlled drugs.[118] The Australian Medical Association has described prescription drug abuse as a “national emergency”[119], and states and territories are supporting national activity to increase the electronic monitoring capability for drugs of dependence, to reduce prescription drug misuse and abuse in the community.

Countries including New Zealand, Estonia, Denmark, Finland, the Netherlands and the UK are investing in electronic prescribing and shared medication records to improve medicines management.

Case study: Estonia – successful implementation of electronic prescribing

The Estonian ePrescription service was activated on 1 January 2010. Implementation was initially led by the Estonian eHealth foundation (established by the state, the Estonian Health Insurance Fund, a number of large hospitals, and associations of family physicians). Take-up was rapid, contributing to initial implementation issues which required doctors to continue writing paper prescriptions.[120] However, physicians started to increasingly use the ePrescription service as problems were solved. Now 99% of total prescriptions are processed electronically and 92% of individuals who had used ePrescriptions were either very satisfied or satisfied with the service about one year after their launch, and in a 2015 survey, ePrescriptions were among the most popular eServices in Estonia.[121]

Medicines management, including medicines safety, real-time prescription monitoring, and a single enterprise-wide drug catalogue have been identified as key priority areas for investment by the states and territories.[19] The National Medicines Policy[122] and National Strategy for Quality Use of Medicines (QUM)[123] provide direction regarding quality processes and continuous improvements in the use of medicines, with the high-level goal of improving health outcomes for Australians.

The strategic approach to increasing availability and sharing of prescriptions and medicines information is to complement the work already underway, and support the Commonwealth Department of Health and the states and territories in establishing a national medicines program to implement digital services and solutions to increase the safety, quality and efficiency of medicines use across health and care. This program will also support governments in managing the use of controlled drugs in real time and reduce harm from misuse of these substances.

The Agency will work in collaboration with Australian governments and industry to improve medications management for both healthcare consumers and providers by co-producing and publishing a national digital medicines management blueprint which will include development of the infrastructure, specifications, policies, legislation and change, adoption and training activities for clinicians. The Agency will assist the development of proposals by scoping the implementation trials required to enable the services needed to support end-to-end digital medicines management, recognising the need to provide education and training to support adoption by the pharmacist workforce.

Initiatives will include enabling services such as electronic prescriptions, and a shared and usable view of medicines information, ensuring providers and patients can access the best possible consolidated medicines list via the My Health Record system.

Aged Care Reform

All Australian governments are committed to ensuring that older Australians receive appropriate high-quality and affordable health and aged care services.[99]

The National Digital Health Strategy will support that objective by prioritising a digitally enabled medicines management program, making prescribing safer in aged care facilities and reducing adverse drug events, which disproportionally affect older Australians.[104] Enabling secure messaging, and the exchange of high-quality data between healthcare providers will also enable practitioners in aged care facilities to better plan and coordinate care.

The aged care system in Australia is being reformed to ensure it is the best possible system, and to offer greater choice and flexibility for consumers.[124]

My Aged Care is the main entry point to the aged care system in Australia. The Australian Medical Association suggested in their submission to the consultation process that the My Aged Care gateway should be combined with the My Health Record system to help give “a full and holistic view of all health and care providers involved in the patient’s care and what they are providing”.[116] The Australian Digital Health Agency will work with My Aged Care to determine how information in the My Health Record can help deliver on its vision to make it easier for older people, their families and carers to access information on ageing and aged care, have their needs assessed and be supported to locate and access services available to them.

How will Australia benefit?

  • Risk and harm to health consumers will be minimised through reduced adverse drug events.
  • Prescription misuse will be reduced through real-time monitoring.
  • The cost of hospital admissions for adverse drug events will be reduced (reduced drug–drug interactions, allergic reactions and inadequate dosing, either due to inadequate prescription or dispensing errors).
  • Health system capacity will be increased due to more efficient and accountable administration of medication, improved consumer self-management and reduced hospital admissions.
  • Complications and disease progression will be reduced for patients due to higher medication adherence.

Framework for Action - How Australia will deliver the benefits of digitally enabled health and care

Critical Success Factors of Australia's National Digital Health Strategy