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article imagePrescribeIT - Canada’s e-prescribing service: Interview Special

By Tim Sandle     Oct 29, 2017 in Health
PrescribeIT is Canada’s new national e-prescribing service. The scheme works with with 20 community pharmacy companies, representing more than 3,300 pharmacies in the six provinces. To find out more we spoke with Tania Ensor.
PrescribeIT has been established, as part of the Canada Health Infoway, to serve all Canadian pharmacies and prescribers to provide a safer and more effective medication management. This is achieved by enabling prescribers to transmit a prescription electronically between a prescriber’s electronic medical record and the pharmacy management system of a patient’s pharmacy of choice.
In addition, PrescribeIT aims to improve patient safety, reducing harm and costs associated with opioid misuse. Furthermore, the service sets out to protect Canadians’ personal health information from being sold or used for commercial activities.
To find out more about this digital health initiative, Digital Journal spoke with Tania Ensor who is the Group Director for PrescribeITT Marketing Strategy and Stakeholder Relations.
Digital Journal: What are the major challenges facing pharmacists today?
Tania Ensor: In the 2016 National Survey of Community–Based Pharmacists:  Use of Digital Health Technology in Practice, conducted by Nielsen and commisioned by Canada Health Infoway and Canadian Pharmacists Association, community‐based pharmacists report that regardless of the format in which prescriptions are currently received, they transcribe data into their local electronic pharmacy practice management system for new prescriptions an average of 61 times a day.  
Indeed, 25 percent report they are dissatisfied with regard to the time required to transcribe prescription details into their pharmacy practice management system. With regard to specific operational workflows, the majority of community‐based pharmacists report dissatisfaction with the time required to communicate with prescribers; issues related to drug coverage (e.g. public formulary, third party insurance); completeness of indications as entered by prescribers.
As well, the majority (69 percent) of community‐based pharmacists reported that widespread adoption of e‐ prescribing would likely result in a decrease in medication errors; and 74 percent said that with supporting change management and transition resources, e‐prescribing would increase their pharmacy’s productivity in the long‐term.  In fact, 96 percent of community‐based pharmacists in Canada report that they would enroll and/or advocate for their pharmacy to enroll in e‐prescribing.
The use of an electronic medical prescription service.
The use of an electronic medical prescription service.
MC4 Army
DJ: Is there anything different about the situation in Canada compared with other countries?
Ensor: Three specific considerations for Canada:   First, A unique aspect in Canada is our federation and the resulting fragmentation of the healthcare system. Second, Canada is facing an immediate public health crisis of prescription drug abuse, particularly opioids, causing harm and even death for far too many Canadians. According to the International Narcotics Control Board, Canada is the second largest consumer of prescription opioids, after the United States. Third, a recent study compiled for the Globe and Mail by IMS Brogan revealed that in 2015 there were 53 opioid prescriptions for every 100 people in Canada.
In 2015, Canada Health Infoway conducted a feasibility study and found that Canada lags behind developed countries in the implementation of e‐prescribing.  e‐Prescribing has been successfully rolled out in several countries/jurisdictions around the world and a key finding from the environmental scan is the high level of adoption in regions where there has been a national solution.   
DJ: What are the advantages of e‐prescribing?
Ensor: PrescribeIT results in more secure prescribing of narcotics and other controlled substances, improved data for narcotics monitoring programs, and enhanced medication compliance for Canadians. At least 20 percent of new prescriptions are never filled, leaving both the prescriber and the pharmacy unaware that the patient is not taking their medication. Improved medication compliance (especially for patients with chronic conditions such as congestive heart failure, hypertension, diabetes or mental illness) reduces emergency department visits and re‐hospitalizations.
PrescribeIT is a national, not for profit and vendor-neutral service that is available to all patients, prescribers and pharmacists.  A single, national system will ensure:  Patient choice and simplicity and ease of use (No patient, prescriber, or pharmacist confusion over which system to use); complete health care data and integrity (particularly with opioids); patient health data is protected from commercial use; an influence‐free prescribing and dispensing environment; no missing data due to fragmentation by multiple services; and cost efficiencies achieved through a single pan‐Canadian system and economies of scale are optimized (small entities are not paying more).
A package of Tamiflu is seen at a pharmacy in New York  April 27  2009
A package of Tamiflu is seen at a pharmacy in New York, April 27, 2009
Mario Tama, Getty/AFP/File
DJ: How does this approach lead to a better service for pharmacists?
Ensor: Using an electronic prescribing service like PrescribeIT will deliver significant value to many stakeholders in the health system. PrescribeIT will be integrated directly into the pharmacy PMS and is designed to adapt to the existing workflows for pharmacy users.
By contributing towards the cost of sustaining the service, pharmacists can be assured a long‐term voice in the development of the solution and will experience increased time for patient care and safety, fewer transcription errors, reduced need for prescription clarification with prescribers, improved communication with prescriber, more time for patient consultations and potential for increased first fill compliance.
DJ: What about patients, how do they benefit?
Ensor: Research has demonstrated that in countries where e‐prescribing is available, patients may experience better health outcomes and enhanced safety. Other benefits for patients include fewer medication‐related errors, less risk of losing prescriptions, lower risk of privacy breaches due to fax transmissions issues, less fraud and abuse of prescriptions, patients pharmacy of choice assured, more time to spend with prescribers and pharmacists on clinical issues, improved medication adherence, and lower wait times and increased satisfaction.
DJ: What were the major challenges with developing the PrescribeIT technology?
Ensor: The biggest challenge has been securing the support of vendors and retail pharmacy partners.  In a short time, we have however been able to secure the support of more than 20 retail pharmacy companies representing more than 3,300 pharmacies in the six provinces with whom PrescribeIT has agreements.   
DJ: How did you go about testing the technology?
Ensor: The PrescribeIT technology on its own, as well as PrescribeIT as it works with the electronic medical record and pharmacy management system technologies undergoes stringent user, conformance and quality testing.  Deployment in the field is not authorized until that testing is complete.   
Pills
File photo: Pills
Tom Varco
DJ: How was data security addressed?
Ensor: Protecting patient personal health and prescription information is of the utmost importance to PrescribeIT. Security has been addressed through the strong identity proofing of users, multi‐factor authentication and use of cryptographic encryption. It is for this reason that we have conducted rigorous testing of PrescribeIT to ensure that all privacy and security standards are up to date, and comply with both federal and provincial privacy requirements.  
Furthermore, electronic medical records connected to PrescribeIT will require multi‐factor authentication from a registered prescriber before an electronic prescription can be generated and sent to a pharmacy, thus greatly reducing the possibility of any unauthorized access to the system and patient information. 
PrescribeIT’s data is stored and processed within Canadian borders and the service will have a back‐up and recovery infrastructure that will apply to applicable computing environments. Back‐up copies of information and software shall be taken in a secure and privacy-protective manner and tested regularly.
DJ: How do you plan to develop the technology in the future?
Ensor: When PrescribeIT is ready for full-scale rollout (Spring 2018), it will allow prescribers and pharmacists to create, receive and renew prescriptions; secure physician‐pharmacy messaging, and integrated access to public drug formularies, status updates, cancellation, standardized terminology through the National Clinical Drug Dataset and enhanced identity proofing and multi‐factor authentication.  
This will result in more effective medication management, enhanced patient safety, and help reduce fraud and abuse. By mid‐2018, PrescribeIT will offer secure electronic transmission of prescriptions for all medications, including narcotics; electronic delivery of a prescription to a patient’s pharmacy of choice; ability to send prescription renewal requests from a pharmacist to prescriber; prescriber integrated access to public drug formulary to help confirm relative costs and
coverage; secure messaging between prescribers and pharmacists to eliminate fax and phone activity; and integration with provincial/territorial drug information systems to contribute to secure patient medication histories.
Dietary supplement pills
Dietary supplement pills
Ragesoss
DJ: What has the take‐up been like?
Ensor: PrescribeIT is currently working with 20 community pharmacy companies, with local, regional and national reach, representing more than 3,300 pharmacies in the six provinces with whom PrescribeIT has reached agreements (Alberta, Manitoba, Ontario, Nova Scotia, New Brunswick, and Newfoundland and Labrador).
In addition to the support from community pharmacists, more than 900 physicians, on behalf of their 718,000 patients, have expressed interest in the service. In August 2017, PrescribeIT went live in Huntsville, Ontario and was quickly followed by two pharmacy locations and two doctors in Kingston, Ontario.  Another site will be launching soon in the Niagara Region of Ontario.   Limited production releases will continue in select communities, with wider rollout to other provinces and territories available in mid‐2018.
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