In this digital age almost all services can be accessed electronically, making the use of pen and paper obsolete. Almost. However, the medical fraternity has a track-record of being slow to adopt new and innovative technology, even simple technology. Head of Health-Soft, one of South Africa’s leading providers of e-scripting software and part of the Med-e-Mass group, Hannes Robberts, explains how if adopted, e-scripting could go a long way in reducing errors and improving patient safety.

Adverse drug events (ADEs) are an unfortunate reality of the medical world. In some cases there is no way of knowing if a patient would react badly to a drug. At a pharmacy level, ADEs can be prevented by eliminating script interpretation errors through the use of technology in the form of e-scripting.

In the US, where e-scripting is mandatory in many states, statistics show that dispensing errors occurred in up to 10% of scripts before e-scripting was introduced.

As a pharmacist, I remember how challenging it can be to decipher not only a doctor’s handwriting, but also their intention within a script. Often the pharmacists on duty came to a consensus decision on what the doctor wanted when they were unsure what was prescribed and couldn’t reach the doctor to confirm. E-scripting offers a far superior alternative.

How e-scripting works

With e-scripting, scripts are generated on a software platform that takes care of most of the admin associated with issuing a prescription. The e-scripting platform is, for example, set up to include all the information a script has to have to be legal, and automatically fills in the correct ICD-10 code for medical aid claims, if the doctor and patient agree to its inclusion. Importantly, the document’s format ensures clear instructions and no confusion regarding drugs and dosages.

An electronic data exchange interface transfers the script directly from the doctor’s practice management application (PMA) to the pharmacy, leaving no chance for the patient to alter it or for the script to be lost. No more faxing is needed. Should the patient’s preferred pharmacy not be electronically linked to the practice, the doctor simply prints a copy of the script for the patient to take with them.

Our aim is to help doctors and pharmacies form networks based on their shared use of our e-scripting solution. The relationship that comes from medical professionals working closely together ultimately benefits patients and it also makes life easier for everyone if the pharmacist doesn’t have to call the doctor to clarify scripts.

The value e-scripting adds

More than just an electronic script template, e-scripting software stores the patient’s history, allowing the doctor to quickly and easily refer to previous prescriptions, basic clinical notes and treatment decisions.

This functionality is particularly handy in the case of chronic conditions. Instead of having to write out a new script every time, the doctor can simply refer to the patient’s treatment plan by calling up the previous script, verify that everything is still valid, change what is needed, and render it again.

Similarly, doctors can save their preferred treatment protocols for specific conditions. The software also speeds up the issuing of sick notes, referral and personalised letters, and references for the Workman’s Compensation Association (WCA) and Road Accident Fund (RAF), freeing up more time for patient interactions.

In group practices, e-scripting is extremely valuable as it allows the different partners to see each other’s prescription history for a specific patient. A patient can still receive the best care even when their preferred GP is not available.

E-scripting furthermore allows a practice to do away with paper and files in favour of an online system, and to be more efficient – resulting in a more professional image in the eyes of its patients.

E-scripting is far more than a printout of a computer generated document; the intelligence behind it creates enormous value in terms of time saving, accuracy and improved patient care.

The status of e-scripting in South Africa

In most first world countries e-scripting is a requirement because of patient safety and doctors can be penalised for not using it. Unfortunately, South Africa is not there yet.

E-scripting is still a choice and, sadly, many doctors are reluctant to embrace technology in their practices. While Health-Soft, for instance, has signed up around 2,000 doctors to use its e-scripting software, not all of them are active users. This is despite the system not costing them anything – installation, support and licencing are subsidised and therefore free.

Some doctors think that using technology will slow them down, and for others it’s a case of being comfortable with how things have always been done. But we are working hard to change their mind-sets by proving the benefits of e-scripting.

The large-scale rollout of the e-scripting function that allows scripts to be sent directly to pharmacies has also been held back by the question of what constitutes an electronic signature on a script. Previously a grey area in South African legislation, regulations published by the Department of Health (DoH) in August 2017 have now clarified it. According to the regulation: “Every prescription for medicine shall be written in legible print; hand or typewritten; or prepared with an electronic agent as defined by and in compliance with the Electronic Communications and Transactional Act, 2002…and shall be signed with an advanced electronic signature by an authorised prescriber.”

The requirements for an advanced electronic signature are, however, onerous to implement and companies like Med-e-Mass had to carefully consider the best way to conform.

I am pleased to say that we are now ready to comply, and are in a position to allow medical practices and pharmacies to be compliant in the near future.

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