The huge disconnect between doctors, patients and pharmacists is having a huge impact on the well-being of patients. Co-operation between doctors and pharmacists is vital in ensuring patient medication adherence.

Dr Eloise Malan, an independent medical practitioner and the first doctor in Africa to send a fully legally compliant e-script to an enabled pharmacy.

However, this does not always happen and the general practitioner, the gatekeeper to health, faces a daily administration nightmare in managing patients’ health outcomes.

To address the issue, Marius van der Westhuizen, the chief architect and Product Manager of Intermedix South Africa, developed the iCanScript e-scripting solution.  The result is that Intermedix has partnered with CompuGroup Medical SA (CGM SA), a subsidiary of CompuGroup Medical SE, one of the world’s leading medical information technology companies. CGM synchronizes healthcare delivery by developing solutions for healthcare professionals and has more than 400 000 customers worldwide.

Intermedix now proudly offers iCanScript, an e-scripting application developed in South Africa and powered by CGM SA. iCanScript is currently used by more than 1 000 doctors in South Africa and the number is growing.

What is e-scripting?

Following a patient’s diagnosis, a medical prescription is issued. The digital version of this process is known as e-scripting. The iCanScript e-scripting platform makes use of Advanced Electronic Signature (AES) for a quick, easy and secure prescription platform that streamlines the prescription process. Doctors can now create a digital script and sign it with a password or PIN using their personal AES. The patient then selects an e-script-enabled pharmacy from the doctor’s application, to which the e-script is routed. The pharmacist prepares the prescription and the medication is ready for collection.  The doctor receives an electronic notification once medicine has been dispensed to ensure knowledge of the patient’s medication compliance.

Dr Eloise Malan, an independent medical practitioner, who was the first doctor in Africa to send a fully legally compliant e-script to an enabled pharmacy, said, “At first, I was reluctant, but the benefits convinced us.  The connection between the doctor and the pharmacy and knowing that my script is going straight to the pharmacy is great. Instead of sitting in the evenings catching up on admin, emailing and answering requests for repeat scripts, I can do it there and then during a consultation.”

How is it legally compliant?

In reference to the legitimacy of the iCanScript platform, Jackie Maimin, a practising pharmacist and the CEO of the Independent Community Pharmacy Association (ICPA), commented, “A script belongs to the patient and only becomes the property of the pharmacist once the prescription has been dispensed in full. There is a lot of uncertainty around the validity of electronic and digital scripts. What I can say, is that in my opinion, iCanScript fulfils the legal requirements for an electronic prescription as outlined in Regulation 33 of the General Regulations of The Medicines Act.”

Doctors go through a fingerprinting process authenticated by the Department of Home Affairs (See footnote.) before being issued with their personal AES certificate to use when digitally signing all their medical and clinical documents.

In his review regarding the iCanScript e-scripting solution with the new AES of the doctor, Mr Pierre Marais, a respected attorney who specialises in  SA healthcare legislation, said, “We are therefore of the opinion that the iCanScript  e-scripting model ensures satisfactory controls in respect of the safe dispensing of medicine on prescription of a doctor, which safeguards include the integrity of the medicines prescribed, easy detection of any amendment to the original  prescription as intended by the doctor or tampering with the signature of the doctor and the fact that the prescription is kept in a readily accessible manner for reference purposes and is therefore lawful with complete or full impunity for doctors, against charges of unprofessional conduct or unethical conduct by the HPCSA in terms of rule 17 of the Ethical Rules for Doctors.”

Maimin continued, “There is a study that shows that there is a R12.5 billion (5.6% of total health expenditure) avoidable cost opportunity and that significant contributors to this are non-adherence and medication errors. Non-adherence is the largest cost, where, on average, a patient only fills 7 out of 12 prescriptions each year. Some don’t even fill the first one. With e-scripting one can see exactly what is happening with a prescription. For non-adherence, the avoidable cost opportunity is estimated at R5.6 billion – this is where patients don’t take their medication and end up in hospital or require other expensive interventions. Dispensing errors also creep in when pharmacists can’t read the script or misread it in terms of the actual medication or strength. With e-scripting there is no chance of a translocation error.

“It’s an absolute no brainer. It is efficient, reduces costs and reduces errors.  In addition, doctors will know exactly what is dispensed for the patient. This is an important sharing of information as sometimes patients decline certain items on the script and the prescriber should be aware of this.”

The benefits of e-scripting

iCanScript with AES is beneficial to doctors, pharmacists and patients alike.

Doctors can be assured that patients receive the correct medication. In addition, access to detailed digital records will allow doctors to review historic prescriptions on a patient’s profile for quick review of compliance and re-issue of repeat prescriptions.  The system is quick, safe and secure and confidentiality and integrity of digital scripts are guaranteed, as prescriptions cannot be altered once signed with an AES.

Patient care is enhanced through the accuracy of digital prescriptions as pharmacists do not have to decipher what medication or strength was written on a prescription. Patients select a pharmacy of their choice for collection or delivery of their prescribed medication and the pharmacy prepares the script on receipt of the digital script. There is no more waiting in queues for the patient. There will also be reduced co-payments as the doctor, who has access to the formulary medication approved by medical aid schemes, can select appropriate medication that is approved by the patient’s medical scheme.

For the pharmacist, there is improved workflow efficiency as a result of the automated delivery of the e-script into the pharmacy practice management system. There is also high-quality customer service as prescriptions and prescribed minimum benefits claims are prepared before the patient collects the medication. In addition, there is the potential for reduced medical errors as digital scripts are highly legible and require less typing input from the pharmacist when filling the script.

Why is e-scripting a big deal?

According to Marius van der Westhuizen, all parties in the health ecosystem are now for the first time connected and accountable as part of a multi-disciplinary team taking care of the patient’s health outcomes. He adds, “The patient is co-responsible for his/her healthcare and is involved in his/her healthcare journey, the pharmacist together with the patient drives adherence and the doctor can see what the patient is taking, leading to improved patient care and health outcomes.

“In addition, there is no cost for issuing the AES to doctors or for the use of the e-scripting technology, as it is imbedded in the practice management software.”

Dr Bruce Longmore, from Sizimpilo Medical Consulting in KZN, highlights another reason why e-scripting is a big deal and says, “Scripting is a critical part of the consultation process. Having the ability to access medicine databases and view generic substitution allows us to create legible, accurate and cost-efficient scripts. AES is the only way to protect the identity of the doctor and help combat fraud, waste and abuse in the healthcare sector.

“Sending scripts directly to the chosen pharmacy’s dispensing software allows for swift and accurate dispensing. It also improves patients’ adherence to fill their prescriptions.”

Van der Westhuizen concludes, “We are proud to have finally found a solution to the great disconnect in SA healthcare to ensure improved health outcomes for patients by bridging the gap between doctor and pharmacist.”

Readers who require more information, can contact Marius van der Westhuizen at marius.vanderwesthuizen@intermedix.co.za  or visit www.intermedix.co.za