Saving time for Doctors & Patients

The headline seemed so promising

“The federal government is proposing to automate the prescription approval process to help save time for doctors and patients”

Finally – they are understanding our worries and stress. Or so it would seem

Currently the system for obtaining Pharmaceutical Benefit Authority Prescriptions involves one of three processes:

  1. For a small group of medications only non-GP Specialists are allowed to prescribe the drugs
  2. Some drugs require paperwork to be filled out and sent away by the GP or other Clinician
  3. Some drugs can be granted a streamlined authority which is hardly more than just ticking another box in the software in front of the doctor
  4. The majority however involves calling a 1800 number. The wait can be short or sometimes ridiculously long . Once they have picked up the call the process is usually fairly painless – the GP reads off the detail that was prepopulated by the desktop software and has the required permission details within seconds. Once you have them on the line you can then process all the authority applications you have on hand in quick succession

Calling the authority number can certainly be a frustration – our small clinic can sometimes spend up to 5 or more hours per month on the line to this number – and only the GPs make these calls.

One should therefore be grateful for the proposed changes however the documents tabled in parliament are very vague .

It seems fairly obvious that the expectation would be that Clinicians would be doing this through the Health Professionals Online Services system (HPOS)

The HPOS system can be accessed through one of two processes:

Using a Medicare Individual Public Key Infrastructure certificate (PKI) – this usually involves  the use of a USB dongle and has the challenges of:

  • Requiring installation of finicky software on each PC
  • Not working on Windows ten machines
  • Not working on Apple machines
  • The use of ridiculously complicated passwords that cannot be changed
  • Only working with certain browsers (The ATO’s software has this same frustrating limitation)

It does appear that the Health Department is aware of the frustration this causes so they are phasing the PKI system out and now we have PRODA that will provide us with access to HPOS and within HPOS to the PBS Authority system.

Being a naturally curious person and having a rare free moment I decided to give the new access system a trial run this morning.

It was not very re-assuring:

  • Time from opening the PRODA webpage to the stage where I could press the submit button to apply for the approval – six minutes. Assuming  that there are no further steps beyond pressing the submit button we therefore find that we are spending around 40% of an average consult’s time on gaining approval for one lone authority script. A process that will have to be repeated for every single authority script. A process that will cost the patient and/or Medicare money each time I do it as I will not be doing it for free in my free time afterhours
  • The process described above involved clicking on a button no less than sixteen times
  • I had to enter data, click on boxes or choose items from a dropdown list no less than ten times during the process. A slow process for a two finger typist such as myself.

A chat with some industry insiders revealed that the plan was to have the PRODA process integrated with the desktop software that most GPs have in their clinics.

For all practical purposes would simply mean that the vast majority of approvals would be part of the streamlined group. This would be a good thing however software designers are notoriously slow in catching up on these things. An example that springs to mind is how the most commonly used desktop program that GPs use still refer to My Health Record as the PCEHR – over a year since the description had changed.

Many Clinicians applying for Authority Approvals are off course also not General Practitioners and any reduction in a telephonic service will have an impact on them – the likely flow-on effect of this work being dumped on the patient’s GP

I cannot see the Health Department placing any urgency on integrating  GP desktop programs with the changes. Once they have cut the costs of running the Authority system by reducing the costs involved in running a phone system, sorry, I should say by saving time for doctors and patients, they will wash their hands of the issue as it is no longer their concern, is it?

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