Nzeps Access Prerequisites Reference Guidelines for General Practice for Medtech Sites

New Zealand electronic Prescription Service Access Prerequisites

Reference Guidelines for General Practices (Including Prerequisites for controlled drugs)

Applicable to Medtech32 latest version and Medtech Evolution latest version

Version 1.0 Date: December 2016 Document information

Version 1.0 Prepared December 2016 Author Gordon Chamley

Review

Name Reviewer’s Role Comments Mark Anderson NZePS Programme Director Clare Kirk NZePS Change Manager

Approval

Name Approver’s Role Signature Date

Document Version History

Version Date Description 11/4/201 Draft for discussion. 0.1 6 14/4/201 Revised draft, restructured. 0.2 6 19/4/201 Restructuring and further revision. 0.3 6 20/4/201 Further restructuring and revision. 0.4 6 21/4/201 Title page reformat and general revisions. 0.5 6 26/4/201 First draft for review (very draft). 0.6 6 27/4/201 Revisions to ‘First draft for review’. 0.7 6 29/4/201 Revisions from review by Clare Kirk. Second 0.8 6 draft for (wider) review. 13/5/201 Revisions to ‘Second draft for review’. 0.9 6 0.10 1/6/2016 IT Support drafts from Peter Sergent added. 0.11 9/6/2016 Develop incomplete sections. 10/6/201 Reviewed ‘Beta site draft release’. 0.12 6 14/6/201 Revisions to ‘Beta site draft release’. 0.13 6 22/11/20 Updated after Sector Operations review 0.14 16 6 / Finalised after review 1.0 12/2016

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Disclaimer Whilst every reasonable effort has been taken to ensure information accuracy within this publication, the New Zealand Ministry of Health make no warranty or guarantee that the information is error-free and will bear no responsibility for the results or consequences or the use of this publication NZePS Access Prerequisites – Reference Guidelines for General Practices

Table of Contents

Version 1.0 Last Updated 13 Apr 2017 Page 4 of 44 NZePS Access Prerequisites – Reference Guidelines for General Practices

A.1. Purpose of this Document The purpose of this document is to ensure the practice has a smooth transition to accessing the NZ ePrescription Service (NZePS). In order to achieve this purpose, the document: 1. Supports a clinical walkthrough at the practice of core NZePS functionality. 2. Guides the practice administrator in incident prevention and efficient incident handling. 3. Guides the practice’s IT technical support in ensuring NZePS technical requirements are met, and in efficient incident handling. 4. Specifies the process for requesting Ministry approval to prescribe controlled drugs on standard prescription forms using NZePS.

A Glossary of Terms used in this document may be found in Glossary: Glossary. A Preparedness Checklist can be found at the end of this document.

A.2. Audience for this Document This document is directed to general practices that are implementing NZePS to improve the management of prescriptions, including controlled drug prescriptions. It is intended for use by the persons fulfilling the following roles for that general practice:  The practice NZePS prescriber ‘champion’.  The practice NZePS administrator/manager.  The IT support professionals that service the practice’s computer systems. It will also be useful to all prescribers and non-prescribing nurses within the general practice who are likely to use NZePS to prescribe or to support prescribers.

A.3. Overview of NZePS NZePS allows prescribers in approved practices to electronically generate and transmit a prescription for medicines to a pharmacy, and for the pharmacy to update the electronic prescription with the dispensed medicines record to return to the prescriber. Closing the feedback loop between prescriber and pharmacist through NZePS will over time enable significant quality improvements in medicines management. When the prescriber with access to NZePS prints a prescription, a unique identifier for the prescription is created by NZePS. The PMS prints the identifier as a barcode on the prescription form. At the same time, an electronic version of the prescription is created and sent encrypted to the NZePS health information exchange broker (NZePS broker). As at June 2016, 976 pharmacies (98% of all pharmacies) have access to the broker service, via Connected Health. When the patient presents the prescription at a pharmacy, the barcode can be scanned to allow the identifier to be quickly entered into the Pharmacy Management System (PhMS) and for the PhMS to request the electronic version of the prescription from NZePS. Different PMS vendors have implemented different secure networks to connect practices to NZePS. MyPractice sites connect directly by the secure health network, Connected Health. Medtech sites connect via a Medtech managed ‘Cloud’ based service, which then connects to Connected Health. Regardless of which method of connection is used, any practice accessing NZePS must ensure their IT, and their selected provider’s IT, comply with the privacy and security requirements of HISO 10029:2015 Health Information Security Framework. NZePS also allows a pharmacist to create an electronic prescription record when needed e.g. from a paper prescription without a printed barcode; or when the prescriber generated electronic prescription can’t be downloaded from NZePS; or when dispensing from a phone conversation with a prescriber for an unsigned or referred prescription; or other special cases such as from a Rest Home chart or Standing Order. Currently 97% of the approximately 20 million electronic prescription records per year processed by NZePS are ‘dispensed prescriptions’, created at one of the 976 pharmacies connected to NZePS, when a pharmacist dispenses using a paper prescription only. When the NZePS quality

Version 1.0 Last Updated 13 Apr 2017 Page 7 of 44 NZePS Access Prerequisites – Reference Guidelines for General Practices improvement ‘closed loop’ is fully functioning this percentage should drop from 97% to less than 1%. Benefits  The process for faxed prescriptions is made easier by eliminating the need to post the original signed, printed prescription for non-controlled drugs to the receiving pharmacy, or for the pharmacy to return a faxed copy to the prescriber for signing. The ePrescription must be downloaded from NZePS at the pharmacy.  Once a practice has Ministry approval to generate NZePS controlled drugs the triplicate form can be eliminated as long as all conditions are met.  The prescriber can provide a comment for the pharmacist (e.g. why an unusual dose has been prescribed) thereby eliminating the need for a phone call from the pharmacist.  The pharmacist can also provide a comment for the prescriber when dispensing.  The prescriber can choose to be notified after ‘n’ days if a patient’s medication has not been dispensed.

A.4. Getting started

4.1 Steps to follow when your practice decides to access NZePS

1. Let your PHO know of the practice’s interest in using NZePS. 2. Identify an NZePS prescriber ‘champion' for the practice to work with the practice manager and IT support person. 3. Upgrade to the latest version of Medtech (check with Medtech). 4. When ready to access NZePS complete and sign the Medtech Service Activation Form (SARF) found on the Medtech website and send to Medtech. Details in link below http://www.medtechglobal.com/chis/ 5. Practice manager, prescriber ‘champion' and the practice IT support person read and become familiar with the NZePS Access Prerequisites - Reference Guidelines for General Practices http://www.health.govt.nz/our-work/ehealth/other-ehealth- initiatives/emedicines/new-zealand-eprescription-service 6. AND familiarise themselves with the NZePS functionality. Refer to Medtech’s 'User Guide' and 'Quick Reference Guide' on the Medtech website. http://www.medtechglobal.com/chis/ 7. Communicate with your key local pharmacies to let them know the practice will soon access NZePS and start to generate barcoded prescriptions. Communication between the practice and local pharmacies is a key criterion for success of NZePS. It means both parties understand the impact on the other if things are not right and both can then realise the benefits of NZePS. 8. Medtech will be in touch to activate the practice for NZePS. 9. Once Medtech has activated the practice for NZePS the practice manager/administrator can set up the 'prescriber champion'. Refer to Medtech 'Set up Guide' on Medtech website. http://www.medtechglobal.com/chis/ 10. The practice manager / prescriber ‘champion’ / practice IT support person check off the Preparedness Checklist at the back of the NZePS Access Prerequisites - Reference Guidelines for General Practices.

11. Prescriber ‘champion' starts to generate barcoded prescriptions. Initially this is for non-controlled drug prescriptions only (2 weeks minimum). 12. The Ministry or Medtech will advise the practice if there have been any unexpected instances where ePrescriptions have not been able to be downloaded from NZePS at the pharmacy for any reason e.g. may be a technical issue at the practice or pharmacy end. The Ministry receives a daily report on this from NZePS and they or Medtech will be in touch if the practice keeps showing up on this daily report.

A.5. Controlled Drugs

5.1 Process for Ministry approval to generate controlled drug prescriptions

1. Once Medtech has activated the practice to access NZePS the prescriber ‘champion' is set up by the practice administrator and starts to generate barcoded prescriptions. Initially this is for non-controlled drug prescriptions only for a minimum of 2 weeks. 2. The Ministry or Medtech will advise the practice if there have been any unexpected instances where ePrescriptions have not been able to be downloaded from the NZePS broker at the pharmacy for any reason e.g. may be a technical issue at the practice or pharmacy end. The Ministry receives a daily report on this from NZePS and they or your software provider will be in touch if the practice keeps showing up on this daily report. 3. If no unexpected instances over the 2 week period (i.e. the practice has not heard from the Ministry Contact Centre or Medtech) then the practice administrator can set up other prescribers in the practice for NZePS. Again this is for non-controlled drug prescriptions only. 4. If no unexpected instances over a period of a month (i.e. the practice has not heard from the Ministry Contact Centre or Medtech) the practice can request Ministry approval to generate NZePS controlled drug prescriptions if they feel ready to do this. Email [email protected] (Reference NZePS / Request Approval for CDs).

Note: The practice must wait to receive Ministry approval (by email) before starting to generate NZePS controlled drug prescriptions.

By generating NZePS controlled drug prescriptions the practice is consenting to agree to and meet the three conditions of the in-market trial and the Requirements for NZePS controlled drug prescriptions (refer below).

5.2 NZePS in-market trial conditions

Once Ministry approval is given for a practice to generate NZePS controlled drugs the practice will be required to

Version 1.0 Last Updated 13 Apr 2017 Page 11 of 44 NZePS Access Prerequisites – Reference Guidelines for General Practices rigorously meet the same three conditions agreed to by the initial in-market controlled drug trial sites. These three conditions will remain in place until formal notice of the in-market trial being finished is provided by the Ministry. The timeframe for this is still to be determined.

The three conditions are:

1. The practice must limit the flow of NZePS controlled drug prescriptions to specific ‘named’ pharmacies where the majority of their controlled drug prescriptions flow. The practice decides which pharmacies these are.  The practice must get each pharmacy’s agreement to receive NZePS controlled drug prescriptions and to dispense via NZePS.

2. The prescriber must ensure that the patient understands that the NZePS controlled drug prescription must only be taken to one of the ‘named’ pharmacies and be presented during normal working hours (for both the pharmacy and the practice).  NOTE: The patient must retain the right to choose where they take their prescription to be filled. If a patient does not wish to take their controlled drug prescription to one of the ‘named’ pharmacies then the prescriber will need to complete a triplicate form. 3. The prescriber must ensure that the patient understands that if, for any reason, the ePrescription for controlled drugs is not able to be downloaded from NZePS then it is not a legal prescription and can’t be dispensed. A triplicate form will then be required.  If a triplicate form is required the prescriber must CANCEL the original ePrescription before completing a triplicate form.

5.3 Requirements for NZePS controlled drug prescriptions

1. NZePS controlled drug items must be printed on a separate prescription form to that of non-controlled drugs except where the ingredients are used in the making of syringes and clear instructions stipulate the medicines to be included in the syringe. Multiple controlled drug items can be printed on the same prescription form. If there are too many controlled drug items to fit on one page then multiple pages will be

printed. All pages will have the same barcode number and are treated as one prescription. 2. The barcode and barcode numbers must exist and be legible. Please check before giving the signed barcoded prescription to the patient.

3. If a patient presents with a request to reissue an NZePS controlled drug prescription (for whatever reason) then:  Do not issue a triplicate paper form or repeat new ePrescription unless ePrescription for controlled drug in question is SUCCESSFULLY cancelled i.e. The NZePS medication Status must indicate “Cancelled”  When reprinting a Prescription use the ‘Reprint’ function as this will generate a prescription with the same barcode number as the original, ensuring it can only be dispensed once.  If ‘DO REPEAT’ function is used then the second Prescription will have a new barcode and will be treated as a new prescription (as in issuing repeats). Note: If for any reason the NZePS controlled drug prescription is not able to be downloaded from NZePS at the pharmacy it is not a legal prescription. The pharmacist will need to request a triplicate form unless the cause of the error is able to be quickly identified and fixed.

A.6. Clinical Preparedness for NZePS

6.1 Role of the Practice NZePS Prescriber ‘Champion’

This person will act as the lead clinical change agent within the practice organisation. As a minimum, the prescriber ‘champion’ will lead decision making during the planning stages, negotiate consensus among all those involved in implementing NZePS at the practice, and maintain communication and enthusiasm during implementation. The prescriber ‘champion’ should be a respected and recognised leader within the practice as well as a practitioner who will ultimately use the system alongside his or her colleagues. Having a prescriber in this role is considered by some to be a critical success factor.

6.2 Familiarity with the Medtech NZePS Training Materials

The prescriber ‘champion’ should be familiar with the following training materials for either Medtech32 (refer to Appendix Medtech32 NZePS Documents Medtech32 NZePS Documents) or Evolution (refer to Appendix Evolution NZePS Documents Evolution NZePS Documents):  NZePS Electronic Prescribing User Guide – Prescribing  NZePS Electronic Prescribing User Guide – Setup  NZePS Quick Reference Guide – Prescribers  NZePS Quick Reference Guide System – Administrator  Medtech NZePS Webinars (refer to Appendix Medtech NZePS Webinars Medtech NZePS Webinars).

6.3 Prescriber Responsibilities for NZePS Prescriptions

Each prescriber that will use NZePS to generate electronic prescriptions shall: 1. understand the importance of ensuring that the barcode and barcode number are clearly legible on every paper prescription, so that the pharmacy can use them to retrieve the electronic copy of the prescription from the NZePS broker

Example of barcode and barcode number:

2. know how to access and process notifications of dispensing and pharmacist changes, 3. know how to process Referred and Unsigned NZePS prescriptions (NOTE: functionality currently on hold, future use)

6.4 Prescriber Responsibilities for NZePS controlled drug Prescriptions

The prescriber has additional responsibilities generating NZePS controlled drug prescriptions and should be able to demonstrate their understanding of these. A controlled drug prescription can be either:  An H572 or H572M triplicate prescription form provided by the Director General of Health and completed in the handwriting of the controlled drug prescriber; or  An NZePS controlled drug prescription form electronically generated by a system approved by the Director General of Health containing a barcode which is scanned (or the barcode number is manually entered if the scan fails). For an NZePS controlled drug prescription to be a legally dispensed: a) the paper copy of the prescription must:  be the original signed copy, or a faxed copy of it with the original signed copy forwarded to the pharmacy within two business days b) the electronic copy of the prescription must:  be downloaded from the NZePS broker by the pharmacist using the paper prescription’s barcode or barcode number Note: An NZePS controlled drug prescription is not a legal controlled drug prescription until the barcoded prescription has been downloaded from the NZePS broker (electronic prescription repository) Thus, controlled drugs may NOT be dispensed from an NZePS controlled drug prescription (i.e. it is not a triplicate H572 form) if that prescription is unable to be downloaded from the NZePS broker at the pharmacy.

Each prescriber that will use NZePS to generate NZePS controlled drug prescriptions shall:

1. do so only within a practice that has Ministry of Health approval to generate NZePS controlled drug prescriptions 2. understand and meet the NZePS controlled drug in-market trial conditions 3. understand and meet the requirements for NZePS controlled drug prescriptions 4. understand the requirement to ensure that the barcode and barcode number on every paper prescription for NZePS controlled drugs are clearly legible as the prescription cannot otherwise be dispensed without the triplicate form 5. understand their responsibilities around faxed prescriptions for NZePS controlled drugs (i.e. that the signed original of a faxed NZePS controlled drug prescription must be forwarded to the dispensing pharmacy within two business days) 6. understand their responsibilities around reprinting prescriptions for NZePS controlled drugs, should they be lost, stolen etc. and know how to do this (i.e. must use the Reprint functionality so that the reprinted prescription has the same barcode and barcode number as the original copy of the NZePS controlled drug prescription)

A.7. Clinical Familiarisation with NZePS The following tasks are designed to familiarise prescribers, and the practice administrator, with the range of new functions enabled by NZePS.  Producing and processing NZePS prescriptions, including for NZePS controlled drugs  Improved processing of faxed, unsigned, and referred prescriptions The tasks in this familiarisation programme require joint planning and cooperation between the general practice and the local pharmacy. It is essential for each of these tasks that the pharmacy dispenses electronically using NZePS (i.e. successfully retrieves the ePrescription using the barcode / barcode number and dispenses from that), rather than doing a ‘manual’ dispensing. In these tasks the following codes are used to denote the person conducting that part of the task: AP: The authorised prescriber at the general practice (e.g. a general practitioner, a nurse practitioner etc.) N: A nurse generating a repeat prescription for the authorised prescriber to authorise. There must be local policy to guide this process to clarify that the nurse is not prescribing in this instance and that the authorised prescriber is accountable for the prescription. DP: The dispensing pharmacist at the pharmacy processing the NZePS prescription. Test Patients listed in ‘NHI Numbers Allocated for Production Testing. NHI Numbers Allocated for Production Testing’ are available to use for the following tasks. IMPORTANT: When using test patients, prescribe only non- subsidised medicines to avoid the possibility of the pharmacy accidently making a payment claim. When in doubt about how to complete any of these tasks, refer in the first instance to the training materials detailed in section Familiarity with the Medtech NZePS Training Materials Familiarity with the Medtech NZePS Training Materials.

7.1 Manage Prescriptions

7.1.1 New Prescription AP. .Produce a prescription using Generic Name of Medicines and print paper copy. Before signing prescription, check

that barcode and barcode number below signature line are legible. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and check that the prescription details are identical to those on the paper copy. Dispense the prescription. AP. .Check prescription status indicates it has been dispensed.

7.1.2 Repeat Prescribing of Regular Prescription Items AP. .Prescribe medications that this patient has had prescribed previously (a repeat prescription) and print paper copy. Check that barcode and barcode number are legible. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and dispense it. AP. .Confirm dispensed status.

7.1.3 Amending a Prescription AP. .Produce a prescription using Generic Name of Medicines and print paper copy. Amend prescription item and print prescription. Amended prescription is printed with a new barcode and barcode number. Original prescription is cancelled automatically at the NZePS broker and can no longer be used for dispensing.

7.1.4 Cancelling a Prescription Item before Dispensing AP. .Produce a prescription using Generic Name of Medicines and print paper copy. Cancel prescription item: cancellation succeeds. If this is a real-life situation and the patient has already left the practice, then it is advisable to contact the patient or pharmacy, if known, to explain that a prescription item has been cancelled.

7.1.5 Prescribing with Two Repeats using Generic Name of Medicines AP. .Produce a prescription using Generic Name of Medicines, with two repeat dispensings of the medicines, and print paper copy. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and dispense it. AP. .Confirm dispensed status. DP. .Retrieve prescription from NZePS broker and dispense first repeat. AP. .Confirm dispensed status. Cancel prescription item: cancellation fails because item is part-dispensed.

7.1.6 Prescribing with ‘Brand Substitution Allowed’ Note that prescribing using generic names of medicines is the standard and this example is given only to demonstrate the use of the ‘Brand Substitution Allowed’ feature in exceptional situations. AP. .Produce a prescription using Brand Name of Medicines endorsed with ‘Brand Substitution Allowed’ and print paper copy. Take to pharmacy. DP. .Retrieve prescription from NZePS broker, dispense the subsidised generic, and add a note to the prescriber indicating brand changed (refer to Accessing and Viewing Pharmacist Comments Accessing and Viewing Pharmacist Comments). AP. .Confirm dispensed status. Request and receive pharmacist’s note to prescriber. Acknowledge notification received and display pharmacist’s note to prescriber.

7.1.7 Prescribing a Multi-Page Prescription AP. .Produce a prescription using Generic Name of Medicines, containing multiple prescription items such that the printed paper copy extends over several pages, and print paper copy. Check that the barcode and barcode number are identical and legible on every page of the printed paper copy. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and check that the prescription items are in identical sequence to those on the paper copy. Dispense the prescription.

7.1.8 Reprinting an Undispensed Prescription This function is used to replace a lost or destroyed, undispensed prescription with an identical copy, including the barcode and barcode numbers. Having identical barcode and barcode numbers on the copy ensures that the prescription can be dispensed only once, since the electronic copy on the NZePS broker will have a status of ‘dispensed’ as soon as any copy of the prescription is dispensed. If the original prescription was stolen then it could be cancelled and a new prescription created to replace it. This would prevent the original prescription from being dispensed using NZePS although, unlike an NZePS controlled drug prescription, it could still be dispensed manually. This task is intended to demonstrate both the Reprint function and how an NZePS prescription cannot be dispensed twice – once from the original prescription and once from the Reprint. AP. .Produce a prescription using Generic Name of Medicines and print paper copy. Check that barcode and barcode

number are legible. After checking that status is ‘Active’ and NOT ‘Dispensed’, use the ‘Reprint’ function to print a copy of the prescription. Notice that the original prescription and the reprint are identical, including the barcode and barcode number. Take both original prescription and reprint to pharmacy. DP. .Retrieve prescription from NZePS broker using the ‘copy’ prescription and check that the prescription details are identical to those on the paper copy. Dispense the prescription. Retrieve prescription from NZePS broker again using the original prescription and check that the prescription details are identical to those on the paper copy. Attempt to dispense the prescription; dispense fails as it is already dispensed. AP. .Confirm dispensed status.

7.1.9 Nurse Generating and Printing an Unapproved Repeat Prescription N. . .Produce a repeat prescription using Generic Name of Medicines and use ‘print and park’ function to print a draft paper copy of prescription. Check that NO barcode or barcode number are printed on draft prescription, but that ‘DRAFT’ is printed on it.

7.1.10 Reviewing a Repeat Prescription, Editing, Approving, and Printing AP. .Retrieve repeat prescription that was produced by nurse, edit prescription as required, then approve it and print paper copy. Check that barcode and barcode number are legible. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and check that the prescription details are identical to those on the paper copy. Dispense the prescription. AP. .Confirm dispensed status.

7.2 Fax Prescriptions

7.2.1 Faxing an NZePS Prescription AP. .Produce a prescription using Generic Name of Medicines and print paper copy. Fax to pharmacy. DP. .Check that barcode and barcode number are legible on faxed copy of prescription. Retrieve prescription from NZePS broker by scanning barcode on faxed copy, and dispense it.

7.2.2 Faxing an NZePS controlled drug Prescription This is the same process as detailed in Faxing an NZePS Prescription Faxing an NZePS Prescription, with the additional condition for NZePS controlled drug prescriptions that the signed original prescription must be sent to the dispensing pharmacy within two business days.

7.3 Unsigned Prescriptions

NOTE: The electronic unsigned prescription process is currently on hold and is for future use. The current manual process for unsigned prescriptions should still be used.

7.3.1 Viewing and Accepting an Unsigned ePrescriptions in Provider Inbox AP. .Request a pharmacist, either by phone or via a rest home administration chart, to create a prescription. DP. .Produce a prescription as requested then send to the prescriber a paper copy for a signing, and an electronic copy for updating the patient record. AP. .Receive, sign, and return to the pharmacist the paper copy of the prescription. Receive electronic unsigned prescription message in Provider Inbox, acknowledge it is correct, and ‘Accept’.

7.3.2 Viewing and Rejecting an Unsigned ePrescription in Provider Inbox AP. .Request a pharmacist, either by phone or via a rest home administration chart, to create a prescription. DP. .Produce a prescription as requested then send to the prescriber a paper copy for a signing, and an electronic copy for updating the patient record. AP. .Receive the paper copy of the prescription, determine it is incorrect and notify the pharmacist. Receive electronic unsigned prescription message in Provider Inbox and ‘Reject’. DP. .Correct the prescription according to the prescriber’s reason and re-send the paper. AP. .Receive, sign, and return to the pharmacist the paper copy of the prescription. Receive electronic unsigned prescription message in Provider Inbox, acknowledge it is correct, and ‘Accept’.

7.4 Referred Prescriptions

NOTE: The electronic referred prescription process is currently on hold and is for future use. The current manual process for referred prescriptions should still be used.

7.4.1 Viewing and Accepting a Referred ePrescription in Provider Inbox AP. .Produce a prescription using Generic Name of Medicines and print paper copy. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and check that the prescription details are identical to those on the paper copy. Determine that a change to the prescription that is outside the pharmacist’s scope of practice and agree this with the prescriber. Change the prescription accordingly, dispense the amended prescription, then send to the prescriber a paper copy for a signing, and an electronic copy for updating the patient record. AP. .Receive, sign, and return to the pharmacist the paper copy of the prescription. Receive electronic Referred prescription message in Provider Inbox, acknowledge it is correct, and ‘Accept’.

7.4.2 Viewing and Rejecting a Referred ePrescription in Provider Inbox AP. .Produce a prescription using Generic Name of Medicines and print paper copy. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and check that the prescription details are identical to those on the paper copy. Determine a change to the prescription that is outside the pharmacist’s scope of practice and agree this with the prescriber. Change the prescription accordingly, dispense the amended prescription, then send to the prescriber both a paper copy for signing, and an electronic copy for updating the patient record. AP. .Receive the paper copy of the prescription, determine it is incorrect and notify pharmacist. Receive electronic Referred prescription message in Provider Inbox and ‘Reject’. DP. .Correct the prescription according to the prescriber’s reason and re-send the paper and electronic copies to the prescriber. AP. .Receive, sign, and return to the pharmacist the paper copy of the prescription. Receive electronic Referred prescription message in Provider Inbox, acknowledge it is correct, and ‘Accept’.

7.5 Supplementary Information for Pharmacist

Whenever a prescriber adds supplementary information for the pharmacist, the information is added to the NZePS copy of the prescription that the pharmacist can retrieve and view on- screen, but is not printed on the paper copy of the prescription. Instead, an envelope icon is printed at the bottom right of the paper copy of the prescription to indicate that supplementary information for the pharmacist has been added to the NZePS copy of the prescription. Example of the envelope icon:

7.5.1 Marking Prescription with Unusual Dose Quantity and Adding Explanatory Comment AP. .Produce a prescription using Generic Name of Medicines, mark it as Unusual Dose Quantity and add reason for this (refer to appropriate Medtech User Guide – Prescribing New Medications Features), then print paper copy. Before signing prescription, check that barcode and barcode number below signature line are legible and that there is an envelope icon to the right of prescriber signature line. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and check that the prescription details are identical to those on the paper copy. Note the envelope icon on the paper copy and find the Unusual Dose Quantity indicator and its explanatory comment. Dispense the prescription. AP. .Check prescription status indicates it has been dispensed.

7.5.2 Adding Prescribing Reason to Prescription AP. .Produce a prescription using Generic Name of Medicines, add a Prescribing Reason (Refer to appropriate Medtech User Guide – Prescribing New Medications Features), then print paper copy. Before signing prescription, check that barcode and barcode number below signature line are legible and that there is an envelope icon to the right of prescriber signature line. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and check that the prescription details are identical to those on the

paper copy. Note the envelope icon on the paper copy and find the Prescribing Reason. Dispense the prescription. AP. .Check prescription status indicates it has been dispensed.

7.6 Accessing and Viewing Pharmacist Comments

7.6.1 Viewing Pharmacist Comments in Provider Inbox and from View ePrescription Module AP. .Produce a prescription using Generic Name of Medicines and print paper copy. Before signing prescription, check that barcode and barcode number below signature line are legible. Take to pharmacy. DP. .Retrieve prescription from NZePS broker and check that the prescription details are identical to those on the paper copy. Add a Comment to the prescription. Dispense the prescription. AP. .Check prescription status indicates it has been dispensed. Find Comment added by pharmacist: Method 1: Look in Provider Inbox Method 2: Look in View ePrescription Module.

A.8. Management and Administrative Preparedness for NZePS

8.1 Role of the Practice NZePS Administrator

This person will drive the NZePS implementation process by tracking and supervising the activities that need to take place. In the planning stages, the practice NZePS administrator will ensure that the necessary information is gathered and provided to the key decision makers and that decisions are made in a timely and appropriate manner. During the later implementation phases, this person will, at a minimum, create and oversee the timeline for setup, training, and launch. In some practices, the practice manager may step into the practice NZePS administrator role; in other practices, a reliable and respected consultant could fulfil this role. In rare instances, the same person may act both as practice NZePS prescriber champion and as practice NZePS administrator.

8.2 Familiarity with the Medtech NZePS Training Materials

The practice NZePS administrator should be familiar with the following training materials for either Medtech32 (refer to Appendix Medtech32 NZePS Documents Medtech32 NZePS Documents) or Evolution (refer to Appendix Evolution NZePS Documents Evolution NZePS Documents):  NZePS Electronic Prescribing User Guide – Setup  NZePS Quick Reference Guide System – administrator It is also recommended that the practice NZePS administrator views at least the NZePS Setup and Configuration segment of the Medtech NZePS Webinars (refer to Appendix Medtech NZePS Webinars Medtech NZePS Webinars).

8.3 Incident Prevention and Handling

An NZePS incident is any issue related to system performance, unexpected behaviour, application errors, or loss of connectivity affecting the NZePS service’s ability to function effectively.

8.3.1 Incident Mitigation The practice NZePS administrator should mitigate the occurrence of NZePS incidents originating from the practice by following the relevant ‘NZePS Quick Reference Guide System – administrator‘, and by ensuring that all aspects of the systems are maintained, such as:

 PMS vendor software is kept up-to-date  Regularly check that good quality, legible output is produce by all printers and fax machines that are used for printing or transmitting prescriptions

8.3.2 Incident Remediation Incidents may be reported to the practice NZePS administrator by:  prescribers or others within the practice  pharmacists experiencing difficulty with an ePrescription from the practice  IT support contacts for your practice or other organisations  the Ministry online helpdesk Attempt to identify the full symptoms of the incident, and determine the possible causes. Address each of these, and then test whether the incident is remedied. If it is, advise the party who reported the incident that it has been remedied. For example, if the printed copy of the prescription cannot be scanned by the pharmacist, check if the print quality of the prescription is satisfactory, identify the source printer of the prescription and make a test print on the printer, then if necessary replace the ink or toner cartridge to see if that corrects the print quality. Refer to section Troubleshooting Guide Troubleshooting Guide for assistance with known incident types. If the cause of the incident cannot be determined or remedied then it will be necessary to report the incident to the appropriate first level support organisation for logging and resolution.

8.3.3 Incident Reporting and Logging Whenever an incident occurs that is beyond the practice to resolve, it should be reported to the appropriate first level support organisation for logging and resolution. Depending on the type of problem, this may be your IT technical support or your PMS vendor (i.e. Medtech helpdesk). In some instances it may be appropriate to contact the Ministry online helpdesk, although this is normally done on your behalf by your first level support contact if they are unable to remedy the incident themselves. Help and support contact details can be found in Help and Support. Help and Support. This section is part-completed: the incomplete details vary by practice and the practice NZePS administrator should determine and complete them.

When emailing the Ministry of Health online helpdesk, please insert ‘NZePS’ as the reference at the start of the email subject.

A.9. Management and Administrative Set up for NZePS

9.1 Check HPI facility ID

The practice NZePS administrator should ensure that the practice HPI facility ID, including a hyphen and the check digit (e.g. F0A123-B), is correctly set up in Medtech. To ensure you have the correct HPI facility ID, refer to the table at http://www.health.govt.nz/nz-health-statistics/data-references/code- tables/common-code-tables/facility-code-table. If your practice name and HPI facility ID is not listed in this table then a new HPI facility ID may be obtained from [email protected].

9.2 Set up Access to NZePS for Practice NZePS Prescriber Champion

Follow the instructions in Medtech’s document ‘NZePS Electronic Prescribing User Guide – Setup’ (refer to Appendix Medtech32 NZePS Documents Medtech32 NZePS Documents) or Evolution (refer to Appendix Evolution NZePS Documents Evolution NZePS Documents) to activate the practice for NZePS and provide access for the NZePS practice prescriber champion.

9.3 Check Print Quality of Practice Printers

On every page of all prescriptions printed from every printer at the practice that could be used for printing prescriptions:  The barcode number must be clearly legible to anyone reading it  The barcode must be legible in every instance when read with a pharmacy barcode scanner If this is not the case then it is necessary to identify which printers are at fault, and then remedy this.

9.4 Check Fax Quality with Local Pharmacies

On every page of all prescriptions received at a local pharmacy by fax from every fax machine at the practice that could be used for faxing prescriptions:  The barcode number must be clearly legible to anyone reading it  The barcode must be legible in every instance when read with a pharmacy barcode scanner

If this is not the case then it is necessary to determine whether the sending or receiving fax machine is at fault, and then remedy this.

A.10. IT Technical Support Preparedness for NZePS

10.1.1 Ensuring reliable network communications The success of the NZePS ecosystem is dependent on reliable communications between the networked system components. From the practice perspective this entails:  A reliable internet connection  A functioning message pathway to and from the Medtech hub  Legible printing and faxing of prescription barcodes and barcode numbers This will involve the practice IT support team working collaboratively with Medtech technical support technicians to ensure this is in place and functioning effectively, and may involve some or all of the following:  Internet connections  Routers  Firewall settings  Platform / software configuration  Other security considerations  Troubleshooting printers and fax machines

10.1.2 Incident Reporting and Logging (refer 6.3.3)

A.11. IT Technical Support End-to-End Connectivity Testing Once Medtech technical support has completed activation for the practice to access NZePS, they will conduct end to end testing with dummy prescriptions for test patients. If connectivity issues arise during this testing then they may seek the assistance of the practice IT support team at this time to help resolve any issues.

A.12. Troubleshooting Guide The following table contains the most common issues that arise, the impact that this has on the person experiencing the issue, and a link to the detailed guide, below, that indicates the appropriate course of action to resolve the issue.

Symptoms Impacts Possible Causes and Recommended Actions / Remedy ePrescription status Unable to dispense NZePS Unavailable remains as “To be NZePS controlled If the View ePrescribing Module fails to update the Status of Sent” in View drugs. Prescriber an ePrescription from “To be Sent” to “Active” within a few ePrescribing must retain paper minutes of printing the prescription then this is an Module of Medtech copy, cancel indication that ePrescriptions are not reaching the NZePS electronic copy, broker from the practice. For NZePS controlled drug and re-prescribe prescriptions this is a critical issue that prevents manually on 3-part dispensing. This condition may be caused by one of the form. following: More effort to  dispense non- The system configuration at the practice has been changed controlled drug and is now faulty – contact the practice’s IT Support prescription provider. manually.  The NZePS connection between the practice and the NZePS broker is faulty – contact Medtech Helpdesk.

Pharmacy cannot Unable to dispense SCID Unreadable retrieve NZePS controlled When the barcode (SCID) on the paper prescription cannot be ePrescription drugs. Prescriber scanned by the pharmacy barcode reader and the barcode number must re-prescribe cannot be typed in because it is illegible, the pharmacy on 3-part form. should first determine whether this is the original paper More effort to prescription or a faxed copy of it. dispense 1. If the paper prescription is a faxed copy: prescription The pharmacy should check and, if necessary, remedy the manually. quality of its fax machine output then request the prescription be re-faxed. Once fax output quality is eliminated as the root cause, the pharmacy should contact the originating practice of the prescription and report the print quality issue. The originating practice should then check the original paper prescription to determine whether the prescription printer of the practice fax machine is the root cause, and remedy this accordingly. The original prescription should then be re-faxed. 2. If the paper prescription is the original: The pharmacy should contact the originating practice of the prescription and report the print quality issue. The practice should then check the quality of its prescription printer output and remedy any faults (e.g.

Symptoms Impacts Possible Causes and Recommended Actions / Remedy toner low), then re-print the prescription with a legible barcode and barcode number and, depending on urgency, fax or send it to the pharmacy. Server Unavailable This indicates that the pharmacy system is not communicating with the NZePS broker. The pharmacy should contact their IT provider to remedy this. SCID Unavailable When the barcode (SCID) on the paper prescription has been scanned by the pharmacy barcode reader, or the barcode number has been entered by the pharmacist, and an ‘ePrescription could not be fetched’ or ‘The script is not on the HIE Servers’ message (or similar) is returned by the NZePS broker, the most likely cause is that the prescription has not reached the NZePS broker from the practice. This may occur for just one, or for all, of the prescriptions issued by that practice. The pharmacy should contact the practice and ask them to check that their prescriptions are getting to the NZePS broker (check the status of the missing prescriptions in the practice PMS). If not, the practice may need to contact their IT provider to remedy this.

Contents of paper Consumes Prescription Discrepancy and NZePS prescriber and The contents of the paper prescription do not match the prescriptions do not pharmacist time contents of the NZePS prescription retrieved by the pharmacy match resolving the from the NZePS broker. This is a serious issue that should be discrepancy. reported to the Ministry of Health Online Helpdesk. Attach a scan of the paper prescription and a screenshot of the electronic one (blank out personally identifiable data in both).

Contents of paper Consumes Prescription Altered by Hand prescription have prescriber and The contents of the paper prescription have been altered by been altered by pharmacist time hand. The pharmacy should contact the originating practice of hand resolving this the prescription to advise that prescriptions may be altered issue. only by using the prescribing functionality provided for this purpose and request the prescriber to amend the electronic prescription, print it with a legible barcode and barcode number, sign it, and, depending on urgency, fax or send it to the pharmacy. If this is a recurrent behaviour from the same practice then it should be reported to the Ministry of Health Online Helpdesk.

A.13. Background For newsletters, and the Connected Health Information Services Request Form, refer to the website links at NZePS Background NZePS Background in References: References. For answers to frequently asked questions about NZePS, refer to the website links at http://www.health.govt.nz/our- work/ehealth/other-ehealth-initiatives/emedicines/new-zealand- eprescription-service. http://www.health.govt.nz/our-work/ehealth/other-ehealth- initiatives/emedicines/new-zealand-eprescription-service in References: References.

A.14. References

A.15. Medical Council of New Zealand – Good Prescribing Practice This statement aims to assist doctors to maintain appropriate prescribing practice. (April 2010) https://www.mcnz.org.nz/assets/News-and- Publications/Statements/Good-prescribing-practice.pdf

A.16. Pharmacy Procedures Manual Pharmacy Procedures Manual V7.2 http://centraltas.co.nz/assets/Publications/Pharmacy- Documents/Funding-monitoring-and-processes/Pharmacy- Procedures-Manual/CPS012PharmacyProceduresManualV7.2.pdf

Pharmacy Procedures Addendum V7.2 http://centraltas.co.nz/assets/Publications/Pharmacy- Documents/Funding-monitoring-and-processes/Pharmacy- Procedures-Manual/CPS011PharmacyProceduresAddendum- V7.2.pdf

A.17. NZePS Background An overview of NZePS, periodic NZePS Newsletters, the Connected Health Information Services Request Form and FAQs can all be found here: http://www.health.govt.nz/our-work/ehealth/other-ehealth- initiatives/emedicines/new-zealand-eprescription-service

A.18. Medtech32 NZePS Documents NZePS Electronic Prescribing User Guide – Prescribing http://www.medtechglobal.com/wp- content/uploads/2016/02/NZePS-electronic-prescribing- Medtech32-User-Guide-Prescribing-FINAL.pdf

NZePS Electronic Prescribing User Guide – Setup http://www.medtechglobal.com/wp- content/uploads/2016/02/NZePS-electronic-prescribing- Medtech32-User-Guide-Setup-FINAL1.pdf

NZePS Quick Reference Guide – Prescribers http://www.medtechglobal.com/wp- content/uploads/2016/02/NZePS-Quick-Reference-Guide- Prescribers-FINAL.pdf

NZePS Quick Reference Guide System – administrator http://www.medtechglobal.com/wp- content/uploads/2016/02/NZePS-Quick-Reference-Guide- System-Administrators-FINAL.pdf

A.19. Evolution NZePS Documents NZePS Electronic Prescribing User Guide – Prescribing http://www.medtechglobal.com/wp- content/uploads/2016/02/Nzeps-electronic-prescribing- Evolution-User-Guide-Prescribing-FINAL1.pdf

NZePS Electronic Prescribing User Guide – Setup http://www.medtechglobal.com/wp- content/uploads/2016/02/NZePS-electronic-prescribing- Evolution-User-Guide-Setup-FINAL2.pdf

NZePS Quick Reference Guide – Prescribers http://www.medtechglobal.com/wp- content/uploads/2016/02/NZePS-Quick-Reference-Guide- Prescribers-FINAL2.pdf

NZePS Quick Reference Guide System – Administrators http://www.medtechglobal.com/wp- content/uploads/2016/02/NZePS-Quick-Reference-Guide- System-Administrators-FINAL2.pdf

A.20. Medtech NZePS Webinars Online video training materials http://www.medtechglobal.com/chis/  The webinar playlist is as follows:  Viewing Dispenser Comments  Viewing and Actioning Referred Prescriptions  Rejecting an Un-Matched Unsigned Prescription  Print and Park Feature  How to Amend a Medication  Actioning an Unsigned Prescription  NZePS Setup and Configuration  How to Prescribe a Medication

A.21. NHI Numbers Allocated for Production Testing

NHI Number Family Name, Given Names Gender Date of Birth ZZZ0016 ProdSmokeTest, Sector, One Male 20/11/2015

ZZZ0024 ProdSmokeTest, Sector, Two Male 3/5/2012

ZZZ0032 ProdSmokeTest, Sector, Male 29/8/1996 Three

ZZZ0059 ProdSmokeTest,, Sector, Male 3/7/1970 Four

ZZZ0067 ProdSmokeTest,, Sector, Male 6/9/1945 Five

ZZZ0075 ProdSmokeTest, Sector, Six Female 20/07/2015

ZZZ0083 ProdSmokeTest,, Sector, Female 12/6/2012 Seven

ZZZ0091 ProdSmokeTest, Sector, Female 22/5/1992 Eight

ZZZ0105 ProdSmokeTest,, Sector, Female 2/1/1965 Nine

ZZZ0113 ProdSmokeTest, Sector, Ten Female 6/4/1938

ZZZ9994 Labtest, John Male 1/1/1978

A.22. Help and Support

The empty cells in this table should be completed by the practice NZePS administrator with the contact names, telephone numbers, and email addresses of the support services that the practice would use in the event of incidents arising with their use of NZePS. It ensures that this aspect has been properly addressed, and provides a ready reference for contacting the support organisation when an incident occurs. Support Contact Name Telephone Email Address Organisation Number(s) Medtech Support Romit 0800 263 support@medtechglo Walters 3832 bal.com

IT Support Specialist

Ministry Online Nichola 0800 505 125 onlinehelpdesk@moh Helpdesk Collins .govt.nz

Other (specify)

A.23. Glossary

Glossary Term Description Cancel Script Make a prescription item cancelled when a item data entry or workflow error has been made.

Closing the loop Dispensing details, including changes and comments made by the pharmacist, are returned to the prescriber electronically to facilitate improvements in prescription quality.

Incident An NZePS incident is any issue related to system performance, unexpected behaviour, application errors, or loss of connectivity affecting the NZePS service’s ability to function effectively.

NZePS New Zealand electronic Prescription Service allows prescribers in approved practices to electronically generate and transmit a prescription for medicines to a pharmacy, and for the pharmacy to update the electronic prescription with the dispensed medicines record to return to the prescriber. When the prescriber with access to NZePS prints a prescription, a unique identifier for the prescription is created by NZePS. The PMS prints the identifier as a barcode on the prescription form. At the same time, an electronic version of the prescription is created and sent encrypted to the NZePS health information exchange broker (NZePS broker). When the patient presents the prescription at a Pharmacy, the barcode can be scanned to allow the identifier to be quickly entered into the Pharmacy Management System (PhMS) and for the PhMS to request the electronic version of the prescription from NZePS.

NZePS broker The online repository to which NZePS prescriptions are sent, where they are stored, and from which they are retrieved by the pharmacy.

Glossary Term Description NZePS controlled An NZePS controlled drug prescription form drug electronically generated by a system prescription approved by the Director General of Health containing a barcode which is scanned (or the barcode number is manually entered if the scan fails).

Offline An electronic prescription created by a prescription pharmacy from the original paper prescription when the original electronic prescription cannot be retrieved from the NZePS broker (also known as a Pharmacy Generated Prescription).

Original SCID When an offline prescription is created by a pharmacy it is issued with a new SCID, and the ‘Original SCID’ that is printed on the paper prescription is recorded with it so that the offline prescription can subsequently be linked to the original one on the NZePS broker.

Pharmacy See Offline Prescription. generated prescription

PhMS Pharmacy Management System. From the NZePS perspective, the PhMS is the software used by the pharmacy to interact with NZePS (e.g. retrieve electronic prescriptions from the NZePS broker, send notifications of dispensing, etc.)

PMS Patient Management System. From the NZePS perspective, the PMS is the software used by the practice to interact with NZePS (e.g. send electronic prescriptions to the NZePS broker, receive notifications of dispensing, etc.)

Practice NZePS The driver of the NZePS implementation administrator process. Will ensure that the necessary information is available to the key decision makers and that decisions are made in a timely and appropriate manner. Will create and oversee the timeline for setup, training, and launch.

Glossary Term Description Practice NZePS The lead clinical change agent prescriber (prescriber) within the practice champion organisation who will lead decision making during the planning stages, negotiate consensus among all those involved in implementing NZePS at the practice, and maintain communication and enthusiasm during implementation.

Referred A pharmacist may need to amend a prescription prescription item that has been presented but is outside their authority to change, and so must be referred to the prescriber to make the change. Generally this change will be agreed verbally by the prescriber and the script changes dealt with retrospectively.

Repeat The repeat prescribing of one or more prescription regular prescription items for a patient, usually done at periodic intervals (e.g. 3 monthly). This is not a repeat dispensing of prescription items from the same prescription.

SCID The unique SCript Identifier of each NZePS prescription (ePrescription); it is printed at the bottom of each page of the paper prescription form as the number and barcode that is scanned by the pharmacy to request the NZePS prescription from the NZePS broker.

Stop a script Make a prescription item inactive when a item clinical decision is made to discontinue a course of medication.

Unsigned Pharmacies may dispense medication for a prescription Patient without a printed prescription (e.g. at a prescriber’s request verbally or off a rest home chart that has been faxed). Once dispensed, a copy of the prescription must be signed by the prescriber and returned to the dispensing pharmacy.

Preparedness Checklists for NZePS This checklist is provided to help ensure that the practice is prepared for accessing NZePS.

Practice NZePS Prescriber Champion checklist

You are familiar with:  Medical Council of New Zealand – Good Prescribing Practice  Medtech’s NZePS Electronic Prescribing User Guide – Prescribing  Medtech’s NZePS Quick Reference Guide – Prescribers You understand:  The importance of checking barcode and barcode number legibility on prescriptions  The importance of prescribing using medications from the current version of MIMS  The issues with prescribing using medications from ‘favourites’ lists or previous prescriptions  The additional responsibilities and implications of NZePS controlled drug prescriptions  How to access and process notifications of dispensing and pharmacist changes  How to process prescriptions referred back through NZePS by a pharmacist  How to process unsigned NZePS prescriptions raised by a pharmacist from a phone call  How to process unsigned NZePS prescriptions raised by a pharmacist from a rest home chart You have:  ‘Walked through’ all of section Clinical Familiarisation with NZePS Clinical Familiarisation with NZePS, using a test patient

Practice NZePS Administrator checklist

You are familiar with:  Medtech’s NZePS Electronic Prescribing User Guide – Setup  Medtech’s NZePS Quick Reference Guide System – Administrator You understand:

 Your responsibilities for incident mitigation, remediation, reporting and logging  Which organisation to call when you need help and support with NZePS You have:  Setup access to NZePS for the Practice NZePS prescriber champion  Checked print quality of all practice printers used for printing prescriptions  Checked print quality of prescriptions faxed from practice to a local pharmacy  Resolved any issues with print / fax quality of prescriptions  Completed contact details in Help and Support. Help and Support  Checked Medtech has completed successful end-to-end NZePS test  Checked active MIMS subscription is in place and current version is installed and updated regularly to align with the update to the pharmacy medicines list.

IT Technical Support checklist

You understand:  The network configuration between the practice PMS and the Medtech hub  Your responsibilities for incident reporting and logging, remediation, and escalation You have:  Provided Medtech with secure access to connect the practice to NZePS  Helped the NZePS administrator resolve any issues with print / fax quality of prescriptions  Supported Medtech in completing successful end-to-end NZePS test

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