Irritation is a state of mind. I am reminded of the old ditty ‘Big fleas have little fleas upon their back to bite them, little fleas have lesser fleas and so on ad finitum’. For the last few years, I have been upping my cranky old man index. I am losing patience with the perennial inconsistencies, design flaws and sheer bloody mindedness that seems to exist in the larger fleas that specialise on pharmacists’ skins. One such flea is the dispensary printer, more specifically, the requirement to print prescriptions.

Not too long ago, I took part in a trial looking at the issues surrounding the removal of the requirement for printing electronic prescriptions. At the time, I felt it was more in hope than expectation. As most of you will remember, electronic transmission of prescriptions arrived, almost overnight, at the start of the COVID-19 pandemic. When the legislation was drawn up, it was clearly done on the basis of switching like for like — effectively replicating the manual prescription process with an image-based version, but with a twist: this being the specific requirement that any prescription received by email only became legal once it was printed out. This went a long way towards proving the old maxim that computers are an excellent way of generating even more paperwork. The thought of a paperless pharmacy was far from the imagination of the legislative drafters. One of the perennial talking points, ever since, on the many pharmacy social media sites was, how often did you need to print a repeatable GMS prescription? Indeed, it begged a greater question. Church philosophers heatedly debated the old question of how many angels could fit on the head of a pin. We have the modern pharmacy equivalent of how many original prescriptions can you print from one email?

While some would say the answer depends on which PSI inspector you had, the reality is that it really illustrated the drafting choices of the time. Clearly when you print from an email, you’re not printing an original. You are printing a copy of an electronic message that you have received. However, I digress. Events have overtaken us.

The good news is that all this will be moot. New legislation will finally do away with, in most cases, the need to print prescriptions received through Healthmail. This is a major advance. Most of us have drawers and indeed sets of filing cabinets full of a mixture of patient files and prescription folders. While these won’t be completely eliminated, this key piece of legislation will go a long way towards regularising a fairly onerous burden. In order to go completely paperless on prescriptions there are specific requirements placed on the PMR system. Most of these are pretty obvious. The first is that the records are securely maintained. This is typically done through a mixture of restricting physical access and software controls. There is a requirement for appropriate unalterable audit trails, where you can see who did what, and when. There is an obvious need to be able to track all supplies made on foot of a specific instance of a prescription. This would replace the endorsement that typically occurs with paper prescriptions. And, naturally, there is a requirement that any electronic copy of a prescription, with associated transactions, would be available for inspection, if required. There will be additional provisions for controlled drugs and we are hopefully heading into an era where we finally have electronic controlled drugs registers.

On a practical level, when I participated in the trial, it became obvious that screen real estate is an important part of any electronic prescription system. Either you have a giant monitor, that can display the PMR system and the prescription image on separate windows, or you have a dual monitor set up. In our pharmacy we found a second monitor was a better solution. This was because it allowed the technician to prepare the prescription without constantly looking over the pharmacist’s shoulders. Personally, I think there will need to be a redesign on the PMR screens. Ideally you would have the prescription image and directly underneath it you will have the actual brands that are being dispensed. This would allow for both a safer and more effective, preparation and checking process.

All in all, this legislation reflects another part of a good day’s work by the IPU. The collaboration between the Department of Health, the PSI and ourselves has once again delivered dividends. We are seeing positive and practical steps towards a more modern form of pharmacy practice. It is, in a way, setting up the groundwork for proper electronic prescriptions and integrating digital processes with associated records. It will help ease us into a more streamlined workflow, which can only be good for both patients and pharmacists. Bring it on.