Frequently Asked Questions
What is doctor shopping?
Doctor shopping, prescription shopping and medication shopping are terms used interchangeably to describe when a patient visits multiple practitioners to obtain more medicines than is medically necessary.
They may do this unintentionally or deliberately when they fail to disclose their previous prescriptions to the practitioner they are seeing. This places prescribers in a precarious position as they may have difficulty discerning whether or not a patient actually requires the medicine they request.
Adding complication to the problem, some patients my genuinely believe they need the medicine they seek, despite it being medically too much. To provide transparency around a patient’s recent prescription history, MediSecure created DrShop.
Why is doctor shopping a problem?
Doctor shopping is an increasing public health issue as more and more Australians are becoming dependent on medicines that are potentially addictive. Prescription medicine addiction represents a hidden public health epidemic. We are all aware of the dangers of illicit drugs; however, statistics show that prescription medicine is in fact responsible for more overdose deaths.
As this is such a hidden problem, there is limited information on the magnitude of the issue. The National Drug and Alcohol Research Centre found that in 2010, 705 Australians aged between 15-54 died as a result of prescription opioid overdose, up from 500 in 2008.
Data from the Coroner’s Court of Victoria shows that pharmaceutical drugs contributed to 81% of overdose deaths. Illicit drugs contributed to 40%. In 2014, more Victorians died as a result of prescription medicine overdose than were killed on our roads.
Evidently, this is a serious problem.
What is DrShop?
DrShop is a Real Time Prescription Monitoring service. It delivers important information in real time at the point of prescribing. This supports better decisions around prescriptions for medicines with a significant risk of addiction. The DrShop tool uses data from a connected network of registered MediSecure prescribers to alert them to prior prescribing activity for medicines of addiction. It delivers this critical information to the prescriber’s chosen clinical system without any disruption to workflow.
Who has recommended Real Time Prescription Monitoring?
Experts from the medical, addiction, drug and alcohol, and other sectors have uniformly called for a Real Time Prescription Monitoring system, as the only viable solution to doctor shopping.
Successive Victorian Coroners have also made formal recommendations for such a system.
Here are some examples:
“I merely add my voice to the chorus of coronial voices throughout Australia who, for years, have recommended the development and implementation of a computer aided system to endeavour to manage the problem of ‘doctor shopping’ and ‘pharmacy shopping’. […] The system would need to be readily available to all prescribing medical practitioners and/or dispensing pharmacies. It would also need to operate in real time.”
Coroner Phillip Byrne, finding in 1335 of 2001, delivered 16 August 2002.
“The Victorian Department of Health implement a real-time prescription monitoring program within 12 months, in order to reduce deaths and harm associated with prescription shopping. The program should include the following functionality: (a) a primary focus on public health rather than law enforcement; (b) recording of all prescription medications that are prescribed and dispensed throughout Victoria without exception; (c) provision of real-time prescribing information via the internet to all prescribers and dispensers throughout Victoria without exception; (d) a focus on supporting rather than usurping prescribers’ and dispensers’ clinical decisions; and (e) facilitating the ability of the Victorian Department of Health to monitor prescribing and dispensing to identify behaviours of concern.”
Coroner John Olle, finding in death of James, 5181 of 2009, delivered 15 February 2012.
“As a matter of urgency, the Victorian Department of Health must implement a real-time prescription monitoring system that records information on dispensing of all Schedule 8 drugs and all Schedule 4 drugs of dependence in Victoria and makes this information available to all Victorian pharmaceutical drug prescribers and dispensers, so they can use the information to inform their clinical practice and reduce the harms and deaths associated with pharmaceutical drugs.”
Coroner Jacinta Heffey, finding in death of Paul Kanis, 0367 of 2012, delivered 17 December 2014
How do I use DrShop?
Joining the DrShop network is simple. It fits within your current prescription writing workflow in your current clinical system.
To register you just need the following:
- The most recent version of MediSecure electronic prescription exchange service (PES), V3. We will then be able to install DrShop software on computers used for writing prescriptions at the practice (this is done remotely once you register)
- Each individual prescriber will need to register for security purposes
How long does DrShop take to install?
DrShop takes between 2-3 minutes to install on each computer used to write prescriptions in the surgery.
For the majority, our Melbourne based support engineers can dial in remotely to your practice and perform the installations quickly and with limited disruption to your business.
How were the medicines of addiction chosen?
MediSecure followed published data from the Victorian Coroners Court to develop the comprehensive list of medicines that are reported by the DrShop Real Time Prescription Monitoring system.
You can see the comprehensive of medicines list here. These medicines have appeared in many of the overdose related deaths investigated by the Victorian Coroner in the last 20 years. As a consequence they are implicated as medicines of addiction.
How safe is the data used by DrShop?
The DrShop system uses the same data encryption framework as is used in the MediSecure electronic prescription exchange service (PES). The MediSecure electronic PES has undergone a rigorous commonwealth compliance audit and the framework has achieved Commonwealth Government accreditation.
MediSecure conforms to the ATS 4888.x standards and is listed on the NEHTA eHealth Register of Conformity as accredited to produce conformant PCEHR Prescription Records and PCEHR Dispense Records.
Can I search for a particular patient on DrShop?
No. DrShop has been designed with patient safety and privacy in mind.
DrShop only allows alert messages to be sent to an enrolled prescriber at a registered practice. The prescriber can only see the prescription history for the patient whom they are consulting and only for medicines with a significant risk of addiction.
Only the type of medicine and suburb in which it was prescribed will appear, in which the privacy of the individual is protected.
How does DrShop fit into my prescribing process?
DrShop will only activate and provide alerts when the prescriber is writing a prescription for a medicine with a significant risk of addiction.
The prescribing process remains the same until the prescriber prints the prescription. Upon clicking ‘print’ if there is a recent prescription history for other medicines of addiction, then an alert will appear in the prescriber’s clinical system.
The prescriber can choose to view an extended version of this information, from the past 90 days, detailing the types of medicines and the suburb in which they were prescribed.
The prescriber can then use this information to determine whether they will print the prescription as normal or cancel it and remove the paper from the printer.
What alerts are shown in real time?
When a medicine of addiction is prescribed, the DrShop system presents the prescriber with 1 of 3 pop-up alerts:
- DrShop has identified that medicines of addiction were prescribed for this patient in the past 90 days by other prescribers
- DrShop has identified that medicines of addiction were prescribed for this patient in the past 90 days. All those prescriptions come from your prescriber number
- The DrShop system has not found any medicines of addiction prescribed in the last 90 days
What should a prescriber do when an “activity found” alert appears?
The decision of what to do with this information is at the discretion of the prescriber.
An alert simply identifies prescribing activity. This activity may be entirely legitimate and necessary. The information available to the prescriber will enable a quick judgment as to whether further medicines are required. If the doctor believes the activity is questionable, they can decide how best to proceed.
DrShop makes no value judgments from the activity; we understand that the prescriber is best placed to make such decisions.
What are the terms and conditions for my practice to use DrShop?
In order to have access to the DrShop service, the most recent version of MediSecure Electronic prescription exchange service needs to be in operation. The terms and conditions of both services can be found here.
Is Patient Consent required to use DrShop?
The use of any ehealth protocol or tool requires informed consent from a patient. The Privacy Act is very clear about the use of patient data. Where patient data is to be shared with another professional or any other service, then a case exists for the patient to give “informed consent”.
It is recommended that each practice seeks its own legal advice as to the requirements of the Privacy Act and its impact on the procedures and protocols of the practice. MediSecure sought such advice in 2009 and again in 2014 following discussions with the RACGP and AMA in 2009 and with AMA in 2014. As a result of this advice, MediSecure published the Patient Consent Protocol in June 2009.
If you are currently using the MediSecure Patient Consent Protocol, then there are no additional consent requirements for your practice or for you as the clinician.