Electronic prescribing

The Australian Government, in collaboration with states and territories, has accelerated the delivery of electronic prescribing to help protect people most at-risk from COVID-19. Electronic prescribing, where available in the community, will provide patients with a choice to receive either an electronic or a paper prescription from their prescriber. Visit the Electronic Prescriptions website for more information.

An exemption from the NSW Poisons and Therapeutic Goods Regulation has been granted to allow electronic prescriptions to be legally issued and dispensed in NSW.

On this page

1. Information for software vendors
2. Information for prescribers
3. Information for community pharmacists

Information for software vendors

To participate in electronic prescribing, software vendors are required to meet the requirements in the Electronic Prescribing Conformance Profile developed by the Australian Digital Health Agency (ADHA). The ADHA publishes information for vendors on the Electronic Prescribing Conformance Process.

NSW requirements

For an electronic prescription to be legally valid in NSW, all systems participating in the prescribing, transmission and dispensing of the prescription must be listed on the ADHA Electronic Prescribing Conformance Register with a Conformance ID. Such a prescription is then termed a 'Conformant Electronic Prescription'.

Specifications identified in the Electronic Prescribing Participating Software Conformance Profile as having a jurisdictional requirement are provided below and must be met.

PRES-13

Electronic prescriptions are accepted in all circumstances where systems are conformant (i.e. each participating system has a Conformance ID) and the prescription contains all required details (see PRES-17).

PRES-17

For an electronic prescription to be legally valid for dispensing in NSW it must contain the details listed below. This list incorporates prescription requirements under the Poisons and Therapeutic Goods Regulation 2008. (Where possible, Reference IDs from the Conformance Profile are listed).

• Conformance ID of the system used to create the prescription (PRES-83)
• Healthcare Provider Identifier – Organisation (HPI-O) of the practice or organisation from which the prescription is issued (PRES-18)
• Healthcare Provider Identifier – Individual (HPI-I) of the prescriber (PRES-83) (see Note 1)
• unique prescription number for the prescription (PRES-83)
• prescriber name, practice address and telephone number
• date (and time) of issue
• patient’s full name (first name and last name)
• patient's address (PRES-18) (or email address or mobile phone number but only in specific circumstances - see Note 2)
• patient’s date of birth (PRES-18)
• name, strength and form (if not readily apparent) and quantity of the medicine (PRES-18)
• adequate directions for use (including route of administration if not readily apparent) (PRES-18)
• number of repeat supplies authorised, if any (PRES-18)
• interval between any repeats (PRES-18) (see Note 3)
• the NSW authorisation reference number (PRES-18A) (see Note 4)
• prescriber specialist qualification (PRES-18) (see Note 5)
• annotation with the words “issued under clause 37 of the NSW Poisons and Therapeutic Goods Regulation” or similar (see Note 5)

Notes

1. See the Electronic Prescribing Participating Software Conformance Profile for requirements for Open PDS and Direct PDS.
2. In the case where the prescription is for azithromycin for the treatment of chlamydia in the partner of the presenting patient, email address or mobile phone number of the partner is accepted as an alternative to the physical address.
3. The interval between any repeats must be stated for medicines in Schedule 8 (S8) of the Poisons Standard ('controlled drugs' or 'drugs of addiction') and Schedule 4 medicines listed in Appendix B of the Poisons and Therapeutic Goods Regulation 2008 (S4B) (e.g. anabolic/androgenic steroids).
The interval between each repeat supply must be clearly specified (e.g. stated as number of days).
4. The NSW authorisation reference number (known as the 'NSW Authority number') is distinct from, and independent of, the 'authority code' associated with an Authority PBS prescription for restricted medicines.
   
   The NSW Authority number is issued by the NSW Ministry of Health and is alphanumeric in format, and may be prefixed with a text string of letters/characters, including 'AU', 'CNS', 's28c', 'CL', 'RA', and 'PG(T)'. Examples are AU123456789, RA998. 
   
• a Type A drug of addiction (see clause 122 of the Poisons and Therapeutic Goods Regulation 2008), i.e. Schedule 8 psychostimulants and pharmacist-compounded Schedule 8 medicines
• a Schedule 4 (S4) medicine listed in clause 37 of the Poisons and Therapeutic Goods Regulation 2008 (e.g. clomifene, isotretinoin) (or as specified in Note 5)
  
5. For S4 medicines listed in clause 37 of the Poisons and Therapeutic Goods Regulation 2008 (e.g. clomifene, isotretinoin) the prescription must include either:
   
• the prescriber’s specialist qualification (abbreviation is acceptable and could be up to 12 alphabetical characters) AND the text “issued under clause 37 of the Poisons and Therapeutic Goods Regulation 2008” or words to that effect, OR
• the NSW Authority number (see Note 4).

• handwriting and hand signature on the prescription
• underlining and initialing of any dose that could be regarded as dangerous or unusual
• for S8 medicines, the quantity to be dispensed written in words as well as figures.

• endorse in ink:
• the date of dispensing
• the pharmacy address
• the prescription reference number
• the word 'CANCELLED' where no valid repeat supplies remain
• keep S4B and S8 prescriptions in hardcopy
• store S4B and S8 hardcopy prescriptions separately

PRES-23

Under the Poisons and Therapeutic Goods Regulation 2008, a person issuing a prescription for a Schedule 4 medicine listed in Appendix D of the Poisons and Therapeutic Goods Regulation 2008 (S4D) or a S8 medicine must keep a record of it for a period of at least two (2) years.

Medical records otherwise must be kept as required under the Health Practitioner Regulation National Law. They should be retained in a retrievable format and readable state for their minimum required retention period.

PRES-24

All NSW required details (see PRES-17) shall be displayed.

Electronic prescriptions should be displayed in a similar manner to paper prescriptions.

DISP-4

While there is no requirement for each dispenser to login for each dispense transaction, the pharmacist authorising a dispense event must ensure their identity is recorded against each dispense event, for example, by entering their initials before each dispense event.

DISP-33

The NSW Poisons and Therapeutic Goods Regulation 2008 has no mandatory requirement to record receipt of supply in the dispensing system.

For opioid substitution therapy, the pharmacist may record that the dose has been received by the patient.

DISP-34

All records must be retrievable in human readable format immediately by any pharmacist in charge at any time at the premises where the prescription was dispensed and retained for two (2) years from the date of dispensing.

DISP-36

The dispense record must contain:

• details of the prescription (see PRES-17)
• the date (and time) on which the prescription was dispensed
• the name (first name and last name) of the pharmacist who dispensed the prescription (that is, the pharmacist who personally dispensed the prescription)
• the pharmacy name and address

All dispense records must be retrievable in human readable format immediately by any pharmacist in charge at any time at the premises where the prescription was dispensed and retained for two (2) years from the date of dispensing.

DISP-51

Records (prescribing and dispensing) must be searchable, filterable and retrievable by categories including by patient, by prescriber, by drug, by legal category (at least S8, S4B, S4D, and S4, and optionally S3, S2, and unscheduled).

DISP-50

PRES-17 provides a list of prescription details required to be displayed to the dispensing pharmacist.

MI-10

Records must be immediately retrievable in human readable format at the premises and retained for two (2) years.

MI-10A

Records (prescribing and dispensing) must be searchable, filterable and retrievable by categories including by patient, by prescriber, by drug, by legal category (at least S8, S4B, S4D, and S4, and optionally S3, S2, and unscheduled).

Frequently asked questions

How do I get my software approved for use in NSW?

A separate approval from NSW Health is not required where a system conforms under the Electronic Prescribing Conformance Assessment Scheme and has been listed on the Electronic Prescribing Register of Conformance with a Conformance ID.

Send enquiries to MOH-PharmaceuticalServices@health.nsw.gov.au.

Information for prescribers

Electronic prescribing is permitted for both PBS and non-PBS prescriptions in the community where all systems participating in the prescribing, transmission and dispensing of the prescription conform under the national Electronic Prescribing Conformance Assessment Scheme. If your prescribing system is conformant it will be listed on the Electronic Prescribing Register of Conformance with a Conformance ID. Your software vendor can also provide you with your system's Conformance ID if it has one.

Prescribers must ensure that the electronic prescription created by their prescribing system contains all the required details (see PRES-17 above). The requirements in NSW are the same as those for paper prescriptions with a small number of exceptions.  Prescribers of conformant electronic prescriptions do not need to comply with the following paper prescription requirements:

• handwriting and hand signature on the prescription
• underlining and initialing of any dose that could be regarded as dangerous or unusual
• for Schedule 8 (S8) medicines, the quantity to be dispensed written in words as well as figures

If a prescribing system does not have a designated field for a required detail (e.g. NSW Authority number, which is required for certain S8 medicine prescriptions), a prescriber must ensure the detail is entered into the system so it will be displayed to the dispensing pharmacist. A pharmacist can dispense an electronic prescription only if all required prescription information is displayed. Contact your software vendor if you have any concerns or queries about how to enter details in your prescribing system.

Electronic prescriptions are not valid for veterinary practitioners.

For more information on electronic prescribing visit the Australian Digital Health Agency's Electronic Prescribing - For Prescribers.

Information for community pharmacists

When dispensing an electronic prescription, community pharmacists (both the pharmacy proprietor and the dispensing pharmacist) must ensure that all of the systems participating in the prescribing, transmission and dispensing of the prescription conform under the national Electronic Prescribing Conformance Assessment Scheme and that the electronic prescription has the details required for it to be legally valid in NSW (see PRES-17 above). Pharmacists should be particularly vigilant that the on-screen display shows repeat intervals and the NSW authorisation reference number ('NSW Authority number') where they are required (see PRES-17 above).

A pharmacist should not assume that dispensing a prescription is legal merely because the prescription has been digitally transferred.

Key things to note

• Under electronic prescribing, a prescriber gives a paper token or sends a digital token (also known as ‘Evidence of Prescription’) to the patient or his/her authorised agent. The prescriber does not send it directly to a pharmacy, unless the patient or his/her authorised agent has requested this to be done for one or more of his/her prescriptions. The prescriber should document the request.
• The paper or digital token presented to the pharmacy is not a legal prescription. It is used by the pharmacist to ‘unlock’ the legal prescription so it can be dispensed.
• A prescription that is created, transmitted or dispensed from a system that is not listed on the Electronic Prescribing Conformance Register with a Conformance ID is not legally valid for dispensing.

Requirements for electronic prescriptions

The requirements for electronic prescriptions are the same as those for paper prescriptions with a small number of exceptions. Patient date of birth is required for electronic prescriptions. Prescribers do not need to hand write or hand sign the prescription, nor underline or initial any dose that could be regarded as dangerous or unusual, nor for S8 medicines, write the quantity to be dispensed in words and figures.

Pharmacists who dispense conformant electronic prescriptions are exempted from the requirement to:

• endorse in ink:
• the date of dispensing
• the pharmacy address
• the prescription reference number
• the word 'CANCELLED' where no valid repeat supplies remain
• keep S4B and S8 prescriptions in hardcopy
• store S4B and S8 hardcopy prescriptions separately

Pharmacists are exempted from these requirements because conformant systems record the date of dispensing, the pharmacy address and the prescription reference number, and securely transmit and retain details of prescriptions which are easily searchable. Repeats of conformant electronic prescriptions for S4B and S8 medicines, therefore, do not have to be dispensed at the same pharmacy which dispensed the original prescription. A patient can take the new token for their repeat prescription to a different pharmacy if they choose so.

When dispensing electronic prescriptions, pharmacists should be particularly vigilant that the on-screen display shows repeat intervals where required. A prescription for a S4B or S8 medicine with repeat/s specified must show an interval for repeats. If no repeat interval appears, directions for any repeat supplies are invalid and no repeats can be dispensed. The pharmacist may only dispense a single supply. The prescription should be electronically cancelled to prevent a new token from being issued.

Pharmacists should also be vigilant that the NSW Authority number is displayed where it is required (see PRES-17 above). The Authority number must be displayed for a prescription for:

• a S8 psychostimulant (e.g. dexamfetamine, lisdexamfetamine, methylphenidate)
• a pharmacist-compounded S8 medicine
• a S4 medicine listed in clause 37 of the Poisons and Therapeutic Goods Regulation 2008 (e.g. clomifene, isotretinoin), unless the prescriber belongs to an authorised specialist group. In this case, instead of including the Authority number the prescriber may include their relevant specialist qualification and the words “issued under clause 37 of the Poisons Regulation” or words to that effect.

Electronic prescriptions are not valid for veterinary practitioners.

Prescriber and patient identity for Schedule 8 prescriptions

The Electronic Prescribing Conformance Assessment Scheme has safeguards to ensure the dispensing pharmacist can be confident in the identity of the prescriber issuing the conformant electronic prescription.

For conformant electronic prescriptions for S8 medicines that include all required details, a pharmacist does not need to contact the prescriber to verify the prescription where the pharmacist does not know the patient. If a pharmacist has doubt about the identity of the prescriber or any other aspect of the prescription or the patient’s treatment he/she should contact the prescriber directly.

Validity of tokens

Pharmacists must be confident the token presented by the patient or his/her authorised agent has not been fraudulently obtained or altered. Where the pharmacist has concerns, the same steps as used for paper prescriptions are appropriate, including sighting the patient’s or agent’s identification document/s (e.g. photo driver licence) and/or contacting the prescriber. If the token for a S8 or S4D prescription has been altered or fraudulently obtained, the electronic prescription should be cancelled to make the token invalid and unable to be used by any person. The Police should be informed immediately.

For more information on electronic prescribing visit the Australian Digital Health Agency's Electronic Prescribing - For Dispensers.