QScript detection issue

Practitioners understand the issue may be arising because patients can register their Medicare card with a practice but if their date of birth or other identifying information is out slightly or they have an alias, QScript is not nuanced enough to recognise the discrepancy. Doctors were particularly concerned about breaching QScript requirements where patient details have been so registered and they prescribe medication for which the patient has already obtained a script elsewhere or should not have been prescribed.

QScript have provided additional advice on this issue and steps practitioners can take to ensure patients are not being prescribed medications in breach of the requirements. 

The following in an excerpt from an email from the Director, Monitored Medicines Unit Dr Bill Loveday.

Thank you for your email seeking information in relation to the recording, reporting and matching of patient information in QScript. 

Creation of patient profiles
Data populated into QScript is gathered from a range of sources. Patient profiles in QScript are either:

• automatically created based on information received in medication events (i.e. prescription data sent from pharmacy dispensing software and clinic prescribing software) 
• manually created by Queensland Health staff (e.g. when recording prescribing approvals). 

Information gathered from these sources is then matched with prescription events and verified using a range of matching criteria and a patient profile is created in QScript. 

The national real-time prescription monitoring (RTPM) solution (which includes QScript) uses multiple data elements to match prescription events to patient profiles, including:

• Individual Health Identifiers (IHIs)
• Department of Veterans Affairs (DVA) numbers
• patient first name, surname and date of birth.

If there are variations in the patient information received by or input into QScript or a transcription/data-entry error made at source clinical software systems, duplicate patient profiles may be created in QScript. If AMA Queensland members have identified duplicate patient profiles in QScript, they can contact QScript technical support on 1800 776 633 or IT.QScript@health.qld.gov.au, and:

• provide details of each duplicate profile identified e.g. first name, middle name, surname, date of birth, address, Individual Healthcare Identifier etc. (you may wish to provide a screenshot)
• identify which profile(s) has the correct information (if known). 

Importantly we encourage all practitioners to check that a patient’s information is accurately recorded in their clinical software including checking that:

• the patient’s name is correct – ideally this should be the name recorded with Medicare
• the patients date of birth is accurately recorded – it is a requirement under section 124(1)(d)(ii) of the Medicines and Poisons (Medicines) Regulation 2021 that the patient’s date of birth is included in all monitored medicine prescriptions.
• where possible:
  • the patient’s IHI has been recorded and validated
  • the patient’s Medicare and/or DVA number has been recorded.

Ensuring these key identifiers are recorded and accurate will help promote patient safety and a better QScript user experience, through improved data integrity. To that end, users of clinical software systems are encouraged to ensure they are using the software to the vendors’ specifications (including the validating of IHI numbers) to ensure information is recorded accurately within their software which supports data accuracy within QScript and the wider digital health ecosystem.

Patient searches
Minimum requirement P1-1 of the Monitored Medicines Standard requires prescribers to be able to provide evidence of the reasonable steps they have taken, prior to prescribing a monitored medicine, to confirm the patient’s identity. Pages 11–13 of the Monitored Medicines Standard Companion Document provides some guidance on this, which may be of assistance to your members. 

In particular, prescribers are encouraged to consider whether the information they find in QScript (including a search result of ‘no matching record found’) is consistent with their knowledge of the patient. If this is not the case, they may wish to conduct additional searches using different permutations of the patient’s details or—if the patient’s IHI has been validated—the prescriber can manually search for the patient in QScript using just the patient’s IHI.

Further, members may wish to refer to the following resource for further guidance and troubleshooting assistance for specific technical issues users may encounter including when conducting a patient search:

QScript troubleshooting - Version 1.0 (May 2022) (health.qld.gov.au)

Please note, there is a national issue impacting all Australian RTPM systems that impacts how and when patient demographic information is updated. Queensland, along with our jurisdictional colleagues and the Australian Digital Health Agency, are currently working with the RTPM vendor (Fred IT Group) to resolve a range of data quality issues. 

QScript maintains an audit trail of the patient searches a health practitioner has performed and which patient records they have viewed i.e. evidence the health practitioner has checked QScript.

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