Real time Prescription Monitoring

Australia has a growing national problem with the misuse and abuse of pharmaceuticals. The number of harms including deaths from prescription medicines has increased and is now higher than illegal drugs.

DORA is intended to be a clinical support tool for prescribers and pharmacists, to enable them to better identify and manage patients who may be exhibiting signs of drug dependency or drug seeking behaviors, such as ‘doctor shopping’.

DORA is being introduced to improve the safety of ACT patients by providing prescribers and pharmacists with valuable information before they write or dispense a prescription for a controlled medicine.

DORA is not intended to disadvantage patients where there is a legitimate clinical need for a medicine and where a prescriber is authorised to prescribe a controlled medicine for a person.

For more information about DORA, please see the following fact sheets:

• DORA Fact Sheet – Prescribers and Pharmacists
• DORA Fact Sheet – Patients
• DORA FAQ – Prescribers and Pharmacists
• DORA FAQ - Patients

A record in DORA is a health record and is protected by law under the Health Records (Access and Privacy) Act 1997. The Medicines, Poisons and Therapeutic Goods Act 2008 outlines acceptable use and offences related to this information. Strict penalties apply for any person found to be inappropriately accessing or using DORA information.

The ACT Government is committed to ensuring the security of patient data within DORA. DORA has undergone rigorous security testing and complies with the ACT Government Protective Security Policy Framework and the ICT Security Policy.

The use of DORA by health professionals is not mandatory. However, all eligible prescribers and pharmacists are urged to use DORA as a new part of their clinical practice, with the aim of minimising potential harms.

Whilst the use of DORA is not mandatory, prescribers are still required to seek Chief Health Officer (CHO) approval prior to prescribing a controlled medicine for continuing treatment or where treatment is to continue greater than two months, or where the patient is drug-dependent.

DORA contains information about controlled medicines that have been dispensed in any state or territory for ACT patients.

Specifically, information will appear in DORA for any controlled medicines that have been dispensed from an ACT pharmacy, regardless of a person’s address. Information will also appear in DORA for controlled medicines that have been dispensed interstate for ACT residents.

DORA also displays any ACT prescriber CHO approvals that are in place for a patient.

DORA may also display cautionary prompts for health professionals for some patients. Prescribers and pharmacists should contact the HPS if they have any concerns regarding a patient’s approval or dispensing history.

Any prescriber of controlled medicines or pharmacist may apply to access DORA to support ACT patient care. This includes prescribers or pharmacists working outside of the ACT. Prescribers include doctors, dentists and some nurse practitioners. Intern doctors or pharmacists may also apply to access DORA.  

Prescribers and pharmacists can register for DORA via the DORA website using a device with a trusted PKI certificate* installed and appropriately configured (see Access to DORA below).

Applicants need to provide a range of verification documents to the HPS to complete their registration. This includes 100 points of ID and details of their AHPRA registration and unique Healthcare Provider Identifier-Individual (HPI-I) number.

For more information about how to register to use DORA, please see the DORA Registration User Guide.

Health practitioners other than a relevant health practitioner* can apply to the Chief Health Officer (CHO) for an authorisation to access and use DORA under the Medicines Poisons and Therapeutic Goods Act 2008 (MPTG Act). 

Access Authorities may only be issued if the intended access is consistent with a purpose of the DORA monitored medicines database and otherwise in the public interest.

To apply for a DORA Access Authority, please complete the DORA Access Authority Application Form and return to the Health Protection Service via fax: 5124 9309, email: pss@act.gov.au or in person: 25 Mulley Street, Holder ACT 2611.

Once an Access Authority application is approved, applicants will then need to complete the DORA registration form to register for a DORA account and provide verification documents to the HPS. 

* A relevant health practitioner is defined in the MPTG Act to be a person authorised by regulation to prescribe or supply a monitored medicine.
 

All pharmacists and prescribers are able to access DORA via the DORA website, using a device with a PKI certificate installed and appropriately configured*.

Please note some users with a PKI certificate may experience initial difficulties accessing the website due to configuration of the certificate on their device. Should you experience difficulties in accessing the site, please refer to the attached instructions to assist you with certificate set up.

For further assistance, please contact the Health Protection Service for support on 02 5124 9208 or pss@act.gov.au 

Prescribers may also access DORA via a new electronic SmartForm for CHO approval applications. The SmartForm allows prescribers to apply to the ACT Health Protection Service for controlled medicine CHO approval online or directly via their practice management software.

The SmartForm includes a DORA link so that prescribers can easily look up details for their patient in DORA, as part of submitting their approval application.

*Public Key Infrastructure (PKI) certificates

To access the DORA website, health professionals will need to use a device with a NASH PKI certificate installed. A NASH PKI certificate is used to secure the connection from DORA to the health professional’s computer in order to ensure the security of patient records.

DORA utilises the same NASH PKI certificate that the Department of Human Services uses for securing My Health Record. If a health professional can access My Health Record on their computer, then they can also access DORA.

For more information about NASH PKI certificates, including information about how to obtain a NASH PKI certificate, visit the Department of Human Services – Medicare website.

ACT Health has developed a DORA eLearning course to assist prescribers and pharmacists in using DORA. The course is available online and is designed to take approximately 25 minutes to complete. The course learning objectives are as follows:

Demonstrate knowledge about high level evidence of harms associated with pharmaceutical abuse and misuse in Australia.

• Learn about the rollout of DORA in the ACT, including how to register to access and use DORA as part of clinical practice.
• Demonstrate how to manage a patient request to prescribe or supply a controlled medicine, though the use DORA as a clinical support tool.

The eLearning course has received Continuing Professional Development (CPD) accreditation for pharmacists and general practitioners. Full details are below:

For pharmacists

This activity has been accredited for 0.5 hour of Group 1 CPD (or 0.5 CPD credits), suitable for inclusion in an individual pharmacist’s CPD plan, which can be converted 0.5 hour of Group 2 CPD (1 CPD credit) upon successful completion of relevant assessment activities.

For general practitioners

This activity has received RACGP accreditation for Category 2 Activity CPD points in the QI & CPD Program for 2017 – 2019 Triennium.

In addition to the eLearning course, the DORA User Manual has been developed to assist prescribers and pharmacists in using the DORA web application.

Real time reporting refers to the process by which pharmacies report dispensing information to ACT Health so that it can be viewed in DORA in real time.

Real time prescription monitoring refers to the process or system used by health professionals to monitor prescriptions dispensed for a person, in order to assist their clinical decision making or identify potential harms.  

All ACT pharmacies are required to report supplies of all controlled medicines to ACT Health, in accordance with the Medicines, Poisons and Therapeutic Goods Act 2008.

Prior to March 2019, all ACT pharmacies were required to manually submit this information to ACT Health each week via a web portal.

ACT Health has established real time reporting for pharmacies in collaboration with the Australian Government to support DORA’s rollout in the ACT. A real time data feed has been established to the ACT DAPIS and DORA system from the National Data Exchange (NDE) which forms part of the national Real Time Prescription Monitoring (RTPM) system.

The real time data feed enables dispensing information to be viewable for health professionals in DORA in real time, immediately after a prescription is dispensed. Information is also received via the NDE for dispensing events from interstate community pharmacies where a patient has an ACT address.

As a result of this change, ACT community pharmacies are no longer required to submit weekly controlled medicines dispensing reports to ACT Health.

All ACT community pharmacies are currently able to report dispensing information to the NDE via their dispensing software.

As of March 2019, most hospital pharmacy systems are not able to report information to DORA in real time via the NDE. Hospital pharmacies that are unable to report in real time are still required to submit weekly electronic reports to ACT Health. The Australian Government is working to establish real time reporting via the NDE for hospital pharmacies. Further updates will be provided by ACT Health and the Australian Government when this occurs.

The ACT is the first Australian jurisdiction to integrate with the NDE. The ACT plans to adopt full national real time prescription monitoring functionality in the future following initial ACT DORA rollout.

• DORA FAQ – Prescribers and Pharmacists
• DORA FAQ - Patients