POLICY: Prescribing: Access to the Pharmaceutical Information Program (PIP) or electronic Health Record (eHR) Viewer

Preamble

The Pharmaceutical Information Program (PIP) has been developed with the primary purpose of improving patient care in Saskatchewan.  The PIP program provides authorized health care providers access through a secure computer network to information about drugs dispensed to Saskatchewan patients by community pharmacies in Saskatchewan, and by select out of province pharmacies. The PIP also permits authorized providers to enter allergy/intolerance information and to ePrescribe. 

The electronic Health Record (eHR) Viewer is a secure website that authorized health care providers can use to access clinical information on Saskatchewan residents.  It includes information such as medication information, laboratory results, medical imaging reports, and records of hospital visits.  The eHR Viewer includes medication information from the PIP, including medications dispensed by any community pharmacy in Saskatchewan, and select out of province pharmacies, to Saskatchewan residents with a valid Health Services Number (HSN) for the past 25 months.

Definitions

For the purposes of this policy, the following definitions apply:

Physician(s) means all physicians, residents, post-graduate trainees and medical students who are registered on a CPSS register.

Prescription Review Program (PRP) medications are those listed in CPSS Regulatory Bylaw 18.1.

Guiding Principles

The College recognizes that optimal prescribing requires access to a patient’s past and current medication profile, including current prescriptions and dosages.  Ideally, physicians (or in the case of the eHR Viewer, their designate with appropriate credentials) should access a patient’s medication profile in the PIP or the eHR Viewer prior to the physician writing any prescription, and particularly for Prescription Review Program (PRP) medications.  The review of this information has the potential to reduce risk by alerting physicians to contraindications and allergies, therefore preventing harmful drug interactions and combinations.  It also has the potential to alert physicians to patients who are not taking their medications as prescribed, and to assist in preventing patients from obtaining multiple prescriptions for the same or similar medications from multiple providers.

However, the College recognizes that there are still systemic and technical challenges that prevent some physicians from regularly accessing the PIP or the eHR Viewer.  These challenges can include a lack of or unreliable internet access and lack of access to either platform in certain facilities.  Additionally, the College recognizes that there remains a lack of awareness of the ability to integrate Electronic Medical Record (EMR) systems and the PIP/eHR Viewer, and in some cases a lack of operability in such integration.  This has presented an additional barrier to the efficient use of the PIP/eHR Viewer.

College expectations of all physicians licensed in Saskatchewan who prescribe and/or order medications

All physicians licensed in Saskatchewan who prescribe and/or order medications must have active login capability with either the PIP and/or the eHR Viewer.  In circumstances where the physician is unable to obtain active login capability with either the PIP and/or the eHR Viewer, or where that login capability is suspended or rescinded by eHealth, the physician must report this to the College.

When access is available, the College recommends that physicians view a patient’s medication profile in the PIP or the eHR Viewer prior to prescribing.  This is highly recommended when prescribing opioids or other psychoactive medications to a patient and, most particularly, when the physician does not look after the patient on a regular basis.

In circumstances where the physician attempts to review the PIP and/or the eHR Viewer and finds the patient profile to be masked, prior to prescribing the physician must obtain patient consent to unmask, unless in one of the following two scenarios where consent is not required:

• In an emergency, when the person is unable to provide consent.  This would allow a physician to access the prescribing history in an emergency such as if the person is unconscious or unable to provide consent due to their illness;
• When the physician is prescribing PRP medications.[1]

Physicians must report to the PIP program, or such other person or organization as may be specified by the PIP program, all activities by any individual or entity that the physician reasonably suspects may compromise the confidentiality of confidential information or be a breach of this policy.

Other CPSS resources

POLICY – Informed Consent and Determining Capacity to Consent

POLICY – Clinics That Provide Care to Patients Who Are Not Regular Patients of the Clinic

POLICY – Physicians Accessing Patient Specific Information from the Pharmacy Information Program (PIP)

GUIDELINE – The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain

CPSS REGULATORY BYLAW 18.1 – The Prescription Review Program

[1] See section 5 “Masking Your Personal Information” at https://www.saskatchewan.ca/government/health-care-administration-and-provider-resources/ehealth/pharmaceutical-information-program#masking-your-personal-information