Uplifting the prescription output from ieMR eHealth Queensland

Aim

This project aimed to uplift the prescription output from the Queensland Health ieMR to be in line with legislative, clinical, administrative and technical expectations. This change to the CCL code for prescription output will ensure better performance, data accuracy, and compliance with state legislation.

Outcomes

• Development of standard prescription layout consistent with existing PBS stationery
• Layout refined in the development of the updated output
• Prescription particulars were updated to be in line with the transition from the Health Drugs and Poisons Regulations (1996) to the Medicines and Poisons Regulation (2021)
• Prescription layout now conforming to the updated requirements in accordance with the National Health (Pharmaceutical Benefits) Regulations 2017
• Patient demographics printed on the prescription now consistent with governance approved details visible from the banner bar of ieMR

Background

In 2021, Queensland Health's hospitals, including The Prince Charles Hospital (TPCH), Cairns and Hinterland Hospital and Health Service (CHHHS), and Torres and Cape Hospital and Health Service (TCHHS), were granted approval by Services Australia to generate PBS prescriptions on plain paper. This change aimed to address several operational challenges, primarily the high costs, administrative workload, and resource demands associated with ordering, tracking, storing, and securing prescription stationery provided by Services Australia. The move to plain paper prescriptions was seen as a way to streamline prescription processes and reduce the reliance on pre-printed prescription forms.

In 2022, Queensland Health began considering the feasibility of adopting this initiative statewide, particularly within the Integrated Electronic Medical Record (ieMR) system. Directors of Pharmacy from various ieMR sites unanimously supported the proposal, which was subsequently endorsed by the Medications Sub-specialty Group (MedsSSG). This support led to the establishment of the ieMR Plain Paper Prescription Printing Working Group (iPPPPWG), which was tasked with developing a proof of concept for plain paper prescriptions within the ieMR system.

However, one significant challenge arose as Queensland Health's existing prescription output did not meet legislative requirements for prescriptions printed on plain paper. This required an uplift to the system's Cerner Command Language (CCL) to ensure compliance with the necessary regulatory standards. Consequently, changes to the prescription code driving the output were needed to align with both legislative requirements and clinical best practices.

Despite the iPPPPWG's conclusion of work on the project in 2024 - after Services Australia withdrew support for plain paper prescriptions - some related improvements continued to progress. In April 2025, several key updates were successfully implemented into the system's production environment. These updates included the ability to print S100 and regular PBS prescriptions separately, the grouping of authority prescription items, the improved handling of prescription details spanning multiple pages, and the enhanced patient weight data representation. Additionally, the project addressed broader system modifications such as flexibility in representing patient age in various units (hours, weeks, months, years), and a reduction in the patient weight lookback period from 30 days to 7 days. Importantly, the project also facilitated the inclusion of Aboriginal or Torres Strait Islander status in patient demographics.

This project highlights the complexities and challenges of aligning healthcare IT systems with both legislative requirements and evolving clinical practices. Despite the setbacks and changes in direction, the project contributed to important advancements in prescription generation, patient data representation, and overall healthcare information management within Queensland Health. The outcomes of this initiative provide valuable insights for future healthcare system improvements and demonstrates an ongoing commitment to enhancing workflows and patient care.

Discussion

The adoption of CCL code within Queensland Health has established a critical foundation for managing prescription orders and ensuring compliance with legislative requirements. The system's ability to generate printed outputs is essential for maintaining consistency in workflow and operational processes. Although the system was initially customised from Victoria's version of CCL, Queensland Health has utilised this opportunity to address issues through updates, which, while time-consuming, highlight a strong commitment to maintaining compliance and optimising operational efficiency. This continuous improvement approach demonstrates Queensland Health's resilience in adapting the system to meet evolving requirements.

Having navigated through the complexities of optimising the CCL code, Digital Health Solution (DHS) gained invaluable insights into the challenges and opportunities within Queensland Health's digital healthcare infrastructure. The process of improving the system has been rigorous, yet it has allowed DHS to refine the approach and ensure that the core framework is robust and adaptable. Queensland Health is now entering the integration phase of its healthcare IT transformation, aligning the CCL code with other healthcare technologies to ensure seamless interoperability. Following this, a comprehensive testing phase will validate system performance across various scenarios, allowing for adjustments before full-scale implementation. With a solid foundation in place, these next steps are critical to enhance system capabilities, improve data exchange, and support the goal of improving patient safety and care delivery by enabling more efficient workflows and better clinical outcomes.

However, a significant weakness lies in the complexity of the CCL code itself. The code's intricate structure, with multiple layers of logic, has made it difficult to interpret, modify, and maintain efficiently. As a result, making necessary updates has proven to be a lengthy and resource-intensive process. Each change requires extensive analysis, coding, testing, and validation, resulting in delays and a high-risk environment where unintended consequences are more likely to occur.  Despite these challenges, the opportunity to optimise the CCL code by streamlining and simplifying the code resulted in Queensland Health improving data collation and output, removing redundant logic, and enhancing overall system performance. This enabled faster, more accurate prescription outputs and help future-proof the system, ensuring it remains adaptable to changing legislative and operational demands. Moreover, this change would enhance the system's scalability and ensure that updates can be rolled out more efficiently and with less risk of unintended impact.

Ultimately, by optimising the CCL code, Queensland Health would create a more agile and reliable system capable of supporting future advancements in digital healthcare, such as the transition to fully electronic prescriptions. The implementation of electronic prescriptions represents the next critical step in Queensland Health's ongoing transformation, marking a shift towards a more streamlined, paperless system that will enhance prescribing efficiency, reducing errors and improving patient safety, setting the foundation for future advancements in digital healthcare. Streamlining the code now would ensure that Queensland Health is better positioned to integrating new technologies, improving data processing and reducing administrative burdens. This foundational work will not only ensure that current legislative requirements are met but will also enable Queensland Health to lead in digital healthcare innovation.