Real Time Prescription Monitoring

Real Time Prescription Monitoring (RTPM) enables prescribers, pharmacists and medicines regulators to access real-time information regarding a patient’s medication history with respect to specific high‑risk drugs and corresponding details of legal authorisations to prescribe.

In 2018, the COAG Health Council agreed to progress national RTPM as a federated model with jurisdictions committed to progressing development and adaptation of systems to connect to and interface with the Commonwealth Government’s National Data Exchange (NDE) to achieve a national solution. This forms a significant clinical practice, information technology and regulatory change within each jurisdiction. Tasmania continues to engage with the Commonwealth regarding integration with the NDE and how this will impact on Tasmania’s already well-established RTPM system.

Tasmania was the first Australian jurisdiction to implement a RTPM system in 2009. The clinician facing component of the solution, called DORA, was first made available to prescribers and pharmacists in 2011.

DORA is a secure real time prescription monitoring website that allows prescribers and pharmacists to access information about Schedule 4 and 8 opioids and all other Schedule 8 drugs dispensed from pharmacies for Tasmanian patients. DORA was introduced in Tasmania to help reduce the growing harms in the community associated with pharmaceutical abuse and misuse.

A prescriber or pharmacist can look up information in DORA for any patient that presents to them. Information displayed will include patient details as well as their Schedule 4 and 8 opioid and Schedule 8 drug dispensing history and any Tasmanian prescriber approvals that are in place for them.

DORA is an extension of the Drugs and Poisons Information System (DAPIS), which is used by the Tasmanian Department of Health’s Pharmaceutical Services Branch (PSB) as its RTPM system.

Why use DORA?

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 behaviours, such as ‘doctor shopping’.

DORA has been introduced to improve the safety of Tasmanian patients by providing prescribers and pharmacists with valuable information before they write or dispense a prescription for a Schedule 4 and 8 opioid or Schedule 8 drug.

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.

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

Voluntary use of DORA

The use of DORA by health professionals is not mandatory. However, all eligible prescribers and pharmacists are urged to use DORA as a 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 approval under Section 59E of the Poisons Act 1971 prior to prescribing a Schedule 8 drug where a patient is or has been declared drug-dependent in Tasmania, the drug has been prescribed for a period of more than two months, a medical practitioner has issued a Section 59B notification for the patient, or for those Schedule 8 substances which carry an increased risk of harm due to potency or patterns of use requiring prior approval under the Poisons Regulations 2018 (eg fentanyl, hydromorphone, ketamine, methadone and psychostimulants).

Information in DORA

DORA contains information about Schedule 4 and 8 opioids and all other Schedule 8 drugs that have been dispensed in Tasmania for Tasmanian patients.

Specifically, information will appear in DORA for any Schedule 4 and 8 opioids and all other Schedule 8 drugs that have been dispensed from a Tasmanian pharmacy, regardless of a person’s address. Currently, information will not appear in DORA for Schedule 4 and 8 opioids or Schedule 8 drugs that have been dispensed in other jurisdictions for patients.

DORA also displays any Tasmanian information regarding authorities issued to prescribers under Section 59E of the Poisons Act 1971 and may include relevant signals to assist a prescriber or pharmacist’s clinical decision making.

Registering to use DORA

Any prescriber of Schedule 8 drugs or pharmacist may apply to access DORA to support Tasmanian human patient care. Prescribers include doctors, dentists and 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 hold current AHPRA registration.

For more information about how to register to use DORA, please contact the Pharmaceutical Services Branch on 6166 0400 or pharmserv@health.tas.gov.au

Access to DORA

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

For further assistance, please contact the Pharmaceutical Services Branch for support on 6166 0400 or pharmserv@health.tas.gov.au

*Public Key Infrastructure (PKI) certificates

To access the DORA website, health professionals will need to use a device with a Medicare PKI Site Certificate installed. A Medicare PKI Site 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 Medicare PKI Site Certificate that the Commonwealth Department of Human Services uses for securing MBS Online and PBS Online claiming transmissions.

For more information about Medicare PKI Site Certificates, including information about how to obtain a Medicare PKI Site Certificate, visit the Department of Human Services – Public Key Infrastructure webpage.

Real Time Reporting from pharmacies

Real Time Reporting refers to the process by which pharmacies report dispensing information to PSB 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 the prescribing and supply of relevant substances to a person, in order to assist clinical decision making or identify potential harms.

All Tasmanian pharmacies are required to report supplies of all relevant substances to the Department of Health, in accordance with the Poisons Regulations 2018.

Real Time Reporting 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 Real Time Reporting for dispensing events from hospitals where the patient is not admitted.

All Tasmanian community and hospitals pharmacies currently report dispensing information to DORA using Real Time Reporting via their dispensing software.

Community or hospital pharmacies that are unable to report in real time are still required to submit electronic reports to PSB.