Confusion over repeat prescription app Echo after ordering error

A prescribing committee has flagged concerns about a repeat prescription app after a patient used it to mistakenly order the wrong dose of medication.

Calderdale CCG documents show South West Yorkshire Area Prescribing Committee (SWYAPC) has questioned the safety of Echo, an NHS-approved app that allows patients to order repeat medication from their GP.

The problems arose when a patient ordered the wrong strength of warfarin through the app. The blood thinning drug is used to reduce the risk of conditions arising from blood clots – including strokes and heart attacks – and a patient’s dose can change frequently.

SWYAPC said the error caused “significant additional workload in the practice to follow up and check the request”.

The CCG’s report implies there is some confusion over the role of the service, with SWYAPC suggesting that “patients can order anything via the app”.

Echo is not a prescribing service, but instead allows users to request repeat medication from their doctor and have it delivered free of charge to their door.

Users enter their medication details into the app, along with details of their NHS GP practice. If the repeat prescription is approved by the patient’s GP, medication is automatically reordered for them when it begins to run low.

Speaking to Digital Health News, Echo co-founder Stephen Bourke said that there were “at least nine separate checks” before medication is sent to the patient.

Bourke explained the app also verified each patient’s identity to avoid prescription misuse.

It was noted in the CCG’s report that SWYAPC had “limited information on the company or its nature; only that Echo requests medication from GP via a fax on a patient’s behalf”.

Bourke said: “Echo’s business model is still not completely understood – it’s new to the market and not like any traditional healthcare service.

“Unlike some online pharmacies and GP apps, it is not a prescribing service. It has a unique team of pharmacists and technologists behind it, and is on the NHS Digital app store – one of the approved digital tools available for a patient.”

As the number of online patient services increases, more questions are being raised about their governance, as well as their role in the typical healthcare ecosystem.

Because Echo is not a prescribing service, General Medical Council (GMC) guidelines do not apply, nor is the app regulation by the Care Quality Commission (CQC).

Alistair Murray, clinical director at Echo, told Digital Health News: “Our partner pharmacies are regulated by and adhere to all the principles set out by the GPhC (General Pharmaceutical Council). Echo adheres to all of these principles, but as we are not a pharmacy we are currently not regulated by the GPhC.

“We have set up an independent clinical board made up of academic and practicing clinicians who meet on a quarterly basis to ensure high standards are maintained.”

Echo has been expanding its business with healthcare providers in recent months having secured £7m in series A funding in October 2017.

The company’s latest figures suggest the app has been downloaded more than 100,000 times since being launched in November 2016.