Electronic prescribing: Delivering the Information Strategy. Tanya Pankhurst Jamie Coleman

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1 Electronic prescribing: Delivering the Information Strategy Tanya Pankhurst Jamie Coleman

2 The brief Implementing the information strategy locally eprescribing Where electronic prescribing fits into EPR beyond the national programme Moving forward: critical success factors and quality

3 HISTORY OF HEALTH IT

4 eprescribing Great Expectations How much difference has computerising healthcare made in solving the wider problems faced by contemporary health care services? IM&T strategy (1992) / Information for Health (1998) person-based information (NHS number) systems integration (reduce data duplication) deriving management information from operational systems Information security and confidentiality information sharing via an NHS-wide network

5 Delivering 21 st Century IT Support for the NHS 2002 Patient centred Effective ecommunications Learning/knowledge management Time saving Good quality data Delivering 21st Century IT Support for the NHS National Strategic Programme

6 Connecting for Health Connecting for Health - national programme for IT formed 2004 with responsibility for delivering Single, centrally mandated electronic care record for patients and connect 30,000 GPs and 300 hospitals for secure and audited access DoH now seeking local software solutions rather than single nationally imposed system

7 Where we are now 2011: Informatics planning Fast, safe modern IT systems Case histories, schedule care, prescribe, order tests, view results Universally available accurate records Telemedicine services Remote monitoring

8 Patient Admin System eprescribing Order Comms / Results Reporting Electronic Scheduling Coded Clinical Letters

9 Where we are now: The Information strategy May 2012 DoH published information strategy To give people more control over their care Improving access to information Better access to health and care records Test results should be available electronically booking or re-arranging appointments on line

10 Implementing the information strategy locally In-house developed myhealth at UHB What this is Key features Developing the electronic record In-house developed EPR

11 Patient Involvement Information more specific to them Their view of their ward dashboard E diaries 2 way communication Engage them in missed dose management

12 Electronic patient records Pharmacy Stock Control Systems Developed from Primary Care eprescribing System In-house developed systems Part of a wider EHR integrated solution

13 Local development University Hospitals Birmingham In-house developed Hospital-wide Electronic Patient Record Developed by Wolfson Computer Lab Continuous development for over 10 years Always in conjunction with UHB clinical staff

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23 The future: How can we improve quality? Reduce errors to a minimum (strategic aim) By using purpose built IT systems (strategic enabler) Critical success factor improving quality By employing point of care decision support (PICS) Front line error filter Convert data to information Inform NHS professionals Inform patients Inform management teams Benchmarking

24 IT in Error Management Benchmarking Filter improvement Data Analysis Front line filter Clinician Information Patient information Quality Management

25 IT investment at UHB Wolfson Computer Lab: 16 programmers and 6 trainers IT services: 20 programmers/ large support staff (Portal/myHealth/other software) Informatics: 11 programmers (120 staff including coders/clerks)

26 UHB filter = PICS Clinical Decision Support System Prevents errors at point of decision Allows analysis and rectification of systematic problems Provides clear audit trail Manages all inpatient Drug prescribing and administration Laboratory requests and results Imaging requests Internal referrals

27 Clinical Dashboard Turning data into information

28 % of Missed Antibiotics Antibiotic - % Missed Doses 12% 11% 10% Step Change Percentage Points p= % 8% 7% 6% Step Change Percentage Points p<0.001 Gradient Change Percentage Points per Week p= % 4% 3% 2% 1% Step change in % missed doses when information shared with clinicians / managers % Missed Doses Parsimonious Model Intervention Period of Data Removed Further highly significant change when CEO started RCA meetings 0% Jan 08 Mar 08 May 08 Jul 08 Sep 08 Nov 08 Jan 09 Mar 09 May 09 Jul 09 Sep 09 Nov 09 Jan 10 Mar 10 May 10 Jul 10 Sep 10 Nov 10

29 Improving Prescribing Dose Omissions Trust Quality Accounts Priority 1 Institutional indicatives Demonstrated improved quality AND reduced mortality

30 Percentage External Comparators Omitted doses: Antibiotics UHB (PICs) System A System B

31 Percentage External Comparators Omitted doses: Non antibiotics UHB (PICs) System A System B 0.00

32 Deaths / 1000 discharges UHB vs England Mortality 5.00 y = x y = x UHB England no UHB England y = x J R Soc Med Sh Rep 2012;3:36

33 Summary Implementing the information strategy locally Patient centred care; locally developed electronic systems Where electronic prescribing fits into EPR beyond the national programme Eprescribing integrated into a EPR informs clinical decision support Moving forward: critical success factors and quality Data can be used to identify and change clinical management and directly influence outcomes

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