Electronic prescribing

Transcription

1 Electronic prescribing Jacqueline Surugue IHE Europe, IHE Pharmacy Past President of the FIP Hospital Pharmacy Section Past President of the European Association of Hospital Pharmacists Member of the Board of Hospital section Council at the French Order of Pharmacists Hospital Pharmacist, Chief of Department Centre Hospitalier Georges Renon, NIORT, France 1 No conflit of interest 2 1

2 Electronic prescribing: questions I am pro I am con My heart inclines to both I do not know I do not care 3 The electronic prescription The computer-based electronic generation of a medical prescription, taking the place of paper = a technology but not only 4 2

3 Pros A technology but not only Because it allows, electronically and in a optimized way: Transmitting Sharing Storing Retrieving Information 5 Pros A technology but not only A machinery for checks, controls, and decision support Diagnostic support Alerts and notifications Clinical guidelines Decision making tools CDS Clinical Decision Support Lab test results software Integration with medication information and decision support software Integration with expert systems Prescription Management Systems Dispensation assistance software Drug interactions Duplications Redundancies Contra indications Allergies Nursing care Plan Information for administration Prescription assistance Dosage regimen Dose calculation Doses range given patient s age and weight Pharmaceutical analysis Recommendations Pharmaceutical advice 6 3

4 A technology but not only It virtually affects all operations and has completely redesigned the clinical process and workflow in hospital and also in community. From paper based clinical record keeping To integrated digital care records Towards a paperless world 7 Benefits for the patient Clear legible prescription Complete and detailed prescription, with all relevant information for a proper observance Trustworthy prescription, with multiple checks and controls Easy delivery: no need to drop off and wait for the pharmacist to fill the prescription. The prescription has been transferred by the prescriber to the Pharmacist and is ready when the patient arrives to the Pharmacy. Easy follow up Easy refills Saves time. Increased patient safety 8 4

5 Benefits on national level Follow up of the prescribing activity Follow up of the drug substitution performance (biosimilars,generics ) Follow up of costs Follow up of Vigilances (pharmaco, toxico, bio, medical devices vigilances) Epidemiology and statistics Increased quality Increased safety Expected savings 9 Benefits for Healthcare professionals Clear prescriptions Complete prescriptions Dosage Route of administration Rythm of administration Length of treatment Age, weight Refills Allergies. 10 5

6 Benefits for Healthcare professionals Prescription Readily available 24/24 7/7 From anywhere, on demand Multi access user No more retranscription Easy follow up 11 Benefits for Healthcare professionals Better coordination between healthcare professionals Better management of the medication workflow Decrease of clinical risk Less errors Less misinterpretations Less phone calls Traceability Timely access to prescriptions Saves time Increased quality Nurses spend more time with the patient and less time with the prescriber Increased safety 12 6

7 Cons However Healthcare professionals expectations are not always met Electronic prescription is not a magic bullet, as of today It can contribute to errors Unexpected errors Unintended consequences Increases mortality if poorly implemented 13 Cons Unexpected errors Bugs Error in dose calculation: i. e. administration in 4 hours instead of 24h Error in software for prescription connected with electric syringe pump Errol in software extending the duration of infusion of heparin, glucose, sodium chloride Simultaneous connexions of several prescribers: 4 anticoagulants prescribed for the patient Excessive slowdowns and failures Too many clicks because of too slow response leading inadvertently to signatures of messages or document the prescriber could not visualise. Failure of the server Examples from the litterature 14 7

8 Cons Unexpected errors Lack of interoperability Poor interface between different softwares Lack of information exchange Combined causes: poor ergonomics, poor design, inappropriate use Wrong click in a drop down menu Information entered in the wrong field i.e. allergy Inappropriate free text Wrong patient, Wrong drug Wrong route of administration No alert on allergy Improper default settings of the software Errors +++ Too small characters, several screens for one same prescription Errors +++ Too many lines Duplications of drugs Contradictory instructions Lines not read Examples from the litterature 15 Cons Unexpected errors Electronic prescribing is slower than handwritten at least for the first prescription* Increased workload for the prescriber: - many fields to fill, - successive alerts to answer - too many clicks! Prescribers prescribing electronically declare spending less time with the patients. * Prescription on discharge and refills are quicker 16 8

9 Cons Unexpected errors Electronic prescribing forces the prescriber to a mental process he is not used to. Research in human and information sciences demonstrates that too much information on the screen results in a cognitive overload. Cognitive ressources being not expandable, e prescribing mobilizes and captures the prescriber s attention to the detriment of the other tasks he is entrusted to. 17 Cons Unexpected errors In case of difficulty or problem, the result is this: leading the prescriber to circumvention strategies 18 9

10 Implementing electronic prescribing: What role for the Hospital Pharmacist? Recipe for a successful implementation 19 Implementing electronic prescribing: Multidisciplinary team Mixed competencies Collaborative practice A project team* A project leader Leadership, assertiveness Best if charismatic The Head Director of the hospital The CEO of the hospital Prescribers A pharmacist IT specialist The Director of the Nursing department Head nurse cadres *Leading group/ Pilot group / Steering group The success lies in the capacity of the project team to obtain the prescribers adherence

11 A project team* A project leader They must be communication relays for their peers The Head Director of the hospital The CEO of the hospital He must be available, reactive and responsive They must show a strong political support Prescribers A pharmacist IT specialist The Director of the Nursing department They must all be highly involved Head nurse cadres He has a key role configuring the prescription software Team work skills appreciated *Leading group/ Pilot group / Steering group 21 Implementing electronic prescribing: At the stage of choosing the e prescribing software Benchmark hospitals/colleagues Inquire about the software: - was it developed by the editor selling it? - are studies on usability published? There is a need of compulsory tests prior to software being launched on the market. Because of costs and extended time to market, editors use to ask their clients to highlight problems and difficulties and to propose solutions: «Club of users» 22 11

12 IHE Europe: a European initiative for interoperability in health information systems Connectathon = Marathon for connectivity. Results on IHE website 23 Implementing electronic prescribing: At the stage of choosing the e prescribing software Inquire about the editor: - is it a leading editor or a small company? - did it develop the software? - did it develop a product range? Is there a similar software in that range? One strategy of leading companies is to buy from smaller companies softwares competing with the ones they developped to strengthen them on the market

13 Implementing electronic prescribing: At the stage of testing the e prescribing software Appreciation of the screens design - The proportion of the screen devoted to the prescription - The whole prescription on a single screen - Size of the characters: readibility & clarity Appreciation of ergonomics: - Search button - Switch button to lab tests server - Fluent pull down menus 25 Implementing electronic prescribing: At the stage of testing the e prescribing software Appreciation of the functionalities: - Integration of data bases for checks and controls - Integration of the Drug / Medical Devices Formulary - Interoperability with the existing IT solutions Test simple scenarios of our daily life: - Methotrexate once a week for rheumatoid arthritis - Insulines (different types, different doses) - Anti vitamin K every other day - Several patients files being opened simultaneously 26 13

14 Implementing electronic prescribing: At the stage of testing the e prescribing software Remember: For the prescriber, the number of clicks is the best indicator! If too many clicks 27 Implementing electronic prescribing: The project must be presented with a medical (not IT) perspective, demonstrating benefits for the patient to the prescriber. The prescribing software should be choosen collaboratively. Adequate human ressources must allocated. Fear from the prescribers to be controlled on their medical activity Resistance to change Poor IT knowledge must be overcome 28 14

15 Electronic prescribing at EU level: an issue for Europe 29 Electronic prescribing: an issue for EU 30 15

16 Electronic prescribing: an issue for EU Sweden Norway UK Transmission of eprescriptions develops in all countries from prescribers to pharmacies Denmark Andalucia Spain France Veneto region, Italy 31 Estonia, Hungary Slovakia Croatia Denmark The most advanced Countries for EMR 32 16

17 33 Electronic prescribing: an issue for EU The main ehealth cross border interoperability project in EU 34 17

18 To bridge Patient Summaries across the Atlantic Operational basis of the EU/US MOU on ehealth / Health Information Technology cooperation roadmap An «interoperability bridge» To support interoperability for health care and health care delivery 35 Electronic prescribing: questions I am pro I am con My heart inclines to both I do not know I do not care 36 18

19 Thank you for your attention 37 19