Hospital Electronic Prescribing and Medicines Administration (HEPMA): an update

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Lorena Wiggins
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1 Hospital Electronic Prescribing and Medicines Administration (HEPMA): an update Gail Caldwell Director of Pharmacy NHS Forth Valley (on behalf of Ascribe HEPMA Evaluation and Lessons Learned Commission Project Boards)

2 NHS Scotland ehealth Strategy Improving the safety of patients taking medicines and their effective use Established Safer Medicines Working Group Balance shorter term objectives of improving medicines reconciliation with the longer term objectives of HEPMA, as part of hospital electronic patient record (EPR) Needs of stakeholders, pragmatic and incremental solutions, better use of what exists, range of incremental options to full HEPMA implementation (based on nationally available system)

3 Safer Medicines Working Group - Vision

4 HEPMA - Where are we now? For HEPMA to be acceptable for immediate deployment any system must support the safe move from paper to electronic prescribing and administration HEPMA will underpin medicines governance National HEPMA Operational Requirements and associated test scripts developed to test safety (used during PMS procurement exercise)

5 HEPMA - Operational Requirements Level 1 Must (Immediate) Moving safely from paper to electronic Level 2 Should (Short Term) Added value that electronic prescribing brings Level 3 Could (Medium Term) Complex prescribing / rules based DS Level 4 Would (Long Term Aspirations)

6 HEPMA - Operational Requirements

7 HEPMA Making it happen Two SG commissions funded to address key barriers 1. Patient safety evaluation of Ascribe HEPMA system 2. lessons learned resource to inform business case development and support safe implementation

8 HEPMA Making it happen JAC HEPMA nationally evaluated and passed the key safety barrier (2009) NHS Ayrshire & Arran JAC HEPMA live in Ayr, Biggart, Arran War Memorial Hospitals, Mental Health and ICU in Crosshouse. Paediatrics Q Rest of Crosshouse Q Interfaced with PMS (Admissions, Transfers and Discharge) Provides basic clinical decision support (allergy, drug interactions, therapeutic duplicates and clinical protocols)

9 HEPMA Making it happen NHS Lanarkshire (2013) JAC successfully implemented in three care of elderly wards Business Case for Monklands being developed

10 HEPMA - Ascribe Evaluation May technical evaluation of application Failed to meet basic safety level as per the OR October live site visit confirmed status of observations Product in early development, beta testing in 20 bedded orthopaedic ward Conclusion - not fit for immediate deployment in NHS Scotland Conclusion accepted by Safer Medicines Working Group

11 HEPMA - System options HEPMA real time clinical system and must link with PMS (ADT Minimum) NHS Scotland committed to Intersystems TrakCare, restricts HEPMA options integral to other PMSs Pharmacy system interface delivers benefits of end to end process Vision/EMIS/eForms/eWard: not designed to support hospital prescribing and administration

12 HEPMA - System options System National Safety Evaluation JAC Passed Ascribe Failed UK Implementation Status Good UK presence and in NHS Scotland Single beta test ward in England PMS Established with TrakCare Unknown Integration Pharmacy TrakCare None done None in UK Full Unknown Other best of breed Full Full None done Variable Unknown Unknown

13 HEPMA - Lessons Learned Inform business case development, support consistent and safe implementation Triangulating published evidence, local evaluations with qualitative data from multidisciplinary interviews at NHS AA, Lanarkshire and CEPAS sites Governance, technology, people, process, training Clinical system in partnership with ehealth Major role for ADTC and Medicines Governance Evidence base, best practice recommendations, case studies, self assessment checklist and action planning tool Resource available for user testing early 2014

14 HEPMA - Incremental approach Safely move from paper prescribing and administration charts to an electronic system (HEPMA) Ensure HEPMA is linked in real time to Master Patient Index for admissions, transfers and discharges Use HEPMA prescribing information to feed discharge handover Stage 2 Add decision support and edischarge Activate automatic decision support (allergies, drug interactions, therapeutic duplicates) Electronically send discharge information to Primary Care Implement guidelines to help prescribers do the right thing Stage 3 Integrate with other clinical applications and EPR Implement rules based decision support linking laboratory and other data Integrate with PMS and EPR using context sharing to move between clinical applications Electronic Links from primary care Closing the loop - DM&D messaging

15 HEPMA Best use of what exists Immediate implementation of national HEPMA system i.e. JAC Passed the safety bar in 2009 Live in multiple sites in UK Immediate option, subject to business case Lessons learned resource to support safe implementation, available early 2014

16 HEPMA Best use of what exists Link with Pharmacy system essential to allow the benefits of end to end processes to be delivered, NHS Boards with Ascribe Pharmacy could: In the short term, implement JAC HEPMA with or without JAC pharmacy? In the longer term (around 5-10 years based on current knowledge on system maturity and development timescales): Collaborate to undertake patient safety evaluation of the HEPMA software market including TrakCare Pharmacy and Prescribing and available standalone HEPMA systems. This builds on the current commitment to the Intersystem s TrakCare PMS in NHS Scotland. Establish a strategic partnership between Ascribe and selected NHS Boards to act as beta test sites to develop the Ascribe HEPMA system. NHS Board(s) would be selected by the ehealth Strategy Board. Discussions with ehealth leads, 13 th November 2013

17 HEPMA - Conclusion a key component of national strategic vision essential component of EPR, fundamental building block to safe, efficient and effective communication of medicines information with primary care high clinical demand first incremental step, move safely from paper to electronic prescribing and administration immediate implementation, JAC lessons learned resource, early 2014 developing other potential incremental options

A Good Practice Guide

A Good Practice Guide Implementing an Electronic Prescribing and Medicines Administration System: A Gd Practice Guide Healthcare Improvement Scotland 2014 The contents of this document may be copied or reproduced for use within