Electronic Prescribing in Secondary Care let me tell you a story

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1 Electronic Prescribing in Secondary Care let me tell you a story Professor Ann Jacklin BPharm, CHSM, FRPharmS Centre for Medicines Safety & Service Quality University College London & Imperial College NHS Trust Independent Pharmacist Advisor

2 Are you sitting comfortably? About me Electronic prescribing why bother? Isn t it about time? Love em or hate em Getting there Still some way to go? But May now be time for optimism & engagement?

3 Why bother? Medicines management is central to the quality of healthcare. Nearly all patients are given medication as a result of a visit to hospital 7,000 individual doses are administered daily in a typical hospital. Up to 40% of nurses time is spent administering medicines. 10,000 hospital patients each year have serious adverse reactions to medicines, and one-fifth of clinical negligence litigation stems from hospital medication errors. The Chief Medical Officer has set trusts a target to reduce serious medication errors by 40%.

4 Why bother?(2) High priority needs to be given to electronic patient records and to electronic prescribing, which should provide significant understanding of the effectiveness of medicines and help to track patients between hospital and primary care. Electronic prescribing reduces medicine errors significantly by providing timely, legible information. The Information for Health Strategy expects 35% of trusts to have installed electronic patient record systems (including the reporting of results and prescribing) by 2002, and all trusts by 2005.

5 2001 Isn t it time?

6 How far have we got? eprescribing uptake England (61%) of 165 hospital trusts responded in survey of English hospitals 70 (70%) had at least one EP system in place 56% of sites with EP had more than one system in place. Four sites had more than 4 systems 63 different systems Nearly half of respondents had EP systems supporting in-patient prescribing (47.5%, n=48). 13% NHS trusts use for inpatient prescribing in adult medical and surgical wards 11% adult critical care 1% paediatric/neonatal critical care 3% renal 34% chemotherapy Discharge prescribing in 65.3% (n=66) of sites Outpatients was the least catered for (5.9%, n=6) Ahmed, Franklin and Barber (2012)

7 Love em or hate em PWC report January 2013 NHS could save billions of pounds a year if ambitious, proactive NHS organisations improved their use of information technology. Around half of this billion - could be generated from four actions, including the roll-out of e-prescribing in hospitals and the Electronic Prescription Service in primary care. Priority action drive rollout/use of electronic prescribing in hospitals. Potential benefit ~ 270m p.a Reduction in prescription errors Efficiency gains Improved patient safety Improved patient experience. 14 th January 2013 Final report A review of the potential benefits from the better use of information and technology in Health and Social Care Final report 7

8 .in response January 2013 Jeremy Hunt Health Secretary announced that the NHS is to become paperless by 2018 and focused on electronic prescribing as a key element of this approach.

9 Unblocking the blocks? NHS England Medical Director Sir Bruce Keogh Supporting hospitals to replace paper with digital systems will help relieve patients frustration at having to repeat their medical and medication history because their records were unavailable. Expanding the use of electronic prescribing of medications in hospitals will help improve safety, save lives and save taxpayer s money. And help was needed : ehealthinsider s annual survey of IT many IT directors wanted to prioritise e-prescribing programmes. projects shelved due to financial pressures & difficulty of making a short term saving on e-prescribing systems.

10 May 2013 Technology fund announced 260m 90m 2013/14 170m 2014/15 Enable trusts to accelerate progress towards Integrated Digital Care Records By March 2015 Patient online access to own GP records Paperless referrals By April digital information to be fully available across NHS and social care services, barring any individual opt outs. 10

11 July 2013 same fund new name Safer Hospitals Safer Wards published Details of application process for technology fund Expression of interest by end July 2013 Applications for eprescribing Progress towards system-wide (multi-organisation) digital care record Advanced scheduling Applications no limit for value or volume 11

12 and by end July 2013 Total 777 projects received 16 projects ineligible 49 withdrew at some stage Applications per Trust Range 1-13 Average of 3 Value: maximum 17m - lowest 5.5k 12

13 September 2013 and now more money! 250m extension to the Safer Hospital, Safer Wards Technology Fund, increasing its value to over 500m to help patients get better and safer care. The fund is available to NHS trusts to support the widespread adoption of modern, safe electronic record keeping, replacing outdated paper based systems for patient notes and prescriptions with integrated digital care records (IDCRs).

14 Project selection process. 248 interviews over 17 days (September/October 2013) 84 interviewers - multidisciplinary 154 face to face (Leeds and London) 94 telephone Applicants probed on key areas essential for successful delivery of business change enabled by technology Clinical buy-in and leadership Programme management Commercial strategy Board level support 14

15 May 2014 Memoranda of Understanding being signed Project milestones Monitoring criteria Project management Clinical digital maturity index Benefits realisation plan Successful projects to be published on NHS England website shortly ~50+ eprescribing projects 15

16 Arise. Technology Fund Two (the next 250m) Prospectus and application process being finalised May 2014 Priorities Open source Integrated digital care records eprescribing for paediatrics 8 week application period Interviews will be held 16

17 So how close are we to the benefits? Not many UK studies yet.most show modest benefit. Need more evaluation to show Reduction in prescription errors Efficiency gains Improved patient safety Improved patient experience

18 Non-charted medicines.

19 180 Drug Expenditure per FCE Wirral Hospital Source Clinical Benchmarking Company Ltd

20 Formulary Changes Drug A Drug B Time (months)

21 Secondary use of data

22 What is technology good at? Repetitive tasks, same every time Follows the rules Forcing functions Can t proceed until you ve completed all the fields More legible than handwriting Reminders Supporting formularies, protocols, standardisation of treatment Audit trail

23 But Can be inflexible New error types Selection errors from menus Menus often present very long lists of options which prescribers not familiar with Assumptions - the computer must be right Alert overload Supporting formularies, protocols, standardisation of treatment requires substantial local development & maintenance Care plans/order sets/ review

24 Assumptions Human-computer interaction causes most deaths of all IT induced fatalities Eg a UK hospital: ~1000 cancer patients under-dosed with radiotherapy over 9 years. Decision support software incorporated in machine, staff did not know and applied a second, manual dose reduction calculation McKenzie Knowing machines 1996 Assumption that EP system would include allergy checking, when it didn t...

25 Successful implementation Requires Support for change from leaders and staff Development of a gradual and flexible implementation approach Adequate resources Equipment, staff, infrastructure Acceptance that setbacks will occur and will need managing Spetz et al. What determines successful implementation of inpatient IT systems? Am J Manag Care. 2012;18(3):

26 eprescribing Toolkit

27 Summary Huge potential patient safety benefits Not easy otherwise would have been solved by now Clinical digital records are now moving forward at pace eprescribing is core Implementation is challenging but NOT impossible Technology Fund Two offers further opportunities It s a journey, we want everyone on board!

28

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