Electronic Prescribing and Eligibility System pes A system based on lessons learned in Europe
Please note:- The opinions contained in this presentation are those of Mr. R. Patrick M. Davis and in no way reflect or are they meant to reflect the opinions or policies of the Directorate of Information Systems or the Department of Health Social Services & Public Safety (NI)
Here we are
This bit here Health provision through Department of Health Social Service and Public Safety (DHSSPS) Northern Ireland Government organisation. Different organisation from other UK home countries, Wales England and Scotland.
Northern Ireland Population of 1.8 million Dispensing Community Pharmacists are private commercial enterprises Unless eligible for exemption, patients pay the pharmacist who passes the money on to DHSSPS Current charge is 6.50 per prescription item Over 15 million prescriptions issued by GPs per year and growing at 5% per year. Total cost of prescriptions in 2004/05 was 382.8 million Total receipts from prescription charges was 12.7 million
Losses to Public Purse The current estimate of prescription fraud is 7.8 million per annum Of this 95% is estimated to be fraud initiated by the patient (not paying when they should) A total of 7.41 million per annum (2004/05)
What is εpes? Mandate and Brief In order to support the Departmental Fraud Action Plan and the Family Practitioners Service repayments an electronic means of capturing, recording and validating Form Information is needed
Current Manual Processes Reimbursements Pharmaceutical Repayments System Electronic Data Capture CSA NIPPI System All Script Storage Counter Fraud Unit Social Security Agency MIDAS Cross Checking
EPES ( Original Preferred Option) Reimbursements Pharmaceutical Repayments System Manual Electronic Data Capture (Pharmacist) NIPPI All Script Storage Manual Standby Information Systems (Dispensed Information) Communication Method? Counter Fraud Unit Social Security Agency MIDAS Cross Checking
Initial Proposals Manual entry of data at pharmacies No change in current processes except the addition of fields for patient claim If prescribed data to be captured double entry required Electronic batch transfer from CPs to CSA NO. Pharmacists not happy at all
Lessons from Amsterdam What I learnt from the German & Danish experiences Eva Susanne Dietrich Ib Johansen
Challenges with Paperless ETP Technical issues with resilience and performance (always connected & data transfer speeds) The legal status of a paperless electronic prescription Changes to GP prescribing systems and surgery protocols. Issues regarding the use of electronic signatures by GPs/CPs Issues regarding the use of electronic signatures by the patients claiming exemptions The use of electronic records in prosecutions and civil actions Identification of the patient at the CP counter
Lessons from Amsterdam What I learnt from the Spanish experiences Teresa Molina Lopez
Use of Linear and 2D Barcodes
Modified Print Driver All information sent to the printer is encoded into the 2D barcode and placed at a specific location on the form. No changes needed in GP Prescribing Software
2D Barcode reader Key elements in new automated process 2D Bar Code printed on prescription by GP prescribing system Barcode reader in CP for automated reading into CP dispensing system
EPES Reimbursements Barcode Generation (GP) Automated Electronic Data Capture (Pharmacist) Data confirmation for patient through Patient Receipt NIPPI Pharmaceutical Repayments System Confirmation Scanning (CSA) All Script Storage (Images Recall?) Manual Standby Information Systems (Prescribed & Dispensed) Communication Method? Counter Fraud Unit Social Security Agency MIDAS Cross Checking
The Patient Receipt Mr. Jones HHDN3498576/009 29 th May 2006 JJR The Pharmacist No. of Items 2 0.00 (J)
The Patient Receipt Mr. Jones HHDN3498576/009 29 th May 2006 JJR The Pharmacist No. of Items 2 13.00 (P)
The Patient Receipt Sticky Label (bag label) that confirms (to the patient) the information stored on the database in relation to their claim for free prescriptions, or receipt of their due payment. Generated from the Database (not the till) with the bottle labels Protects the Community Pharmacist from claims of indiscretions by the patients/customer Assures the patient/customer that their wishes in respect to their claim have been recorded correctly on the Database. Increases the probability that the information, on which the CFU/FPS will act, is agreed and as accurate as possible.
BENEFITS Fewer medication transcription and coding errors Increased efficiency Better Communication Channels Fraud reduction Repeat prescribing benefits Decrease costs Improved quality Improved public health Improved practice (Mundy and Chadwick )
BARRIERS Privacy and security Cultural and Organizational issues Senior management and clinician commitment Cost of transformation * Legalities * Technical problems * Multiple drug codes Education and implementation Professional, Practice and Patient Issues * Less of a problem with EPES (Mundy and Chadwick )
Numbers Community Pharmacists Systems AAH/Lloyds 56 (81) McLernons 372 (484) Alliance Systems 51 (76) Boots (Systems Solution) 28 (42) 506 (683) GP Systems Emis 146 isoft 86 InPractice 109 Merlock 25 366
Costs Full implementation completed 2 years from award of contract Capital Costs (over 2 years) 4.3 million Annual Service Costs Target fraud savings (Over 5 year period) 650K /annum 8.3 million Full project costs recouped within 5 years of award of contract On-going savings into the future
Conclusions EPES is ETP using a surprising route. EPES is Affordable EPES is Effective EPES has a robust Business Continuity strategy
The End