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ePrescribing update

ePrescribing update. Ann Slee Clinical Lead ePrescribing programme, NHS Connecting for Health www.connectingforhealth.nhs.uk/eprescribing. Outline. ePrescribing programme aims Update on work to date ePrescribing moving on. ePrescribing programme aims. Focus on hospital-based care

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ePrescribing update

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  1. ePrescribing update Ann Slee Clinical Lead ePrescribing programme, NHS Connecting for Health www.connectingforhealth.nhs.uk/eprescribing

  2. Outline • ePrescribing programme aims • Update on work to date • ePrescribing moving on

  3. ePrescribing programme aims • Focus on hospital-based care • Facilitate and support the delivery of ePrescribing • Definitions, standards, content/approach, requirements etc • Working with NHS CFH local programmes, system suppliers, NHS trusts…

  4. Where does it fit? • One of the five key elements (the “Clinical 5”) for secondary care within the Health Informatics Review • Key to delivery of trusts’ quality and safety agendas • Darzi, QIPP…. • Increasing pressure (and clinical imperative) to deliver systems

  5. The National Programme for IT operates in England and the country is split into three areas, each of which has an LSP. London Programme for IT (LPfIT): BT Capital Care Alliance North, Midlands and East (NME) Programme for IT (NMEPfIT): Computer Sciences Corporation Alliance (CSCA) Southern Programme for IT (SPfIT): BT taking over 8 live Cerner Millennium sites from Fujitsu. ASSC approach for remaining trusts. There are 10 SHAs in England and they are represented in the three Programmes for IT. Local programmes for IT

  6. Outline • ePrescribing programme aims • Update on work to date • ePrescribing moving on

  7. ePrescribing work 2006/07 • Definition of oncology prescribing specification • Benchmark of existing oncology systems • Funding for interim solutions 2006 • 18 cancer networks in progress or implemented • Clarify Output Based Specification (OBS) requirements for all specialties • Functional specification published Jan 2007

  8. Reducing risk • Hazard framework guidance published August 2008 • Outlines main design elements that required to reduce known areas of risk identified in literature and anecdotal reports • Excludes decision support • Available on website • System evaluations (2008) identified strong correlation between compliance and impression of safety and usability

  9. System Evaluation - Approach 1. Front Line Clinical Review 2. Func. Spec & User Interface ePrescribing System Demo Functional Specification Mapping & Professional UI Review ePrescribing System Evaluation 4. Long Term Partnership 3. System Technical Specification Pre-Evaluation Questionnaire All available on nww Connecting for Health website

  10. Weighting • Front Line Clinical Review 48/100 • Front Line Clinical Impressions 7/100 • Functionality and User Interface 20/100 • System Technical Specification 10/100 • Long Term Partnership 15/100

  11. Systems Evaluated • 12 systems identified • Not comparing like with like • Full EPR system • Standalone eP • Results need interpreting with this in mind • All suppliers given feedback • Similar exercise in oncology moved system development on • Report and methodology at nww.connectingforhealth.nhs.uk/

  12. Strong correlation At the end of the scripted demo, the panelists voted Yes / No to the question: Is this system safe? The panel’s total score against the NHS CFH ePrescribing Hazard Framework The total score of the panel’s subjective usability questions, asked after each section of the demo Using the “Error trap” method

  13. Further ePrescribing guidance • User interface guidance • ePrescribing in secondary care available on CUI website www.cui.nhs.uk • Reducing the risk of mis-selection of opioids • available on eP web pages

  14. VTM TF Virtual Trade Therapeutic Family Moiety VMP AMP Virtual Actual Medicinal Medicinal Product Product VMPP AMPP Virtual Actual Medicinal Medicinal Product Pack Product Pack Key underpinning element - dm+d ibuprofen BRUFEN BRUFEN 400 mg tablets (and 33 other AMPs incl. 25 manufacturer’s generics) ibuprofen 400 mg tablets (and 16 other VMPs) ibuprofen 400 mg tablets (100 tablets) (and 7 other VMPPs) BRUFEN 400 mg tablets (100 tablets) (and 1 other AMPP)

  15. dm+d VTM TF Virtual Trade Therapeutic Family Moiety VMP AMP Virtual Actual Medicinal Medicinal Product Product VMPP AMPP Virtual Actual Medicinal Medicinal Product Pack Product Pack Ingredients & strength Coded form Coded route Availability CD status Prescribing flags Availability Licensed route Excipients Manufacturer

  16. Overall aim • Prescribing model for secondary care, interoperable with all other care settings • Minimum data requirements for all prescriptions • Maximise safety & flexibility • On-screen presentation • Safe administration • Between-system messaging

  17. Common medicines terminology • Enables computable equivalence… … is computably equivalent to “2ndary care style: paracetamol – oral – tablets – DOSE 1000 mg – four times a day paracetamol 500 mg tablets – oral – DOSE take 2 – four times a day VMP from dm+d Dose Syntax compliant data VTM from dm+d Dose Syntax compliant data Coded form from dm+d

  18. Framework: Types and Rules • 29 medication types • Each represents a recognisable real-life prescribing pattern and defines the minimum data required at the time of prescribing • Allows maximum flexibility within dose based prescribing • Any prescription can be mapped to one of these types by knowing the VTM + Route • And occasionally other data… • 1 + 10 rules • Use dm+d content & flags, plus other content in SNOMED, to enforce safe prescribing in particular circumstances

  19. dm+d • Major changes to support secondary care complete June 2009 • dm+d secondary care implementation guidance for ePrescribing published • Progressing through Information Standards Board

  20. Challenges and lessons learned • ePrescribing is often referred to as “too difficult” • Technically and culturally • Systems not available • But there are successful implementations… • NHS CFH commissioned a report identifying the challenges and lessons learned

  21. Challenges and lessons learned • Includes • ePrescribing functions and benefits • Motivations • Ensuring success • Managing safety • Planning • Managing in use • Technologies • Look ahead

  22. Available on ePrescribing web pages now www.connectingforhealth.nhs.uk/eprescribing

  23. Outline • ePrescribing programme aims • Update on work to date • ePrescribing moving on

  24. Information design booklet • Partnership with NPSA and CUI • Recommendations sourced from: • Academic research • Existing guidelines (NPSA, ISMP etc) • Anecdotal evidence/lessons learned • CUI usability research • Publication scheduled January 2010

  25. Moving on… • Priority – support successful implementation of hospital-based systems • Design, build, test, configure etc • Further lessons to share • Benefits

  26. Clinical decision support strategy • Detailed work on each area of active CDS • Dose range checking – consultation May, June 09, publish Oct 09 • Allergy checking – consultation Oct 09, early 2010 & publish 2010 • Hazard framework guidance for CDS • 5 rights – right information, person, intervention format, channel, time in workflow. • Implementation support for individual elements • Assurance/Standards work - NICE • Alert design research –Edworthy & Avery

  27. ePrescribing forum • Aim – to maximise the benefits from the implementation of ePrescribing by promoting and supporting collaboration amongst all interested parties

  28. Continued standards development • dm+d – further work with dm+d team • Name order, shortened names for display, flagging high risk medicines etc, etc….. • Clinical safety • System standards

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