Hospital Electronic Prescribing and Medicines Administration (HEPMA)

1. Hospital Electronic Prescribing and Medicines Administration (HEPMA) Improving safe, effective and person centred care On behalf of the eHealth SLWG (With thanks to many contributors) On behalf of the eHealth SLWG

2. Setting the scene • Quality and eHealth strategies • Academic evaluation and local experience • Progress • Question for today

3. Context Safe Effective Person Centred http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf Scottish Government, May 2010

4. Safety of Prescribing & Administration % Opportunity For Error Per Annum in NHS Scotland

5. Medicines Governance - Stakeholders Prescribing and Administration

7. The paper based system • Aberdeen / London in patient prescription and administration record • Structured approach to prescribing and medicines administration • Links prescribing and administration in real time • Tried and tested over 50 years in the UK • Despite limitations remains in use • Single Record for NHS Scotland to improve safety-alignment not major redesign • Limitations: • Hand written • Multiple transcription / handover points • No prescribing advice and decision support • No link with increasing number of IT clinical systems • data on medicine usage collated manually

8. Primary Care ePrescribing Architecture GP’s have been using computers to generate prescriptions for years • Computers used to generate prescription • Signed • Taken to Pharmacy for dispensing – electronically retrieved • Electronically processed for pricing 1 : 1 relationship

9. Hospital ePrescribing Architecture 1 : many relationship

10. Healthcare Improvement Scotland Seminar May 2011 • ePrescribing is continuously evolving in complexity and scope • ePrescribing systems need a lot of customisation over time by many people in order to maximise the opportunities for improving outcomes • The evidence of the effectiveness of these systems is at present limited – this reflecting naïve assumptions on time horizons, methodological limitations and a failure to appreciate the importance of “reinvention” • Future implementations should proceed in an evaluative context in which the value of both formative and summative evaluations is recognised eHealth Research Group, The University of Edinburgh

11. Local Observations • HEPMA provides legible prescriptions aided by decision support • Legible rubbish is more dangerous than illegible rubbish • HEPMA is a tool to aid not replace human behavior • HEPMA does not make decisions - prescribers still are responsible for the quality of data they create • HEPMA does not overcome the basic educational needs of prescribers (who ever they may be) and the need for care and attention

12. Local Observations • The different designs and logic inbuilt into different systems will deliver different benefits and raise different risks • Need a lot of monitoring for safety • Database needs a lot of QA and testing • Potential benefits from standard Scottish system • Lack of quality research to support widespread implementation • Research is very time consuming

13. Healthcare Improvement Scotland May 2011 Convergence

14. Ehealth - Supporting the quality strategy5 aims: • Maximising efficient working practices • Supporting people to communicate with NHS Scotland and manage their health. • Contributing to care integration • Enhancing availability of information for staff • Improving medicines safety and effective use http://www.scotland.gov.uk/Publications/2011/09/09103110/0 (Sept 2011)

15. eHealth Strategy 2011 - 2017 “To improve the safety of people taking medicines and their effective use” A short life working group has been established by the eHealth Strategy Board to balance the shorter term objective of improving Medicine Reconciliation with the longer term medication management objectives of HEPMA against a reduction in the capital available for eHealth developments.

16. eHealth Strategy 2011 - 2017 • The SLWG has been asked to: • consider the needs of all stakeholders in the medicines process • focus on pragmatic and incremental solutions, including better use of what exists • and consider a range of incremental options leading to full HEPMA implementation (based on the nationally available system) The group will report back to the Strategy Board in late 2011. • “We will implement the recommendations proposed by this short life working group.”

17. Short Life Working Group - Actions • What have NHS Boards achieved to date in the following areas • Admission for scheduled or unscheduled care • During the inpatient stay • Discharge back into Primary Care • Plans or thoughts regarding progression over the next 1 – 3 years

18. Paper Based

19. Electronic Discharge Letter (eIDL)

20. eMedicines Reconciliation (GGC)

21. Current HEPMA in NHS Scotland

22. Future Requirements

23. Summary of Where We Are..... • Strategic commitment - Quality Strategy, eHealth Strategy • Clinical will and enthusiasm • Experience and lessons learned • Academic engagement • Robust technical infrastructure • Technical and clinical support requirements acknowledged • Scottish standards for HEPMA • Scottish operational requirements and test scripts

24. eHealth Strategy 2011 - 2017 “To improve the safety of people taking medicines and their effective use” A short life working group has been established by the eHealth Strategy Board to balance the shorter term objective of improving Medicine Reconciliation with the longer term medication management objectives of HEPMA against a reduction in the capital available for eHealth developments.

25. Summary of Where We Are..... • Shorter term objective of improving medicines reconciliation • Substantial progress with medicine reconciliation on admission • Emergency Care Summary (ECS) • Format and content • eMedicine reconciliation form • Standards agreed and a how to guide for local development • Progress on the eIDL underpinned by SIGN 65 • SIGN 65 being updated – cross representation

26. Question for today How do we realise the longer term medicines management objectives of HEPMA against the reduction in capital available for eHealth? Managing the needs of all stakeholders Using pragmatic solutions Making better use of what exists Incremental options leading to full HEPMA