ePrescribing Update

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ePrescribing Update

• Ann Slee
• Clinical Lead, ePrescribing Programme
• NHS Connecting for Health
• ann.slee_at_nhs.net

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ePrescribing

• the utilisation of electronic systems to
  facilitate and enhance the communication of a
  prescription or medication order, aiding the
  choice, administration or supply of a medicine
  through decision support and providing a robust
  audit trail for the entire medicines use process.

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Objectives

• National ePrescribing programme aims
• ePrescribing work to date
• ePrescribing moving on

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National ePrescribing Programme Aims

• Facilitate and support the delivery of
  ePrescribing
• definitions, standards, content/approach,
  requirements etc

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What does eP cover?

• ePrescribing systems in practical terms will
  provide
• Computerised entry and management of
  prescriptions, including medicines
  administration
• Knowledge support, with immediate access to
  medicines information, e.g. BNF
• Decision support, aiding the choice of medicines
  and additional checking with alerts such as drug
  interactions
• Computerised links between hospital
  wards/departments and pharmacies
• Improvements in existing work processes
• A robust audit trail for the entire medicines use
  process

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Why is it taking so long?

• eP is complex and challenging to deliver
• includes 3 types of prescribing plus
  administration
• Must meet numerous specialty specific
  requirements
• Key safety challenge
• In integrated systems follows delivery of other
  key elements
• 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
  agenda

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Objectives

• National ePrescribing programme aims
• ePrescribing work to date
• ePrescribing moving on

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ePrescribing work to date..

• Definition of oncology prescribing specification
• Benchmark of existing oncology systems
• Funding for interim solutions 2006
• 14 cancer networks implementing or implemented
• 4 at late planning stages
• Clarify Output Based Specification (OBS)
  requirements for all specialties
• Functional specification published Jan 2007
  (www.connectingforhealth.nhs.uk/eprescribing)

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Reporting

• Information out will be key
• Systems must be built with reporting in mind
• Framework identified
• Workshop and consultation undertaken
• Reporting document published on website

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Reducing risk

• Hazard framework guidance
• Published August 2008 www.connectingforhealth.nhs.
  uk/eprescribing
• User interface guidance being produced
• Initial guidance available on CUI website
• Standard drug dictionary

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dmd dictionary of medicines and devices

• Needs to support computable equivalence

is computably equivalent to secondary 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 dmd
Dose Syntax compliant data
VTM from dmd
Dose Syntax compliant data
Coded form from dmd
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Secondary Care Prescribing Model

• Identified minimum data requirements to produce
  unambiguous prescriptions
• Maximise safety flexibility
• For example
• Beclometasone inhaler 2puffs twice a day
  AMBIGUOUS
• Need to add strength and inhaler type
• Secondary care prescribing model / rules
  www.connectingforhealth.nhs.uk/eprescribing

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dmd

• Changes to dmd to support secondary care in
  progress
• completion April 2009
• dmd secondary care implementation guidance for
  ePrescribing being consulted upon
  http//www.dmd.nhs.uk/documentation

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Challenges and Lessons Learnt
There are no secrets to success. It is the
result of preparation, hard work, and learning
from failure. Colin Powell

• Often quoted as too difficult
• Technically
• Culturally
• Systems not available
• There are successful implementations
• Commissioned a report identifying the challenges
  and lessons learnt

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• Available in April 2009
• Report
• Short briefs
• Presentation

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Objectives

• NHS CfH structure
• ePrescribing work to date
• ePrescribing moving on

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ePrescribing Moving On

• Delivery of systems a priority
• Implementation support
• Decision support guidance
• Hazard framework guidance
• Implementation support
• Development and sharing of rules
• Other themes dmd, clinical safety, system
  standards

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Strong reasons make strong actions William
Shakespeare
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