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

SETTING THE SCENE

• Quality and eHealth strategies

• Academic evaluation and local experience

• Progress

• Question for today

CONTEXT

http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf Scottish Government, May 2010

SafeEffectivePerson Centred

Safety of Prescribing & Administration

% Opportunity For Error Per Annum in NHS Scotland

Medicines Governance - Stakeholders

Prescribing and Administration

Electronic Prescribing and Administration

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

Primary Care ePrescribing Architecture

Computers used to generate prescription

Signed

Taken to Pharmacy for dispensing – electronically retrieved

Electronically processed for pricing

GP’s have been using computers to generate prescriptions for years

1 : 1 relationship

Hospital ePrescribing Architecture

1 : many relationship

Healthcare Improvement Scotland Seminar May 2011

eHealth Research Group, The University of Edinburgh

• 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

Local Observations

HEPMA provides legible prescriptions aided by decision support

Legible rubbish is more dangerous than illegible rubbishHEPMA is a tool to aid not replace human behaviorHEPMA does not make decisions - prescribers still are

responsible for the quality of data they createHEPMA does not overcome the basic educational needs of

prescribers (who ever they may be) and the need for care and attention

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 safetyDatabase needs a lot of QA and testingPotential benefits from standard Scottish systemLack of quality research to support widespread

implementationResearch is very time consuming

Convergence

Healthcare Improvement Scotland May 2011

• 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

EHEALTH - SUPPORTING THE QUALITY

STRATEGY

5 AIMS:

http://www.scotland.gov.uk/Publications/2011/09/09103110/0 (Sept 2011)

“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.

eHealth Strategy 2011 - 2017

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.”

• 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

Short Life Working Group - Actions

Paper Based

Electronic Discharge Letter (eIDL)

eMedicines Reconciliation (GGC)

Current HEPMA in NHS Scotland

FUTURE REQUIREMENTS

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

Summary of Where We Are.....

“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.

eHealth Strategy 2011 - 2017

• 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

Summary of Where We Are.....

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

Question for today