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Electronic Prescribing In Hospitals: Moving Forward: News and Updates

This conference looked at moving forward with Electronic Prescribing and Medicines Administration (EPMA) in a hospital setting and where eprescribing fits within your digital roadmap to a paper free at the point of care service. Electronic Prescribing has the potential to support the medicines use process that can be delivered at every stage from prescribing to administration, it can provide management of prescriptions and will also give immediate access to medicines information.

Speakers and Presentations

ePrescribing: National Developments

Sean Brennan, Independent Consultant in Healthcare Informatics, Clinical Matrix

  • national developments in eprescribing
  • eprescribing lessons from the digital examplars
  • developing effective measures of eprescribing maturity
  • where Electronic Prescribing fits into Electronic Patient Records
  • standardizing eprescribing across hospitals
  • understanding digital maturity
  • how can we use eprescribing to change prescribing behavior
  • moving forward: critical success factors

Sean emphasised the need to shift away from the drive to 'go paperless' and focu on using technology to support nurses adn doctors with what they do.

Sean started his NHS professional career in Pathology and when he was Chief Scientific Officer in Immunology re-trained as a General Manager.

Part of the‘re-training’ was to establish a Clinical Audit Department in the Huddersfield Royal Infirmary, as a result of this successful development, he was seconded to the Department of Health as a Clinical Audit Advisor initially at Richmond House London transferring up to the new Quarry House in Leeds in 1996.

It was during his time in clinical audit that Sean was drawn into health informatics – realising that without timely and accurate clinical information, it was impossible for clinicians to undertake any critical evaluations with only the paper case notes as source.

He became the project manager for the NHS’s national Electronic Patient Record (EPR) Programme at the time of Information for Health in 1998 (i.e. before the National Programme for IT and Connecting for Health). He has also experienced work with a clinical computer supplier (Northgate Information Solutions) and then 14 years as a successful independent health informatics consultant undertaking NHS projects including the development of EPR strategies; IM&T business cases; benefits realisation of the EPR, clinical and information governance projects and re-design of clinical services utilising emerging technologies where appropriate in Scotland, England and the Isle of Man.

He is a popular presenter on the health informatics and clinical effectiveness circuit and is a successful facilitator of interactive workshops with electronic voting technologies. He ran a series of EPR workshops in Dubai for 5 successive years.

His best-selling book ‘The NHS IT Project: The Biggest Computer Programme in the World Ever!’ (although released ten years ago), is still a useful reminder of the path that NHS computing has taken and needs to continue to take.

Towards the Digital Hospital: Electronic Prescribing within EPR

Dr Mike Fisher, Chief Clinical Information Officer, Consultant Cardiologist, Royal Liverpool & Broadgreen University Hospitals NHS Trust

  • electronic prescribing within an integrated EPR
  • where eprescribing fits within our digital roadmap
  • moving beyond the hospital to whole systems
  • towards a digital hospital
  • links to the NHS five year forward view and the digital road map

Dr Fisher also said digitalisation isn't about going paperless there are definite clinical and safety advantages.  He said that ePrescribing brings up new errors and requires interoperability to be seamless, and recommends that a full electronic health record system is acquired rather than implementing ePrescribing alone. Dr Fisher finished his presentation by saying outcome critically depends on how the deployment is planned and executed which is even more important than the particular system chosen.

Dr Mike Fisher’s Full Presentation Click Here

Dr. Fisher is a consultant cardiologist at the Royal Liverpool University Hospital and the Liverpool Heart and Chest Hospital. He specialises in interventional cardiology and particularly in managing patients with difficult to treat angina, but has a lively interest in research and audit, which accounts for his interest in data. He has a background in IT, having worked as a programmer, operator and database administrator for ICL and the Post Office in the past and also having run his own small IT software firm. For his sins, he is also the Chief Clinical Information Officer (CCIO) for the Royal Liverpool trust!

Electronic Prescribing: learning from two decades of experience

Brian Power, Lead Informatics Pharmacist, Wirral University Teaching Hospitals NHS Foundation Trust

  • embedding an electronic prescribing system to drive changes in clinical practice
  • engaging clinicians in electronic prescribing and medicines administration
  • our approach, experience, critical success factors and developments
  • lessons and learning from two decade of electronic prescribing
  • challenges in migrating to a new electronic prescribing system

Brian Power’s Full Presentation Click Here

Pre-Event Abstract:

Wirral Hospitals were at the forefront of the implementation of electronic patient record (EPR) systems in the UK. As part of the resource management initiative in the late 1980s the American TDS 7000 system was procured. This included a patient administration system (PAS) and clinical modules and was called PCIS. The challenge of taking this American system and customising it to the UK was undertaken by a team of technical and clinical staff. The initial work entailed rolling out the PAS system followed by ordering and resulting for laboratory and radiology tests. Electronic prescribing and medicines administration (EPMA) were implemented in the early 1990s. This was piloted in a number of wards first before being extended to the majority of wards in the hospital.

The original EPR system was used for over two decades but it has been replaced by the Cerner Millennium system. Cerner Millennium is another integrated EPR system and this has been implemented gradually over the past few years. Again the challenges have been adapting a US system to a British healthcare environment and EPMA was implemented in November 2014.

There are many key learning points from over two decades of experience. One of the key ones being that the system can never stand still. PCIS was continuously maintained and customised in response to drug formulary changes, risk management issues and national initiatives. This is also the case with Cerner. Having adequate resources is essential to ensuring that the EPMA system can be maintained and new functionality added. A robust PAS system is essential as well as having steps in place to promote near perfect identity management to try and prevent wrong patient selection and the serious clinical risk that this brings. EPMA has been instrumental in reducing many of the errors associated with drug prescribing but it is not a panacea and can increase certain types of error.

The success of the system has been due in no small way to the fact that it is easy to log on and that it is fast and reliable. There has been a strong information governance culture with staff being aware of the importance of protecting patients’ data and not sharing passwords. It has been a big advantage having a single integrated system for most clinical applications. This has been seen as a Trust wide system and not just something being imposed on clinicians by the pharmacy department. Continuing clinician engagement is also essential not only not ensure the successful implementation of the system but also to ensure that it is embedded into the hospital to support and improve clinical practice.

The transitioning from one electronic patient record system to another at Wirral was a huge undertaking that took careful planning and required significant investment in terms of resources and technology. The challenge since then has been to roll out EPMA to all areas of the Trust and to work on system optimisation as part of the Global Digital Exemplar project.

Brian is Lead Informatics Pharmacist at Wirral University Teaching Hospital. He has worked at Wirral since 1999 and he is responsible for the maintenance and development of the electronic prescribing system. In recent years this has involved being part of the team tasked with replacing the legacy electronic patient record system. This culminated with the implementation of the Cerner electronic prescribing and medicines administration system in November 2014.  He has also been involved with developing and implementing systems for venous thromboembolism assessment. He has worked clinically as Lead Clinical Pharmacist for the Elderly Care directorate at Wirral and continues to provide a regular clinical commitment.

Future events of interest:

Data Quality and Clinical Coding for Improvement
Monday 2 October 2017 
De Vere West One Conference Centre, London

Delivering a Paperless NHS: Intelligent Electronic Document Management in Healthcare
Monday 9 October 2017 
De Vere West One Conference Centre, London

Electronic Prescribing in Mental Health
Wednesday 18 October 2017 
The Studio Conference Centre, Birmingham

13 July 2017


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