Post on 14-Feb-2016
description
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