Meetings & Conferences

Dr Young said that in order to deliver a high quality service that is cost effective there must be good information technology. But, the question is, does the National Health Service have the money to spend on IT? From 1998 to 2004, about 1.5 per cent of the total NHS budget, which is upwards of £60bn, was expected to be made available for spending on IT. However, Dr Young explained, not all the money designated for IT is used for that purpose and developments such as waiting list initiatives have taken priority. In 2000–01, 50 to 80 per cent of the money allocated to IT was spent on other such priorities. "What we want is a situation where money given for IT is used for IT. My understanding is that this will come about." He added that he was confident that the amount of money devoted to IT would double to 3 per cent of the NHS budget over a period of one to two years.

Reducing drug costs

Dr Young said that there is evidence that electronic prescribing systems reduce drug costs by, for example, suggesting cheaper but equivalent drugs, supporting hospital formularies and giving detailed, but accurate, data on drug prescribing. They also have the ability to take into account patient issues such as allergies, drug sensitivities and height and weight, whereas it is almost impossible for individual prescribers to take all these issues on board when writing prescriptions. Not only can the systems do this, but they should do this, he said.

Nick Mapstone, project manager, Audit Commission, said: "The case for electronic prescribing and electronic records is so compelling, I am pretty confident that the funds will be there to do it." Implementation of the electronic health record and electronic prescribing systems will lead to greater patient empowerment, greater concordance, fewer readmissions, better health outcomes and lower costs, he believed.

Adverse drug reactions and medication errors affect both the cost and quality of health care and currently cost the NHS £500m a year in longer stays in hospital. Over 10 per cent of patients experience an adverse event and each adverse event results in an extra 8.5 days' stay in hospital, he said. Mr Mapstone added: "A typical hospital has five beds occupied by patients who have been made sicker by medication errors". Many of these errors could be eliminated through the use of electronic records and electronic prescribing systems and automation, he said. In the United States it has been shown that electronic prescribing could eliminate 75 per cent of medication errors.

Automating dispensing will free pharmacy staff to provide front-line patient services. Pharmacy is not a room in a hospital and the profession needs to see its principal role as being at the patients' bedsides, he said. The central role pharmacists play in managing medicines effectively is outlined in the Audit Commission's report "A spoonful of sugar". "Some people have said that the report is something like a chief pharmacist's charter and should be written in green ink", he added.

An international problem

Mr Mapstone also said that medicines management is an international problem and not just a problem that the NHS is having. Dr Barry Blumenfeld, clinical informatics research and development, Partners Healthcare System, Boston, Massachusetts, said that at Brigham and Women's Hospital, Boston, medication errors have been shown to account for 5 per cent of all medical errors made in both inpatient and outpatient settings and that adverse drug events have cost the hospital $5.6m a year in additional care costs. He also said that only 5 per cent of hospitals in the US have electronic prescribing systems compared with 13 per cent of UK hospitals.

Brigham and Women's Hospital has a computerised physician ordering system (CPOS) which is now in its third generation. This has improved practice, resulting in fewer adverse drug events and reduced cost and morbidity associated with errors. Benefits of writing prescriptions using CPOS include providing the prescriber with dosing advice and a variety of alerting functions such as drug interaction checking and drug allergy checking. Patients also have bracelets that are barcoded and can be scanned by nurses to find out what medication they are on.

Debra Walker, pharmacy computer services manager, Liverpool Health Authority said that an audit of the progress for implementation of level 3 EPR had been carried out in the north west region. Out of the 33 hospitals that responded, six sites had electronic prescribing in some form, including pilot systems. One site was running the system throughout the hospital for inpatients but no hospital was prescribing electronically in an outpatient setting. Of the remaining sites that did not have electronic prescribing, 22 expected to have a pilot scheme running within the next three years. The audit also indicated that five different pharmacy systems and 11 different hospital information support systems were being used.

Although the use of computer technology and automation to help reduce such errors is encouraged in the Audit Commission's report, implementing electronic prescribing will involve significant changes within organisations and the impact on the pharmacy department must not be underestimated, Mrs Walker said.