| In one community pharmacy near Perth, the electronic transfer of prescriptions
(ETP) is a reality: 99 per cent of prescriptions are now received in
this way. This marks the start of Scotland’s acute medication service
(eAMS), the third of the four core services to be implemented under the
new community pharmacy contract. eAMS is dependent on ETP and it should
be operating in every pharmacy in Scotland by next autumn.
Alison Strath, principal pharmaceutical officer, Scottish Govern-ment,
says: “eAMS will be phased in, starting this month but in the main
from January 2008, with a view to it being in place across Scotland by
September 2008 at the latest.” She points out: “eAMS does
not require everyone to be ready for a specific date, which means that
we can afford to phase the implementation to allow for all the technical
and administrative complexities that arise when implementing the electronic
transfer, dispensing and processing of prescriptions.”
Alex MacKinnon, head of corporate affairs at Community Pharmacy Scotland,
comments: “We are pleased with the progress in the pilot sites,
which we have already visited. Both the Scottish Government and Community
Pharmacy Scotland are keen to see an early introduction of ETP functionality
to support the planned implementation of both eAMS and the chronic medication
service.”
Testing proves system works
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Pharmacist Andy Watson scans in prescriptions
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ETP is being tested in Scotland at Davidson’s Chemists in Bridge
of Earn, Perthshire, in collaboration with the system provider and the
Scottish Government.
Andy Watson, pharmacy manager, says: “It has
exceeded my expectations. The system worked from the first moment it
was set up and it has been straightforward to use.”
Of course,
the whole point of having a test site is to identify problems before
the system is rolled out. But, nearly two months after the system was
installed, Mr Watson says the number of issues that have had to be resolved
has been small.
Karen Gordon, operations manager at Davidson’s Chemists, comments: “It
has been a case of ironing a few things out. From our experience as a
test site, we believe that ETP is currently working extremely well. This
is demonstrated by the fast and efficient downloading and creation of
the electronic messages.”
How eAMS works is explained in the Panel (p643).
The system on test at Davidson’s is provided by Cegedim Rx but,
since all pharmacy computer system suppliers were given the same service
specification, others are
expected to be similar.
“Both the GP and community pharmacy system suppliers were given specifications,
which detailed the necessary requirements and the optional extras or
desirable features,” explains Ms Strath.
“The same core functionality
has been integrated into the individual systems’ existing dispensing
functionality therefore the systems still retain their key differentiators.
The testing phase allows us to ensure the eAMS programme deliverables
have been included and to check the impact at the pharmacy.”
Cegedim Rx appears to have been quick to deliver eAMS but, according
to managing director Simon Driver, the company has simply delivered what
was agreed. “The Scottish Government and Atos Origin [NHS Scotland’s
IT partner] were realistic about when things could be achieved and asked
us when we could deliver eAMS. We have delivered to that agreed timescale,” he
says. “The testing has gone exceptionally well.”
Mr Driver adds: “The Scottish approach has been measured and realistic
about what it is trying to achieve. It has taken bite-sized chunks that
give benefits, like eMAS [the minor ailment service], which has been
successful with patients and pharmacists. This is what software is designed
to do: to enable.”
Mrs Gordon explains why they offered to be a test site: “Cegedim
asked us if we wanted to test the system at one of our pharmacies. At
the same time, NHS Tayside identified the GP surgery in Bridge of Earn
as one of the practices that was ahead of the game in installing ETP
software. So we fitted the two together.
“Of course it means extra work
for Andy but it helps that he is a keen, IT-literate pharmacist who doesn’t
mind lots of people visiting the pharmacy to see how the system works.”
Mr Watson points out: “Testing works here because there is only
one GP surgery and one pharmacy in Bridge of Earn so we dispense the
majority of their prescriptions, and have a close working relationship.”
The process of ETP is clearly successful, demonstrated by the fact that
99 per cent of prescriptions received by the pharmacy are now in electronic
form. But what are the advantages? Mr Watson highlights data entry being
faster, particularly for new patients, and the fact that it cuts the
risk of labelling errors.
“When you dispense a new item, the computer
selects the item based on the DM+D [dictionary of medicines and devices]
code so you can’t pick the wrong product,” he explains. Not
only does this prevent data-entry errors but it is also useful for quickly
identifying what a prescriber intends when prescriptions for items, such
as dressings, are written generically.
“Another big advantage is that if the surgery wants to telephone through
a prescription, I just ask the receptionist for the unique number printed
on the prescription form. I can then key that in and confirm the details
back to the receptionist. This is so much safer than taking prescription
details over the phone,” Mr Watson adds. “I also believe
it will save me time in the future,” he says.
However, as a pilot
site, the time he has saved so far in prescription processing is currently
spent auditing the system as part of the pilot or demonstrating the system
to visitors who are keen to see how the new technology works.
Another change eAMS will bring is that prescriptions will be priced using
electronic data sent to Practitioner Services during the dispensing process,
rather than manual pricing using paper prescriptions. Ms Gordon explains
that part of the pilot involves prescriptions being priced both using
the new electronic data and in the traditional way: these prices will
then be compared. The results of this are not yet available.
Mr MacKinnon
adds: “Community Pharmacy Scotland continues to work with Practitioner
Services Division on the implications for contractors of the introduction
of the ePay programme.”
With the pharmacy end of the pilot positive, what do the doctors involved
think of ETP? “Good so far,” says Beena Raschkes,
GP at the Bridge of Earn surgery. “Inevitably there have been problems — but
there should be, we are a pilot. We’ve certainly tested the system
with patient treatment, new partners joining and huge list transfers.
But the process has worked well.”
Dr Raschkes adds: “The
whole process is safer for us as prescribers and for patients. Although
it currently brings little change for us, it provides the security of
knowing that we are reducing risks of transcription errors, reducing ‘missing’ prescriptions
and reducing fraudulent script changes.”
With eAMS just around the corner, what advice would Mr Watson — having
experienced ETP — give to other pharmacists? “Without a doubt,
it is to make sure they are recording patients’ exemption status
on their pharmacy computer records now,” he says. He explains that
if exemption status is recorded in advance, it makes the dispensing process
faster because otherwise it has to be entered when the prescription is
collected.
“Looking to the future, we would like the ETP system to be interfaced
with our EPOS [electronic point of sale] system at the till. Then we
could enter payment details at the point of giving the prescription out.
This would complete the audit trail: the prescription would be scanned
in when received, dispensed electronically, and then scanned out when
picked up, so it would be possible to see exactly when it was processed,” he
comments.
Mrs Gordon adds: “I would tell pharmacists not to panic about [buying]
additional IT since the only piece of new hardware is a scanner. It would
also be worth speaking to your patient medication records provider now
to find out when they will be ready to provide eAMS, and to talk to your
EPOS provider to see if any integration of counter and dispensary systems
is in the pipeline.”
Ms Strath says that some variation exists between the different computer
software suppliers in terms of when they will be ready to implement their
version of eAMS. “This reflects a number of different issues such
as hardware requirements and upgrades, the scheduling of system upgrades,
and the logistics of upgrading and training,” she explains.
All the GP system suppliers have now passed the Scottish Enhanced Functionality
accreditation (which is a system of accrediting software developments).
Four out of five suppliers have completed the beta testing of software
and have permission to start rolling out their software to GP practices.
“It
is expected that this will start in earnest from January but some will
be upgraded during December. To date, 40 GP sites are now enabled for
ETP,” says Ms Strath.
Two pharmacy system suppliers have completed beta testing of their software
and are now ready to start rolling out software. A further two are about
to enter fitness for purpose testing (which is the pharmacy equivalent
of Scottish Enhanced Functionality accreditation) and the other three
system suppliers are expecting to start this stage of testing early next
year.
“Roll out starts in the main from January (2008) with some upgrades
possible during December,” says Ms Strath. “We had thought
about a big launch in December but no-one really wanted to introduce
new software during the busiest dispensing month of the year.” Areas
of the country most likely to see early implementation of ETP are Greater
Glasgow and Clyde, Lanarkshire, Ayrshire and Arran, and Tayside.
Dave Green, ePharmacy programme manager, Atos Origin
Alliance, says: “It
is great to see the start of the national roll-out of eAMS in both GP
practices and community pharmacies. It comes as a result of hard work
in terms of supplier groups, health boards, the Scottish Government and
National Services Scotland.
It is also important to recognise how clinicians
have brought about the success by integrating the solution into the day-to-day
working processes, as well as the technical perspective. There’s
lots more to do but this is a great milestone for us.”
Ms Strath is equally positive. “eAMS testing has already identified
some positive benefits. These include improvements in matching patient
details, in supporting accurate drug selection, in reducing transcription
errors and in reducing the number of key strokes,” she says.
“I
really want to thank the pharmacists and support staff involved in testing
of the systems because they undertake all of the hard work in testing
the software to suit working practices. All other pharmacies will benefit
from their endeavours.”
How ETP works within the acute
medication service in Scotland
Pt (shapiso) Lee /Dreamstime.com
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Once a GP practice and a community pharmacy both
have the computer equipment in place to operate the electronic
acute medication service (eAMS), how does it work?
The first step
is for the GP to produce the prescription. When he or she presses “print” a
prescription, with a barcode printed down the left hand side, is
generated. At the same time, an electronic message is automatically
created which is sent to a central ePharmacy message store.
The
prescription also contains a unique prescription reference number
and, printed under each item, is the drug’s Dictionary of
Medicines and Devices (DM+D) code.
Next, the patient is given the paper prescription (which remains
the legal document) and presents it at a pharmacy. The pharmacist
or pharmacy assistant scans the barcode on the prescription, which
causes the prescription details to be pulled down from the ePharmacy
message store to the pharmacy computer.
When the pharmacist is ready to dispense the prescription, the
first step is to click on the “dispense” icon. This
brings up the details of the prescription on one side of the screen
and the dispensing details on the other side.
The software matches
the patient’s details to those on the pharmacy's computer
records, searching by community health index (CHI) number. It suggests
a match, which must be confirmed by the pharmacist. If the patient
is new to the pharmacy, his or her details are automatically entered
into the computer’s records from the information on the prescription.
Likewise,
if any patient information is missing from the pharmacy’s
records, these are automatically entered from the prescription
details.
Next, the patient’s medication record is brought up. This
allows the pharmacist to select an item from the patient’s
repeat list if the patient has had the prescribed drug before.
The computer then checks using the DM+D code that it is an appropriate
selection for the item prescribed.
If it is an item that the patient
has not had before, the computer matches the drug and offers a
list of generic products or brands (if there is more than one)
containing the drug using the DM+D code. This reduces the possibility
of selecting the wrong drug.
The product’s details and prescriber’s directions are
then automatically filled on the computer's dispensing screen,
and the quantity is then manually added or confirmed. Once all
the information is in place, dispensing labels are printed. The
system then asks if the patient pays for prescriptions, or if he
or she is exempt from NHS prescription charges. This can be recorded
on a patient’s record but, in the case of exemptions where
status can change, may need to be confirmed each time.
To finish the prescription, endorsing details must be added. Apart
from what has been dispensed (according to the DM+D code) and its
pack size, any additional details such as special prices, “prescriber
contacted” information or out-of-pocket expenses can be added
in a separate screen.
It is possible to print these onto the paper
prescription too using an endorsing printer or they can be written
by hand: this is down to the personal preference of the pharmacist.
Finally, the prescription details are sent to Practitioner Services
for payment by clicking “send”. Alternatively, it can
be put into a “pending” status to add or amend details
at a later stage, such as if the patient's exemption details are
not known at the time of dispensing or if an invoice price needs
to be added to the endorsing details. |
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The
Pharmaceutical Journal