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Mr Willson is principal pharmacist, information and supply, Addenbrooke’s Hospital, Cambridge |
Prescribing medicines has traditionally been the main focus
of IT
systems developed for electronic prescribing. For example, as part of
the
Electronic record and
implementation programme,1 the NHS information authority defined electronic
prescribing as “A computer based system to
support and influence the
prescribing and administration of drugs and appliances by
clinical staff.”
Indeed, the prescribing of medicines remains central to even the most
recent electronic
prescribing documents. The consultation document“
Delivering 21st century IT support for the NHS: national specification
for integrated care records service (ICRS)”2 issued
last year, focuses on medicines, largely ignoring the fact that treatments
(for
example,
surgical producures and nursing care activities) other than
medicines and appliances can be prescribed. The ICRS
specification, due to be offically published shortly, is rumoured not
to progress matters on this point.
That this somewhat narrow view of electronic
prescribing is not always
appropriate for a modern,
holistic NHS became clear to us during a recent local
implementation subgroup-funded project at Addenbrooke’s hospital.3 For example, as part of the project, we needed to map the processes involved
in the prescribing of medicines (including those involved in their supply
and providing information about their use). When we did this, it was
clear that medicines
prescribing was linked to a large number of care processes,
creating dependencies. These include, at their simplest,
dependencies between INR (international normalisation ratio) monitoring
and warfarin
therapy. This is partially
reflected, for example, by the existence within the
Addenbrooke’s NHS Trust
of at least six different drug charts.
This interlinking of
medicines prescribing with other care processes suggests to us that there
may be a need to move away from viewing
electronic prescribing as a stand-alone system that is
concerned primarily with the prescribing of medicines and appliances
and see it as part of an integrated electronic system of care – an
EPOC (electronic point of care) system.
During the project at
Addenbrooke’s, we also took the opportunity to gain an insight
into the potential
consequences of moving towards an EPOC system. A major consideration
is that organisations wanting to
implement it will need to
critically review all of their care processes (and not just those involving
medicines
prescribing) and identify how these could be made more
efficient with IT support. This will clearly be time-consuming. Not only
that, but it needs to be done before EPOC is put in place – organisations
that do not know what they want from an IT system are likely to end up
just getting what they are given, which
may not
subsequently meet their requirements.
Consideration will also need to be given to reconstructing the care processes
supported by an EPOC system. Many roles and responsibilites have become
dependent on the system of prescribing developed over the lifetime of
the NHS. Some of these will undoubtedly change if an organisation implements
EPOC. Even so, we as
pharmacists have a vested
interest in ensuring that, when care processes are reconstructed as part
of an implementation, we take the opportunities
presented by such a process. That way, we can ensure that the reconstruction
supports our professional
development set out in such documents as “a spoonful of sugar”.4
On a strategic level, there is an historic underlying
corporate and clinical sceptism about the ability of IT systems and suppliers
to deliver the
necessary level of support. Any failure of a prescribing system is all
the more serious when all the care processes are
interlinked. Hence EPOC raises the stakes, and heightens the risks involved
in introducing an
electronic prescribing system.5
Despite the increased risks however, and despite the time-consuming nature
of the task and the potential changes to roles and responsibilities,
EPOC systems must be the way forward in order to meet the future demands
of a patient-focused, information rich, whole-system NHS. That the ICRS,
in common with the other electronic prescribing
documents that went before it, does not really address the diverse nature
of prescribing, is potentially a problem to
pharmacists, but also a challenge.
References
1. Definition of modules making up EPR level 3 NHS Information Authority
2001.
2. Delivering 21st century IT support across the NHS. DoH 2002.
3. Electronic prescribing project at Addenbrooke’s NHS Trust. Available
from the pharmacy site at www.addenbrookes.nhs.uk
4. A spoonful of sugar – medicines management in NHS hospitals.
Audit Commission 2001.
5. Cross M. Another
IT failure is not an option |
