PJ Online | MM Letters (Why are we not e-prescribing?/Helen Critchlow)

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Medicines Management
Issue no 5, p13
September/October 2002

Letters

Why are we not e-prescribing?

From Tim Root

Tim Root MRPharmS is the Chief Pharmacist at the Royal Marsden Hospital & London Pharmacy Specialist, Clinical Governance & Technical Services

I would like to respond to Helen Critchlow's letter "Why are we not e-prescribing?" (Medicines Management, 3, May/June 2002, p12).

I strongly disagree that it is "only our lack of imagination that is holding us back". There seems to me no shortage of vision among my colleagues about the need for and potential benefits of e-prescribing, nor has there been any lack of effort on the part of hospital pharmacists to find and develop suitable systems.

Although there has certainly been limited success with (usually stand-alone) specialist systems for applications such as cytotoxic chemotherapy, there is and there has been for many years a paucity of genuinely fit-for-purpose software available for acute hospital prescribing in general. I can see no immediate sign of any fundamental change in this situation while the industry clearly does not find it cost-effective to develop systems of the complexity and sophistication required fr what is, in reality, a market.

Unless my experience has been completely atypical, anyone who has tried to do their grocery shopping at any one of the major supermarkets online will have found it a deeply frustrating experience.

Despite investment on a scale the NHS would not be able to contemplate, neither the software nor the customer (user) support is up to the job by a long way. Take away the profit incentive and investment drive, compare NHS expenditure on IT user support to commercial norms and on-line shopping, with the immensity and complexity of the task of e-prescribing and I do not think the pace of NHS progress to date is either surprising or shocking. In many trusts there is still restricted access even to e-mail and the internet with, perhaps, one workstation per ward. The culture gap between that environment and one required to implement successfully and develop e-prescribing might be compared to the Grand Canyon.

I am fortunate to have worked for many years in a trust with excellent and relatively well-resourced IM&T systems, almost all based on in-house software development.

Almost all staff have e-mail access and every ward at least three workstations. A chemotherapy prescription proforma printing system has slowly but reliably evolved to a fully integrated if embryonic prescribing system now in an early pilot stage. Even in our privileged environment, though, limited resources have compromised progress and will almost inevitably continue to do so.

The fact that progress has been painfully slow is undeniable, as is the fact that we are missing the opportunity for big improvements in the management of the financial and clinical risks of medicines use and in the quality and safety of patient care. We must not, however blame or allow others to blame ourselves or our colleagues for this.