NPfIT e-prescriptions: an important new step?

[Anyone reading this article should take note of an important anonymous comment at the end, which explains clearly an important difference between e-prescribing for secondary care and the NPfIT Electronic Prescription Service.]

Glyn Hayes, a former chairman of the British Computer Society’s Health Informatics Forum, says that the e-prescriptions project is arguably the most important part of the NPfIT in terms of the safety of patients.

He told the Conservative Technology Forum at Westminster in May 2009 that e-prescribing systems will reduce medication errors which, he said, are killing hundreds of patients every year in the UK.

“One of my pleas would be: let’s not wait another four years for the roll-out [of e-prescribing]. We need electronic prescribing now. This IT is there to help patient care.”

The introduction of e-prescriptions was a key main objective of the NHS’s £12.7bn National Programme for IT.

Below is an announcement this week on e-prescriptions. The press release is from the Department of Health rather than NHS Connecting for Health which is being merged with the department.

First Electronic Prescription Service Goes Live in Leeds

Patients in Leeds will be the first patients in England to benefit from the introduction of Release 2 of the Electronic Prescription Service (EPS), the Department of Health says.

Patients from Calverley Medical Centre who have ‘nominated’ Liptrots pharmacy will no longer have to call at the GP surgery just to pick up a paper prescription – the GP will send the prescription electronically to the nominated pharmacy.

Liptrots pharmacy currently uses the Cegedim Pharmacy Manager system and has been using EPS Release 1 since 2007. Calverley Medical Centre has been using EPS Release 1 since 2006 and currently use CSC/TPP SystmOne.

EPS Release 2 is a necessary evolution from the out of date paper system.  With 1.5 million prescriptions being issued every day across England and the total increasing by 5% every year, the NHS needs an efficient, clinically safe, electronic system, able to cope with this pattern of prescribing.

EPS Release 2 will provide benefits for patients, prescribers, dispensers and their staff.

For patients the extent of the benefits will depend on their individual circumstances. They include:

– A more convenient service with a reduction in trips to the GP practice just to collect a paper prescription. This is particularly relevant for patients on repeat medication – around 70% of prescriptions nationally are issued for repeat medication.

– Greater freedom of choice, making it simpler for them to use a pharmacist convenient to them.

– Potential to reduce pharmacy waiting times as prescriptions can be prepared in advance of the patient arriving.  

For GPs and pharmacies, benefits include:

– Reduction in workload at GP practices generated by patients collecting individual prescriptions from the GP surgery

– The ability to sign prescriptions electronically will be more efficient for GPs

– The ability for GPs to electronically cancel prescriptions at any point until they are dispensed.

– Reduction in the need for pharmacy staff to re-key prescription information into pharmacy systems.

– In time will remove the need for pharmacy staff to collect prescriptions where they offer a prescription collection service.     
   
In order to ensure that only authorised personnel are able to access the Electronic Prescription Service, access will be via Smartcard. The Smartcard will grant users with different levels of access depending on their function within the prescribing/dispensing process. Essentially, details of the prescription will only be seen by people with the appropriate level of access to the system.

Tim Donohoe, Programmes and Operations Director for NHS Connecting for Health said:

“This is a key milestone for EPS. We have been working closely with the suppliers, CSC/TPP and Cegedim, as well as Leeds PCT, Calverley Medical Centre and Liptrots pharmacy in Leeds to introduce EPS Release 2, which will bring real benefits to patients, GP practices and pharmacy staff.

“We will now focus on learning the lessons from this initial implementation and encouraging other suppliers and PCTs to progress with their plans to deliver the benefits of EPS Release 2 to every GP practice and pharmacy in England.”

Local pharmacist, Jim Liptrot adds, “I am sure that this service will be of real benefit to patients and healthcare professionals. It will provide a convenient, flexible, safe and efficient service. I am delighted that our pharmacy is at the forefront of this important and pioneering technological system.”

Link:

First e-prescription service goes live – Kable

NPfIT – the good and not so good – IT Projects blog

Homerton rejects NPfIT FOI request – IT Projects blog 

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There is a significant difference between "e-prescribing" and the "Electronic Prescription Service (EPS)".

e-prescribing is the use of computer systems by the clinical professional at the point-of-care - so being able to take advantage of looking up on-line reference data on drugs, checking for interactions with other prescribed drugs and known conditions, and generating a legible prescription.

EPS is about the transmission of the prescription as a digitally signed electronic message rather than a piece of paper between prescriber and dispenser (with automated payment of dispensers, too).

EPS requires e-prescribing as a prerequisite. There is an argument that the major clinical benefits come from e-prescribing, rather than from the EPS system itself.

e-prescribing is common in primary care - when is the last time you saw a hand-written FP10? e-prescribing is very uncommon in secondary care - and I think Dr Hayes may have been referring to getting e-prescribing into secondary care, rather than to the EPS system.

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Thank you for taking the trouble to explain the difference between e-prescribing and the Electronic Prescription Service.

Unfortunately I have used the terms interchangeably - though I have now drawn attention to your comment at the start of the article.

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Don't worry - you are not the first to confuse these two prescribing/prescription terms - CfH initially used the two terms interchangeably too.

As "anonymous" states, the reduction of risk through electronic prescribing has nothing to do with the prescription service recently announced - which is it's subsequent transmission and subsequent workflow.

It is during the prescribing process that the majority of clinical prescribing errors occur and it is within the GP system or the hospital (what we used to call EPR) system that this function is undertaken and thereby aided by electronic prescribing systems with clinical decision support.

It is a great shame that this element of the NCRS system (which has the potential to deliver the most clinical benefit) is still no further on than it was six years ago.

This is where the focus should be (and should have been) - not the national electronic record.

Sean Brennan

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Sean

Thank you for the comment - and particularly for the point that electronic prescribing should have had more attention than a national e-record.

I used to be surprised by the number of serious untoward incidents, mentioned in Trust board papers, which stemmed from medication errors.

Now serious incidents related to drugs over-prescribed, or the wrong drugs, or drugs prescribed despite known adverse reactions to them, or the right drugs not prescribed at all, are so regularly reported by trusts that nobody seems to notice (except the patients or their families).

I enjoyed your book on the National Programme by the way.

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The recent development of the EDL (Electronic Discharge Letter) seems to me to have increased the risk of medication errors when patients are discharged from hospital into general practice.

I learned - to my amazement and horror - that hospital pharmacy systems don't hold records of individual patient medication in the vast majority of cases.

No wonder medication errors occur if the unfortunate prescribers have to rely on drug charts at the foot of the bed!

However, there is a problem when the result of this is that the TTO (To Take Out) medication in the EDL (designed to be the *only* discharge letter..) in infants is stated as name of medication without a form (e.g. amoxicillin rather than amoxicillin suspension 125mg/5cc) and the dose in mg.

Apparently this problem is insoluble - so I guess medication errors will continue to increase!

It seems that Community Pharmacy systems don't store batch numbers either.

I agree with everyone: this is a limited area which should be relatively easy to implement electronically - and I just don't believe that *any* *competent* organisation could mix up e-prescribing (as in GP systems for a great many years) and ETP (now EPS) which merely transfers the prescription order!

Serious question - will Lorenzo Regional Care force e-prescribing on secondary care - or abolish it in primary care?

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Thank you Mary. It's remarkable given that £5bn has been spent on the NPfIT - over and above the money usually spent on NHS IT - that the most important systems in general use are, apparently, still so primitive.

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The experience reported by the US Veterans Administration medical services in introducing computer-assisted prescribing (e-prescribing if we must call it that) in wards and clinics was of a large decrease in errors.

Some of those would be expected to be from prescribing, making sure that only things that exist are prescribed, and worrying about documented allergies and so on, but some of it is a reduction in giving the wrong medicine to the wrong patient at the wrong time - the prescription is known to the computer, the medicine is identified to the computer by its barcode, and the patient is identified to the computer also by bar code.

It has seemed for many years to me to be obvious that trying to do this stuff from memory and by hand in a hurry is wasteful and dangerous.

Now that the more honest Trusts are coming into alignment with the European Working Time Directive the saving of minutes of doctor time is more significant, and as more people get to prescribe without the trouble of acquiring a medical degree the obvious benefits are getting larger.

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Barcoding medicines doesn't sound particularly challenging. So why isn't it in general use given the billions spent on IT, usually in the name of patient care?

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