Choose Pharmacy Application Purpose: 1)Provide Project Background 2)Provide Overview of Application 3)Next Steps: Project Go live 4)Questions & Answers

DMR ICT Proof of Concept Project Background: Bid submitted to the WG Health Technology and Telehealth Fund (HTTF) Allowing CP to access the medicines information in electronic Discharge Advice Letters (DAL) Generated by the national Medicines Transcribing and electronic Discharge application (MTeD) only To support and complete electronic Discharge Medicines Reviews (DMRs) Improving and strengthening communication and electronic links with Community Pharmacies (CP) To reduce medicines wastage and patient harm Improve the quality and safety of hospital discharges

DMR ICT Proof of Concept Project Background: During a inpatient stay in hospital, medicines may be changed/stopped (dose, frequency, route) Evidence: discrepancies arise between medicines a patient is prescribed on discharged and the medicines prescribed in primary care A review of 252 discharges in Wales identified: 148 discrepancies (58%) including 82 which were unintended (33%) 31 minor 21 significant 22 serious 8 life threatening

DMR ICT Proof of Concept Project Background: Discharge Medicines Review (DMR) service launched in Nov Sharing information about a patient’s medicines at discharge with their community pharmacy Allows the pharmacist and patient to reconcile and talk about the patient’s medicines Community pharmacist (CP) receives paper Discharge Advice Letters (DALs) and checking medicines prescribed by GP matches information in hospital DAL. Paper based DAL is struggling Often unavailable, incomplete or illegible

DMR ICT Proof of Concept Project

Choose Pharmacy HTTF ICT Solution: Developed a web-based application called “Choose Pharmacy” Building upon and rebranding Common Ailments Service (CAS) Facilitates the electronic availability of MTeD Discharge Advice Letter (DALS) Community Pharmacists to complete eDMR interventions DMR service can be optimised through real time sharing of electronic discharges Made in Wales Sponsored by Welsh Government Chief Pharmaceutical Officer Deliver a proof of concept by March ‘15

Choose Pharmacy Why introduce an Electronic System? Role of Community Pharmacy has evolved from one of dispenser to generic health provider Systems have become efficient at supporting traditional delivery of medication Inadequate: inconsistent sharing of information with community pharmacy identified as a common problem Current challenge: enable consistent and real time patient information sharing between healthcare professionals Choose Pharmacy offers an advancement in connecting Community Pharmacies with secondary care Key building block towards: Better sharing and transfer of patient information by improving IT connectivity Improving communication and availability of patient discharge advice letters to optimise DMR service

Choose Pharmacy Why introduce an Electronic System? Problems when paper DAL late, inaccessible, or incomplete Failings compromise patient safety; Continuation of drugs that have been stopped/changed Adverse drug reactions and; Hospital readmissions Paper DALs prone to human errors, limited information and often illegible Introducing Electronic system: Facilitate faster, real time sharing of DALs (removal of delay and processes with paper) Reduces the need to print, post and fax DALs (capacity and cash releasing benefit) Reduction in lost / misplaced paper DALs Greater security – enforces access security controls and audit (username and password )

Choose Pharmacy Why introduce an Electronic System? Sections of the eDMR form automatically populated from eDAL Connects patient data across systems, services and health sectors Essential step towards the bigger picture of supporting HIE across services and health sectors Information follows the patient wherever care is provided Removing information “lock down” within Health Boards and Hospitals Strengthens communication links with Community Pharmacies (CP)

Choose Pharmacy Demonstration Scenario: 1)Patient discharged from hospital and nominating a community pharmacy 2)Alert sent to a nominated community pharmacy 3)Community Pharmacist (CP) logging on and viewing a CP eDAL 4)CP initiating/completing an electronic DMR

Choose Pharmacy Secondary Care: Discharging a Patient via national Medicines Transcribing and e-Discharge (MTED)

Secondary Care: CP DAL Notification Process Current Medication Stopped Medication Choose Pharmacy Ready for Discharge

Secondary Care: CP DAL Notification Process Community Pharmacy preferences panel

Secondary Care: CP DAL Notification Process Preferences interact with the registry of a patient within the Choose Pharmacy application Patient asked for consent If consented, DMR pharmacy selected

Secondary Care: CP DAL Notification Process When discharged, triggers an “ENAS Alert”

ENAS Alert Nominated Community Pharmacy ENAS alert sent to nominated community pharmacy  ENAS Alert prompts user to login into Choose Pharmacy application  ENAS Alert does not include Patient Identifiable Information (PII)

Community Pharmacist Workflow: Logging into Choose Pharmacy application

Choose Pharmacy Log in Screen Previously CAS GPhC number - User Guide; - FAQs; - Help; - Privacy Statement

PPA

Pharmacy information Confirm location

Home Page CAS Rebranded Start DMR for a registered patient 1.2. More Services CAS DMR Notifications

Choose Pharmacy Home Page CAS Rebranded Since receiving DAL Notifications

Unopened Discharge Advice Letters Patient List View Date Received

Patient Demographics New DMR DMR History

1. GP and Patient Details 2. Discharge Details 3. DMR Part 1 and 2 outcomes 4. Can be printed

DAL panel becomes active Patient Consents New DMR

Community Pharmacy Discharge Advice Letter (DAL) 1. GP and Patient Details 2. Admission and Discharge Details: Date, Time, Method, source and site 3. Medications at discharge 4. Medication stopped: Name and Reason

If tick box selected Discharges details and medications list auto populate eDMR form

eDMR Form Part 1 MedicationsDiscrepancyAction DMR Part 1 Information by: Eligibility Criteria: Method part 1 provided: Number of meds on DAL Number of meds taking

eDMR: Corrective Action Number of discrepancies Follow Up Actions

Submitting eDMR Save Progress until Part 2 completed Discard Changes

Submitting eDMR Enter Part 2 info Submit DMR Indicate if discrepancies resolved

Choose Pharmacy Home Page CAS Rebranded Counters will reduce Sign Out De-Register

DMR Evaluation: 17 th July 2014 Major barriers for CP and Hospital Pharmacists to engage in service: 1) Inability to identify eligible patients – they don’t know when they are discharged Response: ENAS Alert sent for registered patients initially. Second phase, patient nominates in hospital 2) Lack of access to discharge information or if it is received, timing of it is too late Response: Access available to MTED E-DALs. Real time availability 3) Hospitals not referring patients and communication between sectors is poor Response: MTeD enhancement to include community pharmacy preferences 4) Paperwork is not user-friendly and there is too much of it Response: DMR Part 1 form streamlined. Auto populated if e-DAL available 5) No computer system in secondary care which supports DMRs Response: MTeD enhancement to include community pharmacy preferences

Choose Pharmacy Next Steps Pilot commenced 24 th March ‘15 Choose Pharmacy eDMR pilot with 10 x CAV pharmacies Positive feedback No longer need/can enter claims in NECAF DMR part 1 form streamlined Reduction in data entry if eDAL available Improved availability of DALs (pushed) Better collaboration and sharing of information secondary > primary care Extend to BCU West and Cwm Taf (existing CAS sites) Conduct Evaluation

Stakeholder Feedback DMR Part 1 form easier and quicker to complete Frees up time (No need to enter claims into NECAF) No need to enter medicines information! User Friendly and simple to use

SUMMARY WG HTTF project Building upon Common Ailments Service (CAS) and MTeD application Rebranded to ‘Choose Pharmacy’ Enable accredited CP to access an abstracted DAL generating by MTED only at the point of discharge To support an electronic DMR intervention to ensure correct medications are dispensed for patients Help prevent readmissions into hospital caused by medication errors Timescales: Pilot commenced with CAV; planning to upscale to BCU West and Cwm Taf

QUESTIONS