Closing the loop EPR-PHARMACY INTERFACE Bhulesh Vadher Clinical Director of Pharmacy

Introduction Context – Oxford University Hospitals What was the plan? What did we end up with? What we have now? Run through process

4 x Hospitals Secondary / Tertiary / National Adults, Women's and Children Elective and Emergency John Radcliff – Robotic Labelling and Dispensing Churchill – Manual Labelling and Robotic Dispensing Nuffield Orthopaedic Centre – Served by Churchill Horton Hospital – Manual Labelling and Dispensing Electronic Patient Record = Cerner Millennium Plus 4 other systems Pharmacy Stock/Labelling System = Bedford

The plan Strength based prescribing to make prescribing easier Automate as much as possible to increase patient contact time Develop flexible system to cope with 3 work flows Develop rules based auto assignment of product

What did we develop? Risks in auto assignment Who is responsible if it goes wrong? Clinical decision making? Interface only for TTO and Outpatient Rx 7039 Permanent Matches 160227 One off Matches

Foreign System Interface EPR FSI HL7 Message TIE Bedford Bedford HL7 Message TIE EPR FSI The foreign system interface allows two completely different IT systems to communicate using an agreed international standard – Health Level-7 (HL7) Every prescription detail which you can see in the previous slide, e.g. dose, route, frequency etc and many that you can’t see such as patient’s name, MRN, Lead Consultant, allergies etc are contained in the message. Data is sent from EPR to the Trust Integration Engine (TIE) which manages the transfer of data across different systems. It then sends the data on to Bedford. This interface is bidirectional – Bedford sends status messages back to EPR, and at the end of the process sends specific details of exactly what was supplied and how it was labelled back to Millennium

How Does It Work? Bedford Product: DHC054 Patient Name: ZZZXXADULT , ONE Patient Location: J-WD 7A Consultant: Altmann , Paul Order: Simvastatin Dose: 40mg Route: oral Frequency: once a day, at night Drug Form: tablet Pharmacist Verified: Yes Dispense Quantity: 28 Dispense Quantity Unit: tablet(s) Bedford Product: DHC054 Bedford Cost Centre: 7A Bedford Consultant Code: AltP2 Bedford Label Directions: All relevant prescription details will be matched against a product in Bedford, a quantity to dispense assigned and label directions specified. If it is saved as a permanent match, it means whenever a prescription comes to pharmacy with the exact same details e.g. order name, dose, route, frequency, dispense quantity etc, the system will match this against the previously defined product with corresponding label directions. Some details are not required for the matching process, but are required by the system to generate the label and book the product out to the correct cost centre. These include Name, Location, Consultant The system is not making intelligent guesses. Unless all parameters match it will require human intervention to match the prescription to a product and generate an appropriately worded label.

EPR The prescriber completes the white fields A pharmacist, pre-reg or MMT modified the “Pharmacy Use” yellow fields When the pharmacist screens the TTO they set red Pharmacist Verified field to Yes. Only pharmacists can change this field.

Review Prescriptions If there are prescriptions which have not yet been screened by the pharmacist this appears in the nWaitVerified column together with Type of Vwait Once all the prescriptions have been screened by the pharmacist i.e. the Pharmacist Verified field is set to Yes it is released for dispensing – Type EPR Usually there is a mixture of automatic matches and manual matches required. In the event that there is an automatic permanent match for every prescription it has type Auto.

Automatic Matching For this 5 item TTO the system has found a permanent match for the first 3 items, that is a previous prescription with the same order details has been matched permanently against a product with specific label instructions. There is no permanent match for the 4th and 5th item, these must be manually matched.

Manual Matching 1 First you select the product. Sometimes as here it gives you an intelligent guess of the most likely products. Sometimes you have to manually search. Then you enter the label directions – use labelling short codes e.g. P 1dr RE ON There is already a permanent match in the system but it has a supply quantity unit of original pack. Because the pharmacist specified “bottle” it required a manual match. All staff can manually match on a one off basis. Access to do a permanent match is restricted to the EPR team and senior dispensary technicians.

Manual Matching 2 There is already a permanent match in the system but it has no special instructions. Because the pharmacist added special instructions it required a manual match. The system will not let you do a permanent match with special instructions, it has to be done as a One Off match

TTO Complete Message sent back to EPR from Bedford Automatically added to the order comments Message format: TTO Status | Bedford Product Name | Quantity Supplied | Label Directions

Next steps Improve % of auto matches through training Introduce inpatient supply Review the manual matches and see how many could be automated Rules vs AI for matching? What are others doing?

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