NHS Connecting for Health is delivering the National Programme for Information Technology ePrescribing update Ann Slee Clinical Lead ePrescribing programme, NHS Connecting for Health

NHS Connecting for Health is delivering the National Programme for Information Technology

Outline ePrescribing programme aims Update on work to date ePrescribing moving on

NHS Connecting for Health is delivering the National Programme for Information Technology ePrescribing programme aims Focus on hospital-based care Facilitate and support the delivery of ePrescribing –Definitions, standards, content/approach, requirements etc –Working with NHS CFH local programmes, system suppliers, NHS trusts…

NHS Connecting for Health is delivering the National Programme for Information Technology Where does it fit? One of the five key elements (the “Clinical 5”) for secondary care within the Health Informatics Review Key to delivery of trusts’ quality and safety agendas –Darzi, QIPP…. Increasing pressure (and clinical imperative) to deliver systems

NHS Connecting for Health is delivering the National Programme for Information Technology Local programmes for IT The National Programme for IT operates in England and the country is split into three areas, each of which has an LSP. London Programme for IT (LPfIT): BT Capital Care AllianceLondon Programme for IT (LPfIT): North, Midlands and East (NME) Programme for IT (NMEPfIT): Computer Sciences Corporation Alliance (CSCA)North, Midlands and East (NME) Programme for IT (NMEPfIT): Southern Programme for IT (SPfIT): BT taking over 8 live Cerner Millennium sites from Fujitsu. ASSC approach for remaining trusts.Southern Programme for IT (SPfIT): There are 10 SHAs in England and they are represented in the three Programmes for IT.

NHS Connecting for Health is delivering the National Programme for Information Technology Outline ePrescribing programme aims Update on work to date ePrescribing moving on

NHS Connecting for Health is delivering the National Programme for Information Technology ePrescribing work 2006/07 Definition of oncology prescribing specification Benchmark of existing oncology systems Funding for interim solutions 2006 –18 cancer networks in progress or implemented Clarify Output Based Specification (OBS) requirements for all specialties –Functional specification published Jan 2007

NHS Connecting for Health is delivering the National Programme for Information Technology Reducing risk Hazard framework guidance published August 2008 –Outlines main design elements that required to reduce known areas of risk identified in literature and anecdotal reports Excludes decision support –Available on website –System evaluations (2008) identified strong correlation between compliance and impression of safety and usability

ePrescribing System Demo 1. Front Line Clinical Review 4. Long Term Partnership User Interface2. Func. Spec & ePrescribing System Evaluation Functional Specification Mapping & Professional UI Review Pre-Evaluation Questionnaire 3. System Technical Specification System Evaluation - Approach All available on nww Connecting for Health website

NHS Connecting for Health is delivering the National Programme for Information Technology Weighting Front Line Clinical Review48/100 Front Line Clinical Impressions 7/100 Functionality and User Interface20/100 System Technical Specification10/100 Long Term Partnership15/100

NHS Connecting for Health is delivering the National Programme for Information Technology Systems Evaluated –12 systems identified –Not comparing like with like Full EPR system Standalone eP –Results need interpreting with this in mind –All suppliers given feedback Similar exercise in oncology moved system development on –Report and methodology at nww.connectingforhealth.nhs.uk/

NHS Connecting for Health is delivering the National Programme for Information Technology Supplier Weig h t AlertAscribeAtkosoftCambioCISEPIC FileTek/ Med itec h JACOrionUHBVarian System Version Release v9.12v Releas e 7. 2 v3.5.2 x Sprin g 0 8 v6v4.47v3.1v156v Front Line Clinical Review * Retrieve Medication History Prescribe Inpatient Medicines Decision Support Prescribing Off Formulary & Predefined Prescriptions Pharmacy Verification Additional Prescribing Functionality Administration Discharge Prescribing

NHS Connecting for Health is delivering the National Programme for Information Technology Strong correlation At the end of the scripted demo, the panelists voted Yes / No to the question: Is this system safe? The panel’s total score against the NHS CFH ePrescribing Hazard Framework The total score of the panel’s subjective usability questions, asked after each section of the demo Using the “Error trap” method

NHS Connecting for Health is delivering the National Programme for Information Technology Further ePrescribing guidance User interface guidance –ePrescribing in secondary care available on CUI website Reducing the risk of mis- selection of opioids –available on eP web pages

NHS Connecting for Health is delivering the National Programme for Information Technology Key underpinning element - dm+d VMP Virtual Medicinal Product VMPP Virtual Medicinal Product Pack AMPP Actual Medicinal Product Pack AMP Actual Medicinal Product VTM Virtual Therapeutic Moiety TF Trade Family ibuprofenBRUFEN ibuprofen 400 mg tablets (and 16 other VMPs) ibuprofen 400 mg tablets (100 tablets) (and 7 other VMPPs) BRUFEN 400 mg tablets (and 33 other AMPs incl. 25 manufacturer’s generics) BRUFEN 400 mg tablets (100 tablets) (and 1 other AMPP)

NHS Connecting for Health is delivering the National Programme for Information Technology dm+d Ingredients & strength Coded form Coded route Availability CD status Prescribing flags Availability Licensed route Excipients Manufacturer VMP Virtual Medicinal Product VMPP Virtual Medicinal Product Pack AMPP Actual Medicinal Product Pack AMP Actual Medicinal Product VTM Virtual Therapeutic Moiety TF Trade Family

NHS Connecting for Health is delivering the National Programme for Information Technology Overall aim Prescribing model for secondary care, interoperable with all other care settings Minimum data requirements for all prescriptions –Maximise safety & flexibility On-screen presentation Safe administration Between-system messaging

NHS Connecting for Health is delivering the National Programme for Information Technology … is computably equivalent to “2ndary care style: paracetamol – oral – tablets – DOSE 1000 mg – four times a day paracetamol 500 mg tablets – oral – DOSE take 2 – four times a day VMP from dm+d VTM from dm+d Dose Syntax compliant data Coded form from dm+d Common medicines terminology Enables computable equivalence…

NHS Connecting for Health is delivering the National Programme for Information Technology Framework: Types and Rules 29 medication types –Each represents a recognisable real-life prescribing pattern and defines the minimum data required at the time of prescribing –Allows maximum flexibility within dose based prescribing –Any prescription can be mapped to one of these types by knowing the VTM + Route And occasionally other data… rules –Use dm+d content & flags, plus other content in SNOMED, to enforce safe prescribing in particular circumstances

NHS Connecting for Health is delivering the National Programme for Information Technology

dm+d Major changes to support secondary care complete June 2009 dm+d secondary care implementation guidance for ePrescribing published Progressing through Information Standards Board

NHS Connecting for Health is delivering the National Programme for Information Technology Challenges and lessons learned ePrescribing is often referred to as “too difficult” –Technically and culturally –Systems not available But there are successful implementations… NHS CFH commissioned a report identifying the challenges and lessons learned

NHS Connecting for Health is delivering the National Programme for Information Technology Challenges and lessons learned Includes –ePrescribing functions and benefits –Motivations –Ensuring success –Managing safety –Planning –Managing in use –Technologies –Look ahead

NHS Connecting for Health is delivering the National Programme for Information Technology Available on ePrescribing web pages now

NHS Connecting for Health is delivering the National Programme for Information Technology Outline ePrescribing programme aims Update on work to date ePrescribing moving on

NHS Connecting for Health is delivering the National Programme for Information Technology Information design booklet Partnership with NPSA and CUI Recommendations sourced from: –Academic research –Existing guidelines (NPSA, ISMP etc) –Anecdotal evidence/lessons learned –CUI usability research Publication scheduled January 2010

NHS Connecting for Health is delivering the National Programme for Information Technology Moving on… Priority – support successful implementation of hospital-based systems –Design, build, test, configure etc –Further lessons to share –Benefits

NHS Connecting for Health is delivering the National Programme for Information Technology Clinical decision support strategy –Detailed work on each area of active CDS Dose range checking – consultation May, June 09, publish Oct 09 Allergy checking – consultation Oct 09, early 2010 & publish 2010 –Hazard framework guidance for CDS 5 rights – right information, person, intervention format, channel, time in workflow. –Implementation support for individual elements –Assurance/Standards work - NICE –Alert design research –Edworthy & Avery

NHS Connecting for Health is delivering the National Programme for Information Technology ePrescribing forum Aim – to maximise the benefits from the implementation of ePrescribing by promoting and supporting collaboration amongst all interested parties

NHS Connecting for Health is delivering the National Programme for Information Technology Continued standards development dm+d – further work with dm+d team –Name order, shortened names for display, flagging high risk medicines etc, etc….. Clinical safety System standards

NHS Connecting for Health is delivering the National Programme for Information Technology