1. Benefits Approach
ePrescribing Masterclass Webex Kathy Wallis, ePrescribing Domain expert
11 February 2015

2. Purpose of the Presentation
To provide support to Trusts on Benefits Realisation for ePMA projects
Why benefits realisation?
Categorisation of Benefits
Pitfalls – what goes wrong?
Rules for Benefits realisation
Worked example
New Version of ‘Benefits Realisation for ePrescribing Projects’

3. Why Benefits Realisation?
Provides part of the economic case for investment – value for money
Why should the Trust implement ePMA?
What is the Trust going to gain through this?
Provides a focus on WHY implement – what is important to the Trust.
May provide insight on the choice of system:
Improve the prescribing process (efficiency; accuracy; reduce prescribing errors; decision support)
Improve the communications between ward and pharmacy (stock control; efficiency)
Integral part of the patient record / clinical process (complex decision support)
Provides the evidence of a successful implementation: money well spent
Need to keep in line with business case promises

4. Categories of Benefit
Cash Releasing: reducing costs so that resources can be allocate elsewhere
Non-cash Releasing: often efficiency benefits where monies / resources cannot be allocated elsewhere
Qualitative: benefit that is of value but cannot be quantified in financial terms
Societal: savings are realised outside of the health and social care system e.g. patients return to work more quickly

5. Pitfalls to Benefits Realisation
What other initiatives are also taking place – will they impact the same areas of measure
Length of stay
What is a potential benefit in one Trust may not be to yours:
Have processes / resources already been put in place to address the issue?
Baseline measurements are not taken ‘pre-implementation’ making it impossible to demonstrate any improvement / benefit
The benefit is not available to the organisation, e.g. junior doctor costs are paid for by the Deanery, not the Trust
Wrong expectations: not all benefits will be delivered on day 1 of implementation (system optimisation):
May be slow to see benefits as people ‘learn’ the new ways of working and new processes ‘bed in’
May need to modify the configuration / processes as you learn how the system really works

6. Implementation Life Cycle

7. Rules for Benefits Realisation
Measure what is measurable
Set realistic expectations for your organisation
Fit with the local picture
Trust Strategic Drivers
Local opportunities and needs
Each benefit should be defined so that it fits one benefit category. The measure must be appropriate to the benefit category
If the benefit can be measured in more than one way (e.g. cash releasing measure and efficiency measure), the benefit should be listed more than once, highlighting the benefit category and measure for each entry
Each benefit must have an owner and a time plan for delivery

8. Worked Benefits example: Decrease time for drug rounds
Benefit: Decrease time for drug rounds
Benefit Category: Non-cash releasing
Measure: Time for a drug administration round, calculated per patient
Method for measurement: Audit, before and after implementation of the time for a drug administration round. Audit all drug rounds on sample wards for a week and calculate the time taken per patient. Calculate the difference in time per patient for before and after implementation. This time could then be either:
Multiplied by average hourly rate of nurse to calculate the cost of time saved;
Taken as time released to care
Note: this is a crude measure as many factors impact the length of a drug round. However, it does give an indication of the time the process takes. It is recommended that this is calculated as the time taken per patient, as drug round size can vary, even on the one ward, depending on the shift, number of staff on duty etc. An average time per patient can be extrapolated to wards with similar specialties / patient groups.

9. Ten example benefits and method of measurement
Many potential benefits – need to fit your Trust. 10 example ‘generic’ benefit chosen to demonstrate benefits / category of benefit / method of measurement:
Decrease in medication errors, including prescription errors; administration errors; ADRs
Increase in completeness / legibility of prescriptions
Decreased number of missed doses through improved medication supply and improved records
Decrease in number of drug transcriptions / chart rewrite (junior doctors)
Decrease time for drug rounds (nurse)
Decrease in drug expenditure
Increased protocol adherence: Antibiotic stewardship
Increased Protocol Adherence
Staff satisfaction
Decrease in drug waste (for installations of automated drug cabinets)

10. New Version of ‘Benefits Realisation for ePrescribing Projects
NHS England website