electronic prescribing and eligibility system - i2-health · pdf fileelectronic prescribing...

Electronic Prescribing and Eligibility System

pes

A system based on lessons learned in Europe

Please note:-

The opinions contained in this presentation are those of Mr. R. Patrick M. Davis and in no way reflect or are they meant to reflect the opinions or policies of the Directorate of Information Systems or the Department of Health Social Services & Public Safety (NI)

Here we are

This bit hereHealth provision throughDepartment of Health

Social Service and Public Safety

(DHSSPS)

• Northern Ireland Government organisation .

• Different organisation from other UK home countries, Wales England and Scotland.

Northern Ireland• Population of 1.8 million• Dispensing Community Pharmacists are private commercial

enterprises• Unless eligible for exemption, patients pay the pharmacist

who passes the money on to DHSSPS• Current charge is £6.50 per prescription item• Over 15 million prescriptions issued by GPs per year and

growing at 5% per year.• Total cost of prescriptions in 2004/05 was £382.8 million• Total receipts from prescription charges was £12.7 million

Losses to Public Purse

The current estimate of prescription fraud is £7.8 million per annum

Of this…………

– 95% is estimated to be fraud initiated by the patient (not paying when they should)

– A total of £7.41 million per annum (2004/05)

“In order to support the Departmental Fraud Action Plan and the Family Practitioners Service repayments an

electronic means of capturing, recording and validating Prescription Form Information is needed”

Mandate and Brief

What is εpes?

ReimbursementsReimbursementsReimbursementsReimbursements

PharmaceuticalRepaymentsSystem

Prescription

Current Manual Processes

Prescription

NIPPISystem

PrescriptionPrescription


Prescription

ElectronicData Capture

CSA

Social Security AgencyMIDAS

CrossChecking

All ScriptStorage



Prescription

Counter FraudUnit



Prescription



Prescription

All ScriptStorage

Prescription

EPES ( Original Preferred Option)

Prescription

CommunicationMethod?

Counter FraudUnit


CrossChecking


Manual Standby

InformationSystems

(DispensedInformation)

Manual ElectronicData Capture(Pharmacist)


NIPPI

PharmaceuticalRepayments System

Initial Proposals• Manual entry of data at pharmacies

• No change in current processes except the addition of fields for patient claim

• If prescribed data to be captured double entry required

• Electronic batch transfer from CPs to CSANO………….Pharmacists not happy at all

Lessons from Amsterdam

What I learnt from the German & Danish experiences

• Eva Susanne Dietrich• Ib Johansen

Challenges with Paperless ETP• Technical issues with resilience and performance (always

connected & data transfer speeds)

• The legal status of a paperless “electronic prescription”

• Changes to GP prescribing systems and surgery protocols.

• Issues regarding the use of electronic signatures by GPs/CPs

• Issues regarding the use of electronic signatures by the patients claiming exemptions

• The use of electronic records in prosecutions and civil actions

• Identification of the patient at the CP counter

Lessons from Amsterdam

What I learnt from the Spanish experiences

• Teresa Molina Lopez

Use of Linear and 2D Barcodes

Modified Print Driver

All information sent to the printer is encoded into the 2D barcode and placed at a specific location on the form. No changes needed in

GP Prescribing Software

Key elements in new automated process

• 2D Bar Code printed on prescription by GP prescribing system

• Barcode reader in CP for automated reading into CP dispensing system

2D Barcode reader

All ScriptStorage

(Images Recall?)

EPES

CommunicationMethod?

Counter FraudUnit


CrossChecking

Manual Standby

InformationSystems

(Prescribed & Dispensed)

Automated ElectronicData Capture (Pharmacist)

Data confirmation for patientthrough Patient Receipt


NIPPI

PharmaceuticalRepayments System

Barcode Generation

(GP)

ConfirmationScanning

(CSA)

The “Patient Receipt”

Mr. JonesHHDN3498576/009

No. of Items – 2 £0.00 (J)

29th May 2006 – JJR The Pharmacist

The “Patient Receipt”

Mr. JonesHHDN3498576/009

No. of Items – 2 £13.00 (P)

29th May 2006 – JJR The Pharmacist

The “Patient Receipt”• “Sticky Label” (bag label) that confirms (to the patient) the information

stored on the database in relation to their claim for free prescriptions, or receipt of their due payment.

• Generated from the Database (not the till) with the bottle labels• Protects the Community Pharmacist from claims of indiscretions by

the patients/customer• Assures the patient/customer that their wishes in respect to their

claim have been recorded correctly on the Database. • Increases the probability that the information, on which the CFU/FPS

will act, is agreed and as accurate as possible.

BENEFITS

Fewer medication transcription and coding errors

Increased efficiency

Better Communication Channels

Fraud reduction

Repeat prescribing benefits

Decrease costs

Improved quality

Improved public health

Improved practice

(Mundy and Chadwick )

BARRIERS

Privacy and security

Cultural and Organizational issues

Senior management and clinician commitment

Cost of transformation *

Legalities *

Technical problems *

Multiple drug codes

Education and implementation

Professional, Practice and Patient Issues

(Mundy and Chadwick )* Less of a problem with EPES

NumbersCommunity Pharmacists SystemsAAH/Lloyds 56 (81)McLernons 372 (484)Alliance Systems 51 (76)Boots (Systems Solution) 28 (42)

506 (683)

GP SystemsEmis 146iSoft 86InPractice 109Merlock 25

366

CostsFull implementation completed 2 years from award of contract

Capital Costs (over 2 years) ≈ £4.3 million

Annual Service Costs ≈ £650K /annum

Target fraud savings ≈ £8.3 million(Over 5 year period)

Full project costs recouped within 5 years of award of contractOn-going savings into the future

Conclusions

• EPES is ETP using a surprising route.

• EPES is Affordable

• EPES is Effective

• EPES has a robust Business Continuity strategy

The End

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