“Electronic Prescribing, Medicines Administration and Medicines Management:

It’s not Rocket Science, is it?

Alan Heal

“Electronic Prescribing, Medicines Administration and Medicines Management:

It’s not Rocket Science, is it?

Alan Heal

Background

• Degree in computer science & MBA• 22 years in IT• Every role – analysis, programming, support, quality,

project management• Mostly commercial organisations

– financial services, banking, retail, travel, manufacturing, telecommunications & consultancy

– 3 years deputy group IT director – Lloyds pharmacy and AAH pharmaceuticals

• Public sector– The Law Society (£40m transformation programme)– Social housing

• 2001 set up Transit Point

Greater Glasgow NHS Board

• 1 year eMM Project Manager based in Glasgow• eMM Research• Project Scope, Planning, Costing & Startup• eMM Umbrella Programme• Community Pharmacy• eRx Pilot• Process Mapping• OBS/Specification of requirements• Initial shaping of Full Rollout (4200 beds, 232

ward, 20 sites)

eMM Research & Context

• EHR, EPR levels 1-6 & Timescales• National Service Frameworks (NSF’s)

• Integrated Care Records Services (ICRS)

• Procurement Rationalisation (NISP, NASP, LSP)

• Confidentiality & Privacy• UKCPRS• SNOMED-CT

X NOT SCOTLAND• Spoonful of Sugar & Organisation with a Memory• Contacts

Project Planning

• Project Planning - Programme board, Project management, Project Office

• Decision: To Pilot or Not?• Project Briefs & PID for

– eMM Programme– eRx Pilot– OBS– Full Rollout– Community Pharmacy

• Project Plans, Dependencies & Roadmap• Project Organisation Document• Communication Plan• Stakeholder Mapping

Project Planning – Stakeholder Mapping

VirtualIT

Team

EnglishGovernment

ActionStations

PCTASCRIBE

CHIECCI

SGASCRIBE

NHSIADoH

SEHD(CharlieKnox)

CoreHospitalNetworkUpgrade

RelatedProjects

CultureChange/Training

AsscoiationScottish

Trusts ChiefPharmacists

(ASTCP)CommunityPharmacyContractorCommittee

NationalWorkingGroup on

PrescribingPractice

UKSpec

WorkngGroup

Derby

Wirral

Burton

AAA GreatYarmouth

EarlyAdopters

DDSynchronisation

Team

ChiefPharmacists

Group NPF/SMSAC

ClinicalEffectiveness

GroupADTC

TrainingProof

of Concept(Pilot)

UserRequirements(Output BasedSpecification)

PossibleProcurement

FullRollout

ProcessMapping

Documentation& Procedures

Testing Testing

Support

??PanGlasgow

ProgrammeBoard

EMMPROJECT BOARD

- GLASGOW

SpecificShort LifeWorkingTeams

ScottishSpec

WorkingGroup

ASCRIBEUser

Group?GPassUserGroup

GPassReviewGroup

AreaClinicalForum?

CommunityPharmacyContractorCommittee

SCI(Alan Hyslop,Martin Irving)

SCI Store(Alan Hyslop,Martin Irving)

GP-CommunityPharmacy Network

Project

AAAETP

Trials

RoyalPharmaceutical

Society inScotland

CommunityPharmacy

sSCIMP

BMA?

RoyalCollege ofGeneral

Practitioners?

GMC?

Suppliers

MedicineManagement

ProjectBoard

SecondaryCare MMProject

PrimaryCare MMProject

Community Pharmacy

• ETP Trials > Watching Brief

eRx Pilot

• Allow Time• Cost• 24x7 support (IT, Pharmacy, Supplier)• Disaster Recovery Plan• Hardware & Technology Selection

– Mobile Devices & Robustness– Fast Moving, e.g., Smart Card– Thick/Thin Client, Web Based, Portal– Wireless LAN & Security– Size to Cover Peaks Plus Growth

• Data Protection & User Authentication• Software Selection – Functional specialist cf. Generalist

eRx Pilot

• Training– IT Illiteracy & Phobia (Nurses)– Application (on-call JHO)– Superusers

• Clinical Risk – Testing• Project Risk – Shortage of Nurses & Pharmacists• Drug Trolley Redesign• NHS Number & CHI Number• Choice of Pilot Site - General Ward not Critical Care• Evaluation 3 months

EPMA Pilot

• Scope change – Medicines AdministrationMore Risk but More Benefit

Medicines Management

• MM structure• Overlap (Drug Trolley might Disappear?)

• Definition– Original Packs– 28 Day Supply– Patient Lockers– Patient’s Own Medicines (Consent)– Medicine Re-use– Self Administration (Consent)– Responsibility from Clinician to Nurse & Pharmacist,

Nurse Partly Covers Pharmacy Out Of Hours

Medicines Management - Benefits

• Speed up Discharge Process• Reduce Nurse Time on Supply & Admin• Automate process means more time NTPP• Better weekend Cover• Lower Cost through

– Better Use of Drugs– Compliance (Self Administration)– Better Primary & Secondary Care Integration

– Recent Example

Medicines Management – Challenges & Opportunities

• Timing - eRx then MM harder than MM then eRx

• Patient’s Own Controlled Drugs• Primary/Secondary Care Costing• Changing SOP’s and Unions

Medicines Management – Challenges & Opportunities

• Flexible Systems– Technological Change (Robotic Dispensing)– Support Future Process Change– Stock Control of Patient Lockers– MA & Technician Check Trigger Re-Supply– Parallel Imports/Original Packs– Undo Button– Ward re-labelling

EPMA Pilot

• Decision put EPMA pilot on hold – focus on MM, Evaluation, Process Mapping & EPMA OBS/Requirement spec.

EPMA & MM Process Maps

• Map Processes - Current & Future (EPMA & MM)

– High Level– Admission– Clinical Management– Drug Administration– IV Administration– Stock Management– Discharge

• Cardiology (EPMA Pilot team) > Generic > HEMPA (Scottish Top 16 EPMA & MM Guidelines)

EPMA & MM OBS/Requirement Spec.

• EPMA/Pharmacy Close Coupling• Starting Point – Liverpool/Derby Generic

Pharmacy & EPMA spec.• Turn into Scottish Document• 40 hours Multi-Disciplinary Workshops• Clinician Input Biggest Risk• Careful Wording• Piecemeal IT development

– Standardisation

• Consultants Don’t Always Agree

EPMA & MM OBS/Requirement Spec.

• Homeopathic & Herbal Remedies• System Integration & Interoperability• Single Login & Clinical Portal• Access to Pathology Results to

– Make Informed Decision– Feed into DSS/Interaction Checking– Automatic Triggers

• Extra System Flexibility/Configurability = Complexity, Cost, Unclear Process/Program Logic, RISK

EPMA & MM OBS/Requirement Spec. Future

• Link OBS to Process Maps (Patient Journey)

• Wider Review – Stakeholders, Clinicians, Specialisms

• Decisions on Legacy Systems• Once OBS agreed - complete Pilot and do Full

Rollout

Comparison NHS & Commercial

Commercial Organisation NHSManagement authority & delegated responsibility

Project management methodology

Experienced project manger

Vision

Few stakeholders

Ring-fenced resource

Tightly defined objectives & specification

Competition

Status

Quality management system

Management by committees & forums, bureaucracy - Politics

Informal project management

User project manager, no training

Lot of ideas

No clear organisational picture & tentacles

Over-stretched resource

Flexibility to change mind

Collaboration

Passion, Commitment, Motivation, Belief

Resistant to change

IT money siphoned off

Conclusions

• IT is Change Enabler/Limiter• Need Procedures to Change (People) EPMA & MM

• Communication & Involvement is Key– Tap into Committees (Be Seen/Accessible)– Project Vision

• Pragmatic Project Management & Experienced PM• Danger Too Much Change - Prioritise Projects• Allow Time, Money & Resource

“Electronic Prescribing, Medicines Administration and Medicines Management:

It’s not Rocket Science, is it?

Alan Heal

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