Stephen Goundrey-Smith MSc MRPharmS –SGS PharmaSolutions

SGS PharmaSolutions

Pharmacist with experience in hospital pharmacy, community pharmacy and the industry

Electronic prescribing software design analyst

Pharmacy informatics advisor to the Royal Pharmaceutical Society

Experienced consultant in pharmacy informatics

Author of “Principles of Electronic Prescribing” and “IT in Pharmacy: An Integrated Approach”

SGS PharmaSolutions

SGS PharmaSolutions

Collecting your medicine from the pharmacy near where you work – or the one near home..

Up to date, accurate medical information immediately available to the attending clinician if you are admitted to any hospital in an emergency

Your medical information available remotely and in real time to any visiting healthcare professional who sees you

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Continuity & quality of care

Reduction of clinical risk and medication errors

Better and new ways of working for HCPs

Convenience for patients - and HCPs

Patients expect it!

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SGS PharmaSolutions

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….have developed over time – some are older than others

You need to know the infrastructure

You need to know how each EMM process works

Think about what route you need to take to get you where you want to be

We still can’t get to some places….

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Electronic Prescription Service (EPS)

Summary Care Record (SCR)

Hospital Electronic Prescribing

E-Discharge/E-Referral

Hub & Spoke Dispensing

Robotics

EU Falsified Medicines Directive (FMD)

Standards Initiatives

Mobile Technology

Telecare

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Developed under the England national programme for IT (NPfIT)

Used in England primary care

Prescriptions transferred electronically from prescribers to dispensers (pharmacies/appliance contractors)

Uses patient demographic data from national spine

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Implementation process has been slow Oct 15 – 98% pharmacies live - 29.7% of all

prescription items via EPS (various exceptions)

Now moving to “Phase 4” – EPS becomes the default prescription system – majority of Rxs being transmitted by EPS

New functions from 2017 - a) owings management, b) patient tracker, c) dispenser messages

Exploratory work – use outside primary care, homecare, protocol supply

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Summary healthcare record – contains allergies, current meds, previous ADRs

May also contain - significant medical history, care plans, patient wishes

SCR now available for 97% of England population

Benefits for hospital medicines reconciliation

POC Study in community pharmacy –prevented medicines errors, reduced the need to refer elsewhere

SCR to be rolled out in community pharmacy

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…let’s think about the whole UK -England….and Scotland, Wales & Northern Ireland

Devolved healthcare administrations

EPS and SCR are England only – but other devolved nations have similar systems

All other systems have the potential to be used across UK….

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Electronic prescribing and medicines administration (EPMA) in hospitals

Different to primary care - non-product-based prescribing and complex medicine administration

< 20% of hospitals currently use EPMA - is due to increase to > 50% after 2015, due to Technology Fund investment

Hospital EPMA systems may be used to enable e-Discharge, remote care and communications with primary care staff

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In UK, E-discharge systems have been developed to improve hospital discharge process

How can community pharmacy be involved?

Development of e-Referral systems

Refer patients discharged from hospital to community pharmacies for contracted services such as Medicines Use Review (MUR) and New Medicines Service (NMS) – prevents re-admissions

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Some pharmacies – large Rx throughput, so difficult to develop services (NMS, MUR)

Announcement in December 2015 – pharmacy funding cuts

In future – dispensing of medicines could take place at a central “hub”

Medicines would be supplied to patient, along with services and advice at “spoke” pharmacy

Change of law so that hub and spoke can be different legal entities – subcontracting of dispensing

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Pharmacy robots have the potential to reduce dispensing errors, streamline the dispensing process and enable “re-engineering” of pharmacy services

Audit Commission “Spoonful of Sugar” Report (2001) – widespread use of robots in UK hospitals

Slower uptake in community pharmacy –although some pharmacies have installed robots to enable service development

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An Europe-wide industry-led initiative to prevent medicines counterfeiting

Medicines must have tamper-evident packaging and a unique identifier

Authenticity of a medicine must be verified at the point of supply to the public

Could it enable additional benefits? - accuracy checking, product information, expiry date checking and drug safety reporting

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Need standards for joined-up systems and services

dm+d – medicines terminology – underpins England EPS and SCR

SNOMED-CT – disease terminology

Dose syntax – how to describe drug doses

Standards for format and content of clinical records – PRSB

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Mobile phone use is now almost universal the UK – but we’re perhaps not making the most of them

They are used for alerts (repeat Rx collection) & appointments

But what about disease monitoring and adherence monitoring?

More personal data – more privacy issues

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Adherence is a real issue for all stakeholders

20-50% of patients do not adhere to medicine (depending on regimen etc)

Smart packaging – Aardex MEMS, Stora Enso

Smart pills – Lifenote

Barriers to implementation – a) data & communication standards….b) privacy

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Telecare = patient-centred healthcare Remote consultations – greater patient

convenience and service access Housebound, isolated, palliative patients Mobile phones and digital televisions as

interfaces Broadband infrastructure in rural areas is key

factor Effects on access - but also health outcomes

and personalised medicine? Scotland project, NHS England Innovation

Test Beds

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The Summary Care Record can be used to support various medicines-related services

Transfer of prescription information from hospitals to the community can be done with e-Discharge (EPMA systems), e-Referral (web-based systems) – or EPS?

Mobile technology can enable patient monitoring/adherence in a way that enterprise-based systems can’t

Some things still can’t be done – but new data standards will enable them to happen –eg PRSB Crisis Care Project

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Lots of technologies are available, and may be in use for some purpose in some industry

For EMM, we need to ask – is it useful, is it legal, is it viable?

People, not systems – technology should support us and our patients, not vice versa

Seamless EMM will open up new possibilities – with unintended consequences

The growth of open-source technologies will open up new routes to EMM in some areas

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Decide where you want to get to – what are the destinations for your organisation?

Know the infrastructure in your city/state/country – what is already available?

Be aware of the possible barriers to implementation and how to overcome them

Decide how you are going to realistically monitor progress and encourage professional engagement during implementation

SGS PharmaSolutions

Pharmacy Informatics Consultant

Contact me on 0797 152 4318 or sgspharma@hotmail.com

SGS PharmaSolutions