PATIENT RECORDS
Connecting for Health has moved from a position of developing a standard for a national system to becoming a resource for those trusts who wanted to move forward and implement their own systems, he says. This help has ranged from support and advice but the change of government has meant that the future of Connecting for Health is far from certain.
So what will trusts do? They will look at their local needs and at other factors, says Stephen. “If people do decide to do their own thing, then we may well find more people going ahead [with electronic prescribing] in the next few years, but that will partly depend on how the finances are.”
Standards are key
Asked whether he can envisage a doctor being called before the GMC because he or she has not used electronic prescribing, Stephen Goundrey-Smith thinks it’s a possibility. “I think that day is coming, but I’m not sure when – we could see it in the next 10 years.”
He thinks that other
regulators will be looking at e- prescribing, too. For example, if e-prescribing systems which include other functions, such as clinical decision-making support, were to be regarded as medical devices, then the MHRA (Medicines and Healthcare products Regulatory Agency) may be interested.
“I think the GMC work suggests that it is a potential regulatory issue,” he says. “But I think before it’s mandatory for health professionals to use them, that e-prescribing systems should conform to standards.
“I’d like to see professional bodies engaging with suppliers to come up with agreed
72 nhe
standards and I’d like to see suppliers working with professional bodies to find out what clinicians want. I think this is a huge unexplored area and would benefit from further work.”
Pragmatic approach Taking note of the evidence
Although there are relatively few trusts which have implemented trust or hospital-wide electronic prescribing, that doesn’t mean they are e-prescribing free zones. On the contrary, says Stephen, you might find that some have introduced it across one or more units or specialties.
Or they might have an electronic discharge system in place to streamline prescribing communication between the hospital and primary care.
This “pragmatic” introduction of e-prescribing will, he believes, continue to grow over the next few years, particularly as those who have been accustomed to using it move to other units where it is not in use and “spread the word”.
“What you might find is that people might complain about e-prescribing when they have it, but they are bereft when they don’t!” he laughs.
The doctors, nurses and pharmacists who have worked at one of the early adopter sites, such as Winchester and Eastleigh Healthcare NHS Trust, which uses the JAC e-prescribing system, are therefore among the most effective advocates. “The bottom line is that once you’ve
Increasing professional buy-in is certainly a challenge. One way forward – and this is happening to an extent – is by making sure that those who are using the systems are well-equipped to do so. That involves setting and insisting on educational standards, both at an
undergraduate and postgraduate level. Of necessity, this involves getting professional bodies, such as the Royal Pharmaceutical Society (RPS), on board.
Stephen believes that the GMC might actually be ahead of the RPS on this one, as evidenced by its paper on prescribing errors.
But it is not only the professional regulators who are likely to be taking notice. Prescribing errors have been a particular focus of other bodies, such as the National Patient Safety Agency or other quality bodies. If trusts find that they are lambasted for failing to introduce the systems which, the evidence suggests, improve the safety of prescribing, cutting errors and potentially saving lives, they might be impelled to act.
To return to the imaginary scenes in the under-fire trust: “Why?” says the chief executive, contemplating the
got it, nobody wants to go back,” he says.
“There’s a degree of pressure from young pharmacists and doctors in favour of electronic prescribing and that could well be a significant factor.”
loss of even the new, slimmed down NHS pension when he is ignominiously sacked. “Why didn’t we implement electronic prescribing when we saw the evidence in its favour stacking up?” The medical director and chief pharmacist, anticipating their own letters from their respective regulatory bodies, can only nod and agree.
Stephen Goundrey- Smith MSc MRPharmS is a pharmaceutical informatics consultant
Stephen Goundrey-Smith qualified as a pharmacist in 1989 and subsequently gained an MSc in Information Science at City University, London. He has worked variously as a hospital pharmacist, in medical affairs in the pharmaceutical industry and as a domain analyst for prescribing and pharmacy in the healthcare IT industry. He has also worked for the Royal Pharmaceutical Society of Great Britain, the professional body for pharmacists, leading on pharmacy IT policy and professional engagement on IT issues. He is now a consultant in pharmacy IT and healthcare informatics, pharmaceutical marketing and healthcare market access.
He has written a number of papers on pharmacy informatics, and is the author of “Principles of Electronic Prescribing” (2008) (Springer Science), the world’s first book- length publication on hospital electronic prescribing. He has chaired the working group for the Royal Pharmaceutical Society’s Standard Pharmaceutical Care Record initiative and is on the Guild of Healthcare Pharmacists IT Interest Group Committee.
www.connectingforhealth.nhs. uk/systemsandservices/eprescribing/ challenges/Final_report.pdf).
1 Nov/Dec 10
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