“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
Web: WWW. TRANSPT.COME-mail: info@ transpt.com
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