Winchester first on second generation e-prescribing

Tags: A E-Prescribing Fujitsu Information iS JAC Millennium mobile Network Prescribing TDS UK US Wireless Wirral

14 Nov 2006

Winchester and Eastleigh Healthcare NHS Trust has become the first UK trust to install a second generation Electronic Prescribing and Medication Administration system, developed by JAC Computer Services.

The 450-bed Royal Hampshire County Hospital in Winchester is thought to be first UK hospital trust to replace an existing EPMA with a next generation system, a move that required a 'big bang' implementation across the trust.

The EPMA system manages the entire cycle of medication management from prescribing, clinical verification and supply, to bed side nurse administration. Ward based staff use mobile computers on the trust’s wireless network to prescribe and administer medicines at the bedside.

EPMA went live across the Royal Hampshire County Hospital between 11 and 15 September. It integrates with the trust's existing JAC Pharmacy Management module to provide a fully integrated Medication Management solution.

Robert Tysall-Blay, chief executive of JAC Computer Services, told E-Health Insider: "JAC's prescribing and medicines administration system is fully integrated with JAC's pharmacy stock control management system and provides a single seamless system."

The new system also incorporates decision support from First Data Bank Europe (FDBE) providing real-time alerts for potential medical errors due to allergies and drug interactions.

The trust is due to receive a Release Zero Cerner Millennium clinical system implemented by Fujitsu as part of the NHS National Programme for IT. The Millennium system is understood to include electronic prescribing as one of its core clinical components, but not as part of Release Zero.

Winchester has long been one of a handful of NHS hospital trusts actually operating electronic prescribing. The trust was one of a handful of Hospital Information System pilots dating back to the late 80's – together with Wirral and Burton – which implemented TDS and Meditch systems incorporated electronic prescribing.

"The significance of this implementation is that it is the first ever implementation of a second generation electronic prescribing system," said Tysall-Blay.

He told EHI that in some ways this was easier than implementing e-prescribing from scratch as staff were already familiar with using computers for prescribing, but also more difficult as it required a big bang switch over and you couldn't start with pilots in a few wards and build up. "With the trust we did the whole implementation in five days."

So far the Royal Hampshire County Hospital and Hampshire Partner NHS Trust are are using the system with Andover County Hospital to follow.

Peter Knight, managing director of clinical support and asset management at Winchester said: “Having been a long term user of electronic prescribing we are acutely aware of the importance of these systems."

Knight added: "The new system uses mobile terminals to facilitate on-line prescribing and drug administration which will further help our clinical staff in the complex world of medication management."

Deployment of the EPMA took six months from contract signature to go-live and staff have taken to the new system well.

Joyce Bould, clinical lead at Winchester added: “We have been delighted at the acceptance of the JAC Prescribing and Administration system by our staff. They find the system easy to use, and like the screen design because so much information can be seen at once. Clinically, this system gives us what we have wanted for years – prescribing charts on screen, clinical checking, and quick and easy access to patient information.

“Staff are able to use the system effectively after a relatively short training session. Winchester already used electronic prescribing, so we had to go for a ‘big bang’ strategy for our implementation – and run with two electronic systems for as short a time as possible.”

Tysall-Blay added: “Winchester was the first hospital in the UK to implement electronic prescribing, and the uniqueness of Winchester in now being the first site in the UK to replace an existing electronic prescribing system should not go unrecognised.”

Links

JAC Computer Services Ltd

Readers Comments

Burton is not using the same system

rf@medicineit.com

14 Nov 06 11:41

Please note!

Burton, one of the original e-prescribing sites you mention, used and continues to use MEDITECH as a total EPR solution with integrated e-prescribing.

Unlike Winchester and the Wirral, Burton does not need to replace its EPR or e-prescribing system as MEDITECH is one of the successful 'legacy' systems in existence in the UK.

There are marked differences between these sites that this news item fails to address. This is just one of them.

Well done Winchester and I hope the pain is worth it! I have no doubt that it will be.

The problem is...

14 Nov 06 14:49

The problem is... e-Prescribing/e-Drug administration is part of the proposed CfH core clinical "solution" - as it should be. Cerner and iSOFT are contracted to provide a prescribing/administration system sometime between 2008-2010. The pharmacy department system is outside of the core solution and can be procured by the trust chief pharmacist on merit. The 2 leading legacy pharmacy system suppliers are probably 3-4 years ahead on both prescribing and dispensing functionality/useability compared with the Cerner/iSOFT products and will continue to be so as long as they continue development. If you are confused by this scenario so am I and I would appreciate any suggestions how this situation can be moved forward.

GP sort of question

mary.hawking@nhs.net

14 Nov 06 20:13

Hospital pharmacy software is obviously a very good thing - but does this sort of software produce information which can be integrated into the relevant patient care record either before admission or for discharges? One of the danger areas for patients is the change of care providers: primary to secondary care and secondary to primary care. Prescribing is particularly dangerous: *did* the discharging physician know what medication the patient had been on prior to admission - and is the discharge medication the total medication the patient is on (did you really mean to stop the warfarin, and if so why?) or simply a list of TTAs - no implications as to what might have been stopped?

GP Sort of question.....

rf@medicineit.com

15 Nov 06 10:00

It is easy to recognise similarities between community and hospital in this area.

Community and hospital pharmacies typically record the medicines dispensed. This is obviously not all that a patient may be taking or even prescribed e.g. fluids, ward stock medications, OTCs etc.

Separately, the process of a hospital doctor being aware of what the patient was on at admission and informing the GP of what changes were made to this list is sometimes referred to as Medicines Reconciliation.

Stand alone pharmacy systems are unlikely to be able to support this function - more due to pharmacy resources that software capability. However, through interfacing with the NHS Spine, in theory, there is no reason why an interfaced and standalone hospital prescribing system cannot support medicine reconciliation.

However, medicines reconciliation is a complex and dynamic process. For example, what happens if a patient's list of medicines on admission was derived from the patient, the admission list is 'converted' into the inpatient list and even the discharge list, the patient subsequently identifies a mistake in the information they supplied to the doctor on admission? How should the system support the doctor in an efficient and effective manner?

These are infrequent but important scenarios that challenge suppliers. The transmission of appropriate information to the SPINE in these circumstances is an equal challenge, and a lot of work has been completed in this area.

One of the big differences between the UK and the US is that the final list of Discharge Medications is not request to supply as the patient may have enough of a supply at home/on the ward, the inpatient pharmacy may have supplied a 28 day supply long before discharge, the nurse may have supplied a TTO pack etc.

I have not seen the JAC e-prescribing system but I imagine it handles these varied and relatively complex processes that are not found in the US.

Thank goodness some Trusts have pressed ahead despite NPfIT

18 Nov 06 23:34

I visited the USA in June 2005, and went to Scripps Hospital in San Diego. The Medical Director there siad that his drug errors committee was now almost redundant, having introduced electronic prescribing. Prescribing errors are Everest compared with the Ben Nevis of MRSA and C Diff in Hospital Care. Well done Winchester for dealing with the priorities in a single process solution. Inpatient and discharge prescribing are immensely complex issues - if you have "sorted" it then you had better bid to take over NPfIT and make it follow clinical priority issues. Our Trust held back waiting for NPfIT CRS to be good, so we are now at least 2 years behind the pace. We cannot even get out NHS Windows Handheld PCs registered onto our Wireless network - I can use mine on my WIFI at home, but not at work!!!

Re: The problem is ....

19 Nov 06 19:08

Actually, there's only a problem if CfH actually delivers its core systems. Contracted to deliver in 2008 - 2010? I'll believe it when I see it!