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“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 Royal Pharmaceutical Society in Scotland DoH SCI (Alan Hyslop, Martin Irving) SCI Store (Alan Hyslop, Martin Irving) English Government CHI Related Projects EMM PROJECT BOARD - GLASGOW Virtual IT Team Core Hospital Network Upgrade GPass User Group Wirral Early Adopters Derby AAA Community Pharmacy Contractor Committee GPass Review Group Burton Specific Short Life Working Teams Great Yarmouth User Requirements (Output Based Specification) Process Mapping Proof of Concept (Pilot) Training Testing Support Documentation & Procedures ?? DD Synchronisation Team Community Pharmacy Possible Procurement Area Clinical Forum? National Working Group on Prescribing Practice NPF/ SMSAC ASCRIBE User Group? s SCIMP Clinical Effectiveness Group Community Pharmacy Contractor Committee Scottish Spec Working Group Suppliers SG ASCRIBE GMC? ADTC Chief Pharmacists Group Culture Change/ Training ECCI PCT ASCRIBE NHSIA BMA? Medicine Management Project Board Asscoiation Scottish Trusts Chief Pharmacists (ASTCP) Pan Glasgow Programme Board SEHD (Charlie Knox) Action Stations Primary Care MM Project AAA ETP Trials GP-Community Pharmacy Network Project Royal College of General Practitioners ? Secondary Care MM Project Full Rollout Testing UK Spec Workng Group 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 Administration More 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 NHS Management 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) • Communication & Involvement is Key EPMA & MM – 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.COM E-mail: [email protected]