A new government fund to boost adoption of e-prescribing will not be enough to help “laggard” trusts start the journey towards electronic patient records, health IT experts warn.
On Friday, health secretary Jeremy Hunt announced a £260 million fund, primarily for hospitals to increase their use of e-prescribing.
The ‘Digital Challenge’ fund would be a “critical stepping-stone in helping the NHS go digital by 2018”, the Department of Health said.
EHI Intelligence senior analyst SA Mathieson said the fund was substantial, but may not help “laggard” trusts that were not already on the road to EPR.
Research for EHI Intelligence’s forthcoming report, 'Routes to EPR', found that the budgets for individual EPR projects usually ran into tens of millions of pounds.
"Given the large cost of complete projects, the focus on e-prescribing has its merits," Matheson said.
"However, the drawback is that e-prescribing is one of the more advanced pieces of an EPR system.
"One of England's largest trusts told us it will not be able to introduce it until it has improved its hardware and communications infrastructure, and another is implementing it as what it sees as the final stage of its EPR project,” he added.
“So this fund risks helping already good trusts become better, while not doing much for laggards."
Colin Sweeney, ICT director at King's College Hospital NHS Foundation Trust, said the fund was encouraging, but questioned whether it would be enough to achieve the government’s ambitious targets for a digital NHS.
He said e-prescribing was hugely beneficial, but something many organisations struggled to implement. The costs involved were high and benefits were mainly related to patient safety rather than finances.
Sweeney explained: “£260m sounds like a lot of money, but you have to think about how many organisations there are in the country and to make it work you have to have the infrastructure to make it mobile”.
This involved investment in a wireless network and mobile devices to be used at the bedside.
“There’s a fair amount of investment in e-prescribing, not just the software, a lot is the infrastructure. You also need training and acceptance of a different way of working,” he said.
“That money will struggle to cover e-prescribing, as far as full EPR goes it will involve more money than that.”
Royal Cornwall Hospitals Trust IT director Simon Goodwin said the found would help overcome one of the biggest barriers to introducing e-prescribing, which was affordability.
“That said, the biggest issue is managing the major change involved in moving from paper to digital,” he added.
Goodwin was not aware of the process for getting the money, but said on a fair shares basis, Cornwall could expect 1% of the fund.
“Given that we are introducing this (e-prescribing) now, we would expect to be eligible to apply and make use of the fund to accelerate introduction and ensure we have sufficient portable technology in clinical areas to maximise convenient use by busy clinical staff,” he said.
IT trade body Intellect welcomed the fund, but said that e-prescribing should be part of a wider medicines management strategy.
“Simply bolting on ePrescribing with barcode patient identification is the tip of the iceberg and will not fulfil the highlighted patient safety and financial benefits unless considered as part of the wider medicines management and EPR strategies,” head of healthcare Jon Lindberg said.
Intellect recommended that the DH and NHS England not be too prescriptive in awarding the funds to trusts.
“Trusts need to demonstrate a good understanding of how their proposed solution will address their problem and deliver outcomes that improve patient care and safety, and efficiency,” Lindberg said.
“The role of the centre is to promote common standards and provide support for trusts to meet their goals.”
© 2013 EHealth Media.
No hostility "Faithful in Adversity" - all views are goodOutspoken 110 weeks ago
Yes I am sure most of us in Acute Trusts have indeed looked at the GP Systems and their offerings regarding EPRs at one time or another. I am afraid for me they just are not designed for the complexity of care processes in Acute Care. No matter what they would have you believe. They have a lot of potential in Community for sure and certainly have a place perhaps as we in Acute move a lot of our less high acuity care processes into Community settings, but our main CORE Acute processes, nope for me they just are not designed to meet those needs.
The other problem is, many Acute Trusts traverse Local health Communities and there the fun begins. In one, due to GP System of Choice we may have predominantly SystmOne and in the other EMIS. In the Community, which many Acute Trusts inherited within the last 2 years, we can have say SystmOne in one LHC and RIO in another. Then on top of that many LHCs/LHEs have also other systems trying to join up all the healthcare organisations. So what do you choose? the only way is interoperability through standards.
Could I perhaps ask you, if you have ever seen an advanced EPR from say EPIC, MediTech, Cerner, Allscripts? You would see why the GP Systems you mention would not fit all the main processes across an Acute Trust. I am sure some would argue this, but it is each to their own view. For me it is a non-starter.
While you are waving the flag in the GP sector and discussions about EPRs and paperless. There is a lot in many of these articles that is about time that Acute Trusts sent out information, documents etc electronically quickly to the GP systems, to enable continuity of care for patients. I would like to ask these questions:
1. Why do not all GPs use Choose & Book to refer their patients to prevent us in acute care having to try and pull together referrals on two mediums: CAB & paper, into electronic triage and even now some are considering sending us electronic referrals too, so that will make 3 ways. Okay I can procure another software system to help pull these all together and create an efficient referral management system, and will probably do so, but why should I have to?
2. Why when I am trying to send electronic letters, discharge summaries and other documents to GP Practices, can I not get this implemented quickly because:
A) They might not have DocMan implemented to allow the documents to go straight into their GP System. If offered DocuLight (might have misspelt that), then they do not like that, because the document won't go straight into their GP system and someone has to click on it to download it.
B) Even if they have Docman, it takes months and months (1 year in one area) to get all the practices in one catchment area live?
3. Why when I want to implement the Summary Care Record in our A&E departments, are not all the patient's current medications, allergies, alerts for ALL practices submitted to the SCR? That is absolutely critical and especially where you have a lot of transitory patients , that in an emergency that our A&E physicians have access to this data.
This for me is less about Acute Trusts and what we have and haven't done with implementing IT systems, but setting those standards by NHS England to meet the end result for a paperless NHS which is for all care settings to meet, not just acute.
Just my view and no hostility.
I agree that does sound a rather fragmented approachOutspoken 110 weeks ago
So now we have EPMA and Clinical Observations. Okay obviously targeting the Patient Safety elements and in view of the Francis Report that is not surprising. However, would we not want to then include Assessments in that bundle too, as with Results aren't they all very much interlinked? Take Sepsis a major CQUIN and a cause of death. Yes having Clinical Obs would show some possible indications of Sepsis, such as abnormalities in vital signs, and when combined with results and EPMA then these would play a significant part. However, I would say that the Assessment would help join this piece together in terms of patient safety. I wouldn't be that far behnd with electronic ordering either.
Going to be very interesting for sure and I can not wait for the guidance in June.
E-prescribing and observationsJon Hoeksma 110 weeks ago
This was a confused announcement in the way it was made, but some of the details have become a little clearer since.
It now appears that the announcement is to focus on e-prescribing and observations as priority areas in the development of electronic patient records.
Further announcements on EPRs are due in the next month or so.
In an interview with HSJ (subscriptionn required) Tim Kesley said trusts "will be expected to match fund their bid and spend the money within a year", he also stressed that clinicians will be expected to show leadership.
So while the announcement to be welcomed, it was oddly fragmented and confused -- hopefully further clarity to come with the guidance due from NHS England in the Summer.
One other oddity to note is where the figure of 11 deaths a year from prescribing errors comes from. The last national report was A Spponful of Sugar, by the Audit Commission way back the 2001, and that put deaths through medication errors at closer to 200 a year, a figure that was widely thought to be under-estimated.
Jon I'm definitely confusedin arduis fidelis 110 weeks ago
I think its a foregone conclusion that what I'm about to say is going to be received with varying levels of hostility, but the more I see this whole elements of EPR thing rumbling on with no obvious end in sight, the more I have to wonder how many of the people involved in EPRs and associated functionality at hospitals have actually physically looked at what is in one of the top three GP clinical/EHR systems ie EMIS Web, Systmone and Vision 3?