Keighley, the first pilot site for electronic transfer of prescriptions (ETP), has found that before new national systems can be used, staff must first fully reconcile any discrepancies between patient details from the local practice system and the patient demographic details held on the NHS Spine.
Being first to implement ETP meant Keighley had to work through particular teething problems. The most serious of these involved having to manually reconcile the demographic details every one of the 10,000 patients registered at the practice with the information on them held on the Spine’s Patient Demographic Service (PDS) before ETP could be used for that patient.
"Every patient that came into the surgery had to be manually matched to the spine before their first consultation," said Julia Smith, Primary Care Data Quality Lead at Airedale Primary Care Trust. If there was a discrepancy, the practice had to decide whether the local or national data was correct.
Speaking at the PRIMIS conference in Nottingham last week, Graham Spearing, North East cluster ETP lead, said that the problem that required every single patients’ details to be manually verified against the PDS information on the Spine had been fixed earlier this month.
The presentation by cluster, PCT and practice staff involved in the ETP pilot emphasised the paramount importance of data quality. It also highlighted the problems created by inconsistencies between data held on local systems and the central NHS Spine PDS service.
Smith said that the early problem with reconciliation had now been resolved: "Now this only happens when there is a discrepancy." Spearing showed the search screens that staff across the NHS will have to use each time each time local and central patient details don’t match, which provide three levels of search.
When a patient is found, the staff member has to decide which record is the correct one to be retained on the Spine. "There is an issue though about which one you choose, because the one you choose gets written back to the spine," explained Smith.
She also said that mismatches between the practices’ local demographic data and that held on the Spine can be caused by "something as simple as a single space in a patient’s telephone number".
Keighley is using the initial version of the national system that largely mimics the existing paper-based prescribing process. While this first release uses patient demographic details from the NHS Spine, it does not record prescribing information into the national electronic care record on the Spine.
The scale of the challenge and potential benefits are huge. Last year in primary care, over 350 million prescriptions were issued for 655 million items. The scope of ETP is everything dispensed in the community, with the exception of controlled drugs.
Prescribers at the practice now record the prescriptions onto the NHS central Spine and then print out a paper prescription with a special barcode. When a patient gives the prescription to the community pharmacist they scan the barcode and it downloads the prescription data from the spine.
“At the moment there is no change or difference from the old paper system,” said Smith.
“It’s testing the flow of messages at this stage,” explained Spearing. Only in release two of the system, due later this year, will patients’ prescribing details be recorded to the Spine’s PSIS or sent on to the PPA.
Release two of ETP will also enable repeat prescribing, nomination of prescriptions and agreed amendments or corrections to be made to a prescription electronically. Eventually prescribing information will also become available to patients through Healthspace – though the timescale for this is unclear. Full implementation of this more advanced version of ETP is scheduled to occur by the end of 2007.
And despite initial teething problems the system is already proving a success. Since going live in February over 6,000 prescriptions have been transmitted by the two ETP pilots at Keighley and Croydon. A third pilot site in Brighton is due to go live soon.
“ETP is something that both GPs and pharmacists want, we’re pushing at an open door,” Spearing told E-Health Insider.
For the rest of this year roll-out of ETP will be limited while lessons are learned from pilots and capacity for delivery is built up. The vast majority of implementation are due to occur in 2006 and 2007.
Asked whether the 2007 target can be hit, Spearing said: “I’ve been reliably told that the target will be met, by people wiser and more expensive than me.”