Pharmacy informatics

Innovationinhealthcare

Informatics underpins and supports the delivery of pharmacy services across all sectors of pharmacy.

Effective and robust IT systems...

  • Have a positive impact on patient safety, by reducing medication errors.
  • Enable interoperability between systems and so facilitate consistency and quality of care within the wider NHS.
  • Promote efficient service delivery and therefore are vital to the future development of new clinical roles for pharmacists
  • Enable community pharmacists to be connected into the wider NHS, so that their recommendations can be acted upon and their contributions recognised.

Digital Medicines Digital Medicines

England

In England, NHSX has been established to deliver the NHS Long Term Plan and the Health Secretary’s Technology Vision and to coordinate the development and implementation of digital technology in the NHS. There are five key missions:

  • Reducing the burden on healthcare staff so they can be patient-focused,
  • Giving citizens the tools to access information and services directly,
  • Ensuring clinical information can be safely accessed, wherever it is needed,
  • Improving patient safety across the NHS; and
  • Improving NHS productivity with digital technology.

This includes the safe and effective transmission of information about medicines through the NHS, and the use of digital technology to support the services that the NHS needs, including services provided by pharmacists.

The NHS Digital digital medicines implementation programmes (formerly known as Domain E), namely a) Digitising Community Pharmacy (EPS), b) Medicines Data, and c) Integrating Pharmacy Across Care Settings (IPACS) are now in the process of closing or transitioning to new programmes. The Electronic Prescription Service (EPS) is running as a live system.

See: https://digital.nhs.uk/about-nhs-digital/our-work/transforming-health-and-care-through-technology/digital-medicines-domain-e

https://www.nhsx.nhs.uk/who-we-are

Scotland

In Scotland, the Digital Health & Care Strategy describes how digital systems will be used to support person-centred care and improve outcomes (https://www.gov.scot/publications/scotlands-digital-health-care-strategy-enabling-connecting-empowering/) and Achieving Excellence in Pharmaceutical Care: a Strategy for Scotland outlines how the pharmacy capacity can be increased and the role of pharmacy transformed across all sectors to enable person-centred care (https://www.gov.scot/publications/achieving-excellence-pharmaceutical-care-strategy-scotland/). 

The new National Digital Service (NDS) hosted within NHS Education for Scotland aim to develop a National Digital Platform (NDP) based on Open EHR principles and standards to provide a patient record that is accessible across NHS Scotland.

Wales

In Wales, Informed Health and Care - A Digital Health and Social Care Strategy for Wales describes how digital systems will provide access to healthcare services and person-centred care for all Welsh citizens (https://nwis.nhs.wales/systems-and-services/secondary-care/welsh-clinical-portal/). 

The Welsh Clinical Portal enables healthcare staff to log on and view patient records and results - and go to their personalised workspace to access their own relevant patient lists, and the Choose Pharmacy platform is now being widely used in community pharmacies across Wales providing opportunities for implementing new and improved services.

Electronic Transfer of Prescriptions Electronic Transfer of Prescriptions

Systems for the electronic transfer of prescriptions (eTP) are being used in primary care in England, Scotland and Wales.

England

The England Electronic Prescription Service (EPS) enables GPs and other primary care prescribers to send prescriptions electronically to the pharmacy of the patient’s choice. Use of the EPS by pharmacies may improve pharmacy workflow and efficiency, help manage repeat prescription workload and lead to improved stock control. 

See https://digital.nhs.uk/services/electronic-prescription-service.

Scotland

In Scotland, the Acute Medication Service (AMS) enables the electronic transfer of prescriptions to for community pharmacy care, and any associated counselling and advice. 

See https://www.cps.scot/nhs-services/core/acute-medication-service/

Wales

In Wales, the 2D Rx system is used to transmit prescription information electronically from the prescription into the pharmacy PMR system, using a 2D barcode. Unlike the England and Scotland eTP systems, the Wales 2D Rx system does not require a central spine or repository.  

See https://www.wales.nhs.uk/sites3/page.cfm?orgid=771&pid=29234

Falsified Medicines Directive Falsified Medicines Directive

The EU Falsified Medicines Directive came into force on 9th February 2019 and is designed to eliminate traffic of falsified medicines in Europe. From that date, pharmaceutical manufacturers placing products on the European market are required to introduce an anti-tamper device and a unique identifier (a 2D data matrix barcode) which can be scanned at various points along the supply chain to determine its authenticity.

Also from that date, as part of the supply process for medicines with these safety features, pharmacies will be required to check that the anti-tamper device is intact and to scan the 2D barcode on the pack to change the status of the pack from “active” to “inactive—supplied” on the National Medicine Verification System (NMVS).

The UK’s National Medicines Verification Organisation (NMVO) is SecurMed UK, which comprises bodies representing manufacturers, importers, wholesalers and pharmacies, and is supervised by the UK National Competent Authorities (pharmaceutical product regulating bodies), represented by the Department of Health & Social Care (DHSC) and the Medicines and Healthcare products Regulatory Agency (MHRA).

See 1) HM Government FMD Guidance & Useful Resources
(https://www.gov.uk/guidance/implementing-the-falsified-medicines-directive-safety-features#guidance-and-useful-resources)

and 2) RPS FMD Information
(https://www.rpharms.com/resources/ultimate-guides-and-hubs/fmd)

Electronic Health Records Electronic Health Records

Pharmacy teams use pharmacy patient medication record (PMR) systems to store medicines-related information, and these systems are being developed to support new, clinically-focused pharmacy services. However, a number of national electronic health record (EHR) services are now available to provide medicines-related patient information.

England

The England Summary Care Record (SCR) is a national electronic patient record in England, created from data extracted from detailed GP records. SCRs have now been created for over 55 million people in England.
See https://digital.nhs.uk/services/summary-care-records-scr.

The core SCR dataset contains information about a patient’s medication, allergies and any previous adverse reactions to medicines. Additional information might be included, with the patient’s consent, such as significant medical history, reason for medication, immunisations, care plans (for example, anticipatory care information) and patient wishes/preferences (for example, concerning end of life care).

The SCR has been found to be useful with medicines reconciliation on hospital admission - ensuring that medicines prescribed on admission correspond to those that the patient was taking prior to admission. Because the SCR reduces the time spent finding medicines information (i.e. contacting GPs by phone), medicines reconciliation is more likely to take place within 24 hours of admission, in line with National Institute of Health and Care Excellence (NICE) guidance.

Since 2015, the SCR has been rolled out for use in community pharmacies in England. SCR is used in community pharmacies in the following scenarios: a) to check allergies, b) to check current medicines for out-of-area patients when making emergency supplies, c) to check eligibility for services such as flu vaccination. 

More than 96% of the population of England now have a SCR, and community pharmacists are being incentivised to access the SCR with quality payments as part of the pharmacy contract.

Scotland

In Scotland, the Emergency Care Summary (ECS) is viewable by staff at out of hours centres, A&E departments, some wards and also by NHS 24 staff. Pharmacists have been able to gain access to ECS information through direct contact on a professional line to NHS 24 and through locality portals. The ECS contains patient details, GP surgery details, allergies and ADRs and prescribing history. 

As with other national NHS electronic records in Great Britain, patient consent is required every time the record is accessed. Patients may opt out of the scheme by contacting their GP surgery.
See https://www2.gov.scot/resource/doc/143714/0036499.pdf

Wales

In Wales, the Welsh General Practice Record (WGPR) is a national summary of key information created from the GP record, and is used to support unscheduled care. It contains patient details, details of current GP practice, a record of current and recent medication, medical problems from GP consultations, recorded allergies and results of any recent tests.

As with the English SCR, patients need to give consent to allow a health professional to access their record, and there is an opt-out system for patients who do not want to have a WGPR.
See www.gprecord.wales.nhs.uk/home

In England, Local Health & Care Records (LHCRs) are being introduced to enable safe and secure sharing of a patient’s health and care information as they move between different parts of the local NHS and social care system. The PRSB has developed an information standard for the core content of LHCRs – see below.

Benefits of the use of electronic health records (EHRs) include:

  • Patient safety – prescribing is more accurate and prescribing errors are reduced due to more information being available at the point of prescribing.
  • Service efficiencies – reduces the time taken by pharmacy staff to check medication information with GP surgeries, and may reduce time taken for medicines reconciliation on hospital admission by up to 50%.
  • More effective care – enables medicines information to be accessed out of hours or at weekends, and patient queries to be resolved without referring them back to the GP.

RPS has produced general guidance on the use of EHRs.
See EHR Guidance Update March 2016

Clinical Record Standards Clinical Record Standards

RPS also supports the development of professional standards for the content and format of health records. This not only contributes to the safety and quality of patient care, but also supports interoperability of electronic systems. 

For this reason, RPS is a member of the Professional Record Standards Body (PRSB) and has actively contributed to the development of clinical standards relating to pharmacy and medicines.

The PRSB Pharmacy Information Flows project has developed information models for the following community pharmacy service use cases:

  • Emergency Supply (supply without a prescription).
  • Vaccinations (including the flu vaccination).
  • Medication Reviews.
  • New Medicine Service consultations.
  • Appliance use Reviews.
  • Digital Minor Illness Referral Service (DMIRS).
  • Hospital discharge to community pharmacy.

The strategic significance of this work for pharmacy is that pharmacy expertise is brought to bear in the wider NHS, and valuable pharmacy professional activity is made visible to NHS colleagues. The information models that were developed in these projects are now being implemented to enable transfer of information to and from community pharmacies.
See https://theprsb.org/standards/pharmacyinformationflows1and2/

The PRSB Interoperable Medicines project (Digital Medication Information Assurance) consulted stakeholders on the use of a new FHIR based model for “dose syntax” to facilitate the conversion between dose-based prescribing (used in secondary care) and product-based prescribing (used in primary care). 

This will enable automated transmission of information on medicines between care settings and will provide safety benefits with medicines reconciliation on transfer of care and streamlined communications with GPs and pharmacies on hospital discharge. 

This is now at the testing and implementation stage.
See https://theprsb.org/projects-2/digitalmedicationinformation/

The PRSB Person-Centred Care Record Standard specifies the core content of the proposed Local Health & Care Records (LHCRs) – see above. RPS and PSNC are working together to ensure that the interests of pharmacy are represented in this initiative. It is recognised that pharmacists working in different practice contexts would need to have access to most of the likely core elements of the record.
See https://theprsb.org/aboutus/learningfromlocal/

Information Governance Information Governance

In a healthcare environment where IT is increasingly used to produce a joined-up service across care settings, it is essential that health professionals are seen to be handling patient information in a secure way when providing professional services.

Information governance (IG) has its basis in the Data Protection legislation (1998 and 2018) and is a term used to refer to the processes by which personal information is collected, managed, transmitted and used in a secure and confidential way in an organisation. 

All patient identifiable data used by pharmacists, whether accessed from national NHS care records or stored in local or networked systems are subject to the Data Protection Act and associated NHS IG requirements. 

These cover many aspects of good practice in information management and security including prevention of accidental disclosure, security of hardware and software, staff training, management of critical incidents and various others. 

However, a balance needs to be struck between safeguarding patient confidentiality and ensuring that patient information is appropriately available at the point of patient care.

England

In England, the NHS Data Security & Protection (DSP) Toolkit (formerly the Information Governance (IG) Toolkit) for community pharmacy provides the pharmacy profession with guidance and a compliance framework to enable them to address these information management issues. 

The DSP toolkit now has a greater emphasis on cyber-security as well as working processes.

See: https://www.dsptoolkit.nhs.uk/

Wales

In Wales, Information Governance guidance indicates that information security measures must be in place, which would typically include encrypted data, access controls, secure file sharing software, good processes in the software for authenticating user identity, regular back up of information, physical security around IT equipment, processes for disposing of confidential waste and IT equipment, and defined procedures for taking information offsite and transporting personal information.

For Wales, further information on IG is available at:

Scotland

In Scotland, information governance advice is available for information sharing, subject access to records, single sign on and information security for wireless networks, text messaging and social networking.

For Scotland, recent publications have commented on the need to achieve a balance between confidentiality and accessibility of patient information, and  further information on IG is available at:

Hospital E-Prescribing Hospital E-Prescribing

Electronic prescribing and medicines administration (EPMA) in hospitals has the potential to improve patient safety by reducing prescribing errors, to improve hospital efficiency by streamlining work processes and to enable new ways of working in hospitals in order to increase quality of care. 

However, although EPMA systems generally improve medicines safety, they can introduce new errors depending on how they are implemented in the hospital, and optimisation of the system to the local working context is important to minimise new risks. 

There is currently a move toward greater use of closed loop medicine administration, which cross-checks patient identity and medicine dose information in real time to ensure the 5 Rights are correct.

Unlike electronic transfer of prescriptions (eTP) in primary care, where a prescription needs to be transferred, hospital EPMA systems process orders to supply or administer medicines. While both primary and secondary care systems involve electronic storage and transmission of prescribing information, the prescribing process is different. 

Secondary care clinicians usually prescribe according to dose (for example, Amoxicillin 250mg, tds, orally), whereas GPs usually prescribe according to product (21 x Amoxicillin 250mg Capsules, Take One Three Times A Day). 

In order for primary and secondary care prescribing systems to be interoperable, a standard system of dose syntax is needed to ensure that dose information can be stored and transferred in an unambiguous, machine-readable format. The PRSB interoperable medicines project (see above).

Following the publication of the Safer Hospitals, Safer Wards Report in 2013, the Department of Health & Social Care has significant investment in integrated digital care in NHS hospitals, in several tranches. 

The publication of the Carter Report on improvement of hospital pharmacy services and the NHS Long Term Plan has provided more incentive for investment in EPMA systems in hospitals. Following the Carter Review, £75m of funding for EPMA implementations has been made available over 3 years. £16m was awarded to 13 Trusts in 2018-2019, £26m was awarded in 2019-2020 and a third tranche of hospitals will receive funding in 2020-2021. 

At present, around 35% of NHS acute Trusts in England are doing most of their prescribing electronically, and this will increase to over 50% in the near future with further investment and system adoption.

See NIHR Electronic Prescribing Toolkit - https://www.eprescribingtoolkit.com/

The Wachter Report, of the National Advisory Group on Health Information Technology in England, published in 2016, reviewed experience of IT implementations in NHS hospitals to date, and developed ten overall findings/principles and ten implementation recommendations for future implementations.

See the Wachter Report: https://www.gov.uk/government/publications/using-information-technology-to-improve-the-nhs

Digital Capabilities Digital Capabilities

The term digital capabilities is used to describe the extent to which staff members are able to access and use IT system effectively to perform their job role. The term encompasses all aspects affecting access to, and use of technology, not just personal skills. 

The importance of adequate digital capabilities – both in terms of personal skills and organisational systems readiness - is recognised throughout the health service.

All sections of the pharmacy workforce need to be able to use computers and IT systems competently and in a way that is role-appropriate, so they can be personally effective, provide high quality patient-centred care, and realise professional aspirations for themselves and their team.

The need for appropriate digital capabilities in the pharmacy workforce will increase in future for two reasons:

  • The NHS will become more digitally connected and integrated, and research suggests that systems that enable more integrated care can influence professional roles. This will happen with, for example, planned future services in community pharmacy, such as the Community Pharmacy Referral Service (CPRS)
  • The use of artificial intelligence (AI) and intelligent systems will increase, and these will do some elements of tasks that were previously done by the human user. This aspect has been highlighted in the recent Topol Review, which examines the impact of a digitised NHS on its workforce.

RPS is developing its approach to enabling digital capabilities across the pharmacy workforce and will be producing some resources to support pharmacy teams in the future. In the meantime, there are various resources that may be useful to pharmacists who are beginning local work on this issue:

Data Driven Care Data Driven Care

With widespread availability of digital systems to support pharmacy practice in all sectors and the increasing interoperability of such systems, it will be increasingly possible to extract medicine use data from system that can be used, either on its own or linked with other datasets, to optimise medicines use.

There are various forms of data available:

  • Extracts from the prescribing or pharmacy system (hospital electronic prescribing system or community pharmacy PMR system)
  • Datasets like Rx Info, Optum or Fingertips
  • Specialist datasets on evidence-based care – for example, the mental health dataset produced by the Royal College of Psychiatrists.
    See https://mentalhealthwatch.rcpsych.ac.uk/)

Health informatics and data driven care are well-established in medical specialties, but this area is still in its infancy in pharmacy. 

A recent project by the Chief Pharmaceutical Officer’s Clinical Fellows looking at how pharmacy professionals could be supported in developing data driven care found that, while many pharmacists believed that data was important, few had received specific training in use of data or were encouraged to use data in practice.
See NHS England report Supporting early career pharmacy professional in data

As part of its commitment to helping the profession to develop appropriate digital capabilities, RPS will be looking to provide guidance on data driven care to pharmacy teams. 

RPS is also looking to support pharmacist clinical informaticians in their roles by working with the Faculty of Clinical Informatics (FCI) to ensure that resources are available for them.