pharmacy informatics hub

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.

The national information board and digital medicines The national information board and digital medicines

The England National Information Board (NIB) programme is an initiative to establish an efficient, paperless NHS, which is oriented towards the real needs of patients and can provide real information for audit and accountability -  and to provide the necessary infrastructure to support this. The thinking behind NIB is to build digital maturity locally and enable interoperability, rather than develop centralised systems. It is broad-ranging programme, which consists of ten delivery domains.

Domain E - Digital Medicines - contains most of the developments relating to pharmacy, and these developments will have a significant impact on pharmacy working practices. Other domains contain developments for all NHS services, and which will therefore also affect pharmacy (for example, citizen-centred services (Domain A), personal health records (Domain D), email communications (Domain I) and information governance (Domain J)).

Domain E, Digital Medicines, consists of three programmes: A) Digitising Community Pharmacy; B) Integrated Pharmacy across Care Settings, and C) Pharmacy Supply Chain and Secondary Uses.

The current Electronic Prescription Service (EPS) and the Summary Care Record (SCR), and the planned developments of these services, are a key part of the Digital Medicines Domain. The implementation of the Falsified Medicines Directorate (FMD) across all pharmacy settings is also covered by Domain E.

Other elements of the Digital Medicines Domain include:

  • Patient empowerment (including pharmacy patient record access and click and collect services).
  • Hub and Spoke Dispensing
  • Integration of pharmacy with NHS 111
  • Transfer of care
  • Implementation of unambiguous identifiers for all prescribers/secondary uses services to enable availability of detailed prescribing and activity data
  • Securing Excellence in Pharmacy IT, a work stream concerned with developing a good environment in pharmacy to enable digital maturity
  • Delivery of the government's stated policy of prices on medicine labels.

In Scotland, the Prescription for Excellence vision and action plan highlights the strengths of pharmacists as experts in the therapeutic use of medicines and their potential contribution to, and integration into, health and social care teams, and the systems needed to achieve this.

In Wales, 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. Features now available may include medicine transcribing, e-Discharge and access to the Welsh GP Record.

Electronic prescriptions Electronic prescriptions

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

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.

NHS Digital is planning two major developments to enable the vast majority of prescriptions to be transmitted electronically. Firstly, the system is being developed so that patients who have not nominated a pharmacy can receive a token and take it to a pharmacy of their choice in England, in order that their prescription can still be processed electronically. Secondly, there is a plan to enable Controlled Drugs to be prescribed by EPS in future

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

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. 

Electronic health records Electronic health records

Pharmacy teams use pharmacy 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.

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.

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 (ie 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, following a proof of concept study in 140 community pharmacies, the SCR has been rolled out for use in community pharmacies in England. 8700 community pharmacies – over three-quarters of all pharmacies in England - have now completed briefing sessions to gain access to the SCR. 

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. 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.

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.

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 electronic health records (EHRs).

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) (http://theprsb.org/).

The PRSB e-Discharge Phase 2 Project is in the process of developing a detailed model for medication information to support hospital to GP discharge. For further information, see: http://theprsb.org/publications/hospital-to-gp-discharge-summary

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 Act 1998, 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.

In England, the NHS Digital IG toolkit for community pharmacy provides the pharmacy profession with guidance and a compliance framework to enable them to address these information management issues.

Information Governance guidance for Wales 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:

Information Governance and Caldicott – NHS Wales

Information Security and Data Protection - NHS Wales 

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, further information on IG is available at:

Information Governance - eHealth NHS Scotland

Information Governance - NHS Scotland

Recent publications have commented on the need to achieve a balance between confidentiality and accessibility of patient information:

To Share or Not to Share? The Information Governance Review (2013) (known as “Caldicott 2”)

National Data Guardian for Health and Care. Review of Data Security, Consent and Opt-Outs (2016)

 

Hospital e-prescribing Hospital e-prescribing

Electronic prescribing 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.

Following the publication of the Safer Hospitals, Safer Wards report in 2013, the Department of Health made an investment of over £195millon in the Integrated Digital Technology Fund (the “Technology Fund”) to support NHS Trusts in their progression from paper-based clinical record-keeping to integrated digital care records (IDCRs). The initial wave of funding approved 213 electronic prescribing and medicines management projects.

Details
   

The Pharmacy Digital Forum (PhDF)

The Pharmacy Digital Forum (PhDF) is a group, hosted by RPS, which works collaboratively to create a shared understanding of IT developments and requirements, and to enable the appropriate sharing of organisational strategies to maximise the opportunities for collaboration and to minimise duplication of effort. The group is designed to facilitate the exchange of views and interests across hospital and community pharmacy, to ensure the strategies for both community pharmacy and hospital pharmacy IT fit together within any wider healthcare strategy, and will work towards interoperability between each sector and with other healthcare sectors.

PhDF membership is GB wide, and is drawn from across the pharmacy profession, pharmacy industry and from Government. The group usually meets four times a year.

PhDF Terms of Reference

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