Dedalus explains how interoperability standards are creating an effective platform for medicines management and safer care across care boundaries.
Interoperability is cited as the highest priority for NHS IT in this year’s NHS IT Leadership Survey. Most respondents said they were looking to NHSX (the new body responsible for NHS IT) to drive interoperability with clear communications, more funding and established standards.
Digital transformation is at the core of the NHSX mandate with coordination and consistency – developing best practice for NHS technology, digital and data, including data sharing and transparency in setting standards – noted as the top two NHSX priorities. The existing Global Digital Exemplars (GDEs) and Local Health and Care Record Exemplars (LHCREs) are clear examples of the first and the prioritisation of standards for process, data and interoperability is a very welcome second. The more inclusive approach of NHSX harnesses the innovation of both suppliers and the health service to help solve critical issues facing us all.
It is also a huge step in the right direction that overseeing the technology for social care has now been included in the NHSX overall brief. Too long the poor relation, social care is now getting some focus. Time will tell if it gets any much-needed funding – but let’s hope so.
Solving local issues is providing the platform for national solutions
The work in most NHS Trusts at the moment is largely internal. Whilst admin systems have been successfully digitised over the years, the more complex clinical processes are only now being addressed – such as electronic prescribing and digital pathology. Here clinical best practice methodologies and common standards are absolutely critical.
The clear interoperability standards set out in Integrating the Healthcare Enterprise (IHE), Health Level Seven (HL7) and Fast Healthcare Interoperability Resources (FHIR) and endorsed by notable bodies such as INTEROPen are powerful facilitators. The NHS’ mandate, that ePMA systems must use NHS Dictionary of Medicines and Devices (DM+D) data standards for the safe and reliable transfer of medicine information between different clinical systems, will ensure all systems are talking the about the same drug, dosage and usage.
Dedalus’ use of DM+D supports all levels of prescribing – through ingredient, generic product or brand. This, together with the in-built SNOMED CT coding (the standardised clinical terminology used by physicians for diagnoses) ensures the clarity of all patient ailments and treatments throughout the care continuum.
For transference of records between health and social care, the PRSB (Professional Records Standards Body) work on hospital referrals, discharge summaries, handover communications and sorting the disparate practices across the GP network, will ultimately ensure the smooth and accurate digital transmission of patient data between different care settings. Dedalus fully supports existing and emerging PRSB standards for ‘joined-up care’ and, in particular, the new work being done on pathology coding to ensure test results can be included in care data shared across the NHS.
Open standards are beginning to provide the platform for regional solutions such as cancer care and maternity. The regional ‘hub and spoke’ laboratory networks programme set up by NHS Improvement (now part of NHSX) is addressing digital pathology inclusion and key interoperability issues. However, in Wales this process has moved even further with a ‘national’ approach to digital community care, pathology, the Welsh Clinical Portal (EPR) and now even a national electronic prescribing and medicines management solution.
ePMA at Torbay and South Devon forms foundation of regional integrated care
The NHS Long Term plan states that ‘over the next five years, all providers will be expected to implement ePMA systems to reduce medication errors by up to 30%.’ With this in mind, and with a core need to provide safe medications prescribing throughout the whole integrated care organisation, Torbay and South Devon wanted an ePMA solution that was able to meet the urgent needs of both acute and community wards now, whilst being capable of communicating with primary care systems too.
Torbay and South Devon NHS Foundation Trust was one of the first integrated care organisations in England to join up hospital and community care with adult social care. The Trust delivers acute care at Torbay Hospital and runs four community hospitals. It provides health and social care to the local population of 285,000 residents and over 100,000 holiday visitors each year.
The Trust employs 6,000 staff across both health and social care, ranging from hospital nurses and consultants to social workers and physiotherapists who work in patients’ homes. Their joint purpose is to provide safe, high-quality health and social care at the right time and in the right place to enable the local community to live their lives to the full.
After a full OJEU competitive tender, the Dedalus ePMA system was selected. “Our ePMA has been tested in both acute and community care settings. It is performing well, and the rollout is proceeding brilliantly with interoperability opportunities being explored with local primary care IT systems,” states Dr Joanne Watson, System Medical Director. “One of the reasons we chose Dedalus was their commitment to working alongside primary care and their alignment with our strategy of fully integrated care and the move towards becoming paperless.”
The initial roll-out, which covered six medical wards, one ambulatory unit and two emergency admissions units, had substantial clinical buy-in from the Trust and was driven over a single weekend by a dedicated team consisting of clinicians, IT support, trainers, and Dedalus staff. Watson oversaw and directed the rollout.
With over 1,750 staff trained and the Institute for Healthcare QI Methodology employed prior to the rollout, the Trust were confident they had an ePMA system that was acceptable to staff and had worked out how to incorporate it smoothly into the complicated daily practices of the wards.
As Gill Otway, IT Programme Manager mentioned; “The preparation for the roll-out was very thorough with as much clinical process evaluation, system configuration and pre-event training done as possible – although some training still inevitably had to be done during the weekend for bank nurses etc. It was a superb team effort with all key staff well prepared in advance and the wards fully expecting and ready for the change. Plus, there was a lot of behind the scenes support of our ePMA in Procurement and from Mike Green our CCIO.”
The results so far
The system now is being used in earnest by pharmacists, nurses, doctors of all grades and other ward staff. It is already improving clinical processes by enforcing failsafe reviews at the correct times (which paper charts are not able to do) and ensuring prescribing accuracy.
The Dedalus ePMA system has been deployed on both tablets and laptops for use at the bedside and on the drugs trolley. Whilst tablets tested high on usability prior to rollout, operationally it was found that the nurses preferred laptops, so more have been purchased.
At Torbay and South Devon, the ePMA system is directly linked to the Trust’s own Infoflex system for inputting accurate drugs information directly into the discharge summaries for GPs. Feedback from Dr John McCormick, a local GP with a lot of interaction with the Trust and Chief Clinical Information Officer at Devon CCG, has already noted that the implementation has made a ‘noticeable positive difference’ to the information coming out of the Trust, which is now much more comprehensive with clearer medications data.
Watson, added; “The initial rollout was a brilliant team effort and has been such a success that we are already spreading into oncology.” The plan is to explore linking with ED first and then going into the surgical wards. Full Trust rollout is expected by the end of 2019.
“Electronic prescribing and medicines administration are the way of the future – it brings benefits to the whole of the system,” adds Joanne Watson.
“Not only can we reduce medication errors, but we can also take more efficient control of pharmacy and formulary stocks to reduce costs. By stimulating a more efficient discharge of patients and supplying GPs with complete drugs and treatment information, we can begin to avoid unnecessary readmissions.”
Dedalus’ commitment to open standards
Dedalus provide the full range of clinical and diagnostic solutions across both health and social care and are committed to supporting interoperability standards that ensure full care communications both nationally and ultimately internationally.
This article will appear in Health Europa Quarterly Issue 11, which is available to read now.