Organisational benefits – and in particular, improvement of medicine prescribing, administration and supply workflows within a hospital or healthcare provider organisation – have potentially profound implications for the practice of clinical professionals. Because of these efficiencies, healthcare professionals can be confident that time-consuming routine processes can be automated with accuracy, and their time can be released to enable them to engage in more patient-centred activities, which require intuitive input that only a human being can provide. These tasks might include detailed history taking, medicines review, health education, involvement in specialist clinics and patient support groups, clinical research and, of course, evaluating resources and technology that could be used to facilitate further service developments. The staff time that can be released to healthcare professionals
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Notes and References 57
following the introduction of an EP system to deal with the routine tasks and processes of hospital prescribing can be significant; one UK study indicated that, in hospitals where there was an EP system, pharmacists could spend up to 70% of their time on activities relating to pharmaceutical care, rather than the prescribing and supply processes. 15
Nevertheless, in addition to releasing the time of healthcare professionals to focus on other clinical activities, EP systems provide an infrastructure to support these clinical activities, and to support new and emerging services that can be provided by healthcare professionals. The ways in which EP systems can support professional practice are explored in detail in a subsequent chapter.
Conclusion
In many organisations where IT has been used to automate business processes, implementers have sought benefits in terms of organisational efficiency and cost- effectiveness. Such benefits have been observed where EP systems have been implemented in hospitals, although the benefits observed may be specific to the healthcare context in which they were observed, and may not be reproducible in other health economies. Implementers should consider how existing business processes may be automated, and the extent to which automation may allow new business processes, and support changes in professional roles for, and service development by, health professionals. To gain the maximum organisational benefits from EP systems, it is essential that system designers take into account the comments, views and aspirations of clinical users.
Notes and References
1. Slee A., Farrar K. et al. Electronic prescribing: Implications for hospital pharmacy. Hosp.
Pharm. 2007; 14: 217–218
2. E-Health Insider. iSoft director says NPfIT systems “interchangeable.” http://www.e-health- insider.com/news/item.cfm?ID=2662. 2007
3. Kirkman K.P. The five foundations of successful e-prescribing programs. Health Manage.
Technol. 2005; April: 32–33
4. Shane R. Computerised physician order entry: Challenges and opportunities. Am. J. Health Syst. Pharm. 2002; 59: 286–288.
5. Goundrey-Smith S.J. Electronic prescribing – Experience in the UK and system design issues.
Pharm. J. 2006; 277: 485–489
6. Gray S., Smith J. Practice report – Electronic prescribing in Bristol. Healthcare Pharm. 2004;
August: 20–22
7. Farrar K. In: Smith J. (Ed). Building a safer NHS for patients: Improving medication safety.
London, Department of Health, 2004
8. Farrar K. Accountability, prescribing and hospital pharmacy in an electronic automated age.
Pharm. J. 1999; 263: 496–501
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9. Curtis C., Ford N.G. Paperless electronic prescribing in a district general hospital. Pharm. J.
1997; 259: 734–735
10. Fowlie F., Bennie M., Jardine G., Bicknell S., Toner D., Caldwell M. Evaluation of an elec- tronic prescribing and administration system in a British hospital. Pharm. J. 2000; 265 (Suppl): R16
11. Foot R., Taylor L. Electronic prescribing and patient records – Getting the balance right.
Pharm. J. 2005; 274: 210–212
12. Frosdick P, Dalton C. What is the dm+d and what will it mean for you and pharmacy practice?
Pharm. J. 2004; 273:199–200
13. Spencer D.C., Leininger A, Daniels R.,Granko R.P., Coeytaux R.R. Effect of a computerised prescriber order entry system on reported medication errors. Am. J. Health Syst. Pharm. 2005;
62: 416–419
14. Bates D.W., Leape L. et al. Effect of computerised physician order entry and a team interven- tion on prevention of serious medication eErrors. J Am Med Assoc 1998; 280: 1311–1316 15. Abu Zayed L., Farrar K. et al. An evaluation of drug supply as a component of ward phar-
macy activity. Pharm. J. 2000; 265 (Suppl): R68
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Chapter 4
EP Systems as a Risk Management Tool
The practice of medicine is an inherently risky activity. It is to be hoped that many therapeutic interventions are beneficial when used in the appropriate clinical situa- tion. However, the majority of medical treatment interventions – and indeed some diagnostic or monitoring interventions – carry with them an element of risk. An important aspect of the healthcare professional’s job is risk management – to evalu- ate the risks associated with any particular therapeutic or diagnostic intervention and to follow working practices that reduce the risks involved. The clinical profes- sional evaluates risk on the basis of documented experience, together with clinical judgement, arising from his or her own professional experience.
Electronic systems cannot completely eradicate risk in medicine since, by defi- nition, they operate heuristically using defined and discrete datasets and logical algorithms, and their ability to be intuitive is limited. Nor can electronic systems address the human elements of the communication of risk information to, and the assimilation of risk information by, individual patients. Although electronic sys- tems can provide some information support for this, this aspect of risk assessment remains primarily in the domain of the face-to-face consultation between patient and professional, and rightly so. Nevertheless, there is a reasonable body of evi- dence to suggest that electronic prescribing systems can reduce prescribing risks that are associated with, or may be influenced by, prescribing procedures.
This chapter will discuss the ways in which EP systems can influence risks associated with the prescribing, supply and medicines administration process.
Firstly, however, it is necessary to review the potential risks associated with the medicines management process, and the general principles of how these risks can be managed, before examining specific aspects of risk reduction with EP systems.