However, experience with the EPS in England is that implementation of eTP has been slow. The take-up of EPS Release 1 was not as widespread as hoped; only 31 % of pharmacy sites were “business live” in mid 2007 and a year later, when the UK government wanted pharmacy contractors to move on to Release 2, many had not even begun to use Release 1. There were a number of factors behind the delay in eTP adoption . Firstly, there was little engagement with community pharmacists in the early stages of the project. While the business processes of EPS replicated existing pharmacy processes, they did not speci fi cally support improved processes or new pharmacy roles , which were envisaged by pharmacy policy at the time.
Consequently, pharmacists were reluctant to engage with EPS as they felt that the system was being imposed on them by the Government, and were not convinced that the EPS has been designed to serve their best interests. Secondly, the medical profession was initially reluctant to embrace EPS, even though they had the soft- ware capability and have been given funding to do so. The reluctance of GPs to move forward with the EPS was undoubtedly because some doctors felt threatened by pharmacists taking on new roles and encroaching on their territory.
Thirdly, there were issues with the coordination of stakeholders in eTP. In some areas, pharmacies were “technically live” with eTP functions on their pharmacy software, but medical practices are not ready, or willing, to move ahead with EPS.
In other areas, GPs had adopted EPS software and are issuing bar-coded prescrip- tions, but pharmacies were not engaged with the EPS. In a few areas, both surgeries and pharmacies had the technology to run the EPS, but the local PCT was not ready to implement EPS in their area.
Prescribing Management Software
The growth of the primary care trust (PCT) network as payors in the UK, the avail- ability of networked GP systems , managed by the PCTs, and the development of new web-enabled database platforms have made regionalized management of pre- scribing data a possibility. In the US, large healthcare providers such as Veteran Affairs (VA) and Kaiser Permanente have in-house proprietary systems to collect data on prescribing activity and drug use. However, in non-insurance based health economies, collection of prescribing data from a range of individual providers can be problematic, without standard data sets.
In the UK, where GP systems are managed by PCTs, there are systems for extracting and aggregating prescribing data. Data to support the Quality and Outcomes Framework (QoF) is extracted from GP systems to the Quality Management and Analysis System (QMAS) by the NHS Information Centre. There are also prescribing management systems which are interruptive to the prescribing process, and provide decision support to clinicians on choice of medicine, in rela- tion to the local formulary . In the UK, Scriptswitch is used by 138 PCTs to provide prescribing decision support to GPs. Where implemented, the system provides sub- stitution recommendations, based on agreed local NHS guidance. The system also
provides dose optimization information and patient safety actually warnings.
Scriptswitch also has reporting tools to monitor the number of switches that actually take place.
Furthermore, the development of web-based database platforms has enabled the development of commissioning information systems to enable commissioners to monitor activity, performance and payment of provider organizations. These look at total tariff service provision, not just drug use, and so provide a picture of the total expenditure relating to a therapeutic intervention.
Sollis provides a solution, Clarity PBC, which covers:
• Budget management – actual against budgeted, forecast outrun, variance analy- sis, performance alerts, high cost patient alerts
• Activity analysis – elective activity, non-elective activity, A&E attendances, con- sultant to consultant referrals
• Invoice validation – to match recorded activity against invoice claim
• Benchmarking – comparison of individual practices against regional or national average(s).
Sandhill Systems has produced Dune, a “cloud” solution for commissioning information, which can display information through any browser enabled device, and so does not require a speci fi c software installation.
Conclusion
GP computer systems have been in use for many years to help primary care clini- cians manage their practices. Prescribing and the management of medication-related patient information are key functions of these systems, and pharmacists should be aware of how they operate. A number of countries are looking at the possibility of the electronic transfer of prescriptions (eTP) in primary care, which offers bene fi ts of secure prescription transmission, improved patient safety due to reduction of tran- scription and dispensing errors, and work fl ow ef fi ciencies for both prescribers and pharmacies. However, it is important that eTP systems are designed to enable com- munity pharmacists to take their place as a valued member of the primary care team.
With the advent of sophisticated web-based systems and cloud computing, there are now systems with the capability of managing medicines use and claims data across organizations, in order to support the medicines commissioning process.
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Introduction
The development of pharmacy systems to support working processes in both hospi- tal and community pharmacy has taken place over the last 40 years in the UK, US and other countries. For the purposes of this chapter, pharmacy systems are de fi ned as computer systems designed speci fi cally for pharmacy departmental use, with functionality for the management of pharmacy and dispensing processes, such as medicine labelling , patient medication records , decision support for drug interac- tions and other warnings, stock control , ward inventory management, order process- ing and functions to support pharmacy manufacturing processes in hospitals.
Pharmacy systems are often referred to as pharmacy information systems in health- care provider organisations in the United States, or as patient medication record (PMR) systems in UK community/retail pharmacy.