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Implementing a Network E-prescribing Solution Chair: Jeff Koundakjian Former Lead Pharmacist

Implementing a Network E-prescribing Solution Chair: Jeff Koundakjian Former Lead Pharmacist North Wales Cancer Centre. Electronic Prescribing – a Network Approach. BOPA symposium October 2008. David Barber – BOPA 2008.

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Implementing a Network E-prescribing Solution Chair: Jeff Koundakjian Former Lead Pharmacist

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  1. Implementing a Network E-prescribing Solution Chair: Jeff Koundakjian Former Lead Pharmacist North Wales Cancer Centre

  2. Electronic Prescribing – a Network Approach BOPA symposium October 2008 David Barber – BOPA 2008 These slides are intended to provide additional material to illustrate the points made in the presentation and should not be used out of context

  3. Introduction The network Background Business case and procurement Implementation Benefits and drawbacks The future LSCCN ePrescribing Project

  4. The Network LSCCN ePrescribing Project

  5. LSCCN ePrescribing Project

  6. Lancashire & South Cumbria Cancer Network 1.5m population 4 Trusts 6 chemo units 20,000 chemo attendances Cancer centre at LTH Haematology at BVH “Decentralised” LSCCN ePrescribing Project

  7. Background June 2006 – DH and CAT announced capital funding for interim EP system for oncology National solution to be implemented when available (about 4 years) Business cases from Trust or network to be completed by September 2006 Preferred supplier to be named by March 2007 LSCCN ePrescribing Project

  8. Electronic Prescribing Solution LSCCN ePrescribing Project

  9. LSCCN ePrescribing Project

  10. Interim Solution LSCCN ePrescribing Project

  11. Features of an Interim Solution • No interfaces • Time consuming • Politically sensitive • Complex • Expensive • Unreliable • Simple • Less validation • More freedom • Minimise “culture shock” LSCCN ePrescribing Project

  12. Initial Working Group Network pharmacist Lead service improvement facilitator Network manager Head of D&T Lead clinician LSCCN ePrescribing Project

  13. Business Case - Benefits • Why do we need it? • Safer prescribing • Network wide reporting • Scheduling LSCCN ePrescribing Project

  14. Safer Prescribing • About 5-10 serious prescribing errors per month at Cancer Centre • About 1 case maladministration per year • Errors: • Dose alterations not continued • Miscalculations • Transcription errors • Wrong dose • Illegible prescriptions LSCCN ePrescribing Project

  15. Network Wide Reporting LSCCN is a decentralised network – treatments available at all sites LSCCN consistently performs badly on audit of NICE drug use performed by CAT Planning new developments Capacity and demand D&T Audit LSCCN ePrescribing Project

  16. Scheduling 5 sites using paper scheduling Cancer centre using MS Outlook Maximise capacity LSCCN ePrescribing Project

  17. Business Case – Costs • Identify costs • Capital • Software • Hardware • Setup • Revenue • Maintenance • Support • Capital charges LSCCN ePrescribing Project

  18. Costs – Capital • Software • Initial purchase • User licenses • Hardware • Server • PCs • Other e.g. printers, network points • Setup • IT • Training • Configuration e.g. regimens, documentation • Validation LSCCN ePrescribing Project

  19. Costs - revenue • Maintenance • Server • Other equipment • System admin • New regimens • New users • Support • IT • Supplier • Capital charges • Depreciation • Interest LSCCN ePrescribing Project

  20. Business Case • Who do we need? • Oncologists • Finance • Pharmacy • Nursing • IT LSCCN ePrescribing Project

  21. Oncologists Access to patients’ prescriptions from anywhere in network Prescribe using PC not chart Up to date prescription info Calculations Quicker(?) LSCCN ePrescribing Project

  22. Pharmacy Reduce prescription errors Reduce paper chasing LSCCN ePrescribing Project

  23. Nursing Accurate prescribing Reduce paper chasing Nursing documentation(?) LSCCN ePrescribing Project

  24. IT Income stream Interim solution Where is CfH? LSCCN ePrescribing Project

  25. Finance All the above LSCCN ePrescribing Project

  26. Working group • Expanded to include • Haematologist • More pharmacists (oncology and chief) • IT staff from Morecambe Bay LSCCN ePrescribing Project

  27. Technical Architecture LSCCN ePrescribing Project

  28. Outcome of LSCCN Bid – October 2006 • Successful (ish) • LSCCN awarded ~£500k for purchase of ePrescribing software • MBHT agreed to host • MBHT procurement to assist in tender LSCCN ePrescribing Project

  29. Tendering Process Operational requirements (Aug-Dec 2006) Advert in OJEU (Dec 06) 20 expressions of interest (Jan 07) Site visits by applicants (Feb 07) 5 responses Site visits to Norwich and UCLH (March 07) Supplier presentations (March 07) 2 bids Preferred supplier selected (26th March 2007) LSCCN ePrescribing Project

  30. US based company Manufacturers of XRT equipment Expanding European base LSCCN ePrescribing Project

  31. Implementation May- August 2007 Establish implementation plan Hardware installation (MBHI) Database initiation (Canada) Software installation Establish local steering groups Mapping exercise LSCCN ePrescribing Project

  32. Regimen Building • WebEx training • Internet portal • Regimen building • 2 pharmacists • 4 months • ~300 regimens LSCCN ePrescribing Project

  33. Training LSCCN ePrescribing Project

  34. Training • Super-user training • 4 sites • 3 days at each site • Nurses, pharmacists, IT, reception/admin staff • Cascade training LSCCN ePrescribing Project

  35. Administration • Information governance • Contingency plans • Error reporting • Change management • System admin • Communication plans • Legal issues • SOPs • Validation • Regimens • Processes • Reports LSCCN ePrescribing Project

  36. Roll-out (October-December 2007) • Staggered go-live • New patients from go-live date • Minimum dataset • Name • NHS no. • DOB • Tumour type & stage • Allergy status • Scheduling • Nurse administration LSCCN ePrescribing Project

  37. Results (what we did right) Roll out completed on time and within budget (got VAT part-refunded) 1st fully networked cancer network in the UK (we think) All solid tumour chemotherapy prescriptions (and most IV haematology) electronic since February LSCCN ePrescribing Project

  38. Benefits Realisation – Safety • Fewer calculation errors • No transcription errors • Legible prescriptions • Wrong regimen • Need regimen for every eventuality e.g. IV/oral, cisplatin/carbo, infusor/pump, trial arms • Creatinine • Entered manually LSCCN ePrescribing Project

  39. Benefits Realisation – Scheduling Now possible Variable uptake Further training LSCCN ePrescribing Project

  40. Benefits Realisation - Reporting • Basic reporting possible • Network wide – good • Local unit – poor • Where does patient belong? • Report building • Complex • Expensive • Time consuming • Varian report builder now available LSCCN ePrescribing Project

  41. Results (where could we have done better) • Training • What do we need to know? • How do we set up an unknown system? • Further training organised • Data entry • Underestimated time to enter patients • Validation errors • Capecitabine minimum dose 1300mg • Caelyx regimen set to 3 weekly LSCCN ePrescribing Project

  42. Results (where could we have done better) • Prescribers “jumping the gun” • Paper prescriptions do not translate easily to electronic ones • Differences in rounding etc • Paper and electronic prescription in circulation • IT • Should have got fully engaged at all sites from outset LSCCN ePrescribing Project

  43. Teething Troubles • Access rights • “Why won’t it let me do my job?” • Number/position of PCs • Printing issues • General software faults (mostly minor) • Crashes • Network issues • Creatinine clearance calculator LSCCN ePrescribing Project

  44. Other Benefits (the bits we like) • No paper chasing • Access from anywhere in network • 1 log-in • Network consistency • Manage change • Antiemetics • Dose banding • Hydration • Reporting • Very flexible system • Stable program LSCCN ePrescribing Project

  45. Drawbacks (the bits we don’t like) • Printed prescriptions • Steep learning curve esp. Prescribing • No electronic clinical check • Lots of paper • 1 x A4 per cycle/day • Very passive system – difficult to keep track • No paper to scribble on! LSCCN ePrescribing Project

  46. Non-interfaced system • Duplicate patients • Rare • Manageable • Creatinine clearance for carboplatin • Be vigilant! LSCCN ePrescribing Project

  47. The Future Improve reporting & data quality C-PORT Notes Oral chemo Communication System upgrades CFH LSCCN ePrescribing Project

  48. Thanks for Listening Any questions ? LSCCN ePrescribing Project

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