epharmacy Programme Table Feedback Irish ehealth Ecosystem Meeting 29/06/2015

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1 epharmacy Programme Table Irish ehealth Ecosystem Meeting 29/06/2015 Compiled By Tom Bannon Office of Chief Information Officer Mob:

2 Following a series of awareness raising initiatives, starting at ehealth Week in 2013 and culminating at the HISI Annual Conference in November 2015, the Health Service Executive (HSE) appointed the Health Informatics Society of Ireland (HISI) and the European Connected Health Alliance (ECHAlliance) to facilitate the ehealth Ireland Ecosystem. A very useful & Informative discussion around scope & delivery of the ehealth Ireland epharmacy Programme took place at the at the Irish ehealth Ecosystem meeting in Dublin 29th June 2015 and the following represents the feedback received on the day.

3 The following feedback was received from the table discussions by participants at the meeting. There are a number of recurring themes but a clear need to further develop and clearly define the scope definition and potential programme content 1 National Drug File Doctors prescribe drugs but pharmacists dispense products and patients consume products the difficulty is marrying these concepts together Ireland needs to identify the database for users of drug products GP s, pharmacists etc. Huge social and economic cost associated with lack of interoperability Standards need to be established, use of SNOMED etc. National drug file needs to be adapted locally and configured helps with interoperability with systems across the economy Database can be tailored for individual needs Needs to be centrally managed and maintained, UK is an example HIQA needs to be brought on board All stakeholders should be involved in management and maintenance of a drug file

4 2 Electronic Prescriptions In Primary Care Standards exist and are established to some degree Work has been done in the area and there are pilots already Should be using standard barcodes where they are required Look at benefits for GP s o Need more information o Opportunity to provide feedback loop Steps to deliver the process o Client index would be very useful using national identifier o Legislative changes req to support the electronic prescription o Need GP and pharmacy index in place o Should do a pilot now Think about managing the whole area of repeat prescriptions Is there a tool to help with adherence and compliance Eliminate paper in the future Potential contribution for the SMD Steering Group needed System should be pull rather than push i.e patient decides which pharmacy to use?

5 3 Hospital Group Closed Loop Pharmacy What is e-pharmacy, does this include e-prescribing clarification needed EHR needed before moving to e-prescribing National identifier required Standardisation with implementing the national drug file Governance, management, maintenance, documenting workloads Learn from best practice Transfer of information moving between primary and secondary care How is data moved between existing systems, what format is it in Innovation Compliance of software or medical device Can re- imbursement models drive the capture of information by the patient Opportunities for app development at patient care level 4 Patient Portal Pharmacists, practitioners, hospitals, nursing homes, patients and carers will all contribute to portal Control o What is prescribed o What is fulfilled o What information is given from the discharge system back to the primary care centre Should be a national housing portal, with unique patient identifier number prescription can be tracked Critical info can be given to carers like side effects, dosage etc - simplify this info on the portal How will patients access the portal pin code system, allergy info should not require pin code

6 5 Paediatrics Digital Pharmacy Record It shouldn t entirely be led by the children s hospital, but a paediatric level of care pharmacy record is not meant to be a standalone record Needs strong sponsor which will be critical to its success, ideally strong credible paediatrician with experience Standards should be merged with a flexible structure that is agile Cross-border is a dynamic which should be considered o Discrepancies need to be bridged o Use clinical terminology as a baseline, for sync, integration Re-use is key o Adopt as much as possible o Maintenance is considered given time constraint s by 2020 o Clinical, info and technology standards Need for strong communication in education with stakeholders Information governance needs to be addressed for crossborder

7 6 Tools For Better Pharmacy Management Access to Data is best tool o GP systems o Patient information systems Available data set across primary, secondary etc. one data set that everybody can use Sharing of data optimizes care Dashboard (portal) that a GP or community pharmacist can tap in to o This can empower the patient with mobile devices Summary of care records Timely access to data Remove paper from the process as much as possible o automating where possible o Reduces workflow o Speeds up transit time Error prevention standardisation Direct communication decreases workload Pro-active patient notifications - mobile Patient information leaflets how does this feed into the patient portal

8 7 Prescribing Record As Part of Discharge Process Discharge is part of an overall process that changes as healthcare evolves o Recording data collect quality data once and use many times to avoid info gaps Patient empowerment drugs, info o Patient is vulnerable post discharge they receive new or existing drugs Support healthcare professionals mismatch of drug lists Secondary use evaluation, analytics Regulation & best practices, pharmacy, info, clinical Barriers o Disconnected processes o lack of incentives o who s role is it to record data and who can record this electronically in primary and secondary care o digital divide o unavailability of drugs Solution o Records available through digital means o Look at existing systems o Patient portal o Patient ownership o Integrated with rest of care and research processes

9 8 Prescribing analytics More analytics required - particularly hospitals Lots of data, little information o Legacy nurse prescribing records that could be analysed exist. o Begs the question - what other data do we have available? o It s not just about drugs-it should cover anything that can be ordered-incontinence pads o Drug utilisation review Stakeholder involvement: o Entire ecosystem needs to be included - public, private - reduce fragmentation o Needs assessment Who are the stakeholders and why do their needs vary What are their needs Target most utilised meds and ones applicable to most at risk groups re: adherence o Best practice elsewhere (epsos) so it can applied to needs assessment Adherence o Safety component o Safety analytics How is it tied into the electronic patient journey Can they be used to identify root causes and improve process o Use analysis - are they actually using it prescribed products and data! Understanding trends and outcomes - are practices prescribing appropriately Google - flu epidemic Patients like me - FDA. ( Patient Registries as triangulation - ( ) Simple to complex model - learn from what we have available and work out Access to PCRS data

10 8 Prescribing analytics (continued ) Process and people o How will we make the right people aware of whatever solution emerges - user buy-in Patients o Central to solution o How can prescription analytics be utilised to improve patient understanding. Could analytics be utilised to support understanding and improve adherence? o Literature tells us that - many patients don t know what they re taking. o Patient portal - we have groups in the room who have developed excellent communication platforms. o What are patients taking that isn t being recorded? o Patient level analytics is key! o How to educate to change behaviour? Collaboration o Gap between practical (prescribers) and theoretical (pharmacists) re: drug interaction knowledge Semantics and standards o Data model as a common standard - using information standards o 2-level model information system such as open EHR enables common dataset that can be tailored for local requirements. Informing policy development o Better financial decisions from better analytics System must incorporate multiple prescribers o How these players interact - e.g. what happens when a consultant prescribes and a GP notes a problem with it/needs to discontinue. Data capture o Needs contextual awareness - clinical data is different to what is required for reimbursement - avoid gaming o Needs to be easy to generate, find, query, use - and should occur in real time Information transfer - has to be both ways

11 9 Better Care Through Improved Pharmacy E-prescribing will lead to improved accuracy, safety, compliance and decrease cost EHR needs to be in place beforehand E-prescribing can be implemented and tied in with EHR It is part of the IMF/Troika instruction Standardisation should be done from the start Pre-developed is better in the longer term Lots of good prescribing systems already available There are well established systems in the UK and internationally Ireland should adopt with instruction from NSAI e-prescribing should be an opportunity to overhaul the prescribing process A patient portal should be made available Relatives should have access to info Allow a new form of communication between pharmacist and doctor will allow revision of relationship between the two Opportunity to review revenue model. 10 Other Other Initiative(s) Yet To Be Defined

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