Starting his career in Melbourne, Australia at one of Melbourne’s major hospitals, Antonios quickly developed his clinical knowledge and experience. Antonios’ love for community side of care led him to Ireland, where he did a mix of community and Hospital care while starting to focus on mental health.
After pursuing a great opportunity in London at the Royal Marsden, Antonios continued to build on his specialisms until he decided to go back into Community where he would have more of a tangible impact on the wellbeing of patients.
Working mainly in medicines value, homecare and integration of different services, Antonios is looking at how he can bridge gaps and move towards digital. For the last two and a half years, Antonios has been working on ePMA projects. We were keen to understand his ePMA project, it’s challenges and it’s benefits for patients in Gloucestershire.
NHS England has set an ambitious target to be paperless by 2024, a major part of which is implementing electronic prescribing and medicines administration systems in hospitals. Although progress is being made, there remain challenges to overcome.
EPMA systems can vary widely, from simple electronic versions of the traditional paper drug chart to a fully integrated system that seamlessly connects with patient records and dispensing software.
“It’s taking that drug chart and putting it into a digital environment.”
While, on paper, e-prescribing is a laudable idea, bringing it into fruition is far from simple.
How far hospitals have come is difficult to measure because some have EPMA systems in certain clinical areas but not in others. Ann Slee, associate chief clinical information officer (medicines) at NHSX, says around 35% of acute trusts in England are now live with EPMA, meaning that 80% or more of their inpatient prescribing is done electronically. Many more are in the process of implementing systems and, with the pace of this accelerating, Slee expects 50% of acute trusts to have EPMA systems in place “before long”.
For Antonios, the benefits of digitising records are clear and obvious. From Improved patient safety through a reduction in medication errors to a reduction in the overall time taken to prescribe, check, supply and administer medicines – there are a number of important benefits to an EPMA programme.
For Antonios, one of the most important changes is the implementation of a process onto something that may have previously relied on the accuracy of the person writing it down on a piece of paper.
“The beauty of an EPMA system is that it’s allows you to promote best practice. So, because you have very defined way of navigating the system, it’s not just up to the person on the day that’s writing that prescription. You can then start to bridge differences in methods, habits of what people actually do, , and kind of start to push them into a more sort of appropriate direction.”
With new models of care emerging and evolving, there is a clear need for more effective information sharing between care settings, organisations and geographies, as well as between professionals and citizens, to optimise patient outcomes and quality of care.
This above paragraph is taken from NHS England and summarises their stance on the interoperability of new and emerging systems as a key consideration for now and the future. At the heart of Antonios’ EPMA programme is a harmony with other systems across different sites.
Previously at East Kent, Antonios knows what it’s like to work with disparaging systems.
With five different hospitals, three major ones and two smaller ones which all used to be separate trusts, all with their own ways of working, their own cultures and their own ways of prescribing, East Kent needed harmony which EPMA provided.
“You can keep a really good eye across what’s happening everywhere. It gives you a lot of data, a lot of information, so that you can start to actually see where hotspots are for certain things, how you can start to deal with any problems that arise in a much more proactive way, than you would with paper where you have to audit and go backwards in time to address things.”
Like with most digital transformation programmes, there are certain challenges that stand in the way of complete success. The complex nature of transformation through technology requires lots of resources and many different stakeholders, many of which won’t understand the solution as well as the programme lead might. Helping these stakeholders understand the changes and see the benefits is one of the most challenging aspects of a transformation programme like the one Antonios is involved in. .
“It is a new way of looking at something that might not have changed for a long time.”
A program like EPMA isn’t something someone can avoid, either. For a clinician, it’ll be all encompassing.
“That leads to those issues of how we bring people up to speed who are very good at their job, but now need to actually build this into their daily work-life. ”
At the end of the day, EPMA is a computer system and a computer system is only as good as the data being put into it. A key point for Antonios is how he continues to support those using the system through incorrect inputs that result in errors in a way that avoid frustration.
“Selection errors, typing the wrong thing and thinking you’ve typed the correct thing, you know, scrolling where you don’t mean to scroll, and then you change the unit of measure, and all those sorts of things where you think you’ve done the right thing. And then all of a sudden, you put that across and the person reading at the other end doesn’t trust it.”
Ensuring there is ample time for preparation to ensure the system is robust enough to handle errors and report on them is key while accepting that while significant risk will be reduced in some areas, risk will be introduced into other areas.
“Clinical decision support, which is an active cross-checking system for allergens and other potential prescribing problems, can have significantly reduced risk. But it’s a balancing act. As long as you have a process of identifying and eliminating those areas or trying to minimise those areas, then you can find your way through.”
