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Bob SugdenCentre for Software
ReliabilityUniversity of [email protected]
Rob WilsonCentre for Social and Business Informatics
University of Newcastle [email protected]
The work described here was carried out by the authors together with a consortium led by the Sowerby Centre for Health Informatics at Newcastle, including the School of Pharmacy and Pharmaceutical Sciences (University of Manchester); the Industrial Statistics Research Unit
(University of Newcastle) and QinetiQ
ETP + ERDIP = ICRS?
Experience of the Evaluation of
ETP Pilots
Electronic Transmission of Prescriptions (ETP)
(aka National Prescription Service)
will be supported in Phase 2 (2006-8) of
the Integrated Care Record Service (ICRS)or NHS Care Records Service (NCRS)
(formerly known as the Electronic Health Record)
N.B. Use of electronic means to prepare and issue paper prescriptions is widespread in UK general practice
ETP - Terminology
ETP was piloted and evaluated in England in 2002
The Department of Health commissioned:
- three ETP pilots
- in three different health areas
- using three different business models
- privately financed by private consortia:
Flexiscript, Pharmacy2U, and TransScript
ETP – Context of Pilots
ETP - Stakeholders
Although there is a considerable body of literature on electronic prescribing, few refer to electronic transmission from GP to pharmacy, and none to transmission to a body such as the NHS Prescription Pricing Authority (PPA)
Studies from the USA and Denmark suggest that ETP confers benefits for GPs, pharmacists, and patients, making the whole dispensing process less time-consuming
ETP – Evaluation Literature
The evaluation was intended to:• explore the socio-technical context• assess the change management issues
inherent in introducing ETP to general practices, pharmacies and patients
• develop technical standards
The evaluation was planned as a formative exercise to run in tandem with the pilots…
ETP – Context of Evaluation
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
March 02 to Feb 03
Me
ss
ag
es
Pharmacy2U Flexiscript TransScript
ETP – Message Volumes
GPGP PharmacyPharmacyeT
oken
Patientor Carer
eToken
Paper
Paper
AB
W1 X1eTok
en
Patientor Carer
eToken
Paper
Paper
AB
W1 X1
Patientor Carer
eToken
Paper
Paper
AB
W1 X1
RxRelay?
EDI EDIW4 X4
Paper
PPA
EDI EDIC
Y
Z
PPA
EDI EDIC
Y
Z
TelephoneeCommuncation
W3
Paper pickup by pharmacyPaper pickup by pharmacy W2
Current
ETP
KEY
Current
ETP
KEY
ETP – Message Models
Acute
Update EPR
Signed by GP
Issued
Repeat
Check EPR
Update EPR
Rx Choice
Issued
Query Resolution
by GP
Signed by GP
Dispensed
Query Handlingby Admin.
GPprocess
Patientpresent
Patientabsent
Adminprocess
Pre-ETP - Current Prescribing Process
Acute
Update EPR
[Print]
Signed by GP
Issued
Repeat
Check EPR
Update EPR
[Print]
Rx Choice
Issued
Query Resolution
by GP
Signed by GP
Dispensed
Query Handlingby Admin.
GPprocess
Patientpresent
Patientabsent
Adminprocess
GPprocess
Post-ETP - Prescribing Process
1. Political imperative to implement (50% ETP target by 2005) –
DON’T PANIC! - be realistic about the difficulties, timescale and cost
2. Numerous stakeholder sensitivities –
be clear about the objectives and how they will satisfy the stakeholders
3. Structure, time, finance, and incentive to learn from evaluation -
be prepared to spend time & money learning from & rectifying mistakes
4. Technology can deliver –
but make sure the problem(s) are understood before building solution(s)
5. And finally - a fruity theory of system evaluation…
ETP - Evaluation Learning Points
Oh **** its all gone shaped!!
Evaluating a
…when you thought it was a
Pilots Always Bear Fruit
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