King's showcases e-prescribing roll-out

Tags: A E-Prescribing iCM iSoft King's London UK

28 Jan 2010

King’s College Hospital NHS Foundation Trust has started rolling out its iSoft e-prescribing system trust-wide.

The system enables prescribers to order their patient’s medication electronically and view scheduled and administered medications on an electronic drug chart via the iSoft Clinical Manager electronic patient record system.

The trust is one of the first to use the functionality, which is also in use in Salford and was piloted at Epsom and St Helier.

Ben Fidler, senior clinical analyst at King’s, told E-Health Insider: “Orders are placed in the same way as a diagnostic test in the native functionality of iCM, so it has been fairly straightforward for staff to pick up.

“It also helps to steer users towards the most common routes and standard doses, which not only makes selecting the correct dose easier but is one of the ways to reduce errors.”

The electronic prescribing and medicines management project team began rolling out the system in November 2008 in a general medical ward.

Fidler added: “The ward was a 30-bed high turnover ward, which we purposely chose because it was particularly difficult.

"We then spent six months piloting the system and tweaking the application before it went live in May 2009 on a low turnover, elderly care ward.”

In September 2009, the trust doubled the size of the EPMA team to eight and has now started rolling out two wards per month.

Fidler added: “This year we have decided to really pick up the pace. We intend to have 40 wards rolled-out by the end of the year.”

The trust is also the first in the UK to implement portable refrigerated drug trolleys from RDP, which have a computer fixed on top.

Dr Jack Barker, clinical lead for IM&T at the trust, said: “We want it to go all the way from A&E to discharge, but our problem at the moment is that A&E is treated as a different hospital. Everyone wants e-prescribing but it’s a painful road.”

E-prescribing was one of the many systems that the trust showcased at its annual IT open day last week.

The trust invited staff to see demonstrations of older systems, such as its PAS and EPR, and newly implemented systems, including an electronic whiteboard, self check-in kiosks and an e-rostering system.

Links: RDP

ISoft

King's College Hospital NHS Foundation Trust.

Opinion and Analysis: King's held its annual IT open day last week and Sarah Bruce was there. Read her feature in opinion and analysis.

Audio: Or listen to her interview with the trust's director of ICT, Colin Sweeney, recorded on the day.

Sarah Bruce

King's picks McKesson whiteboard system (13 Jul 2009)
King’s adds VitalPAC to EPR system (23 Jan 2009)

Readers Comments

Electronic Ordering - NOT ePrescribing

29 Jan 10 06:21

With respect - I know what has been done here and I have to congratulate Ben on the huge effort in achieving this. And believe me iCM is a hell of a lot of work if you want to use it to order drugs.

But to call it ePrescribing is an insult to those of us who have fought for real ePrescribing for years.

iCM does not support drug-drug interaction checking, does not support dose-range checking, does not support contra-indication checking, ASSUMES THE DOSE IS GIVEN, and is the most horrendous drug file configuration and build I've ever seen. A true nightmare to maintain.

iCM was designed for the ordering of tests and communication of the results - it was never (ever) designed with ePrescribing in mind.

The only benefit is a legible medicines order and the ability to influence good prescribing by use of predefined orders.

Sorry - but ePrescribing means more to me that what has been achieved here - but perhaps I've set the bar too high?

I think it's more likely that the political pressure to do something went something like this "...we already have iCM and iSOFT STILL do not have anything to offer and are unlikely to - so we will have to shoe-horn electronic ordering of drugs into what we have..."

Still - again - I do congratulate Ben on this huge effort.

e-Prescribing? No. e-PR? Yes.

29 Jan 10 12:08

To echo the comments above - only a huge effort from the implementation team has resulted in this system being rolled-out. Ben deserves the congratulations on a "sucessful" project.

However, to call this an e-Prescribing system is not only wrong and massively misleading, it is an insult to the team who put the system in! It is essentially an Electronic Patient Record with some default drug, dose and route information.

The alternative approach

29 Jan 10 12:53

Sit back, do nothing, blame the supplier. I guess this has the advantage requiring no effort.

Well done Kings, keep on delivering useful, patient centric functionality to your organisation.

Blame the Supplier

29 Jan 10 13:17

"Blame the Supplier" - in this case YES.

iSOFT has had plenty of ePrescribing SMEs on board over the years - and all of them have walked - iSOFTs treatment of its own and contract clinical professionals is to blame - simply ignoring the SMEs they've had on board isn't good enough.

In this case the blame for not developing ePrescribing DOES lay with iSOFT.

But I will echo congratulations to Ben and his team in getting this done.

Kings: Hoping to join the Elite.

ben.fidler@kch.nhs.uk

29 Jan 10 14:09

Ben Fidler:

NHS Connecting for Health’s formal definition of ePrescribing is as follows:

The utilisation of electronic systems to facilitate and enhance the communication of a prescription or medicine order, aiding the choice, administration and supply of a medicine through knowledge and decision support and providing a robust audit trail for the entire medicines use process (NHS Connecting for Health, 2007).

I admit we have not yet implemented ‘knowledge and decision support’ however we plan to add this functionality once available.

On a point of order – iCM does provide full dose administration recording functionality and does not simply assume the dose is given. We have seen the developments that have been made to iCM to make the prescribing and administration processes slicker and are impressed with the level of clinical decision support that is being made available in a future version.

I applaud those who have implemented an ePrescribing system with full knowledge and decision support and hope you would be willing to share this valuable experience with Kings. We aspire to join this elite group.

To our credit we have completely replaced the paper drug chart, insulin card, anticoagulation card, and fluid chart on 7 medical and are ready to deploy to the rest of the trust.

The team at Kings is providing a fantastic service to our wards and the system is becoming robustly embedded.

We are convinced that any e-prescribing & medicines administration system must form an integrated (not interfaced!), core component of any electronic patient record system and would say further that a separate prescribing system would not support either the clinicians or the patients at Kings.

Are we proud of our Electronic ‘Ordering and Administration’ of Medications (EOAM) system? Yes we are, however we do recognise that we have a lot more to do and will do so when the functionality is delivered.

Re: Blame the supplier

29 Jan 10 14:14

Whilst I do not and cannot disagree with your assessment of the culture at iSOFT regarding clinical SME's, the point I was making was that blaming the supplier is the easy option and gives Trusts a convenient excuse to make little or no progress.

Kings are proving that with a lot of effort, motivation and progressive thinking great things can still be achieved in-spite of any software limitations. It must also be said that Kings is not alone in this respect.

Damned if you do, damned if you don't

colinsweeney@yahoo.com

29 Jan 10 22:03

A lot of very interesting comments here. At least I am pleased with the congratulations that have been passed on to Ben and the team, who have worked extremely hard to get this to work.

And that is the important thing - it does work. It's not perfect by a long chalk but it provides a lot of benefit. Do not underestimate the benefits of legible drug charts, the fact that drug charts are accessible from wherever a clinican has access to a PC in the hospital (they don't get "lost") and there is a level of decision support - every patient has to have their allergies recorded now, penicillin reactions are highlighted and the formulary guides prescribers to record the correct dosages and route.

As the first commentator said i.CM is not an easy system to set this up in, which adds to the praise of the team, but it is the system that all our clinicians use for treating our patients and it makes sense to use it if it provides benefits for prescribing, which it does. Drug ordering can be included in order sets and the method of requesting is not new to people, as it resembles requesting a test - and actually does not need to be any different.

What is new is the recording of administration of drugs by nurses but they have taken to that relatively easily and in fact are the major advocates of the system.

Also because we are recording drug prescribing and administration electronically we actually have a record of what is happening to our patients, which we can audit and report on. This is not easily achieved from a paper drug chart.

Our expectation, from what we have seen from later releases of i.CM, is that a lot of the deficiencies of the system, including a number of items mentioned in point 1, if not fully addressed will be significantly reduced.

Our clinical director for ICT was one of the cynics about the benefit of the system when we first introduced it, but now sees lots of ways it could benefit patient care from A&E, in outpatients and from the clerking through to discharge. He is very excited by the possibilities

As response number 3 intimated our view is that it is better to do something and get benefits early than to contemplate your navel and hope for a nirvana that may never come. If we had taken this view we may never have implemented what became i.CM ten years ago and not had all the benefits that it has provided.

I'm sorry but there is no such thing as perfection.

As an example I would have used my NHS address for this comment but there seems to be an issue at the moment with the eHealth Insider website accepting it, so pragmatically have used my yahoo address instead.