09.04.11
The Electronic Prescription Service
Release 1 of the Electronic Prescription Service is now technically enabled in around 80 percent of GP practices and pharmacies. The evolution from paper to electronic prescriptions continues with Release 2 which will enable real, tangible benefits to be realised, says Alex Trewhitt
When you look at most modern day processes and transactions, very few are still totally reliant on paper. Remember the first time you used an e-ticket when flying abroad? While many of us probably felt slightly apprehensive about travelling to the airport without a ticket securely zipped away in our pockets, after you’ve done it once I guess it just becomes the norm.
Most people probably haven’t even thought about how such technology could be applied to the prescription process which, theoretically, dates back to the very beginnings of the NHS. Perhaps this is because few comprehend the huge volume of paper prescriptions that are administered each working day in England – which currently equates to around 1.5 million.
The scale of introducing an electronic prescription service is significant. Connecting over 8,000 GP practices and 10,000 community pharmacies to enable such volumes of prescriptions to flow securely between a variety of different clinical systems poses not only a huge technological challenge, but also a logistical one.
Due to the complexities of introducing a system of this scale, a decision was made early on to split implementation over two ‘releases’ of software. Clearly the most important consideration when introducing any system of this type is to maintain patient choice and safety throughout the implementation process. Adopting this approach enabled us to uphold this by separating out the majority of technical upgrades from those affecting day-to-day business processes and, more importantly, patients.
Release 1, therefore, is primarily concerned with implementing the technical infrastructure required to support an electronic service. This involves suppliers of GP and pharmacy systems developing their systems to comply with a series of clinical and safety standards set by NHS Connecting for Health. Once a system is awarded EPS accreditation, the supplier is permitted to deploy the system to its customers. In addition to having an accredited system in place, users must also have an N3 connection (most suppliers offer an integrated system/connectivity package) and possess a registered smartcard and unique six figure passcode in order to operate EPS Release 1.
The only real business change associated with Release 1 relates to data entry. When a prescription is generated using a Release 1 GP system, a unique barcode is printed on the prescription form which corresponds with an electronic prescription message that is sent to the EPS (through the N3 connection). When a patient takes this prescription to a Release 1 enabled pharmacy, the barcode is scanned to retrieve the prescription details from the EPS. This alleviates the need for the prescription details to be re-keyed manually as they were previously. In some instances this can save time, but more significantly, it contributes to a reduction in transcription errors that account for a large percentage of patients admitted to hospital as a result of an adverse drug reaction.
The critical factor in Release 1 is that the paper prescription is still signed by the GP and can therefore be used to dispense medication if taken to a non-EPS enabled pharmacy. This upholds the commitment of maintaining patient choice as it doesn’t limit the patient to only using EPS-enabled pharmacies. The fact that electronic prescription messages are in essence flowing in parallel with paper prescriptions means there is always a back-up in place if something goes wrong – which again is critical when implementing a system of this size and nature.
Getting to a fully electronic service
With Release 1 now technically enabled in around 80 percent of GP practices and pharmacies, we are now on the brink of moving to Release 2. Once introduced, Release 2 will enable real, tangible benefits to be realised.
In terms of technical functionality, the real cornerstone of EPS Release 2 (which underpins the transmission of electronic prescriptions without the need for a signed paper prescription) is the introduction of ‘advanced electronic signatures’. This enables GPs and other prescribers to apply an electronic signature to the prescription message, making the need for a signed paper equivalent redundant.
One of the buzz words you may have come across in relation to Release 2 is ‘nomination’. This new concept, when coupled with advanced electronic signatures, is what will enable the prescribing process in most circumstances to become totally paperless. It basically means that patients have the option to choose, or ‘nominate’ a pharmacy (and other dispensing contractors) to receive their electronic prescriptions automatically. This means that when a nomination is recorded on a patients’ record, the electronic prescription is channelled directly to that pharmacy via the EPS.
In terms of patient benefit, this will result in a more convenient process as a trip to the GP practice just to collect a prescription form will no longer be required. The extent of this benefit will obviously depend on individual circumstances as some patients may already use a prescription collection service. Nomination works in a very similar way but without the geographic limitation of the proximity between GP practice and pharmacy. Essentially, patients can nominate a pharmacy that is convenient to them – not one that is located near their GP practice.
If a patient doesn’t wish to nominate, they will continue to be issued with a paper prescription. In the initial stages of Release 2, this will continue to be a signed paper prescription as only nominated prescriptions will be signed electronically. In the longer term, once the majority of pharmacies are Release 2 enabled, prescriptions not marked as nominated will also be signed electronically. In this scenario, the patient will be issued with a ‘prescription token’ which is simply a paper copy of the prescriptions details (and is not signed by the GP). This will be printed with a barcode to enable a pharmacy to retrieve the electronic prescription onto their system.
Release 2 will bring many benefits for both clinical and administrative staff working in GP practices and pharmacies. Repeat dispensing will no longer require a number of paper batch issues to be printed and prescribers will be able to cancel electronic prescriptions, ensuring that an element of control can be maintained over repeat dispensing regimes.
Pharmacies will benefit from being able to electronically submit endorsements for electronic prescriptions dispensed which will result in a less burdensome reimbursement process. Also, because nominated electronic prescriptions may be received in advance of the patient arriving, Release 2 will provide the scope for them to streamline workflow and manage stock control more effectively.
Moving forward
Getting to this stage has involved extensive consultation and discussion with GPs, pharmacists, patients and other stakeholders. As the programme moves forward we will undoubtedly face new challenges, so ongoing consultation will be invaluable to overcoming them. From day one we have been committed to delivering a service that is robust, fit for purpose and helps end users undertake their day-to-day operations. This will continue to be the case as we draw closer to the realisation of EPS Release 2.
More information about the EPS is available at www.connectingforhealth.nhs.uk/eps. Specific queries can be emailed to [email protected]
Alex Trewhitt is from the Electronic Prescription Service, NHS Connecting for Health
Tell us what you think – have your say below, or email us directly at [email protected]