In this feature we go in depth to focus on Electronic Prescribing and Medicines Administration (EPMA) and speak with University Hospitals of Leicester NHS Trust and Nervecentre to explore the area further.
University Hospitals of Leicester is adopting Nervecentre’s Next Generation EPR, which includes a fully integrated, closed loop EPMA. The trust signed a 10-year strategic partnership with Nervecentre to deliver a next generation Electronic Patient Record (EPR) that harnesses mobile technology.
First, we asked Paul Volkaerts, CEO at Nervecentre a few questions to understand some of the challenges and considerations with EPMA projects:
Paul said: “EPMA systems are complex. There is an enormous amount of variation with drugs, and the modelling of this variation drives the complexity in order to provide the most granular clinical decision support possible. We are proud to have been able to deliver an EPMA solution that is both comprehensive and utilises innovative approaches to help to further improve safety and to make the system easier to use.
“To drive this innovation, we have been working closely with a multi-disciplinary team of nurses, doctors and pharmacists to ensure the system meets all of the objectives of the people that use the system. This helped us to fully understand the variations and the complexities. It is important to take a broad approach to partnering, to develop ideas with a wide variety of people.”
Could you tell me about your solution and important areas to consider?
“EPMA systems have been around for over 10 years, so mature systems already exist, and that provides the opportunity to understand what works well and what doesn’t. For instance, we were able to avoid the challenges of interoperability by ensuring dose information was natively FHIR compliant from the outset, and we were able to review many clinical incident reports to improve the safety of the UI, such as building the administration process around the “five rights of medicine administration”.
“The challenge of delivering a product into an existing market is that even the first version of our EPMA had to handle the most complex scenarios and medications, and we took a collaborative approach to achieve that.
“Medicine management is one of the highest risk areas of acute care, and the opportunity for digital systems to reduce that risk is significant, but systems need be able to support the most complex medications and protocols, and flex to individual patient needs. We were able to look at why, for instance, some hospitals with mature EPMA systems retained paper records for complex medicines such as insulins. We were able to ensure that results and vital signs, as well as clinical information known about a patient, were tightly integrated into the user experience so they could be used to deliver a full picture to a clinician, or provide hide alerts that were not relevant based upon a patient’s pathway or condition.
“We were also able to link medicine information through to our Live Flow operational dashboards, that give actionable insights to clinician’s mobiles, as well as to the command and control room. This allows for example, pharmacists to prioritise the review of a patient admitted with a high-risk medicine in their medication history, over the review of a patient with minimal medication history.
“Our partnership with Sherwood and Leicester is to take this development forward.
“We are well known for mobile, so naturally we’ve brought prescribing and administration of medicines to the patient bedside, where it is safest. We have built closed loop into the system from the start, so you can scan the patient’s wrist band and medicine barcodes, and even the witnessing clinician, using the mobile camera, right at the bedside.”
University Hospitals of Leicester targets digital hospital status
The trust said: “the EPR will power our strategy to become a HIMSS 7 certified digital hospital, which is also helped by the system meeting the NHSX standards including the dm+d drug dictionary and FHIR compliant messaging.
“As part of this partnership an EPMA project team led by Dr Tim Bourne, Chief Medical Information Officer and Graeme Hall, Chief Pharmacy Information Officer, are working closely with Nervecentre to help develop the new EPMA module. Since mid 2019 UHL doctors, nurses, pharmacists and IT experts have participated in development sessions and have now embarked on extensive technical and clinical functionality testing of the pilot version.
“With the EPMA mobile app also coming on stream the project team is gearing up for the live pilot on our renal wards at Leicester General Hospital in the autumn. This will be followed by a trust wide rollout, including the ITU, with further development work for ED and paediatrics.
“We are really excited about this new product as it will bring many benefits to patients and staff. EPMA becoming a component of our EPR will give efficiency and better clinical oversight of the whole patient record. A modern feel designed with clinician teams will bring new safety features including the ability to correctly identify patients and to allow bar code assisted medicines administration (BCMA) with scanning technology.
“BCMA will be further enhanced as the EPMA system enables the roll out of the OptiMed system, allowing fully closed loop medicines management and automated drug round trolley fill.
The trust summarised: “New process pathways will help improve the patient discharge experience, letters and medicines. Sophisticated real-time information displayed as smart lists and live flows will help with effective work prioritisation and management. With inbuilt alerting and notifications it will further drive down risk, and assisting enhanced compliance with national and local quality measures.”