HTN recently sat down with Anna Bunch, Clinical Informatics Pharmacist at University Hospital Southampton (UHS) NHS Foundation Trust, to discuss digital programmes, her secondment, the impact that COVID-19 has had on the world of health tech, and what the future might bring.
Can you tell me about your background?
My name is Anna Bunch, I am a pharmacist and I am currently in a seconded post – from being the digital medicines programme lead at Portsmouth Hospital University NHS Trust.
But my substantive post is at University Hospital Southampton NHS FT as Informatics and EPMA lead Pharmacist.
I’ve had 20 years of doing digital medicine-related projects and programmes, and I have come to Portsmouth to lead their implementation of digital medicines, which is their implementation of Electronic Prescribing and Medicines Administration (EPMA).
Can you take me through your digital programmes and your approach?
Portsmouth is one of the trusts in the region that hasn’t gone digital with their e-prescribing project yet. I led the project at UHS, so I’ve come here with my expertise to lead this programme.
We’ve also just recently started implementing a system in maternity, called BadgerNet. That’s a regional project and we’re going to look at how we can implement the medicines content of the EPMA system into BadgerNet. We are also doing a first of type interoperability project with the new EPMA system and PHU Critical care system allowing the transfer of prescriptions between the systems, so there are some interoperability bits that we need to do. I’m really keen on interoperability, it’s one of the key focuses of my role – there’s no point putting a system in on its own, it needs to interoperate with the other systems across the trust.
My approach is very much about my using my lessons learned from previous projects and ensuring that we have full engagement. I would say that [with] something like e-prescribing it’s all about ‘hearts and minds’, more than just the system itself. We need to get buy-in and that’s not just buy-in from senior leadership, which is very important, but also buy-in from end users – whatever level they might be.
Can you tell us about the stage you’re at now – what went well and what hasn’t, so far?
I would call it pre-implementation; we’re in our configuration of the system stage. We’re working on our training and e-learning packages, engagement with staff…we’re also looking at process mapping, identifying those areas that aren’t standard and aren’t so easy.
It’s not a standard ‘write a paper prescription’ – it’s how I do it, where I do it, where the patient might be in relation to it. Certainly, from my point of view, I understand UHS processes, but I wanted to confirm Portsmouth’s processes are the same and find their differences and their ways of doing things.
We’re one NHS service, hospitals do things slightly differently, so what will the impact be of that slightly different way that the service runs? That’s an important part of our focus now – just all that pre-planning, so that we are ready and informed and engaged. And [that we] engage with the staff [for who] we know it would not be a simple process change or transformation for them. Working through that transformation, a key thing for me is not to just assume – do not assume that just because it’s paper prescribing and we’re going to put it digitally it will just be as simple as that.
To work through those issues – that is how we will make it a successful project. What’s going really well, I would say, is the engagement; the fact that we’ve got buy-in from senior management. I think that has been really useful on the project so far, [as well as] the prioritisation of the IT team for this project.
What’s not going so well is sometimes it’s very difficult to get to people nowadays. In the past you would have meetings; face-to-face meetings all around the trust, all sorts of different specialities – you’ll get a cohort of people in a room and you can have a good, active discussion.
We are very much a Microsoft Teams-based organisation. And for me, sometimes I feel that, as it’s such a hearts and minds project, showing that enthusiasm and explaining things and detailing things through Teams is very hard. I do find that there is a personal touch that’s missing with this.
What successes have you had in the past year?
At UHS, we did some very innovative things. One example is with our digital portal for pharmacy for prioritisation, which allowed communication between staff who were working remotely. It’s proof that it wasn’t designed for that but it worked really well, and we were able to look at some little developments to ensure that our pharmacy teams could work together during COVID.
The other successful thing we did at UHS [was] we basically rolled out our outpatient e-prescribing in two weeks. We had a small clinic that had been running e-prescribing outpatients for the last five years, but we couldn’t quite get traction to move it further than that. When COVID hit and they were saying, “well we’ve got to do these things remotely, I can’t come in”, we suddenly gave them a solution and said, “use this, it’s here, it’s all ready for you.”
We delivered training remotely, we ported out printing within our outsourced outpatient pharmacy – there were no printing issues, they could issue it from the pharmacy.
They use the software Attend Anywhere, dial into the system and prescribe their prescription for the outpatient clinic. It would be sent to our outsourced pharmacy digitally, the outsourced pharmacy would then dispense that.
Within that order, we were doing delivery. At that stage, we said: “Do you want the delivery to be really urgent today, the next two days, or is it five days?”
The whole process worked well, allowing us to continue our care and our treatment for patients in a situation where they couldn’t come to us, and we couldn’t go to them.
Nationally, I think it shows that interoperability for hospital pharmacies to be able to send to a community pharmacy is really needed and I know nationally we’re trying to push that project forward. But we provided a workaround through that, so that was a nice successful project that was done by the team at Southampton.
Another project by the team at Southampton was we put in Omnicell cabinets. We just started to put them in at the beginning of COVID but we finished our project with the rollout of these cabinets into our admission unit.
Our admission unit was very complicated because we couldn’t go in it, it was an isolated hot area for COVID and so we had more difficulties. But we still implemented in that time, which was good and a nice success story for the team.
It shows that you can still do things even during a pandemic and digital enables those ways of working. It’s a really good time to be able to show that.
We’re working on now identifying inpatients for the vaccines – have they had their first dose? Do they need the second dose? And we’re using the digital systems we worked on within pharmacy.
Is there a project that has delivered above expectations?
The project for me that really exceeded expectations was outpatient prescribing. We would probably be doing about 20 prescriptions through our outpatients digital prescribing. When we launched it, we went to over 250 in a week. It doesn’t sound like massive numbers, but our numbers really reduced the number of outpatient clinics we were running.
I just was amazed – it went smoothly, everybody worked well on it, these solutions worked, we came up with some updates to it and it was not only the pharmacy that came up with that kind of idea, but the IT team delivering a solution very quickly. I had clinician teams taking it on and actually coming up to me to say, “how do I do it? What do I need to do?”, and taking it forward. We basically gave them a spreadsheet of how to do it and they did it.
These things can be delivered quickly, smoothly, and without too much of a hitch, with minimal prep training, planning and everything else. I think that stands out to me and a lot of trusts are looking at how to do it. It’s nice when you can give lessons learned to other people.
The big thing is sharing, I’m very much into sharing – don’t keep it to yourself.
What challenges have you faced this year?
I would say the challenges faced this year have been [related to] COVID – our change of remote working, our change in how we communicate with people, and I think that that has been a challenge throughout the NHS.
One of my challenges, on a personal note, is you would have a couple of meetings booked in for different rooms and suddenly it turned into Teams overload. My diary from 8am till 6pm is filled with Teams meetings. I was discussing with a colleague that you can’t even have a comfort break in between, I’m not even finding that I can have a lunch break. And if I’ve got a break, someone suddenly jumps on Teams and calls me.
What’s coming up over the next 12 months?
My next 12 months is the implementation of e-prescribing and moving interoperability within Portsmouth in their digital medicines agenda.
I’m looking forward to seeing – [after] I did it eight years ago at Southampton – how will it change, how is it accepted, how it moves forward, and how can we make it more successful.
I’m working on interoperability and working on the BadgerNet project, defining what we share with the maternity EPR, working on the solution that’s meant to be delivered between WellSky and GE. Transferring medicines data across all of that, and other projects that are coming out across the area networks are all exciting and positive and are moving the digital agenda on.
They’re very happy in pharmacy to be doing their digital agenda. They’re looking at E-Trade and I’m supporting them with their projects. They’ve got a regional hub for distribution, so they’re going to be doing electronic trading between different hospitals, which is new and is exciting, so we’re working on that journey.
I’m grateful that I’m part of it really, it’s nice to help and support and be part of that journey.
Is there anything that you’re passionate about that you would like to share?
Something that I’m keen on is the digital clinical safety setting within the medicines arena. I’m working with suppliers and trusts, to look at how we manage clinical safety within digital medicine. I’m doing this network-wide; I chair the regional WellSky user group, I network with colleagues in the area that are doing the same as me. That’s new within the pharmacy arena – we’re trying to advocate improvement in that space and increase understanding.