Robert Tysall-Blay, CEO of CareFlow Medicines Management and Jonathan Bloor, Medical Director at System C & Graphnet Care Alliance, closed the first day of HTN Now September 2021 with a live discussion about the current challenges in medicines management.
Covering both acute and community settings, and Integrated Care Systems (ICS), this was a wide-ranging webcast in which the speakers discussed the Care Alliance, shared their views on medicines management in the UK healthcare system, and turned the tables on each other with a Q&A session.
Providing some context for the content, Jonathan began by explaining the Care Alliance. “It is an alliance of four British companies – System C, Graphnet, Liquidlogic, and the latest addition, CareFlow Medicines Management, which was formerly WellSky. We’ve got over 900 people across the Alliance now and most of those have either worked in the NHS or social care, and we actually have over 350,000 users of our software,” he said.
Interesting stats shared included:
- Around 30 acute trusts are either running or deploying the Care Alliance’s PAS/EPR using CareFlow, while 38 use the CareFlow Vitals early warning, and clinical communication functionality
- 60 per cent of all councils in the country use Liquidlogic social care solutions
- 20 million people have a shared care record using CareCentric
- 6 million citizens are covered by the Alliance Population Health Analytics platform
- The Care Alliance is also the provider of a national immunisation service for both flu and COVID-19.
Regarding the topic in question, medicines management, the Care Alliance’s Hospital Rx/ EPMA is deployed across 350 hospitals, both here in the UK and elsewhere, delivering 2.4 million prescriptions and 11 million administrations per week.
Rob took over the presentation, explaining: “We’re really excited about the acquisition and joining the Care Alliance. As Jonathan has outlined, when you look at the reach that System C and Graphnet and Liquidlogic have, it’s clear that they are covering all areas of the health and social care sector. We’re delighted to be able to fit in as part of that and to support that expansion of the ability to provide medicines management.”
Jonathan then turned interviewer and, with his journalist’s hat on, asked Rob what he thought the key challenges are in medicines management at the moment.
“This is a really leading and open question,” answered Rob, “I think it’s difficult to pin it down to two or three items because the challenges across the whole of the health and care sector for medicines are numerous. It reflects the fact that this area has been evolving and maturing in the world of digital medicines management over the last decade or so, and we’re still a way off finalising all of that work, to get to a mature digital medicines management situation within healthcare.”
“To summarise it I’d say that, really, we’ve got several challenges mostly related, at the moment, to fragmentation of data and limitations across the healthcare sector in terms of incomplete records of data related to medicines.”
Breaking the challenges down, Rob homed in on medical information: “For example, incomplete or unavailable patient medication information histories. If you look across, not just the acute sector within hospitals, but also other areas of mental health, community, primary care…you’ll see that there are many areas where there are still paper-based systems in place for the management of medicines. Work is ongoing to digitise those areas – and has been for some years – but we’re not completely there yet.
“Also, in other parts of the system, you’ll find specialist areas of care where care records are held in silos…some of the areas around chemotherapy, for example, tend to be fairly silo-ed, then you’ll find other areas in the community and care homes where information is limited or unavailable. In some cases, interoperability – which is, of course, the glue, the method in which we try to join-up healthcare across all of these areas and provide those more comprehensive histories – is, indeed, still a work in progress in many areas.”
“We’re finding that fragmentation and the limiting of records is getting in the way of care being as safe, and fast as it could be, as well as general efficiencies within the system,” he added.
The “care transition” was also noted as an issue. “Often a patient being admitted to hospital comes in with records or a GP record, which has to be manually entered into the systems – it’s not automated, in some cases it’s incomplete, and so admitting doctors have limited information and have quite a torturous route to find a full history,” Rob explained.
Jonathan then shared his first-hand experience, adding: “I vividly remember being a junior doctor, asking patients for their homemade list, their prescriptions, phoning GP having relatives at home trying to get hold of key medicines record information, and then often having to make key decisions… I don’t think we’ve yet solved that. I think, in lots of places, it’s still the same situation for those junior doctors.”
Rob also discussed challenges in internal transitions of care, how the development of ICSs can help with producing regional and national care records, and tackling healthcare inequalities.
On the latter, he said: “Effectively, from a recent study, in one region of the UK originally, it showed that up to 12 per cent of readmissions into hospital were medication related, and that two thirds of those were preventable. They were preventable because they related to healthcare inequalities, particularly around compliance. In certain sectors – for example – the elderly perhaps can’t comprehend if self-administering, or they get forgetful about their medications… and similarly so can those in certain mental health areas….and not forgetting there are sectors of the population where English is not their primary language.
“The quality of care and their outcomes, and the resultant over ordering of drugs, becomes a significant issue and can result in harm and readmission to hospital.”
On data, Rob highlighted the “lack of actionable data”. He said: “We have a number of statistics that show more than £300 million per annum is wasted, due to many of the issues we described. But the lack of actionable data across the whole of the health system is limiting and preventing the tackling of some of those issues. With the lack of access to a comprehensive medication record – and the history – it does limit us on our ability to deliver on other important initiatives…such as the ability to collate all that data to do effective medicines optimisation and other things like the structured medications reviews, which are required by GPs and other teams.”
Jonathan and Rob then delved into further discussions around the topic, including how the ‘What Good Looks Like’ framework aligns with the challenges facing medicines management in areas such as the use of EPMA to reduce errors, expansion of clinical decision support, and the adoption of Shared Care Records.
“We’re really interested in all of this, and we have the capability with the Care Alliance to not just help to ‘level up’ and improve clinical capability and functionality within the acute sectors and mental health, but also more increasingly in the community and across the ICS patch,” said Rob.
He then summarised the Care Alliance’s vision of a solution for these challenges, adding: “To integrate with a Shared Care Record at the ICS-level, to provide that single source of the truth, which is often talked about, to provide that huge platform for data analytics, and most importantly, to capture as much data from all the different care settings to make it as complete of a record as possible. This is nirvana, you may say, yes it’s true – but that’s the passion that drives us, in terms of trying to get to that point of providing that really comprehensive level of medicines management and data.”
Adding his final thoughts, before answering audience questions, Jonathan concluded: “For me, the structural changes that are happening in the NHS at the moment, such as the establishment of Integrated Care Systems, are about delivering a proactive health system, tackling health inequalities, tackling unwarranted variation, integrating health and social care, and really delivering value-based healthcare.
“I think we have to acknowledge that the NHS and social care are still dealing with a pandemic that’s far from over and what’s been achieved, particularly in digital transformation, has been a herculean effort by those staff who’ve had to deal with an unprecedented pandemic. Obviously, all these changes come on top of that, so I think we have to be cognisant of that.”
Watch the full session via the link below: