This October, we are focusing on all things EPMA: electronic prescribing and medicines administration.
Our headline sponsor for the EPMA focus is InterSystems, a leading provider of data management solutions. We spoke with Gary Mooney, Clinical Solutions Executive, to find out more about InterSystems’ EPMA projects, and his thoughts on the challenges and future of EPMA.
To begin, Gary shared some information about his current role and background.
As a Clinical Solutions Executive I get to work across the full lifecycle of the business to support the various teams with pre-sales, procurement, deployment, and post go-live optimisation activities.
My primary focus is to help the organisation and customers to establish a clear vision for how the InterSystems solutions can be adopted, to help achieve service transformation for the delivery of benefits and outcomes for the service, staff, and patients.
In terms of how I got here; I started my career in academic medicine, having completed undergraduate and postgraduate degrees from schools of computer science, management and medicine. I then moved on to work for the Department of Health, managing a digital health team delivering policy initiatives for the Our Healthier Nation White Paper, and moved into the commercial sector after that.
For the last 20 years I have worked for clinical and EPR solution providers in various roles relating to operational delivery, product management, consulting, and sales. During this time, I have worked across the UK and international territories, and I’ve also developed deep experience in the medicines management domain.
EPMA projects at InterSystems
InterSystems has been awarded the Clinical Management System framework agreement by the Health Service Executive in the Republic of Ireland. We are currently deploying our TrakCare EPR solution at two locations in Ireland: National Rehabilitation Hospital; and the National Forensic Mental Health Service. Both projects include enterprise-wide deployments of the InterSystems EPMA solution (which is an integral element of the broader EPR platform).
As tertiary level services, both organisations have specialist medicines use cases and requirements to comply with regional regulatory, legal, and good practice standards.
Having performed an extensive discovery process with both customers, it was my role to lead this activity, we now have a collective vision and insight as to the key benefits the solution will provide both services and front-line clinical staff and how best to adopt our EPR platform.
EPMA learnings
The implementation of EPMA systems can be amongst some of the most challenging digital clinical deployments, due to the ever-increasing complexity of medicines, clinical profile of patients, and the inherent risk from medication errors that can proliferate across significant patient numbers over a small period of time.
Seeing the tangible and significant improvements that EPMA solutions deliver with patient safety, clinical outcomes, service efficiency, financial performance and patient experience makes the effort so worthwhile, however. There is nothing more rewarding than seeing frontline clinicians using the TrakCare EPMA solution as a seamless part of their clinical role to provide patients with safe, appropriate, and timely care.
Complexities in medicine management
There are the obvious complex medications – multi-ingredient infusions, non-linear dosing schedules, therapeutic dosing, sequenced regimens, and so on.
Each of these specific medication scenario needs careful analysis, preparation, validation and ultimately training, but I think the most challenging aspect is the environment into which EPMA solutions are delivered.
In the UK, especially, EPMA solutions are delivered into a highly pressured, under-resourced, clinically complex and changing healthcare environments. Communication can have a significant impact upon the efficacy of medication management systems, both paper and digital – it needs to be timely, precise, and unambiguous.
My advice would be to make sure you gain deep insight into how a customer’s organisation works. Why does it work that way? What works well? Where are the opportunities for improvements? You need to gain deep insights as to the staff roles who will be using the solution, considering their concerns, expectations, and the key benefits to them.
With this insight, the required configuration of the solution and the optimal approach for solution adoption become much clearer. Making too many assumptions at this stage can lead to unexpected problems during an implementation which can be detrimental to the momentum of the change management programme.
Design Thinking is a methodology that really resonates with me. A cornerstone of Design Thinking is empathy, and for me this is the foundation on which an effective EPMA solution should be deployed, with full awareness of how the solution will benefit each frontline clinician.
The product development roadmap
At InterSystems, we have an active roadmap for our EPMA solution to reflect the requirements of the international territories into which the software is deployed. Changing regulatory standards, customer feedback and broader emerging market requirements all feed into the roadmap.
Recently, a significant product enhancement has been the introduction of a new user interface for TrakCare, to reflect modern UI standards and experiences, and the improved navigation and presentation of information. This helps clinicians to digest, correlate and synthesise key patient information to inform appropriate and timely clinical decisions. The new UI framework enables clinicians to seamlessly access real-time and on-demand patient information, using a multitude of traditional or mobile devices such as tablets and a web browser.
The new Clinical Timeline functionality is a good example of new capability enabled by the new UI. It allows clinicians to easily correlate and trend key information sets, such as prescribed medications, dose administration records, blood test results and patient observations.
Interoperability is always a key element of our product roadmap. We see our off-the-shelf capabilities such as FHIR as a key strength for our solution platform. Work is on-going to be able to further support the emerging FHIR standards for the receipt and sharing of medicines-related data.
The evolution of EPMA solutions
I think personalised medicine will continue to play an increasing role to help improve the appropriate selection and dosing of medications for individual patients based upon their genetic profile (pharmacogenomics).
It is estimated that at any given time in the NHS, there are around three medium sized hospitals full of patients suffering from adverse medication incidents stemming from the way in which they have metabolised certain medications, resulting in levels of toxicity or sub-therapeutic response.
EPMA systems need to evolve to include real-time pharmacogenomic decision support to help clinicians select and optimise a patient’s medications. A key challenge currently is that pharmacogenomic test results are still largely reported as text. We need structured and coded data so that it can be used in decision support solutions.
Here’s an example scenario to illustrate how this might work – let’s say an elderly patient is admitted with a transient ischaemic attack, then discharged taking atorvastatin and clopidogrel. Several months later, the patient is readmitted with a weakness in one leg and is subsequently diagnosed with a stroke.
Patients with a reduced function variance in the gene CYP2C19 have been shown to have a risk of major adverse cardiovascular events, such as stent thrombosis. If the patient had a pharmacogenomic test to identify their individual gene profile, and that data was present in the EPMA solution, then a decision support alert could have been triggered to avoid the prescribed medication and suggest an alternative.
I would hope that one day in the future – and not too far away – that pharmacogenomic testing will be routinely available. I’d hope to see it carried by a patient in their personal record and made available to healthcare services they may encounter throughout their life.
Many thanks to Gary for sharing his thoughts and experiences. You can find out more about InterSystems here.
