Transcript Open Source ePrescribing Masterclass

Open ePrescribing
ePrescribing Masterclass
David Jobling &
Keith Farrar
08.04.2015
Introduction to Open Source
What is Open Source? - Paradigm Shift
• Based on software improvement via collaborative open innovation
• Driven by those with desire to use and / or improve the product
• Successful new business models (e.g. RedHat)
• Scale of openness to suit the needs
Based of 4 Software Freedoms
• Free to use software however you wish
• Free to redistribute copies
• Free to understand how it works and adapt it
• Free to make and share improvements with anyone
Introduction to Open Source
Why Open Source?
•
Removes vendor Lock-In
•
Increases responsiveness to fixes and changes in requirements
•
Increases the number of vendors who can support the solutions
•
Decreases Total Cost of Ownership
•
Removes up-front licence fees and capital outlays
•
More competitive pricing for support & maintenance
•
Stimulates wider participation in improving and innovating products
•
Greater control in delivering open interface between systems
•
As easy to support and manage source control as proprietary solutions
ePMA Functionality
4
Introduction to OpeneP – Functional Overview
Elements of an ePMA system
• Ability to document a Medication History
• Support for in-patient prescribing with scheduling of medicines
administration
• Support for the documentation of the administration of medicines
• Support for the creation of ‘short term leave’ prescriptions, with the
automatic suspension of administration during patient absence
• Support for discharge prescribing and reconciliation of changes
made since capture of medication history
• Support for out-patient prescribing
Introduction to OpeneP – Functional Overview
Additional Features of an ePMA system
•
Support for intravenous infusion functionality
•
Support for multiple-component prescriptions (e.g. palliative care syringes)
•
Support for ‘complex prescriptions
•
•
Step up & step down doses
•
Chlordiazepoxide alcohol ‘de-toxification’
•
Sliding scale insulin
Clinical decision support alerting users to
•
Allergies
•
Contraindications
•
Therapeutic duplications
•
Drug-drug interactions
Introduction to OpeneP – Functional Overview
Additional Features of an ePMA system
• Alert if user chooses a medicine not on the T2 / T3 list
• Indicator warning about BNF maximum for anti-psychotic medication
• Alert if cumulative doses exceed BNF maximum
• Pharmacist review of all medications
• Pharmacist noting system
• Intervention log
• Ability to ‘order’ supply
• Ability to refer back for physician review
OpeneP Roadmap
8
OpeneP – Development roadmap Phase 1
Delivery September 2015
•
Pharmacist review functionality
•
Documentation of medicines on admission
•
Discharge prescribing
•
Medicines reconciliation at each stage of the admission / discharge process
•
Short-term leave prescribing with auto-suspension of drug chart
•
Prompt to check allergy status before any medicines are prescribed
•
Enhancements to T2 / T3 functionality
•
Enhancements to Medicines Administration to support ‘self-administration’
•
Delivery of BNF maximum doses and cumulative warning
•
PGD functionality
•
Live Demonstration (https://www.ehrscape.com/openep.html?patientId=999005)
OpeneP – Development roadmap Phase 2
Delivery May 2016
• Antibiotic Stewardship enhancements
• Sliding scale insulin
• Management of ‘High Risk Medicines’
• Ward stock lists and stock ordering
• Electronic Controlled Drug Registers
• Links to external systems (BNF; ‘Yellow Card’; etc)
10
OpeneP – Development roadmap Phase 3
Delivery November 2016
• Out-patient prescribing
• Includes FP 10 and FP 10 MDA
• Includes instalment dispensing
• Links to laboratory results
• ‘Medicines only’ order sets
• Links to VTE assessment
11
OpeneP – Development roadmap – Beyond Phase 3
• Enhancements to Paediatric prescribing
• Including age based links to ‘template’ order lists
• Enhancements to ‘order sets’
• Introduction of ‘mixed’ order sets
• Advanced decision support
• Calculation of renal function
• Context specific alerts
• Oncology prescribing
12
Comparison with
commercial systems
13
Delivery of Requirements
• Current level of functionality assessed at 50% of desired
requirements
• Projected level of functionality targeted at 100% of desired
requirements
• Nearest ‘rival’ assessed at 78% of desired requirements
• Cost of OPEN ePMA (at ‘full’ development cost) is estimated at 89%
of cheapest alternative (based on supplier assessment or 65% if
based on observed functionality
14
Timeline for delivery of ‘gaps’(based on published roadmaps)
)
Key functionality GAPs
from observation of functionality
Supplier 1
Supplier 2
Supplier 3
Supplier 4
compliance
roadmap
compliance
roadmap
compliance
roadmap
compliance
roadmap
Alert on selection of drug not on T2 / T3 Forms
Percentage BNF maximum for anti-psychotic
medicines
0
N/A
0
Q4 2016
0
N/A
0
N/A
Ability to list T2 / T3 drugs by 'class'
0
N/A
0
N/A
0
N/A
0
N/A
Alerts for use of unlicensed route
3
N/A
3
N/A
3
N/A
3
N/A
eCD registers
0
N/A
0
N/A
0
N/A
0
N/A
eCD requisitions
0
N/A
0
N/A
0
N/A
0
N/A
antimicrobial stewardship
Pharmacist review note to prescriber with
endorsement
Auto-chart of in-patient medicines during home
leave
3
Q3 2016
3
Q2 2017
3
N/A
3
2016
Installment prescriptions
0
FP 10 and FP 10 MDA
3
Support for Non-Medical Prescribers
Medicines reconciliation from admission to
discharge
Support for community administration of
medicines (CPNs)
5
0
0
0
0
0
N/A
N/A
N/A
N/A
N/A
N/A
Q2 2017
N/A
3
0
0
3
3
0
0
0
Q4 2016
Q4 2017
N/A
Q3 2015
Q3 2017
N/A
Q1 2017
N/A
0
0
0
0
0
5
0
0
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
0
2016
3
N/A
0
N/A
0
0
Q2 2015
N/A
0
2016
0
0
N/A
15
Progress to date
16
Progress against NELFT requirements
120%
100%
80%
60%
40%
20%
0%
Existing
functionality
Not applicable
Specification
document
prepared
Delivery against NELFT requirement
Specification
document in
preparation
To be addressed
Cumulative Delivery
PAS integration
Performance against Digital maturity
Index Measures
Functionality available (%)
2. Types of Medicines
3. Context of Prescribing
4. Medicines Administration
5. Prescriber Type
6. Medicines Optimisation
7. Secondary Uses
8. Interoperability
9. Communication
10. Supply & Inventory
Management
11. Decision Support
Total Maturity
Functional
Mature
Totals
67
46
73
100
43
50
100
25
43
23
67
50
20
50
25
0
54
35
71
75
29
50
40
9
100
52
57
0
31
28
17
43
41
18
Safety Process
19
Clinical Risk Management – OPEN ePMA
•
Clinical Safety Officer appointed
•
Need to establish the project ‘governance’ for CIC
•
Need to establish governance links to the clinical risk management
process
•
Set up the ‘safety management committee’
•
Organise workshops to refine the hazard register
•
Produce the key deliverables
20
Procurement
21
Open eP Finance & Purchasing
Options for procuring services and assets for Open eP
•
Individual procurement
•
Community Interest Company
•
Other Options
What services would be required?
•
Role of the Prime Contractor
•
Development
•
Implementation
•
Support
Open eP Finance & Procurement
Why Open eP?
•
Involvement in development
•
Quality of the product
•
Shared Knowledge
•
Shared Governance
•
Shared Resources
Technology Fund
•
Capital / Revenue
•
Procuring Services – G-Cloud
•
Utilising Match Funding
For more Information
Peter Coates
NHS England Open Source Programme Head
07798 725131
[email protected]
David Jobling
Community Development Lead
07818 522951
[email protected]
Keith Farrar
Clinical Lead OPEN ePrescribing Project
0784 341 7036
[email protected]
www.openep.org
Twitter @open_ep
[email protected]