Abstract
BackgroundA previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital. Our objectives were to describe the rationale for having multiple EP systems within a single hospital, and to explore perceptions of stakeholders about the advantages and disadvantages of multiple systems including any impact on patient safety.MethodsHospitals were selected from previous census respondents. A decision matrix was developed to achieve a maximum variation sample, and snowball sampling used to recruit stakeholders of different professional backgrounds. We then used an a priori framework to guide and analyse semi-structured interviews.ResultsTen participants, comprising pharmacists and doctors and a nurse, were interviewed from four hospitals. The findings suggest that use of multiple EP systems was not strategically planned. Three co-existing models of EP systems adoption in hospitals were identified: organisation-led, clinician-led and clinical network-led, which may have contributed to multiple systems use. Although there were some perceived benefits of multiple EP systems, particularly in niche specialities, many disadvantages were described. These included issues related to access, staff training, workflow, work duplication, and system interfacing. Fragmentation of documentation of the patient’s journey was a major safety concern.DiscussionThe complexity of EP systems’ adoption and deficiencies in IT strategic planning may have contributed to multiple EP systems use in the NHS. In the near to mid-term, multiple EP systems may remain in place in many English hospitals, which may create challenges to quality and patient safety.
Highlights
A previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital
A decision matrix was created for the hospitals that met these inclusion criteria with the aim of achieving a maximum variation sample based on: number of EP systems in the hospital, likelihood of overlap, and characteristics of the EP systems
Interviewees from sites A and D felt that due to the nature of the EP systems they used, only those clinical staff working across different specialities, such as pharmacists, were exposed to more than one system
Summary
A previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital. Adoption of health information technology (HIT) in English secondary care organisations began in the 1980s. Adoption was generally ‘bottom-up’ which meant that individual hospital organisations selected which HIT system(s) to implement. The English government subsequently offered financial incentives for NHS hospital organisations to adopt electronic prescribing (EP) systems and other technology [2]. In October 2014, a ‘five-year forward view’ to revolutionise the English NHS was published [3]. This acknowledged the drawbacks of the previous government information technology (IT) strategy and proposed a new approach with the aim of achieving interoperability between NHS
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