Electronic Transfer Of Prescriptions Research Articles

500 General practitioners’ views on the electronic transfer of prescriptions to pharmacies in Ireland: a qualitative interview study

Abstract Introduction The use of electronic systems to transfer prescriptions continues to grow in healthcare systems worldwide. In response to the COVID-19 pandemic, legislation was implemented in Ireland in April 2020 to permit the electronic transfer of prescriptions (ETP) from prescribers to pharmacies using a national secure email system (Healthmail). This has resulted in a significant increase in the volume of prescriptions transmitted via Healthmail from general practitioners (GPs) to pharmacies in Ireland. Aim With a clear need to evaluate how stakeholders have been affected by this initiative and to guide the future delivery of patient care, the primary aim of this study was to investigate GPs’ views on the ETP to pharmacies in Ireland via Healthmail and how it has affected their practice. Methods Semi-structured interviews were conducted via video-conference with GPs in Ireland. GPs were identified using convenience and snowball sampling, purposively ensuring variety in age/years of experience, gender, and practice location. Interviews were audio-recorded and transcribed verbatim. Interview transcripts underwent thematic analysis (1). Results Twelve audio-recorded interviews were conducted with GPs between May 2021 and July 2021. The participants had a median of 16 years’ experience as a GP. Four main themes were generated: 1)Efficiencies with prescribing and easing GP workload: even with limited training, GPs felt that Healthmail’s ETP has been easy to use and seamlessly integrated into their practice. Time has been saved and overall workload decreased due to less prescription printing and delegating more to administrative staff with prescription ordering. 2) New GP-pharmacist communication pathways: GPs found asynchronous communication regarding prescription queries less disruptive to their workflow, and particularly useful for less urgent matters. Some GPs were not aware of some Healthmail functions that facilitated additional notes between GPs and pharmacists, whilst others were concerned they had no evidence if pharmacists saw these notes. 3) Security, transparency, and documentation: whilst acknowledging their lack of technological expertise, GPs perceived that Healthmail prescriptions had security advantages over physical ones overall; the increased transparency of the prescription journey minimises the risk of prescriptions being mislaid, damaged, or fraudulently altered, as well as creating an audit trail. 4) Implications for patients: ETP via Healthmail has reduced footfall to practices, reduces multiple pharmacy use, and most patients have adapted well to it. GPs were mostly reluctant to engage routinely in any hypothetical bidirectional communication with patients via Healthmail. Conclusion This study provides strong evidence for continuing the ETP to pharmacies in Ireland as GPs found this initiative easy to use, time-saving, and enhancing both GP-pharmacist communication and GP workflow. However, this study has highlighted stakeholders’ lack of awareness with some functions of Healthmail, so any future systems utilised for the ETP should come with best-practice guidance for all users. While the purposive sampling facilitated GP heterogeneity, snowball sampling may have somewhat reduced the diversity in views; a future survey would be useful in identifying if any GPs characteristics significantly influencing GPs’ views, as well as identifying other issues experienced and novel ideas to improve the ETP process going forward.

Changes to primary care delivery during the COVID-19 pandemic and perceived impact on medication safety: A survey study

IntroductionThe COVID-19 pandemic has had a profound impact on the delivery of primary care around the world. In Ireland, the use of technologies such as virtual consultations and the electronic transfer of prescriptions became widespread in order to deliver care to patients while minimising infection risk. The impact of these changes on medication safety is not yet known. ObjectivesThe aims of this survey study were to investigate 1) the changes that have occurred in Irish primary care since the start of the COVID-19 pandemic and 2) the impact of these changes on medication safety. MethodsAnonymous, online surveys were distributed to general practitioners (GPs) and pharmacists from August–September 2021. Surveys contained quantitative (multiple-choice, Likert scale) and qualitative (free-text) questions concerning workflow changes, medication safety incidents and near misses, and GP/pharmacist perspectives on medication safety and COVID-19. Reported medication safety incidents and near misses were categorised according to the WHO Conceptual Framework for the International Classification for Patient Safety. ResultsIn total, there were 251 responses to the survey, comprising of 211 pharmacists and 40 GPs. The most significant workflow changes during the pandemic were the widespread use of a secure clinical email service (Healthmail) that facilitates electronic prescription transfer and communication (75.3% of respondents) and the increased use of telephone consultations (49%). Overall, Healthmail was widely perceived to have had a positive impact on medication safety. Most GPs did not perceive a change in the frequency of medication safety incidents during the pandemic, while most pharmacists reported a slight increase in incidents. Survey participants highlighted pressure, patient expectations, and patient monitoring as significant challenges encountered during the pandemic. ConclusionsDuring the pandemic, a number of significant changes occurred in primary care in Ireland, particularly involving communication of healthcare information, with varying impacts on workflow and medication safety. Future research should focus on the optimisation of electronic prescribing and telemedicine services in Ireland, patient perspectives on the changes in primary care, and interventions to improve medication safety in primary care.

CP-146 Shared Medication Record discrepancies in association with electronic transfer of prescriptions

BackgroundTranscription errors and drug-related problems occur during transition of care. A national registry of all Danish citizens’ currently prescribed medicines, the Shared Medicines Record (SMR), is currently being implemented in...

In praise of the prescription: The symbolic and boundary object value of the traditional prescription in the electronic age

This paper explores the symbolic and boundary object value of the traditional paper prescription in the context of the planned move to the wider use of electronic prescribing in primary care in the UK and many other countries. It is argued that the traditional paper prescription possesses symbolic value and has been occasionally recognised but more often ignored in favour of the ultimate social object that is the medicine. This paper argues that considering the physical prescription as a boundary object within Star and Griesemer’s typology as a ‘standardised form’ recognises its significance for a range of actors, including not just doctors and patients, but also pharmacists and other stakeholders, in areas such as professional authority, the ceremony of the medical consultation, patient autonomy, surveillance, financial income, as well as medicine supply. The paper goes on to reflect on this boundary object interpretation in the context of the current move to the electronic transfer of prescriptions and it is argued that this may threaten the existing boundary object and its associated value. It also raises broader concerns as to what happens when boundary objects are modified or replaced.

Dispensing errors in community pharmacy: frequency, clinical significance and potential impact of authentication at the point of dispensing

Abstract Objective Our aims were to explore the nature of dispensing errors in community pharmacy, and investigate the potential impact of authentication at the point of dispensing using barcodes or radio-frequency identification tags. Objectives were to develop a dispensing error definition for use in the community setting, to describe the incidence, types and clinical significance of dispensing errors in UK community pharmacies and to assess the likely impact of authentication at the point of dispensing. Setting Eleven UK community pharmacies. Method A definition of a dispensing error was developed using the Delphi technique. A research pharmacist checked dispensed items awaiting collection and compared them against the original prescription to identify dispensing errors. An expert panel assessed the potential clinical significance of the errors identified. We then predicted the likely impact of three different systems of authentication at the point of dispensing: (a) stand-alone; (b) linked to patient medication records (PMR); and (c) linked to electronic transfer of prescriptions (ETP). Key findings We found a content error in 49 (1.7%) of 2859 dispensed items, and a labelling error in 46 (1.6%). The majority (67%) were of minor clinical significance. We estimated that a stand-alone system would prevent about one in five content errors and very few labelling errors, a PMR-linked system would prevent one-quarter of content errors and one-third of labelling errors, and an ETP-linked system would prevent nearly half of content and labelling errors. While none of the three systems would have prevented the one serious error identified, 22–60% of moderate errors could have been prevented, depending on the system used. Conclusion Content errors were identified in 1.7% of dispensed items, and labelling errors in 1.6%. Authentication at the point of dispensing could prevent a significant proportion of these, particularly if the system were linked to PMR or ETP. An experimental study is now needed.

Assessment of ePrescription quality: an observational study at three mail-order pharmacies

BackgroundThe introduction of electronic transfer of prescriptions (ETP) or ePrescriptions in ambulatory health care has been suggested to have a positive impact on the prescribing and dispensing processes. Thereby, implying that ePrescribing can improve safety, quality, efficiency, and cost-effectiveness. In December 2007, 68% of all new prescriptions were transferred electronically in Sweden. The aim of the present study was to assess the quality of ePrescriptions by comparing the proportions of ePrescriptions and non-electronic prescriptions necessitating a clarification contact (correction, completion or change) with the prescriber at the time of dispensing.MethodsA direct observational study was performed at three Swedish mail-order pharmacies which were known to dispense a large proportion of ePrescriptions (38–75%). Data were gathered on all ePrescriptions dispensed at these pharmacies over a three week period in February 2006. All clarification contacts with prescribers were included in the study and were classified and assessed in comparison with all drug prescriptions dispensed at the same pharmacies over the specified period.ResultsOf the 31225 prescriptions dispensed during the study period, clarification contacts were made for 2.0% (147/7532) of new ePrescriptions and 1.2% (79/6833) of new non-electronic prescriptions. This represented a relative risk (RR) of 1.7 (95% CI 1.3–2.2) for new ePrescriptions compared to new non-electronic prescriptions. The increased RR was mainly due to 'Dosage and directions for use', which had an RR of 7.6 (95% CI 2.8–20.4) when compared to other clarification contacts. In all, 89.5% of the suggested pharmacist interventions were accepted by the prescriber, 77.7% (192/247) as suggested and an additional 11.7% (29/247) after a modification during contact with the prescriber.ConclusionThe increased proportion of prescriptions necessitating a clarification contact for new ePrescriptions compared to new non-electronic prescriptions indicates the need for an increased focus on quality aspects in ePrescribing deployment. ETP technology should be developed towards a two-way communication between the prescriber and the pharmacist with automated checks of missing, inaccurate, or ambiguous information. This would enhance safety and quality for the patient and also improve efficiency and cost-effectiveness within the health care system.

Professional Competence and Computer Literacy in e-age, Focus on Healthcare

The healthcare sector is facing an enormous acceleration due to the emergence of new knowledge, drugs, devices and diseases. Professional competence, continuing education, service excellence and patient benefits can be facilitated by the developments in information and computer technology--computer literacy is becoming imperative for all who are involved in healthcare delivery. The paper attempts to identify solutions that can aid the process of ICT uptake for full benefit of patients and healthcare professionals. With the support of published literature, the article considers the importance of ICT skills in general and in healthcare and presents some advantages of generic vendor-independent methods of ICT certification. Discussed are the preliminary results of the United Kingdom's National Health Service information technology reform which addresses the need for intensified use of ICT and applies the ECDL concept. It is useful to complement the introduction of computer literacy as a qualification concept by a standardized accreditation of ICT skills. Solid level of computer literacy creates a reliable and efficient background for everyday activities of healthcare professionals, enables the application of further domain-specific training modules and prepares suitable environments for the introduction and acceptance of new technologies such as electronic health records and electronic transfer of prescriptions by positively transforming the attitudes of users towards them.

How to sign up for a National Care Record Service Acceptable Use Policy: pitfalls and lessons

The National Programme for Information Technology (NPfIT) – now National Health Service (NHS) Connecting forHealth –was established in 2002 to introduce modern IT into theNHS in England. The three pillars were the NCRS, Electronic Transfer of Prescriptions (ETP) and Electronic Booking (now known as Choose &Book). These functions are carried on the Spine, and access to the Spine is controlled by identifying and authenticating individuals, using a Smartcard, with assigned roles limiting the information seen. This article is about the process of issuing Smartcards, the form (RA01), terms and conditions (T&C) and NCRS AUP (Acceptable Use Policy) involved, the unexpected problems I encountered and how I tried to address them – with a lot of help from my friends and contacts.

The National Programme for Information Technology in the NHS

Abstract The National Programme for Information Technology (NPfIT) is an ambitious project to enable the NHS to modernize its information systems. Over £2 billion has been ringfenced for the first 3 years of this programme and more will follow. The main aims are a greatly improved NHS IT network and infrastructure, a national care record service (NCRS), an electronic booking system (EBS) for appointments and electronic transfer of prescriptions (ETP). New clinical systems will be provided by five organizations across England called Local Service Providers. They will have one Electronic Patient Record (EPR) system so there will be a great deal of standardization over the next few years. It is important that clinicians are involved in the development and implementation of these systems, which will affect many aspects of clinical care. The NCRS consists of the local EPRs together with a National Spine record, which is planned to be available from any NHS location. The Spine record will gradually develop to hold a cradle-to-grave review of a person's health, including all encounters with healthcare services, medications, problems, social circumstances, personal preferences, and main clinical findings and procedures. A complex security and confidentiality model is also being designed.

The birth of the e-clinic. Continuity or transformation in the UK governance of pharmaceutical consumption?

Traditional arrangements for the prescription and dispensing of pharmaceuticals have been challenged by the rise of Internet services enabling consumers to acquire these products online, without a face-to-face contact with a professional. This paper considers three moments in the emergence of the ‘e-clinic’ as an alternative route to prescription drugs in the United Kingdom: the electronic transfer of prescriptions; the development of the e-pharmacy and the ‘virtual’ pharmacist, and the establishment of online virtue medicine consultations. We examine the phenomenon in relation to issues of governance, considering the legal and voluntary frameworks that govern prescribing. Documentary and interview data suggest that the Internet has the potential to transform the relations between prescribers, dispensers and consumers, but that stakeholders seek continuity by applying existing governance frameworks and codes of conduct. This continuity can be explained by Rosenau's (Along the Domestic–Foreign Frontier. Cambridge University Press, Cambridge, 1997) model of a contested and fragmenting process of technology governance.

The National Programme for Information Technology in the NHS

The National Programme for Information Technology (NPfIT) is an ambitious project to enable the NHS to modernize its information systems. Over £2 billion has been ringfenced for the first 3 years of this programme and more will follow. The main aims are a greatly improved NHS IT network and infrastructure, a national care record service (NCRS), an electronic booking system (EBS) for appointments and electronic transfer of prescriptions (ETP). New clinical systems will be provided by five organizations across England called Local Service Providers. They will have one Electronic Patient Record (EPR) system so there will be a great deal of standardization over the next few years. It is important that clinicians are involved in the development and implementation of these systems, which will affect many aspects of clinical care. The NCRS consists of the local EPRs together with a National Spine record, which is planned to be available from any NHS location. The Spine record will gradually develop to hold a cradle-to-grave review of a person's health, including all encounters with healthcare services, medications, problems, social circumstances, personal preferences, and main clinical findings and procedures. A complex security and confidentiality model is also being designed.

Patient privacy in electronic prescription transfer

In paper-based prescribing in the United Kingdom's National Health Service (NHS), patients are responsible for protecting the privacy of their prescription information while it is in transit from the prescriber to the dispenser. The UK government has introduced a plan for future NHS reform that includes a change from paper-based prescribing to a national electronic transfer of prescriptions (ETP) system. This brings with it concerns for patient data privacy and questions about the burden of trust placed on professionals in the ETP system. As recently seen in the Emilio Calatayud case in the United States, systems that contain an aggregation of identifiable personal information can be abused. A similar case could result from malpractice in an ETP system. We have developed and implemented an ETP system for the UK NHS. We present our system for protecting the privacy of patient data, describe how we implemented it in Java, and discuss how others can use our system for other applications both inside and outside the healthcare sector.