Digital medicines strategy, IT and automation
Chief Pharmacists are required to be aware of the ways in which digital technologies are being proposed to support the overall transformation agenda across the NHS, the priorities, how these will impact on medicines optimisation and the opportunities that this presents.
The National Information Board is responsible for setting the direction of travel with regards to digital technology across the NHS and oversees the work programme. There are currently ten domains and 33 programmes that have been setup to deliver the digital strategy. Whilst all domains touch on hospital pharmacy, the following two are of particular relevance:
- Domain E Digital Medicines: which will ‘enable and improve pharmacy decision making and outcomes by providing patients and prescribers with streamlined digital services’.
- Domain G Paperless 2020: which will ‘create an NHS “paper free at the point of care” by driving up levels of digital maturity and by enabling the NHS workforce to better utilise the benefits of digital technology’.
A key document relating to the use of technology in the acute provider sector is outlined within the Wachter report . It outlines a series of 10 principles and recommendations that are being used to underpin much of the work on Domain G (see above).
Developments that fall into Domain E include; the Electronic Prescription Service (EPS) and clinical informatics linked to medicines such as digitising community pharmacy, e-homecare, clinician to clinician electronic referral (see RPS Hospital Referral to Community Pharmacy: An innovators toolkit to support the NHS in England (December 2014)). The implementation of the Falsified Medicines Directive also falls (in terms of strategic requirements) into Domain E.
ePrescribing sits within Domain G. Support for ePrescribing can be found at ePrescribing toolkit for NHS hospitals website or by talking to one of the Global digital exemplar (GDE) sites many of whom have already implemented.
The implementation of Dictionary of medicines and devices (dm+d) is a core terminology requirement that underpins work across both of the above domains. Domain E is working to support the wider uptake of dm+d within stock control systems to support a wide range of initiatives including reporting, interfacing and medicines optimisation activities.
To drive the digital development, NHS England through Sustainability and Transformation Plans (STPs) has encouraged the development of local digital roadmaps. Alongside the local digital roadmaps NHS England has introduced digital maturity metrics for providers to use to assess the extent to which their services are supported by the effective use of digital technology.
Several of the recommendations from the Carter review (for example, ePrescribing and medicines administration, accurate medicines coding and modernising the supply chain) also support the digital medicines strategy.
Digital infrastructure is needed to underpin and enable productivity, safety, efficiency and clinical decision making that supports the effective use of medicines. Chief Pharmacists are required to be familiar with both the technology and workforce needed to do this.
Examples of technology enablers include:
- Automation – ensuring capability of pharmacy storage systems to meet the Falsified Medicines Directive, business case for ward based automation, Academic Health Science Network evaluation of unit dose dispensing
- Tools to support compounding and waste reduction in chemotherapy
- Online clinical decision support tools , for example Blueteq (NHS England’s standard electronic contractual prior approval system covering a range of high cost drugs excluded from tariff).
- The use of fundamental standards for systems for example PEPPOL,dm+d and SNOMED CT