Title: Optimising ePrescribing in Hospitals
Funder: Department of Health and Social Care

Abstract: Background: There is now a growing body of work that demonstrates that electronic prescribing (henceforth ePrescribing) systems can substantially reduce the risk of medication errors in hospitals. This evidence has however largely come from evaluations of &ldquo;home-grown&rdquo; extensively customised ePrescribing systems in the United States (US). The applicability of this evidence to the NHS is as a result unclear as the UK market is dominated by commercial &ldquo;off-the-shelf&rdquo; ePrescribing systems. In order to address this important knowledge gap, the National Institute of Health Research (NIHR) commissioned us to undertake a 5-year &pound;2m programme of research to investigate the implementation, adoption, effectiveness and cost-effectiveness of hospital ePrescribing systems. This found that commercial ePrescribing systems can also substantially reduce the risk of clinically important medication errors in cost-effective ways, but realising these benefits is dependent on optimising ePrescribing systems such that the available functionality is (amongst other things) switched on, appropriately used, integrated with other relevant health IT functionality and aligns with clinical workflows. The challenge for the UK is that there is very limited expertise or experience of optimising ePrescribing systems in the NHS. The recently launched World Health Organization (WHO) Global Medication Safety Challenge, investments in the NHS Global Digital Exemplar (GDE) and the NHS Digital Academy, and forthcoming substantial investments in hospital ePrescribing systems all coalesce to provide an unprecedented opportunity to drive forward widespread adoption of ePrescribing in NHS hospitals and also to ensure that these are optimised such that they support national medication safety, quality and efficiency goals. Aims: To build on our recently completed NIHR-funded programme of work and develop policy-relevant insights into how best to achieve systems optimisation of NHS hospital ePrescribing systems in order to improve safety, quality and efficiency of medicines management. Methods: We will undertake a phased programme of work that will involve: i) A systematic scoping review of the literature to identify strategies and approaches that have and are being used to achieve optimisation of ePrescribing systems; ii) Detailed case studies of leading UK and international hospitals to identify potentially transferable/scalable lessons for the NHS; and iii) a series of expert round-table events throughout the life-course of the project to identify strategies, policy barriers and enablers to ensure widespread systems optimisation of ePrescribing software across NHS hospitals. Timescale: 31 months.

Lay abstract: Medicines have important health benefits, but they can also result in accidental harm to patients. This risk of harm can be particularly high in patients who are in hospital. Some of these medication-related harms are due to errors that health professionals make. Our work has shown that computer programs designed to help health professionals in their prescribing and medicines monitoring decisions &ndash; also known as electronic or ePrescribing systems &ndash; can greatly reduce the risks of such errors. Our previous work has shown that this is not a given, as achieving these benefits is dependent on ensuring that the ePrescribing systems are, for example, usable by busy healthcare professionals and fit within their clinical practice. This process of fine tuning or systems optimisation of ePrescribing systems is a field in which the NHS currently has limited experience and expertise. This new project is designed to help address this important gap and by doing this will help the NHS to respond effectively to the World Health Organization s recently launched Global Medication Safety Challenge, which aims to achieve a 50% reduction in harm to patients from medication errors. The work will build on and link with major government investments being made in digital health capacity and understanding and, more specifically, hospital ePrescribing systems to help maximise the benefits of ePrescribing systems to patients. Our work will be carried out in four phases. First, we will complete a detailed review of the literature to identify approaches that have been used to help ensure that ePrescribing systems are made fit-for-purpose for use in busy clinical environments. Second, we will from this literature review, and from our international/national networks of experts identify health system/hospitals that have already made substantial progress in this area and complete detailed case studies of these sites. These case studies will involve a combination of analysis of key documents, interviews with a range of stakeholders and site visits to identify potential lessons for the NHS. Third, we will carry out a series of expert round-table events throughout the life-course of the project to understand how these lessons can, where appropriate, be fast-tracked into routine NHS hospital settings in safe and secure ways. We have considerable expertise both in the field of ePrescribing systems and in the methods described above and are therefore confident in our ability to deliver this work to an international standard in a timely fashion.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE