Title: Investigating the implementation, adoption and effectiveness of ePrescribing systems in English hospitals: a mixed methods national evaluation
Funder: Department of Health (England)

Abstract: Background A number of international benchmark studies have now demonstrated that prescribing errors are common and are responsible for considerable – potentially avoidable – morbidity and mortality. Given the increasing complexity of prescribing decisions, the risk of prescribing-related iatrogenic harm is likely to increase yet further. There is then a pressing need to identify effective approaches to improving the safety of prescribing. Interest is in particular converging on the potential offered by computerised order entry and related advanced decision support systems (henceforth referred to as ePrescribing systems). These systems however vary very considerably in functionality, inter-operability and costs (there is, for example, up to 10-fold differences in start-up and maintenance costs between the basic “non-alerting” and the more advanced “alerting” systems). Building on our substantial body of completed and ongoing work investigating the potential of information technology to enhance the quality of care, we now plan to undertake an ambitious multi-faceted programme of work to inform important national deliberations on the safe, effective and efficient procurement and implementation of ePrescribing systems into hospitals in England. Aims To: • Describe the procurement, implementation, adoption and maintenance of the basic and more advanced ePrescribing systems • Estimate their effectiveness and cost-effectiveness • Develop best practice recommendations for procurement and a toolkit for their successful integration into NHS hospitals. Research plans We will undertake a theoretically-informed, multi-method, context-rich, naturalistic evaluation using the principles of a stepped-wedge design. We will undertake eight in-depth longitudinal case studies in purposefully selected hospitals implementing ePrescribing systems of varying functionality and cost. Our research is organised into five complementary Work Packages (WPs) (see Figure 1, Annex 4 for details of how these inter-relate): • WP1: Procurement, implementation, adoption and maintenance • WP2: Communication and local connectivity • WP3: Assessing impact on prescribing safety • WP4: Health economics and a value of investment analysis • WP5: Integration across WPs to develop recommendations and a toolkit for the NHS. Research team Our team has the necessary breadth and depth of expertise to deliver on this comprehensive programme of research. Furthermore, we have a proven track record of collaborative working and considerable experience with managing substantive programme grants. Programme management A Programme Management Group (PMG), comprising all investigators, will ensure the delivery and governance of all aspects of this Programme. Experienced senior investigators will manage each of the five WPs. An Independent Programme Steering Committee (IPSC) will be convened to oversee this research. Please refer to Figure 2 in Annex 4 for an overview of programme management. Research environment This Programme will jointly be undertaken by experts in investigating the role of IT in improving healthcare delivery based at the Universities of Birmingham, Edinburgh and Nottingham. These institutions are renowned internationally for research in this area, with strong links to relevant NHS settings and academic networks internationally. Anticipated outputs, outcomes and impact of this research Many hospitals in England are planning to implement ePrescribing systems in the near future, but there is currently no guidance for NHS Trusts making these important and costly decisions (up to £1.5m per Trust in start-up costs alone). Our research will provide a detailed scoping of available systems, an assessment of their effectiveness and cost-effectiveness, and an appreciation of the approaches to implementation that are likely to maximise successful adoption. This Programme will, we anticipate, provide clear recommendations on the trade-offs between the different system types and a toolkit for procurement and implementation. Patient and public involvement The Patient and Public Involvement Lead will be given appropriate financial and administrative support to implement an over-arching strategy to ensure meaningful lay input across the Programme (Figure 3, Annex 4). He has recruited a lay member to join each of the five WPs and two lay members to join the IPSC. He will convene regular meetings of these seven additional lay members and feed back to other investigators through the PMG, of which he will be a full member. Ethical implications We will obtain all necessary Research Ethics Committee (REC) and NHS Research & Development (R&D) approvals prior to commencing this work. Justification for resources requested This is a complex multi-faceted investigation, which is to be conducted in hospitals across England. We have developed a costing model for the co-ordinating centre and devolved costings for the collaborating partner universities.


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