Is Electronic Prescribing the next step towards paperless hospitals

Additional funding for hospital pharmacy IT systems needs to be made available – Hospital Pharmacists Association of Ireland
Conference hears about promising IT developments in hospital pharmacies, but more investment required

Hospital pharmacists are calling for urgent investment to be made into the State’s healthcare IT infrastructure, stating that the current pharmacy systems are not fit for purpose.
The Hospital Pharmacists  Association of Ireland (HPAI) Annual Conference, which was held in the Crowne Plaza Hotel, Santry, Dublin from April 8 to 10, heard presentations on a number of exciting and pioneering IT projects established in hospital pharmacies across the country.
These included: the introduction of robots used for the storage and retrieval of medicines; the impact of electronic prescribing on the quality and safety of chemotherapy prescribing in oncology and a national solution for paediatric standardised concentration infusions.
 HPAI President and Chief Pharmacist in Cork University Hospital Ms Deirdre Lynch said that although there are many examples of high quality IT initiatives in hospital pharmacies by pharmacists, overall the sector requires a major automation and technology upgrade due to years of under-investment.
“We welcome the innovations that have occurred in recent years,” according to Ms Lynch.
“But the hospital pharmacy IT sector has suffered years of under-investment. We are calling for investment to be made into hospital pharmacy IT and robotics as the current structure lags far behind even the most basic pharmacy systems in other countries.   Additional funding is extremely important in order to improve the quality of patient care in our hospitals and we urge healthcare leaders and managers to make Hospital Pharmacy IT infrastructure a priority in IT strategy”

A 2012 Pharmaceutical Society of Ireland hospital pharmacy baseline report highlighted the poor standard of IT systems in hospital pharmacies, and a recent survey conducted by the European Association of Hospital Pharmacists found no improvement from the PSI 2012 findings and that the technological infrastructure in hospital pharmacies in Ireland lags behind European counterparts such as the UK and the Netherlands.
In spite of the present IT systemic problems, Ms Lynch said that the HSE’s IT strategy, eHealth Ireland, which is spearheaded by the Executive’s Chief Information Officer, Mr Richard Corbridge, offers hope for the future.
Mr Corbridge delivered the conference’s keynote address on the progress of the implementation of the strategy to date, including the establishment of a national electronic health record.
“An electronic health record across the hospital sector is essential,” according to Mr Corbridge. “We are trying to deliver integrated care across the hospital system. At this moment in time we have silos of paper and silos of older systems that don’t communicate with each other. We need to get to the point where the information is held in a single place and we can link medication records to that and communicate the information to GPs.  That is what we are trying to do. If we are successful, we will save money and we will save lives. Additional investment in technology in health is required in all areas. Capital and revenue extensions will be required to modernise the healthcare system and the eHealth Ireland team are working closely with the Department of Health to ensure that the right funding models can be put in place for this in the future.”
Mr Corbridge said he was impressed by the quality of presentations delivered during the conference, which showed that innovative IT projects were taking place in hospital pharmacies across the country.
E-pharmacy forms a central component of the overall health IT strategy.
One presentation focused on the introduction of two robots to the pharmacy department of the Mater Misericordiae University Hospital (MMUH) to help with the storage and retrieval of medicines.
The introduction of the robots has not only led to process improvements in the dispensary, but also to a much more efficient daily workflow system, while improving stock control and optimising the space required to store medications.
Another presentation showed how the introduction of the electronic software system CATO® in the Mater Hospital for chemotherapy prescribing, compounding and administration has significantly reduced prescribing errors and omissions.
Conference delegates also heard about how a national neonatal standardised concentration infusion drug library has been developed with a phased roll out across neonatal intensive care units and the National Neonatal Transport Team planned to commence in 2016.
The move is a positive development given implementation of paediatric standardised concentration infusions, however the use of smart-pump technology has been slow despite international safety agency recommendations.
St. Luke's Hospital in Kilkenny Shows how it's done
There is palpable impatience in St Luke’s with the pace of change in the health service. I meet a pharmacist who relates his frustration with the reliance on paper-based records. He says the HSE collects all the information about the drugs used by a patient, but only for reimbursement purposes.

“We have to call the HSE and transcribe this information, then pass it on to the GP, who has to transcribe it again. It’s crazy. If we had a unique patient identifier we could do all this electronically but that has to happen nationally.”

He says it would make sense for a discharged patient to go home with the medication they need, rather than having to source it in the pharmacy, at least for the first week. But this doesn’t happen because the money would have to come from the hospital budget.


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