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Come the revolution

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Come the revolution

Pharmacists and pharmacy teams need to have read-write access to patient records if we are to deliver high quality, joined-up care to patients

The rush is on to develop technology to reach a swathe of ambitious NHS targets within five years, and the IT momentum in pharmacy is already building, writes Charles Gladwin

A digital revolution is underway in health and care. Achieving the aims of the Five Year Forward View has created a huge expectation around enhanced digital technology making sure the myriad elements of the NHS talk to each other effectively. This will be crucial if ambitious targets are to be met: alongside seven-day primary care services by 2020. The NHS is also aiming to be paper-free at the point of care by the same date. A big challenge is interoperability, to allow information sharing between electronic systems, but there is also the user to consider. “If there’s one challenge above all, we need to deliver excellent online services by designing them for the people who use them, rather than around the way we are structured,” says Helen Rowntree, head of digital services at NHS England.

Launching the NHS.UK Alpha project earlier this autumn, she said: “We will be mapping out how people find dealing with the health and care system in a number of condition areas. We’ll be talking to them and to frontline staff about their needs. And we will be using that to identify opportunities for improved online information and services.”

And then there’s Code4Health, another NHS England-led initiative to optimise the use of digital tools and technology. It is inviting health professionals to get actively involved in learning to code or write software and to develop apps and other digital applications. But with potentially 300,000 health apps already out there, a pilot scheme is underway to figure out the best ways to evaluate and endorse digital technology for use in the NHS, in public health and in other care services.

An example of the significance of this comes in a recent report in the BMJ publication, Evidence-Based Mental Health. Of the 27 mental health apps listed in the NHS apps library, 14 were for depression and anxiety, said the authors. However, only four provided any scientific proof that they worked when used by patients, and only two of them had been properly evaluated for clinical effectiveness.

SCR and EPS

Pharmacy is starting to see signs of the revolution – the rollout of pharmacy access to the Summary Care Record is underway, having been piloted in 140 pharmacies across five areas in England. “There are significant benefits to be realised for patients, pharmacists, GPs, and the wider health economy by enabling community pharmacy to have access to SCR,” concludes the Health and Social Care Information Centre’s evaluation. “The implementation approach has demonstrated that it is possible and practical to provide this to all pharmacy types and settings.”

Since the Department of Health announced the rollout there has been a move to let community pharmacists have full read and write access to the patient health record. And the Royal Pharmaceutical Society has received MP backing for its campaign, with Sir Kevin Barron, chair of the All Party Pharmacy Group, saying: “Pharmacists and pharmacy teams need to have read-write access to patient records if we are to deliver high quality, joined-up care to patients. Without this kind of information sharing and collaboration among health professionals the NHS will struggle to achieve the efficiency gains it needs.”

Since the spring, all GPs have been required to give patients online access to their records, as well as online appointment bookings and prescription ordering. Unfortunately, GPs are still taking their time with electronic prescribing. However, PSNC has persuaded HSCIC to publish EPS release two data on a weekly basis, flagging up how many GP practices and pharmacies are live.

In early October, while 98.3 per cent of pharmacies and 84.8 per cent of dispensing appliance contractors were live, only 68.6 per cent of GP practices were. Nevertheless, over 144 million EPSR2 prescriptions had been sent to date, almost 325 million items had been dispensed and claimed, and 15.7 million patients had a community pharmacy and/or a DAC nomination.

The average live site usage in September was 43 per cent. The data also enables pharmacies to see their weekly EPS activity and compare it against all other pharmacies. It identifies not only the number of active patient nominations, but also the change in number from the previous week. In mid-October, around 190 pharmacies were live but had no active patient nominations, and over 600 pharmacies had fewer than 100 active nominations. Pharmacy2U had 33,660.

For pharmacy teams wanting to get more out of EPS, HSCIC is part-way through 800 masterclass events, running through to the end of June 2016. Training is tailored to individual PMR systems, and includes information about business process change and business continuity, as well as a ‘claiming and endorsement’ session presented by the Pricing Authority.

Tech for pharmacy business

However, not all the digital revolution is being steered by governmental organisations. PSNC has developed a tool, Check 34, to help contractors check prescription reimbursement. The NPA has exclusive rights to the system and is offering free access to its members. Uptake has been increasing rapidly, with around 3,000 signed up by October, and the NPA hopes the majority of its members will be using the system by the year-end.

The NPA’s Steven Fishwick comments: “Cashflow and margins are tight in many independent community pharmacies. It is important for them to be in control of their business processes and planning, as well as to be certain that they are being accurately remunerated by the NHS. For optimum business performance, all community pharmacies need to be able to assess their own performance data and compare against other pharmacy businesses.”

An independent pharmacy owner involved in piloting Check 34 is Nick Kaye from Newquay. Any issues around signing up to Check 34 were identified and dealt with during the initial trial phase, he says, meaning it is now straightforward to sign up. He uses Check 34 a couple of times a month, mainly to anticipate, and then to check, actual invoice financing.

Data is easy to understand as the system can display information pictorially, he says. “It’s a way that you can monitor trends. It gives me what I need in an accessible way.” Its usefulness has been demonstrated a number of times: an increase in the number of prescription switches between submitted bundles flagged up a training need for the staff providing holiday cover for the dispenser responsible for the end of month return. He has also been able to use the data to highlight to his bank manager the monthly fluctuations in cash flow.

Healthi for advanced adopters

Cegedim Rx launched an advanced adopter programme for Healthi – an online platform for delivering clinical services in a consolidated solution – at the Pharmacy Show in October.

The advanced adopter programme will initially allow participating pharmacies to use Healthi to deliver private flu vaccinations this winter. Then, during the programme’s lifecycle, Cegedim Rx will introduce functionality supporting delivery of NMS, MURs and a variety of private PGDs, as well as creating a link between Healthi and Cegedim Rx’s PMR systems, Pharmacy Manager and Nexphase.

The Healthi PMR integration uses a central cloud-based patient record for data capture, delivering the clinical service, and to update the PMR with any medicines prescribed and dispensed. Healthi is split into two online solutions: Healthi Web and Healthi Mobile. Healthi Web can be used with a variety of browsers on desktops, laptops and tablets. And Healthi Mobile is a Windows 8 tablet-based version of Healthi, allowing clinical services to be delivered via an app. The app for private flu vaccinations has both a patient-facing version, enabling patients to enter their own data, and a clinician app that allows the pharmacist to validate the information.

Clive Eckett, sales and marketing director at Cegedim Rx, says: “I am really excited by the positive feedback we have been given from those customers on the initial pilot scheme; it has been received well by both pharmacists and patients. Healthi provides pharmacy with a major step forward in both consistent service delivery and greater operational efficiency along with an opportunity to interact with patients in a far more effective manner than any other services platform currently in the market.”

Price comparison technology

Another digital business service is the e-CASS2 system, launched last autumn. This “easy-to-use price comparison, stock ordering tool” will work with PMR systems to save time and money. User numbers have grown monthly by 10 per cent and the system has been installed in more than half of the Cambrian Alliance Group’s membership, says Mark Griffiths, CAG chairman.

Installation onto a pharmacy system can be done remotely, and it is fully functional with the following PMR systems: Proscript (including Link); Positive Solutions (Analyst); Rx Web (Helix); and Mclernons. “e-CASS is constantly evolving to meet the needs of pharmacists across the UK. Over time, we at Cambrian Alliance believe the vast majority of pharmacies will move from ordering from printed price lists to live, electronic price comparison tools,” says Mr Griffiths. “And we will continue evolving our e-CASS products to support this growth. In Spring 2016, e-CASS2+ will be launched, representing a new and exciting opportunity for independent pharmacies.”

Chi Kui Chan, of Pentyrch Pharmacy near Cardiff, says: “I have been using e-CASS2 for several months now and it has improved my purchasing beyond compare. Not only has it improved my profit margin but it has saved me so much more time to concentrate and improve other healthcare services and quality time I can spend with my patients.”

Martin Parry, of Parry’s Pharmacy in Treharris, agrees: “Our orders of course vary each month but typically we save around £3,000 per month and this has supported a 2-3 per cent growth in our annual profit.”

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