Electronic transmission of prescriptions

The electronic transfer of prescriptions (ETP) is a Good Thing. Everybody says so. The NHS Plan says that by 2004 “electronic prescribing of medicines [will give] patients faster and safer prescribing as well as easier access to repeat prescriptions” (para 4.21) and community “pharmacists will be able to take on a new role as they shift away from being paid mainly for the dispensing of individual prescriptions towards rewarding overall service” (para 9.8). England’s National Programme for IT (NPfIT) incorporates the provision of a prescription service as one of the three main pillars of its overall architecture.

Over the years, much thought has been given to how prescription transfers might be achieved electronically. Key principles for system development acceptable to the medical and pharmaceutical professions were developed in 1997, and confirmed by the ETP Professional Advisory Group in late 2000; some 15 principles set out a comprehensive framework within which any such project must operate. Three pilots began in the second half of 2002, and have now completed their work. A formal, independent, evaluation was delivered to the Department in April 2003. In brief, it concluded that ETP was technically feasible; that, theoretically, it made some types of fraud easier to detect, though others might become more difficult, or easier to commit; that overall there were no major concerns about security; and that clinicians and patients alike “were on the whole likely to find ETP acceptable, and may come to appreciate the benefits in time”! And, last December, BT was awarded a 10-year contract to set up and run England’s national database of patients’ healthcare records (the National Spine), through which a large part of the ETP messages will be handled as part of the Care Records Service.

All this sounds like great progress. On the face of it, ETP has to be a good thing. The Prescription Pricing Authority (PPA) processed 615m prescriptions in 2002–3 from over 13 000 community pharmacists and dispensing practices, an increase of nearly 6% on the previous year; and the proportion of prescriptions reaching the Authority that have been printed from a computer is increasing, varying from 60% to 80% according to area. Somewhere here there must be an amazing potential to be tapped?

This issue of the Journal looks at some aspects of this important area. Martin Strange, who has been deeply involved in two of the ETP pilot schemes, explores the anticipated areas of difficulty in attaining benefit from ETP, now to be rolled out as a major part of the NPfIT. His wide-ranging review also shows how benefits can be perceived across many fields. They range from an increased capacity to measure compliance — it is estimated that some 20% of prescriptions issued are never filled — through the potential to make the relationship between pharmacist and patient more personal, to allowing the PPA to absorb the 50% increase in workload projected within the next 10 years. It points also to the impact on the internal workings of nearly all general-practice surgeries if subsystems are not re-engineered when one major function is computerised.

In their article, Darren Mundy and his colleagues from the Universities of Salford and Huddersfield report on their evaluation of the perceptions of community pharmacists and primary care prescribers of ETP. As might be expected, these stakeholders believed that, if ETP was implemented in a way that met their requirements, there was a potential for improved patient care, increased systems security, and a reduction in workload, especially in repeat prescriptions. Their apprehensions, however, were many — from pharmacists’ concern about a possible reduction in market share, brought about by the introduction of directed prescriptions, to concern that an electronic system would lack the flexibility to deal with the errors that inevitably creep into a human organisation.

In his article, Will Wilson, Principal Pharmacist and Information and Supply Manager, Addenbrooke’s NHS Trust, examines the interplay between electronic prescribing and the emergence of an integrated-care service. He foresees a time when the current role of pharmacy departments in information and supply will be replaced by clinical systems providing online decision support and accredited knowledge management that functions 24 hours a day, releasing pharmacists to play a more active role in patients’ care.

Quite apart from the linking subject matter, there is a common thread that runs through these articles. All express — in varying degrees — an optimism about the contribution which ETP could make to healthcare. Equally, however — and again in varying degrees — all are conscious of the interaction between systems and people, and of the need for a full understanding of those interactions, without which the best-intentioned system will possibly fail and certainly falter.

There is a lesson here for local service providers, who face the daunting task of introducing systems across the country, which — at least in the first instance — do not have the same immediate impact on clinical practice: it is a lesson they would do well to take to heart.

Michael Fairey