Information prescriptions to be linked to electronic records

25 Aug 2008

The Department of Health is this week expected to set out its vision for information prescriptions that are linked to electronic patient records and a national accredited information system based within NHS Choices.

The final report on the first 20 pilots that ran over the last year is currently with ministers and could be published this week.

It is expected to endorse IPs as a useful tool for helping to manage long term conditions and to pin point how national and local systems for managing them can be integrated.

However, its findings will also highlight concerns about the amount of time they take to dispense, with GPs and consultants in particular worried about the impact on patient consultations.

IPs were proposed in the white paper Our Health, Our Care, Our Say as a way of giving people with long term conditions personalised information about their condition.

In 2007-08 the DH recruited 20 pilots sites to provide the evidence for IPs and explore different models. They included PCTs, acute hospitals and mental health trusts.

A summary report published in August found that most pilots used an IT-based system with only four using paper-only systems to dispense IPs.

It said: “The quality of IT used varied greatly as did the sophistication and infrastructure.”

Ewan King, director of analytic studies at the Office for Public Management and director of the research study for the DH, said that IT was used to develop searchable databases and to allow health professionals or users to populate a personalised IP template – what he called an “IP generator”.

“Only one place, Heart of England NHS trust, managed the golden idea of integrating dispensing an IP with the electronic patient record,” he added. “That’s really difficult to achieve for many places because they do not have fully operational integrated systems.”

The summary report calls for a national directory of accredited information on long term conditions linked to established care pathways.

Ideally this should be accredited using the forthcoming National Information Accreditation Scheme, now being tested by NICE and others.There should also be a range of ready to use templates that can be downloaded and tailored locally.

Mr King said: “The government intends to expand NHS Choices so that it has a directory of quality accredited information – a single sophisticated database covering all the long term conditions, linked to care pathways and accessible by users and health professionals.”

The first six LTC information packages on asthma, coronary heart disease, diabetes, dementia, depression and stroke are already on the website with more in their way.

The DH has also developed an online resource pack to support local implementation.

Mr King added: “The ideal plan is to create an IP generator that links to a national database and local systems. One of the ways it could work is through a package such as EMIS or Invision or, in social care, RIO.

“We would like to work with system providers to develop an inforamtion prescription module within existing care records systems. This would create a pop up screen that links to the national database and populates with information tailored to the patient.

“This could then be printed off or emailed to the patient.”

Talks were already underway with some GP system providers, he added.

Daloni Carlise

Reader's Comments

Joined up thinking NOT (sigh)

25 Aug 08 11:02

Anyone who remembers the ERDIP pilots of the NHSIA era will sense deja vu when reading the Evaluation of Information Prescriptions Interim Report to the Department of Health November 2007

Each pilot is built on diverse pre-existing local infrastructure - "sites adopted very different approaches".

The evaluation sites were self-selected.... >>Sites who applied to be an [Information Prescriptions] pilot tended to have an enthusiastic core team able to drive the project through.<<

A good proportion of these pilots seem to be running well while a significant minority struggle.

>>Some sites have found that the success of the project was overly reliant on the core team. Leadership from participating professional groups has proved useful, if not essential, but sometimes hard to come by. This issue has implications, in particular, for the sustainability of the project and for national roll-out.<<

Fascinating... success is 'overly reliant' on the ingredients of success %-)

Also >>An on-going task for pilots is identifying existing or forthcoming initiatives, policies and practice which either affect or could be linked with [Information Prescriptions].<<

From where we sit it's not a hard to identify NPfIT! Not so the DoH team on this project.. their report does not once refer to Connecting for Health, LSPs, NASPs or any CfH system supplier with the exception of Map of Medicine (with the latter's system receiving a decidedly mixed reception).

The National Library of Health is likewise unmentioned, despite repeated references to the challenges of identifying, cataloging and indexing information resources.

Do those working at the DoH even glance at the nameplate of the next office in the corridor? Even if intra-departmental collaboration is not built in from the outset, it would be comforting if those developing policy demonstrated a basic overview of this area - this is easily obtained from following media such as e-Health Insider or even mainstream coverage in the Guardian (for example). Meanwhile (still like ERDIP) save the early reviews to your hard drives before they disappear and watch ministers make the usual policy leap from "most opt in, small scale locally driven and designed Healthcare IT projects succeed" to "a centrally designed and mandated project will be a success."

Integrate Care?

25 Aug 08 11:56

"..Talks were already underway with some GP system providers, he added..."

Why are we only looking at GP system suppliers? This is a golden opportunity develop functionality to support the acute sector as well as primary care.

Information Prescriptions have been dispensed for some time now in the acute sector.

Product placement? Strategy?

26 Aug 08 17:58

Nice of Mr King to mention two GP Practice Systems Suppliers and one Social Care supplier - perhaps he should have added a caveat "other systems suppliers are available"?

Seriously - surely this example of silo thinking and a reversion to small scale pilots without regard to standards is the best example ever of why the DoH needs an Informatics Strategy (irrespective of CfH's place within that strategy)?

Once again, the DoH is losing the plot and allowing a thousand flowers to bloom in the absence of any direction from the centre. They need to decide whether their strategy is to promote ruthless standardisation, pursue an idealistic anarchist model of local autonomy or have the best of all Worlds and look for a third way.

These itsy-bitsy pilots are simply a distraction and will be overtaken by Web 2.0 developments in the private sector around the management of long term conditions within six to twelve months.

Where has pharmacy gone from the dispensing of information?

ralph.higson@healthscopeuk.com

26 Aug 08 22:08

Having read some of the final report I am particularly disappointed to see that there seems to be little emphasis on the use of pharmacists either in the Hospital or in the Primary Care Sector. Some of these scenarios I would have thought would have been ideal settings for patients to be given information prescriptions along with their medication whilst visiting their pharmacist either in hospital or on the High Street rather than making appointments to see other Healthcare professions. Or have I missed the whole point of the exercise.