NHS Scotland has laid out its priorities for improving pharmaceutical care across the country, with a new strategy document that places a high priority on new digital tools – including paperless prescriptions and increased automation and robotics.
The document aims to address the changing nature of pharmaceutical care, which in recent years has seen more emphasis placed on it as a primary point of care for patients, used to complement more traditional GP and hospital based services. This means that there is a need to increase the size of the workforce, as well as train up existing employees, as well as take advantage of new technologies to increase efficiencies and ease pressure on the system.
Scotland’s Chief Pharmaceutical Officer, Rose Marie Parr, outlines in the document that a key part of transforming pharmaceutical care is to develop a digitally enabled infrastructure. She said:
Since my appointment as Chief Pharmaceutical Officer in June 2015, one of my key objectives has been to build on the impetus for change in the content, quality and way in which we deliver NHS pharmaceutical care in Scotland.
The pharmacy team in NHS Scotland is an important part of the workforce with specialist skills and much needed expertise in medicines. We need to work together with the wider multidisciplinary health and social care team, to ensure that this specialist knowledge in medicines is utilised to best effect for the health and well-being of the people of Scotland.
Following engagement with a range of stakeholders over the last two years, and refreshing the Prescription for Excellence document, published in 2013, the purpose of this strategy is to present a revitalised focus on the priorities that will make improvements happen.
The strategy outlines the following seven actions that NHS Scotland will be taking to ensure that it has the appropriate digital capability to keep pace with the changing nature of pharmaceutical care.
Three boards in Scotland have implemented Hospital Electronic Prescribing and Administration systems (HEPMA). These boards have found that the systems have improved the quality of prescribing, reducing medicine information errors between primary and secondary care, and have reduced missed doses of medicines. NHS Scotland also believes that HEPMA can also offer the opportunity of much better insight into prescribing and other medicine related activities, through data analytics. The objective is that HEPMA will become the uniform standard across Scotland, and all NHS boards have plans in place to implement the systems.
• Electronic prescribing
The strategy outlines that there a number of clear benefits from the introduction of electronic transfer of prescriptions in primary care. Up until now, the ePharmacy programme in Scotland has focused primarily on underpinning GP prescribing activity, as this represents the vast majority of all activity. However, there are growing numbers of new prescribers in primary which would benefit from being enabled to use this ePharmacy infrastructure.
Furthermore, the strategy notes that there may be further benefits to be gained from an incremental move towards paperless prescribing across primary care. For example, it has the potential to improve productivity and efficiency by reducing the time consuming physical printing and signing of prescriptions. Also, NHS Scotland believes that a fully paperless service relying on technology only is less susceptible to most elements of fraud. However, the document notes that this wide-scale change will require new legislation and new IT functionality.
• Access to healthcare information
NHS Scotland notes that there are limitations around community pharmacist access to electronic information and records, such as the Emergency Care Summary, the Key Information Summary and Anticipatory Care Plans. A working group has been established to create a Scottish Code of Practice between Health Boards and GP practices to promote the safe sharing of information across boundaries in healthcare and within the multidisciplinary team, in accordance with the Data Protection Act.
Automation and robotics are increasingly being used within hospital and community pharmacy services in Scotland to dispense and distribute medicines, the strategy notes. This technology is “freeing time for pharmacists and pharmacy technicians to provide pharmaceutical care and reducing the risk of error”.
In addition, semi-automated medicine cabinets are beginning to be used in hospital wards and departments, freeing up time for nurses to care for people. The strategy notes:
We will continue to encourage hospitals to invest in these technologies. More recently, we have invested in deploying automation in a number of community pharmacies. Testing of robotics and scanning technologies is now underway to help us understand more about the economic impact of the technology as well as how it can enable innovative workforce development in community pharmacy by releasing time for clinical care. This work is being evaluated in order that the outcomes can be used to shape future service and policy direction.
• Digital integration
Scotland has a Digital Safer Medicines Programme, which has been formed to enable the improvement of use and sharing of medicines information and of medication-related processes between hospital, primary care and community pharmacy.
The focus of this, alongside the HEPMA systems, includes accurate medicines reconciliation at all transition points, improved quality of medication related information and access to medicines information which is integrated, shared in real time, updated and accessible to those who need it.
• Technology enabled care
The Scottish Centre for Telehealth and Telecare supports the development and expansion of technology-enabled health and social care services in Scotland. Many of its areas of work are relevant to pharmacy, according to the strategy document. These include supported self-management, video consulting and home and mobile health monitoring. The document states:
The development and use of technology enabled care will enable a greater reach into our local communities when delivering NHS pharmaceutical care, specifically to vulnerable people such as those who are housebound or the frail elderly. Access to pharmacy services and advice will be widened as a result, providing more equitable access to NHS pharmaceutical care and delivering improved outcomes for people from the use of medicines.”
More innovative ways of providing existing and new services through technology enabled care will continue to be developed, where due consideration will be given to health literacy and person-centredness in the approaches taken.
• Decision support tools
NHS Scotland believes that the wealth of routinely collected health and social care data used to understand better how the Scottish population use and respond to treatments is key to developing the clinical decision support tools that clinicians and the people they care for need to make the right treatment choices. It highlights health and social care apps as an opportunity, for example.
It notes that there are already examples of how pharmacists are using new digital tools to personalise medicine prescription to maximise health gain and minimise any unintended consequences from treatments. For instance, some pharmacists are using predictive analytic methods to quantify the association between exposure to different types of antimicrobials and the risk of developing a healthcare associated infection to populate a clinical decision support tool.
Plenty of good stuff in this strategy document. As pharmacies takes on a greater role in patient care to reduce the burden on other primary care bodies, it’s clear that efficiencies will be required and digital technologies are going to be key. However, as we know, nothing is easy when it comes to the NHS. The complexity of the organisation and the restrictions around data use make this incredibly complicated.
Image credit - Images free for commercial use