Improving the prescription process in hospitals by prioritising user needs
We are gathering evidence about user needs to find the risks, challenges and opportunities of electronic prescribing – and how it could help health boards and NHS Trusts save money – based on real-time user feedback and experience
30 November 2022
We are working with Digital Health and Care Wales on two parts of the Digital Medicines Transformation Portfolio (DMTP). One of the pieces of work we’re supporting is related to ‘secondary care’. It involves CDPS and DMTP working together with health boards and NHS Trusts to improve the way medicine is prescribed in Welsh hospitals.
Right now, a significant amount of the process is paper-based, but it will soon be moving towards a digital system. This system is known as electronic prescribing and medicines administration (ePMA). This work is a key part of the DMTP. It aims to make the prescribing, dispensing and administration of medicines everywhere in Wales easier, safer, more efficient and effective.
The healthcare context in Welsh hospitals
Hospital-based healthcare professionals transcribe, prescribe, dispense, administer and manage medicine on a daily basis.
The purpose of this process is to:
- deliver the right medicine
- for the right patient
- at the right time
- in the right way
Much of England and Scotland’s health services have already digitised their medicines prescribing processes. There are examples of electronic prescribing in Wales, such as in Swansea Bay University Health Board and for chemotherapy in the cancer centres. However, prescribing medicines in hospitals is still largely paper-based.
The importance of discovery
Health boards and NHS Trusts in Wales are expected to move from the traditional paper-based system to an electronic-based system as quickly as it is safe to do so. They will be procuring new digital systems as part of this change. Many processes, tasks and roles will potentially need to change as well.
This business change to ePMA presents new opportunities to improve patient safety and the experience for patients and clinicians. But there are also several factors health boards and trusts need to consider before they start transforming their medicines prescribing processes, including:
- existing systems and processes
- user journeys, such as daily routines of their staff
- user needs
- potential barriers and drawbacks, such as
- digital maturity skills
- supporting infrastructures such as wifi and hardware
Research goals
- Gather evidence about the context, challenges and opportunities of implementing an ePMA.
- Understand the needs and views of our users around electronic prescribing.
- Understand if our findings, evidence or support will still apply widely and be useful to all, even if they are derived from fewer sites.
How we’ll do it
“Understanding users in terms of their whole experience of a technology, especially how they make sense of it in the context of use, by considering the emotional, intellectual, and sensual aspects of their interactions with technology… the importance of understanding how people do not just use technology, but that they also live with it.”
Research in The Wild, Rogers (2017)
When we conduct user research at CDPS, we don’t look to capture opinions. Instead, we listen to people to understand the barriers they face in their own context.
For the secondary care discovery, we have planned two rounds of onsite visits at Cardiff and Vale University Health Board, Swansea Bay University Health Board and Hywel Dda University Health Board. This is so we can observe, shadow and interview all our users in a real-life hospital setting – from their first step, all the way through to them completing the task they set out to do.
By observing and testing processes and scenarios in person, we hope to spot opportunities for improvements to new digital solutions and services, based on real-time user feedback and experience.
Who we’ll speak to
When we say ‘user’ we really mean everyone that has any sort of touch point and impact on the end outcome.
This includes people who:
- need medicine
- transcribe medicine charts and prescriptions
- prescribe medicine
- dispense medicine
- administer medicine
- manage medicine
- move and store medicine
- oversee the discharge of patients
- create and send hospital discharge advice letters
- manage computers and infrastructure
- develop policy and guidance
This looks like a long and exhausting list. However, if we can cover every possible scenario and process, how much time and money will this save each health board when they come to procure a new digital prescribing system?
Next steps
We will be blogging about our user research as we go – holding up the mirror to health boards and trusts and being open and transparent about what we find.
It will be a 16-week user-centred discovery. In that time, we hope to find out the risks, challenges and opportunities for electronic prescribing.
The on-site visits coming up will be vitally important for us to gain a real understanding of what is happening on the ground in our hospitals. We look forward to sharing what we find with you soon.
Find out more about DMTP by signing up for the newsletter
Sign up for the CDPS newsletter – Centre for Digital Public Services
You are researching challenges…
It’s essential to understand user needs of course, but dependable electronic prescribing depends for its success on the digital systems working reliably, and depends on staff (including incident investigators) understanding technical details. Cybersecurity is the least of the possible problems.
I’ve been an expert witness in NHS cases where the hospital and prosecutors did not understand any technical details, and did not understand the failings of the digital systems. They suspended and prosecuted nurses. The trials collapsed as I was able to interpret managerial and technical failings in healthcare. These foundational problems continue – as these court cases and confidential NHS investigations attest. There are also international cases, such as Ra Donda Vaught’s/Charlene Murphy’s very unfortunate experience with poorly designed and managed dispensing machines, and the lack of just culture that followed from digital ignorance. Worryingly, many digital systems do not provide reliable electronic evidence in the event of legal proceedings, and this collides with the English/Welsh situation that, as a matter of law, digital systems are presumed to have been working correctly unless there is evidence to the contrary – and defendants are unable to provide that evidence to the contrary (the Post Office Horizon is a well-known case in point, where faulty digital led to the prosecutions of 100s of people, and which have now been exonerated by the Court of Appeal).
Safe and secure electronic prescribing, including accurate and usefully insightful investigations as and where necessary, requires a higher level of technical skill than I have so far encountered at scale.
I would humbly suggest you need to add the following stakeholders to your research:
– human factors experts
– human computer interaction experts
– cybersecurity experts
– software engineering experts
Thimbleby’s book Fix IT: See And Solve The Problems Of Digital Healthcare covers all of these topics. The BMA says it is an important book that should be read by all healthcare staff.
The ePrescribing Toolkit (https://www.eprescribingtoolkit.com/) provides insight into multiple implementations of various systems within England.
It summarises and cross references some of the key research that has underpinned the benefits of ePrescribing (including the seminal NIHR research that indicated a 50% reduction in medication error) and highlights ‘lessons learned’ at various stages of the process.
I would recommend it to you.