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.  

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