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An Irish 1st for ePrescribing!


Barcode pilot goes live in Mallow with McLernons' MPS and CompleteGP

Mallow is now the e-centre of Ireland – at least as far as the Electronic Transmission of Prescriptions (ETP) goes – for it is where a prescription generated by a GP system was sent into the cloud and retrieved in a community pharmacy.


Keith McLernon, McLernons, Carl Beame, CompleteGP, and Peter Weedle, Mallow


 

 

 

This pilot, involving CompleteGP and McLernon Computer’s software systems and the Health Hub, University College Cork, went live at the beginning of October and there are now plans to extend its remit around north Cork and thereafter countywide.


What is e-Prescribing?

There are as many definitions of ‘e-prescribing’ as there are words for snow in Inuit – everything from the elaborate, highly convoluted system envisaged by the NHS in England, involving a central ‘spine’ and numerous interfaces (it failed!) to a simple barcode on a prescription (which worked in Northern Ireland).

The Mallow project is somewhere in the middle of this continuum, based on the development experiences of McLernons in the EPES (Electronic Prescription Eligibility System) in the North, with the key focus on the fact that it is patient-driven. In the North of Ireland, all GP systems had the potential to be fitted with a decoder, a ‘black box’, which was inserted between the GP’s computer system, and the printer. This could interpret the data contained within the prescription and printed a 2D barcode on the form which contained the text data in a form that could be scanned into a computer using a specific 2D barcode scanner.

The prescription with the 2D barcode can be scanned in the community pharmacy and the MPS pharmacy system and the patient’s history automatically populated with this new information, subject at all times to the pharmacist being able to intervene as they normally would for drug doses, drug-drug interactions etc.

 

Peter Weedle, a community pharmacist with branches on the Main Street and Townview in Mallow, who uses McLernon Computer’s MPS dispensing system, is at one end of the equation and Dr David Molony in the Mallow Primary Healthcare Centre who uses the CompleteGP software is at the other. Following extensive testing patients common to both practices have had their prescriptions transferred electronically through a central server.

So how does the Mallow pilot differ?

Carl Beame and John Dootson, the chief software developers for the CompleteGP and McLernon Pharmacy systems, got together to review existing methods of e-prescribing and to develop one that would work in Ireland without having to go through all the administrative and financial constraints that normally apply in this area. They sought to develop a system that would work without imposing a significant burden on the GP or the pharmacist. In addition, they wanted to develop a system that would not require a massive infrastructure development, which could have delayed implementation for years whilst waiting on Government approval for this level of investment. What they identified was a method that HIQA sub-sequentially recommended as part of their standards.

However, of utmost importance was the need to be cognisant of the time pressures experienced by both GPs and community pharmacists and it was essential that any proposal did not increase their workload either by one second or by one keystroke!

In Dr Molony’s surgery, the data on each prescription for each individual item is automatically coded and sent to a central computer server, accompanied by a unique code or ‘unlock’ key. The prescription is fully encrypted during the transmission and storage on the central server.

When the prescription is printed, the printer also produces this unique key on the prescription form in the form of a single line barcode. This is automatically generated in the GP’s consulting room by the physician, or in another part of the surgery by the practice nurse or receptionist. It is important to note that it is still the same prescription that is normally produced, except it has the computer unlock code in the form of a single-line barcode.

The data, together with the code, are sent to the cloud and the prescription paper (which is still the legal document) is given to the patient or their carer. As the code is generated locally and not by a central system there is no delay in printing the prescription.

Patient-controlled

At all times, control over the destination of the prescription remains with the patient. Nothing happens to the information until such time as they present the physical prescription in the community pharmacy of their choice.

At that point, the prescription’s linear barcode is scanned in the dispensary and the unique code allows the prescription information to be retrieved from the cloud, and is automatically populated into the dispensing system.

 

 

It is important to stress that responsibility for the dispensing of the correct medicine to the right patient remains, as before, with the pharmacist, and they still have to carry out the various safety checks that they would normally carry out, as well as exercise their own professional judgement as to whether or not the prescription should be filled in whole, in part or not at all.


Commenting on the initial trials Professor Weedle said that it was important that the service be patient directed, to ensure that the patient chooses the GP and the pharmacist they wish to attend. He emphasised that this is a 'pull' system and not a 'push' system (where the GP makes the decision, or can influence the decision, as to where the prescription goes). In the CompleteGP/MPS system the patient decides by either presenting the prescription at the pharmacy of their choice (i.e. the pharmacy can then pull the prescription electronically) or the patient can (using their smartphone) send the prescription in advance to the pharmacy (a patient push system). In all cases these prescriptions can still be dispensed in the conventional way.

The system is also fully legally compliant as the patient will still have to present the original prescription paper at the pharmacy before the medicines are finallydispensed to them.

 

 

By having automatic population of the prescription data in the patient’s history in the pharmacy system an additional safeguard against transcribing errors has been given to the pharmacist to better serve the patient.

The time saved in not having to key in the prescription data can be used by the pharmacist in other ways – most notably interacting with the patient and delivering high quality pharmaceutical care. Something that is in line with Minister Varadkar’s recent introduction of new pharmacy services!

Furthermore, the ability for the patient to send the prescription to the pharmacy in advance allows the pharmacist time to prepare the medicines, or obtain them if it is not in stock, so that the patient doesn’t have to waste time queuing or waiting in the pharmacy. This allows the pharmacist more time to decide what counselling points they wish to highlight to the patient when they present at the pharmacy.

This pilot demonstrates an electronic transfer of prescriptions that is truly designed with patients in mind!