ETP + ERDIP = ICRS?
Experience of the
Evaluation of
ETP Pilots
Bob Sugden
Centre for Software
Reliability
University of Newcastle
Bob.Sugden@ncl.ac.uk
Rob Wilson
Centre for Social and
Business Informatics
University of Newcastle
Rob.Wilson@ncl.ac.uk
The work described here was carried out by the authors together with a consortium led by the
Sowerby Centre for Health Informatics at Newcastle, including the School of Pharmacy and
Pharmaceutical Sciences (University of Manchester); the Industrial Statistics Research Unit
(University of Newcastle) and QinetiQ
ETP - Terminology
Electronic Transmission of Prescriptions (ETP)
(aka National Prescription Service)
will be supported in Phase 2 (2006-8) of
the Integrated Care Record Service (ICRS)
or NHS Care Records Service (NCRS)
(formerly known as the Electronic Health Record)
N.B. Use of electronic means to prepare and issue paper
prescriptions is widespread in UK general practice
ETP – Context of Pilots
ETP was piloted and evaluated in England in 2002
The Department of Health commissioned:
- three ETP pilots
- in three different health areas
- using three different business models
- privately financed by private consortia:
Flexiscript, Pharmacy2U, and TransScript
ETP - Stakeholders
ETP – Evaluation Literature
Although there is a considerable body of literature
on electronic prescribing, few refer to electronic
transmission from GP to pharmacy, and none to
transmission to a body such as the NHS
Prescription Pricing Authority (PPA)
Studies from the USA and Denmark suggest that
ETP confers benefits for GPs, pharmacists, and
patients, making the whole dispensing process
less time-consuming
ETP – Context of Evaluation
The evaluation was intended to:
• explore the socio-technical context
• assess the change management issues
inherent in introducing ETP to general
practices, pharmacies and patients
• develop technical standards
The evaluation was planned as a formative
exercise to run in tandem with the pilots…
ETP – Message Volumes
Pharmacy2U
Flexiscript
TransScript
9,000
8,000
7,000
Messages
6,000
5,000
4,000
3,000
2,000
1,000
0
March 02 to Feb 03
ETP – Message Models
Pre-ETP - Current Prescribing Process
Acute
Rx
Choice
Update
EPR
GP
process
Patient
present
Admin
process
Patient
absent
Query
Resolution
by GP
Print
Signed
by GP
Repeat
Check
EPR
Update
EPR
Print
Query
Handling
by Admin.
Issued
Signed
by GP
Issued
Dispensed
Post-ETP - Prescribing Process
Acute
Rx
Choice
Update
EPR
GP
process
Patient
present
Admin
GP
process process
Patient
absent
Query
Resolution
by GP
[Print]
Signed
by GP
Repeat
Check
EPR
Update
EPR
[Print]
Query
Handling
by Admin.
Issued
Signed
by GP
Issued
Dispensed
ETP - Evaluation Learning Points
1. Political imperative to implement (50% ETP target by 2005) –
DON’T PANIC! - be realistic about the difficulties, timescale and cost
2. Numerous stakeholder sensitivities –
be clear about the objectives and how they will satisfy the stakeholders
3. Structure, time, finance, and incentive to learn from evaluation be prepared to spend time & money learning from & rectifying mistakes
4. Technology can deliver –
but make sure the problem(s) are understood before building solution(s)
5. And finally - a fruity theory of system evaluation…
Pilots Always Bear Fruit
Oh **** its all gone
shaped!!
Evaluating a
…when you thought it was a