Conceptualising and developing a
business case for HePMA systems
Round table discussion
Professor Aziz Sheikh
The University of
Birmingham
24th September 2012
NIHR Programme Grant for Applied Research
Overview
 Hospital ePrescribing and
Medicines Administration
(HePMA) systems
 Outline of our programme of
work
 Structure, organisation and aims
of the workshop
NIHR Programme Grant for Applied Research
HePMA systems
“The utilisation of electronic systems to facilitate and enhance the
communication of a prescription or medicine order, aiding the choice,
administration and supply of a medicine through knowledge and
decision support and providing a robust audit trail for the entire
medicines use process” (NHS Connecting for Health)
Anticipated benefits: patient safety, clinician benefits, service
benefits
NIHR Programme Grant for Applied Research
Investigating the implementation of
ePrescribing systems into NHS hospitals
Aims:
 To describe and understand the procurement,
implementation, adoption and maintenance processes
involved with introducing ePrescribing systems.
 To estimate their effectiveness and cost-effectiveness.
 To develop best practice recommendations and a
toolkit for their successful integration into NHS
hospitals.
NIHR Programme Grant for Applied Research
Our research team
Prof Aziz Sheikh
Prof Robin Williams
Prof Jill Schofield
Zoe Morrison
Dr Jamie Coleman
Antony Chuter
Prof Richard Lilford
Dr Jonathan Shapiro
Dr Kathrin Cresswell
Dr Lily Yao
Dr Ann Robertson
Prof Anthony Avery
Dr Sarah P Slight
Ann Slee
NIHR Programme Grant for Applied Research
Prof David W Bates
Four Work Packages (WPs)
Work package 1
Procurement, implementation, adoption and connectivity
Documentary data, semi-structured interviews, on-site observations, field notes ethnography
Work package 2
Assessing impact on prescribing safety
Stepped-wedge design evaluation with 6&12 months follow-up analyses
of prescribing indicators
Work package 3
Health economics and a value of investment analysis
Estimation of costs (including opportunity costs) of computer systems
of different types; framework for cost categories
Work package 4
Integration across WPs to develop recommendations and a toolkit for the NHS
Interlink the qualitative and quantitative components;
develop a detailed typology of existing systems and their capabilities
NIHR Programme Grant for Applied Research
Patient and
public
involveme
nt
Lots of national interest and planning…
Questionnaires distributed
108
Yes (n=85)
re
Returned (representing
No (n=23)
55 Trusts)
Implementation
plans
Already
implemented
(10 Trusts,
18%)
Currently
implementing
(11 Trusts,
20%)
Planning to
implement/pr
ocuring (30
Trusts, 55%)
NIHR Programme Grant for Applied Research
No current
plans of
implementing
(4 Trusts, 7%)
Increasing range of system
choice…
NIHR Programme Grant for Applied Research
But…
 Relatively limited expertise within individual hospitals
 With the demise of NHS CFH, little in the way of central
guidance, standards or support
NIHR Programme Grant for Applied Research
Need for opportunities for sharing
ideas/experiences/insights
 “In my journey so far it is very important to determine a
clear set of criteria which all systems must comply with.
This is a huge problem.”
 “Need a clear criteria of functionality this is a must and
which is evidence based.”
NIHR Programme Grant for Applied Research
Systems choice
“…one of the problems when you’re assessing a system is there’ll be
systems that have been around for 4 or 5 years, there’s the one that’s
relatively current and there’s the new kid on the block. The ones that
have been around for a long time are based on relatively old
code…old versions of Windows so just look a little bit clunky, the
ones that have been around a couple of years just look swishier…and
the ones that are out there you’re not confident that they’re not
going to go bankrupt in the next couple of years…”
NIHR Programme Grant for Applied Research
Conceptualisation
Assessing local requirements, homework (looking at systems and understanding/re-designing processes),
anticipated benefits, drivers and the underlying evidence base
Project initiation
Establishing a project team, engagement of stakeholders, securing high-level support
Functional specification
Existing range of suppliers and systems, product specification and functionality
Drafting a business case
Process/templates, risks, resources, overview of systems/suppliers, site visits, networking
Procurement/tendering
Process, scoring, engaging suppliers
System choice
Based on needs and available options, analysis of bidders
Contracting
Process, dividing responsibilities, awarding the contract, contract negotiations
Pre-implementation
Training, piloting, work process mapping, IT requirements (infrastructure, interfacing, software, hardware),
continued engagement, configuration and testing, data migration, back-up systems, process management,
implementation strategy and roadmap, champions
Relationship with suppliers, initial support, timelines and transition to BAU
Implementation
Maintenance
Upgrading, on-going support, dealing with workarounds, continuing
development and customisation, change in role of project team
Impact
Benefits realisation, investment analysis
System optimisation
Evaluation
On-going development
Progress reports, lessons learned and sharing of experiences,
benchmarking, data quality monitoring, reporting, risk registers, critical
incidence reports and analysis
E.g. Trusts upgrading to another system
Aims of today’s workshop
 Facilitate open discussion regarding
the development of business cases
from the perspective of different
stakeholders
 Support sharing of experiences and
networking
NIHR Programme Grant for Applied Research
Structure of the workshop
Moderators: Jamie Coleman and Ann Slee
PART 1: Conceptualisation and project initiation
12.30-1.30
Lunch and networking
PART 2: Functional specification and drafting a business case
Group work in breakout sessions followed by feedback to all
NIHR Programme Grant for Applied Research
Organisation of this workshop
 Information and consent
 Anonymity assured, recording preferred
 Kathrin and Rosemary for logistical
questions
 Suggestion sheets for anonymous
feedback
 Evaluation at end of the day
 Summary report will be circulated to
participants for comments
NIHR Programme Grant for Applied Research
Next steps
We want your ideas for
 Conferences
 Workshops
 Round table discussions…
NIHR Programme Grant for Applied Research
Further sources of information
and support…
Our website:
www.chs.med.ed.ac.uk/projects/eprescribing
For copies of presentations, events and updates
NIHR Programme Grant for Applied Research
Date for your diary…
NIHR Programme Grant for Applied Research