Bob Sugden

1
ETP ERDIP ICRS? Experience of the Evaluation
of ETP Pilots

• Bob Sugden
• Centre for Software ReliabilityUniversity of
  NewcastleBob.Sugden_at_ncl.ac.uk

Rob Wilson Centre for Social and Business
InformaticsUniversity of Newcastle
Rob.Wilson_at_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
2
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

3
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

4
ETP - Stakeholders
5
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

6
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

7
ETP Message Volumes
8
ETP Message Models
9
Pre-ETP - Current Prescribing Process
GPprocess
Adminprocess
Acute
Repeat
Patientpresent
Patientabsent
Check EPR
Rx Choice
Update EPR
Update EPR
Query Resolution by GP
Print
Print
Query Handlingby Admin.
Signed by GP
Signed by GP
Issued
Issued
Dispensed
10
Post-ETP - Prescribing Process
Adminprocess
GPprocess
GPprocess
Acute
Repeat
Patientpresent
Patientabsent
Check EPR
Rx Choice
Update EPR
Update EPR
Query Resolution by GP
Print
Print
Query Handlingby Admin.
Signed by GP
Signed by GP
Issued
Issued
Dispensed
11
ETP - Evaluation Learning Points

• Political imperative to implement (50 ETP target
  by 2005)
• DONT PANIC! - be realistic about the
  difficulties, timescale and cost
• Numerous stakeholder sensitivities
• be clear about the objectives and how they will
  satisfy the stakeholders
• Structure, time, finance, and incentive to learn
  from evaluation -
• be prepared to spend time money learning from
  rectifying mistakes
• Technology can deliver
• but make sure the problem(s) are understood
  before building solution(s)
• And finally - a fruity theory of system
  evaluation

12
Pilots Always Bear Fruit

• Oh its all gone shaped!!
• Evaluating a
• when you thought it was a