The following appeared a day or so ago. It is fair to say it caused me to almost ‘choke on the Wheaties’!
Toolkit to cut hospital errors
Karen Dearne | September 01, 2009
A TOOLKIT intended to reduce medication errors in hospitals is under development for the Australian Commission on Safety and Quality in Health Care.
KPMG has been awarded a $320,000 six-month contract to produce a uniform electronic medication management system that addresses issues around prescribing by doctors, dispensing by pharmacists and administration of drugs by nurses.
Commission project manager Neville Board said the work, in conjunction with the National E-Health Transition Authority, "will optimise the safety of systems" being introduced to hospitals.
"While hospital pharmacists have been using computer systems to manage inventories and dispensing for some years, there are few examples of e-prescribing and electronic medication management to date," he said.
"This project aims to do a lot of the complex work -- developing tools to assess available systems and building up planning skills and resources -- so we can offer a robust, adaptable toolkit, rather than having each hospital start from scratch."
KPMG and Trilogy Information Systems will also design "an optimal e-prescribing screen" for users, based on the National Inpatient Medication Chart. The work is due for completion by next January.
More here:
http://www.australianit.news.com.au/story/0,24897,26007658-5013040,00.html
If I read what is said correctly the money is to be spent to ‘develop a toolkit’ to optimise the safety of medication management systems for hospitals who are introducing them.
The rationale for all this seems to be here:
Safe ePrescribing and Electronic Medication Management
There is a need for a comprehensive, best-practice standard set of safe procurement and implementation guidelines for facilities and Areas or states moving toward ePrescribing and electronic medication management (EMM). It is assumed and supported that electronic prescribing in hospitals can improve safety and quality. At the same time, there is potential to increase harm through poorly designed or implemented systems in hospitals.
It is important that tools are developed to ensure that EMM systems are implemented safely, and that their use optimises both safety and quality of care in the hospital environment. This work is a collaboration between National E-Health Transition Authority (NEHTA) and the Commission.
The Commission will be developing the following guidelines:
- User requirements and procurement guide for hospital ePrescribing and electronic medication management (EMM) systems;
- An implementation toolkit for ePrescribing and EMM in hospitals, including safe ePrescribing and EMM practice;
Consideration is also being given to the development of a standard optimal user interface which builds on the National Inpatient Medication Chart, as well as the national standard terms, abbreviations and units.
Contact:
Neville Board, Information Strategy Manager
(02) 9263 3587
Email: mail@safetyandquality.gov.au
The page is here:
What amazes me with this is that a consulting firm and a system developer – both with no apparent experience in the implementation of Clinical Physician Order Entry and Medication Management – including ‘closing the loop’ medication reconciliation systems is doing this work, rather than the experts from companies like Hatrix,(iSoft) and Cerner who already have years of experience in getting these systems right all over the world and who are already putting systems into operation in a number of States.
If the job was to work with current providers to optimise their implementations, this would be better done using clinical experts working with the system providers, not non clinical consultants.
I have absolutely no quibble with the need to do things properly and safely, but I thought that was what we paid the expert implementers to do, working with local clinical staff. I really wonder if we have the right parties in the room to optimise our outcomes for all.
I wonder what the evidence for electronic medication management being done badly is that has prompted this work. It is not clear to me, from the ACSQHC site, although I am aware there is old literature suggesting some early approaches were less than ideal. Readers of the blog will be aware that a publication developed by this same organisation was very badly flawed in an evidentiary and peer review sense.
See here – first topic.
http://aushealthit.blogspot.com/2009/08/useful-and-interesting-health-it-news_23.html
On this topic we actually have a National Prescribing Service which has a deep interest and understanding of this area (they have done great work with GP prescribing systems). I wonder why they are not working with the ACSQHC to establish what, if anything, is needed, and how it might be best delivered?
One also wonders where Standards Australia and IT-014-6-4 fit? There are a few experts there too!
Prescription Messaging
E.scripts will touch more Australians, more often, than any other clinical application
More here:
http://www.e-health.standards.org.au/cat.asp?catid=46
Also who knows if there is any interaction eRX and MediSecure? Given it is a hospital based initiative probably not I would guess.
Overall, yet again lack for coherent governance for e-Health in Australia is having all sorts of miscellaneous projects thrown up without the right levels of co-ordination in my view. At the very least I would hope the project has a steering committee which has the NPS, relevant vendors, some appropriate expert clinicians and NEHTA on it to ensure time and money are not wasted.
Note that NEHTA does have a work program on e-Medication. See here:
http://www.nehta.gov.au/e-communications-in-practice/emedication-management
But there is not a new document published in the area on their website since 22/08/2006. Clearly this is an area of very high priority!
Without all these parties close to what is being done an impractical fiasco would seem to be a real risk.
David.
19 comments:
It will be a fiasco of untold proportions except for one mitigating factor - MediSecure is aligned with the Doctors through the RACGP and it is in everyone's interest that the College does whatever it can to raise the bar and drive ehealth standards around e.scripts into place to the highest level possible. Through the College the doctors have the power to lead the way and the pharmacists have the option to toe the line or suffer the consequences under the new 5th CPA.
You highlight the fact that experts are not being used and in doing so you suggest Hatrix, Cerner, iSoft as possible sources for such expertise including Standards Australia. Your observation is well founded; however it is both correct and flawed. It all depends on which vantage point one views the problem from.
It is flawed from the perspective of those currently in charge continuing to lead the way - be that NEHTA, or DOHA or any of the many Ministerial Advisory bodies and Commissions who pontificate long and loud on ehealth. They themselves lack practical coalface experience in healthIT and hence the necessary insight and strategic thinking required to address the issues creatively. So, they perpetuate the old way of doing things and look where that has led.
On the other hand the correctness of your stance is crystallized so beautifully in the pragmatically simple and perfectly accurate statement “E.scripts will touch more Australians, more often, than any other clinical application”.
This seductively simple statement coined by a pragmatic expert health informatician with decades of experience at the coalface, is sadly one who, like so many other experts, cannot be heard because those in charge do not want to hear.
It means therefore that it is an exercise in futility to hope that attitudes will change significantly to allow the experts to be heard. It means too that industry entrepreneurs like Hatrix must be courageous enough to step up to the plate, accept the risks, and develop solutions to meet the market’s needs unfettered by bureaucratic constraints and idiosyncrasies. In doing so, some will fall along the way and others will grow and prosper. Then and only then will the deaf listen and the experts be heard.
Your commentator above Wednesday, September 02, 2009 10:09:00 PM referred to Medisecure and the RACGP. That is but one view. A similar view applies equally well to the eRx Script Exchange and the Pharmacy Guild. It's important to be balanced and objective.
Well said sir and may I be permitted to add that if in the process some of those experts referred to are able to coalesce and be successful together they deserve to share the rewards of their risk taking endeavours and Government should be willing to pay their price - all power to them.
Your readers should know that in recent years the Guild has done a great deal to “raise the bar” by working closely with government to improve the quality, consistency and accuracy of medication management and compliance and contributed greatly to containing costs to the PBS. These are major achievements soundly acknowledged by government. The Guild's investment in the eRx Script Exchange is another example of being prepared to share the risks and help government deliver its agenda for reform in primary care through the deployment of escripts. There will be “no fiasco of untold proportions”, you are quite wrong about that and well you and your readers know it because the Guild will work closely with government to make certain that does not happen, it has the resources, the power and the commitment that is evident to all. It is to be hoped the doctors will do the same.
Dear commentators -’ Wednesday, September 02, 2009 10:09:00 PM and Thursday, September 03, 2009 10:39:00 AM it seems to me the jury is out on which party has the ‘power’ to ‘lead the way
Whilst the government inherently has the power the horses have well and truly bolted. Anything government now tries to do to claw back the power will be futile and more importantly destructive of the private sector entities.
By that I mean, destructive to the entrepreneurial flair and fervour of those who have invested the time and effort and taken the commercial risk to do progress ehealth in the face of persistent incompetence by government.
It would be immoral for government to try to claw back lost ground. That doesn’t mean it won’t try, but if it does all it would achieve is disruption of current private sector initiatives and destruction of the entrepreneurial spirit so badly needed by this great country of ours.
So government must now go-with-the-flow. But as the rivers diverge which one will be the safest and the most navigable?
I have grave doubts the Guild’s river will be navigable. I came to this conclusion after reading an article in Australian Doctor this week By Mr Kos Sclavos, president of the Pharmacy Guild. One could be forgiven for thinking the Guild’s President has developed a complex. Have a look at what he wrote:
………. “IN the four years that I have been national president of the Pharmacy Guild, no doctors' organisation has supported any expanded professional role for pharmacists.
All have rejected pharmacists undertaking medical certificates. They have rejected changes to emergency supply. They have rejected medication continuance. They have rejected Pharmacist Only Medicines Notifiable; rejected the Minor Ailments Scheme; rejected pharmacists undertaking vaccinations.
Add to that the rejection of any form of prescribing, including specific pharmacotherapy medicines. Others in pharmacy have made the quantum leap call for MBS rights for pharmacists, yet even the Guild's incremental change proposals have no support.
What a waste of talent it is having pharmacists who have undertaken a minimum of four years of training at the university level and have studied more about the therapeutic impact of medicines than doctors. With all that rejection, it is a wonder pharmacists have not developed a complex.”
Well someone certainly has developed a complex. And it’s not hard to see who. Amen to that.
And with a complex like that he has to navigate his boat through uncharted waters along a river full of hazards and mines. I have grave doubts that the Guild’s river will be navigable.
David,
The Medications team at NEHTA has developed an excellent technical model for ETP, consulting extensively as much as they could with eRx and Medisecure, et al. Since the task of creating the technical documents is my responsibility, I will confirm that NEHTA's engagement with this sector has included people like Hatrix etc.
And the model is not on the NEHTA Website why?
David
For a good discussion on how to properly approach the implementation of Medication Ordering and Management this is a good start.
For All the Right Reasons
Approaching CPOE from a patient safety and care quality perspective is the first critical step toward success by Mark Hagland
See here:
http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=F04426E7C1814945A2CA25AC5B5CFC94
David
David, it is good to know, is it not, that NEHTA has been engaging with Hatrix, Medisecure, eRx, et al? It is also good to know, is it not, that the technical model for ETP is excellent? Finally it is good to know, is it not, that someone has accepted responsibility for creating the technical documents?
Yes, but why is what they are doing a secret?
NEHTA says they HAVE developed! Not are developing!
David.
The English language is very precise, sadly ‘thems that speaks it often aren’t’ (sic). There is a big difference between ‘have developed’, ‘are developing’, and ‘plan to develop’. Oh would that it were not so saith he.
Seems to me this is where the rubber hits the road? For example, the above is all well and good, reassuring maybe, but given NEHTA’s performance over the last few years, its consistent reluctance to engage with industry, its totally non-transparent modus operandi would it not be reasonable to ask: What does the above really mean?
Are you permitted to drill down a little deeper to understand the specifics or would that be wishful thinking?
For example:
1. who comprises the “et al” cohort?
2. what are the stages of and deliverable timelines for the “technical documents”?
3. do the parties [Hatrix, Medisecure, eRx and the et al cohort] have the right to approve, accept and physically and unanimously sign-off on the “technical documents” before they become industry-approved credible documents?
4. what is the architecture and specific objectives of the ETP technical model?
5. how advanced is the ETP technical model? Is it at concept stage, has it been designed in detail, in short - where is it at?
Answers to the above should probably satisfy most skeptics and not infringe any individual party’s rights in that regard.
Does all that seem reasonable?
Like all secrets - it's because they don't want anyone to know.
The project your have referenced would seem to be pretty much in accordance with the AHMC approved Five Year Work Plan to 2010/11 for the Safety and Quality in Health Care Commission. The 5 year plan outlined the main focus of the Commission’s work in 9 priority programs.
Program 8 Managing and Building on Existing Projects has a secondary level
8.7 National Inpatient Medication Chart – and further development.
Three items for action are:
1. Develop, maintain and assist national enforcement of a common national inpatient medication chart
2. Remove risks to patient health caused by transcription errors, by ensuring prescription information is automatically registered as both a PBS prescription and an entry on the inpatient medication chart
3. Advocate for the adoption of electronic prescribing with decision support (EPDS) across health care settings.
I don't read anything in those points that says they should try and second guess the system implementers and local clinicians by having external third parties developing toolkits on how to implement such systems.
David.
Continuing the points from the ones posted on Thursday:
6. What does ETP mean? Why do we need another TLA (Three Letter Acronym)? Aren't existing description adequate?
ETP is Electronic Transfer of Prescriptions. Initialisms and acronyms are part of the landscape and there's no point in fighting it. I didn't know what ETP was either, but it wasn't difficult to find in google: "ETP prescribing". (There's almost always a context word to help locate the correct term.) That doesn't mean that we shouldn't be careful about expanding them in our own communication. Just be prepared to write the ones down you don't know as you come across them and look them up when you can.
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