Why Does This Sort of Silliness Keep Happening?

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:

http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-08_ePrescribing

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

Replacing the simple printing of prescriptions with E.scripts involves the formulation of a prescription, supported by a relevant Clinical Decision Support System (CDS), and secure transmission of the prescription to the pharmacist, who then dispenses to the patient using associated software for data collection and reporting mechanisms.

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.