Last September the NHS’s flagship IT project was finally allowed to sink into the Davy Jones locker of the last government’s IT failures, after warnings from Private Eye , the BMA, and even contractors associated with it. It cost over £12 billion. Even now, some companies may be sucked into the depths with it.
NHS Trusts are now allowed to develop and purchase their own IT infrastructure, allowing for some competition from providers. Not all of these systems will be as successful as each other, but it is to be hoped that most are. At the very worst this mechanism will allow the best systems to survive and propagate, and spread the risk of failure. Having a state funded monopoly on IT using contractors always seemed a prescription for failure. What were the incentives to succeed?
Talking of prescriptions, the development of electronic prescribing systems within the NHS hospital sector does continue regardless. Currently a majority of NHS hospitals continue to use paper based prescribing systems, with all the risks of illegibility and slips and lapses such free reign provides to prescribers. NHS Trusts are contracting different suppliers for the provision of prescribing systems, in much the same way primary care was allowed to develop such systems (perhaps something that should have been learnt earlier).
In any case, what are the benefits of electronic prescribing? A new paper examining the introduction of two commercial electronic prescribing systems in two Australian teaching hospitals sheds some additional light on this.
Westbrook et al performed a before and after medication chart audit of 3,291 admissions at two hospitals. They examined 1,923 prescriptions prior to the introduction to electronic prescribing, and 1,368 following its introduction. This appears to have been a well conducted real-world study, with errors classified into procedural errors, system-related errors, and a severity assessment for the potential of the error to cause harm.
In total there were 11,168 prescribing errors in the 1,923 admissions prior to prescribing – no surprise to any clinical pharmacist. Both commercial e-prescribing systems reduced prescribing error rates by over 55% at both hospitals, despite some differences between the systems and cultures of the hospitals concerned. With regard to serious errors comparison of control wards in one of the hospitals showed a 44% serious error rate reduction with electronic prescribing. Large declines occurred in unclear, incomplete, and legal/procedural prescriptions. There was also some evidence of benefit of electronic decision support, with reductions in duplicate prescriptions.
Electronic prescribing also brings new system errors, which in this study manifested as new clinical errors. It was this propensity to produce new patterns of errors that led to a failure to demonstrate a reduction in overall clinical error rates (otherwise the reduction of clinical errors rates would have been significant). System errors varied with the system and hospital procedures. The authors contend that these errors could be designed or “tweaked” out of the systems, or by increasing training for prescribers. This study illustrates both the benefits of e-prescribing, and the necessity of local vigilance, and design, in the use of the system within the culture of the hospital it is employed within.
Johanna I. Westbrook, Margaret Reckmann, Ling Li, William B. Runciman, Rosemary Burke, Connie Lo, Melissa T. Baysari, Jeffrey Braithwaite, & Richard O. Day (2012). Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study PLoS Medicine DOI: 10.1371/journal.pmed.1001164.t006