Seven things to think about before buying an ePMA

The reasons for implementing an electronic prescribing and medication management system, or ePMA, are clear. An ePMA reduces the stress of healthcare workers, and also helps to save the lives of patients. While ePMA systems might already seem to be a self-evident and indispensable part of every hospital in today’s digital age, many hospitals are only just starting their digital transformation. This is how large healthcare institutions should approach the transition of going from paper to electronic prescribing.

Here are seven questions which hospitals should keep in mind, explained by Roko Malkoč, Bussines Unit Manager, OPENeP, Better’s ePMA solution.

What is the easiest way for a hospital to define its ePMA specifications?

1. Look at how other Hospitals approached their ePMA implementation. Follow their lead.
2. Specifications should mirror your goals and desired outcomes. It is difficult to look critically at your current hospital processes and imagine them in their improved digital form. When preparing ePMA specifications, a good piece of advice is to focus on your desired outcomes. For example, if the system needs to facilitate titration, or if it needs to offer a comprehensive reconciliation process. However, I would advise against listing the specific features you want. We saw hospitals with more than 5,000 features in their specifications. On the other hand, Plymouth hospital defined approximately 500 outcome-based specifications, which made things much more manageable and clear.
3. Have realistic expectations about the system. Prioritise requirements based on your timeline. Being ambitious is good, but don’t expect to have everything all at once. Take time to consider which ward will be the first pilot site, and how implementation will scale to other departments later on. Consequently, a specific ePMA solution might not have everything you want at the start of implementation, as some things are added on later during the development process. 

How do you know which system on the market is the best for a specific hospital?

These are some of the questions to ask yourself and the potential vendor:

1. Does the system cover our core needs? This includes the requirement of permanently removing paper medical charts. Examples would be innovation prescribing, outpatient prescribing, and pharmacist reviews.
2. Does the system enable reports? Only reports and analyses of the data gathered in the system can enable continual improvement.
3. Do you have clear instructions for implementation? The supplier needs to be honest and provide a good methodology for implementation.
4. What small details matter? While it’s important to focus on core functionalities, some small things can also be important. For example, dm+d compliance, integration with decision support, and simplified reconciliation. 

One of the OPENeP functionalities we are proud of, and often notice missing with a large number of vendors on the market, is comprehensive medication reconciliation and an automated discharge summary. OPENeP is designed so that the discharge summary shows a comprehensive and easy-to-understand medication journey, and offers patients further instructions regarding their medication after leaving the hospital.

What should you ask each ePMA vendor?

When a hospital is nearing the end of its purchasing process, it’s time to see demonstrations of different systems. One of the more common mistakes vendors make is to just talk about the features of their solution, which can quickly turn into looking at different buttons on a screen without having any real-life context. A good demo is one where you see a patient’s journey, and how that looks inside the system. You need to see at least five different scenarios, such as various emergency cases, discharge, and outpatient care, and how they play out with IT support.

Some other vital questions in addition to having a good demo should be:

• Does the system use dm+d natively and support maintenance of the local drug formulary?
• Can I export the data easily?
• Can I configure the system so it meets the needs of different roles inside the hospital?
• Can the system run on different devices?
• Does the system help reduce “never events” for high-risk medicines (examples include insulins, warfarin, methotrexate, etc.)?
• Can I build custom order sets (predefined treatments) in the system?
• How much support does the vendor offer during implementation?

Who should be in the hospital’s internal planning and implementation team?

The hospital’s team should include all of the key stakeholders from the different specialised areas. A nurse, a doctor, a pharmacist, the clinical safety officer, someone from the IT department, and, of course, a project manager. The CIO and CCIO don’t necessarily need to be engaged with the team on a daily basis, but they play an essential part in the project when it comes to influencing adoption.

The importance of including different stakeholders in ePMA implementation from the beginning lies in the fact that each representative in the team knows best how to communicate with his or her group of specialists inside the hospital. The inclusion of the IT department is needed because, in the end, ePMA is an IT solution, and the IT department might need to give basic support to the workers.

When we began developing OPENeP roughly seven years ago at University Children’s Hospital Ljubljana (UCHL), we started building the system from scratch. Consequently, we wanted to include the best professionals from the start. From very early on, one of our key architects and advisors from NHS Digital was Keith Farrar – Chief pharmacist at Wirral Hospitals Trust, and later the Senior Responsible Owner of Digital Medicines at NHS Digital. This gave us a competitive advantage when it came to an understanding of the complex needs of each tertiary institution. Keith also shared his in-depth knowledge of the NHS. So far, we have gained the trust of University Hospitals Plymouth NHS Trust, and Somerset NHS Foundation Trust. My best guess is that around 70 clinicians have so far been included in the design and development process.

How do you measure success during implementation?

1. Quality indicators. The first thing you need to ask yourself is, what are you already measuring, and what do you think you should measure? Understanding your objectives and your starting point helps to understand improvement in the future.
2. Quality of data. Many hospitals measure things, but the question is, is the data of a high enough quality to recognise the benefits of process-improvement initiatives? In Plymouth, we’re currently making a detailed analysis of the discharge process. We will be able to see what the exact time savings are, and how much we have reduced errors with the use of OPENeP. Make good comparisons. Unless you measure objectives before and after implementation, you can’t assess progress. For example, we digitised the syringe preparation process in the ICU of the children’s hospital. Nurses need to prepare approximately 200 syringes daily, and they were handwriting each label. The new digitised preparation process now saves 4-6 hours a day.

How much time should you allocate for implementation?

If the hospital starts their ePMA implementation from scratch and everything including the team needs to be set up, then it will probably take just under a year before the first pilot is up and running. This may seem like a long time, but you need to remind yourself that this is not a sprint; you are aiming for a long-term solution.

1. Understand the upcoming changes. You need to organise meetings with different departments and specialists to understand their pains and how an ePMA will help. Go through some workshops with the vendor before the first pilot.
2. Plan strategically. Be well prepared for the future, set aside enough time to test the system, make sure it is well-integrated with your system, make sure your users get enough support during the adoption, and start building guidelines. 

All this may take a little less than a year, and that does not mean you are moving slowly. It means you are well prepared. Then, spend as much as you need on the first pilot, and perhaps on the second as well. After that, if you are satisfied and assess that you are ready to scale, you will need to be fast.

What should you take into account when calculating the cost of an ePMA?

The initial cost will be the price of the system. Good IT support only counts for a third of the final cost. The rest is made up of additional costs for the team and any equipment which doesn't come with the system. Without this equipment the system will not be used, and will not bring any benefits to the staff or the patients.

In the last few years, since the start of our ePMA development, we have spent countless hours researching, talking to users, observing work processes, studying the available literature, and continually improving our solutions. It is extremely gratifying to see the satisfaction of the everyone involved once they get used to the system. When clinical experts who initially opposed the implementation of an ePMA  end up saying,  “I would never go back to paper,” this is the best proof that we are doing something right.

Read also:

• Webinar summary: ‘Why do we need ePMA?’ with Duncan Cripps and Roko Malkoč
• David Chalkley: ‘When implementing an ePMA system, you need to invest in a good team and establish as broad an ownership and engagement as possible’
• Božidarka Radovič: Electronic prescribing saves lives, so make the first step with a gap analysis