“With e-prescribing, every aspect of the pharmacy ordering process can be streamlined”

“Electronic prescribing with stock control integration provides the opportunity to fully digitalise the process, reducing transcribing, saving paper, getting rid of lost or illegible scripts, and providing full electronic status updates,” said Daniel Pugh.

We spoke to Daniel Pugh, Lead Technician for ePMA at South Tees NHS Foundation Trust and Lead Developer at Helix Stock Control, about the role of electronic prescribing and medication administration (ePMA) systems in hospital pharmacies and their medication management processes. With his NHS pharmacy experience spanning 14 years, Daniel has been focused on pharmacy stock control – and solving everyday problems with technological solutions.

Can you share some insights into the current challenges faced by hospital pharmacies in managing their ordering processes?

Many of the challenges we face are due to using outdated systems. A lot of hospitals still rely on traditional methods, such as sending paper requests for medications to pharmacies via porters or pneumatic tubes. This practice originated decades ago. While it may still function, it doesn’t meet the expectations of accountability, safety, or traceability in a modern system, such as real-time progress updates. We’ve addressed this by putting “band-aids” in place, like separate order tracking systems such as PTS. However, the manual burden of accurately tracking everything often leads to incomplete records, with only certain types of items being monitored. As a result, frequent inquiries about the status of medication orders further strain both pharmacy and ward resources. Once the medicines leave the pharmacy with the porter, there is also a disconnect, as their whereabouts cannot be easily tracked.

How do you see electronic prescribing impacting them, and what opportunities does it present?

Electronic prescribing with stock control integration provides the opportunity to fully digitalise this process, reducing transcribing, saving paper, getting rid of lost or illegible scripts, and providing full electronic status updates. Almost every aspect of ordering can be streamlined and simplified, becoming just another part of a greater system. Systems to track medicine bags with the porters (e.g., RFID tags) already exist and can be readily integrated into the system.

As electronic prescribing becomes more prevalent, how do you anticipate it reshaping the dynamics between healthcare providers, pharmacies, and patients in the medication management process?

I think that any changes for patients will come further down the line, e.g., things like access to treatment records from patient devices, but ePMA and shared standards provide the bedrock upon which to build. Generally, electronic prescribing doesn’t really “give” anything to pharmacies as such – we derive added value from where the systems we use utilise matching terminologies and standards. In these cases, as with Better Meds, the previously required transcription data can be sent directly between systems.

How do you see the role of ePMA evolve?

Suddenly, the ePMA becomes the hub for pharmacy activity – you can see the patients' prescriptions and doses, amend their treatment, view their medicine reconciliation, pull in SCR data, send prescriptions electronically and order and track medicines in one view from anywhere with network access. When used with the EPS, this can allow fully remote consultations and prescribing and prevent patients from having to come into the hospital. This is ideal in cases where trusts cover vast and remote areas. When combined with GP Connect, seamless data sharing around all hospital episodes becomes possible – a true patient care record rather than an organisational patient care record.

Eventually, every dose, every prescription, every order and every dispense will be centralised and combined with primary care data, forming a comprehensive care record that provides invaluable insights for prescribers, patients, and pharmacies. At this point, the benefits for patients and ownership of their own data become clear.

In your experience, what are some common misconceptions or barriers that hospital pharmacies face when transitioning from paper-based processes to digital solutions?

A general misconception is that things will become much more complicated or that the system won’t let people work in the way they want to. For the former, I think it’s a justified concern – most healthcare apps aren’t known for their fantastic UX, but things are improving, especially when we think of newer entrants into the market, such as Better, who don’t have 40 years of technical debt. UX is now a separate profession; things like accessibility are serious considerations, whereas once, they were just buzzwords.

For the latter, it is often seen as a downside, but being forced to rationalise and streamline processes is actually one of the main benefits. Pharmacy often complies with tradition rather than looking at potential improvements; as a service, pharmacy tends to dislike change. Over time, we accumulated dozens of small exceptions, changes, one-offs, and various other accommodations that all had valid purposes at the point of conception but created a very messy and difficult-to-navigate system.

How do you anticipate collaboration between various IT solution providers in bringing pharmacy integrations to completion?

It's optimistic to assume that every supplier will prioritise providing standards-compliant, seamlessly interoperable interfaces. The introduction and enforcement of Interoperability Standards Notices (ISNs) by NHSE might encourage suppliers to enhance interoperability. However, it's important to acknowledge that suppliers may not offer this interoperability without additional cost implications for customers. Collaboration among major stakeholders is expected to be gradual, and challenges may be encountered. Without significant intervention from NHSE and the government to establish a baseline of interoperability as a standard, progress may be slow, and efforts may be prolonged.

What strategies do you recommend to hospital pharmacy teams to effectively leverage electronic prescribing technologies to improve efficiency?

Work on getting effective reporting out of the system as early as possible. Real-time visibility of critical or time-sensitive medicines immediately gives a safety net from which pharmacies can act to improve patient care and review where issues are occurring. When combined with ward stock list data, reports like missed doses can provide far more insight than just a “gut feeling” into where things are being missed and why. Using the data available can allow for a very sensitive fine-tuning of stock availability.

Could you discuss any notable trends or advancements you foresee shaping the future of ePMA in relation to hospital pharmacies?

We should strive to advance the ongoing progress of closed-loop prescribing – including deeper integration of various GS1-compliant standards such as GLNs for locations and GSRNs for staff. While the implementation and adoption of dm+d, FHIR, and structured dosages have facilitated some progress in making data transferrable, we should extend our focus beyond just medications and start looking at how every entity and action in the system can be made traceable and identifiable across the system and organisational boundaries. The standards to enable this already exist – we just need to start using them.

Daniel’s work on digitalising the pharmacy ordering process will be further presented at our upcoming Better Meds community event on 23 April in London.