Joining the dots for integrated care
No matter who you ask about what’s next for healthcare, they will say IT connectivity is going to be crucial. The Government’s Health and Care Bill, which is going through Parliament at the moment, places the emphasis on integrated care systems (ICSs) to join up healthcare organisations and improve patient care. As the nation’s Covid-19 vaccination programme has shown, community pharmacy should have a key role to play in integrated care pathways, but it needs to be able to plug into the right kind of integrated technologies in order to realise that potential.
With this in mind, it is now more critical than ever that pharmacy teams can get the most out of their patient medication record (PMR) systems and service platforms, as these sit at the heart of safe and efficient processes and quality service provision for patients and customers. This will prove crucial for successful ICS engagement.
A wishlist for pharmacy
The Pharmaceutical Services Negotiating Committee (PSNC) suggests that pharmacy teams should let their systems suppliers know their wishlist of features. So, what have the major players been doing over the last year to provide pharmacies with better access to more joined-up systems?
In a bid to “fulfil our promise to deliver incremental change”, Cegedim Healthcare Solutions’ Pharmacy Manager system has been “on a journey towards modernisation over the past 12 months”, according to product and technology director Tracey Robertson. Sticking to its 2020 roadmap resulted in two timely first-to-market NHS integrations: the NHS 1-Click SCR (summary care record) integration, and real time exemption checking (RTEC) and prescription tracker – both of which Ms Robertson says are “heavily used features which hugely benefitted pharmacy customers during the early stages of Covid”.
we’ve taken each process that exists in pharmacy, polished it and put it back in
Another aim for Cegedim during the last year was to drive a reduction in stock wastage and improve stock utilisation within stores. Pharmacy Manager’s new stock inventory module provides customers with real-time insight into known stock issues, viewable and actionable with one click. This was closely followed by the launch of its Pharmacy Intelligence Hub, a cloud-based digital management tool that connects a pharmacy head office to its network of stores. Real-time metrics then provide an instant view of store-level activity, including financial performance metrics, stock and order management and dispensing statistics.
At Invatech Health, CEO Tariq Muhammad has not rested on his laurels since the company’s Titan system became the first PMR to be accredited by the NHS for more than a decade in 2019. “PMR systems stand accused of not moving forward and being clunky, so we’ve taken each process that exists in pharmacy, polished it and put it back in to make Titan a really solid, reliable system that delivers on usability,” says Mr Muhammad.
General developments over the last 12 months include speed improvements and more advanced auditing of the journey of every prescription and item. Titan has improved its eRD (electronic repeat dispensing) process as well as its EPS (electronic repeat prescribing) tracker, which allows users to search any prescription on the spine and supports use of the serious shortage protocol.
The pandemic also saw Invatech fast-track Titan’s remote working abilities. “Titan is a cloud-based system; that makes it a lot easier for users to access it from home,” says Mr Muhammad. “We had the capability, but as soon as the pandemic hit, we put a team together to bring forward the concept of being able to access everything you do with Titan in your pharmacy at home.”
Mr Muhammad says Titan is also the only system to use open APIs (application programming interfaces). This allows businesses to connect their internal applications directly with their workflow and, via its Marketplace, invites third party vendors to build connections with the dispensing workflow in an effort to encourage new efficiencies from robotic, logistic, stock, finance and retail systems.
EMIS too, has been joining things up during the pandemic since it acquired Pinnacle Health Partnership LLP and Pinnacle Systems Management Ltd – owners and operators of the widely used PharmOutcomes and Outcomes4Health platforms – in March 2020. “This enabled us to start developing a level of systems interoperability that sets us apart in the market,” says pharmacist and clinical director Sima Jassal. “We focused this initially on supporting our pharmacists in the unprecedented times we are facing with the pandemic.”
Among the Covid-19 services EMIS developed was a Covid-19 support shielded patient check, enabled by the integration of its ProScript Connect software with PharmOutcomes. Last summer, this allowed pharmacists to check for shielding patients who needed their medicines home delivered. This was followed shortly afterwards by integrated functionality between ProScript Connect and PharmOutcomes, which supported the record level of flu vaccinations delivered by community pharmacists.
Following the release of its Analyst QuickPick mobile dispensary picking application, Ian Lynch, senior pre-sales consultant at Positive Solutions, says the company’s focus over the past year has been to integrate the various developments it has made over the last decade, with an eye on creating “a more efficient workflow in the whole pharmacy – not just the dispensary”.
QuickPick is supplied on robust mobile devices as part of a suite of apps that aim to transform the efficiency of a pharmacy by freeing up time for patients rather than prescriptions. Positive Solutions’ aim, says Mr Lynch, is “to allow dispensaries to operate in a paperless manner (in England now and other countries when able to do so), as well as using Analyst PMR to provide a more informed and complete picture of the patients’ circumstances for safer clinical checking, allowing clinical focus to be directed to where it’s most needed”.
A squeeze on margins
Analyst PMR is designed to be fully integrated into its own assembly hub, called Central Fill, as well as third party hubs. Head of product management Mark Merry says this year will see further developments with tote management. “We also look forward to the release of new web products, including management information dashboards OrderManager Web and HxConsult, which is due for release in October and has the capability of reading SCRs and writing back post-event messages using a variety of NHS mechanisms,” he says.
As dispensing margins continue to be squeezed and funding shifts towards patient services, Ms Robertson says the year ahead for Cegedim will see it make significant changes in order to give its customers a flexible choice on how and where they dispense.
“We wanted to support customers by digitally connecting pharmacy group stores and hubs to help leverage the dispensing efficiencies offered by a remote dispensing model,” she says. “So we will shortly be launching Pharmacy Manager’s second-generation hub and spoke solution, which will address a number of industry pain points and deliver a truly connected prescription journey between all pharmacy stakeholders.
“Furthermore, should the current legislation (which prevents contractors dispensing for sites outside their legal entity) change, Pharmacy Manager will also support offsite prescription fulfilment by third-party hubs.”
EMIS is currently working on progressive upgrades for its PMR, informed by a user consultation exercise across all four home nations to understand the changing needs of pharmacies, with the new EPS module being prioritised to support new messaging standards. Ms Jassal says this development will minimise end-user training requirements and speed up delivery, as well as providing enhanced automation options, configurable workflows and more clinical information at the point of dispensing.
More automated clinical and accuracy checks will also free up pharmacists’ time for other things. “To this end, we are enhancing ProScript Connect to support the delivery of the Community Pharmacy Contractual Framework,” she says. “For example, we are working on developing an integrated Discharge Medicines Service (DMS) module, and following successful pilots, we will also be providing a new GP patient referral service to support the NHS GP CPCS [Community Pharmacist Consultation Service].”
Positive Solutions and Cegedim are also progressing work to support the CPCS. Mr Merry says both Analyst and HxConsult will be optimised to support pharmacy teams in delivering services. Ms Robertson says Cegedim has “a solution fully integrated with Pharmacy Manager which will make it super easy to manage CPCS referrals, prioritising patient care and taking advantage of an important source of revenue, which has hooks into a number of crucial services, including the Directory of Services (DoS) for easy forwarding of a referral to an alternate pharmacy, and Manage Your Service (MYS) for reimbursement claims”. This will be followed by the launch of a new patient reporting and management module which, she says, “will drive improved patient care, but also help pharmacies become better retailers”.
The barrier is political, and whether there is a desire from other professions and the powers that be to allow integration
Invatech is pushing ahead with digital transformation too, with Mr Muhammad promising new apps on its Marketplace open API app store around integrations with robot manufacturers (for picking/collection machines) and delivery companies. The company is also building Titan Mail – the ability to email prescriptions directly into Titan – and has completed development of Titan AI, which Mr Muhammad says is “the first AI [artificial intelligence] system ever in pharmacy”. It uses machine learning to support clinical checks by watching what pharmacists do every time they get a prescription.
However, in the current climate, it’s not enough to make sure developments simply match the demands of the Health and Care Bill and the CPCF. Canny suppliers know they must listen to their customers in order to ensure that desirable developments from a community pharmacy perspective are plugged into their roadmap.
“We are in regular contact with the various NHS bodies, along with the industry groups and associations, to understand the direction of travel,” says Mr Lynch. “But we also receive regular feedback from users on how to improve the system and what we should add, and recently completed our largest virtual pharmacy consultation involving contractors representing England, Scotland and Wales in readiness to start work on new projects.”
EMIS also has an active community pharmacy user group and utilises one-to-one deep dive discussions with pharmacists and other pharmacy stakeholders as well as observational contextual sessions inside pharmacies to canvas opinions. Ms Jassal says this enables the company to “get a deep understanding of changing ways of working, identify any existing pain points and design new technology to address current unmet needs”.
Barriers to integrated care
Mr Muhammad says that if the goal is integrating community pharmacy with the rest of primary care, the issue is not necessarily about giving pharmacists more functionality. “Adding more buttons to old systems and old processes that are not fit for purpose will not help pharmacy deliver on future roles,” he says. “The barrier to integrated care is not our ability to develop functionality or a lack of demand from pharmacists. The barrier is political, and whether there is a desire from other professions and the powers that be to allow integration. For example, CPCS integration is due to open up, but the specification for CPCS has not even been released. This prevents anyone from developing any functionality.”
Meanwhile, pharmacists can still only access selected records in the SCR, which Mr Lynch says is “the closest thing we have to a joined-up care record [but] we don’t have a link into or from any prescribing systems at the moment. This would obviously be a really good thing to have, but the care record needs to be joined up through all health and social care settings ideally, which goes far beyond GP systems”.
And there are still too many cogs in the machine. “There are dozens of different IT systems all doing their own thing at the moment”, says Mr Lynch, “so trying to implement a harmonious set of standards across all systems is a real challenge, as each system will need to change to conform. We have been involved with many Professional Records Standards Body discussions in trying to crack this nut and will try and work towards the final agreed standard, but it’s slow going and can only truly work when all systems conform because IT systems should be the enabler of change, rather than the barrier.”