History

History

Pharmacy has a long history of using IT to support service development. Computerised stock control systems were introduced to pharmacy during the 1980s to provide machine-generated labels. Some of these systems also provided limited management information about which drugs had been used and by whom. Systems were further developed to provide automatic stock control, patient medication records and drug interaction warnings. Despite these advances, many systems are still not used to their full potential and have developed at a slower pace over the past few years as the supplier focus has moved towards e-prescribing and medicines administration.

The introduction of automation and automated drug cabinets, as dis-cussed in Chapter 4, as well as advances in e-commerce, has further evolved the supply model. Full systems integration has remained a challenge, with many of these developments operating as stand-alone systems. A key element of integration has been the development and use of key information stand-ards, many of which are starting to go through the formal NHS standards route but to date still remain unused in key systems.

E-prescribing and the EPR were introduced into a number of hospitals in the USA in the 1970s and first introduced into the UK in the early 1990s. The publication of Information for Health in 1998 set out an ambitious timetable for the introduction of the EPR, including electronic prescribing. It proved to be too ambitious and was superseded in June 2002 with Delivery of 21st Century IT Support for the NHS: National Strategic Programme.⁶ This intro-duced the national programme for IT that aimed to speed up the delivery of systems by centrally procuring systems via local service providers (LSPs). Replacing the National Health Service (NHS) Information Authority, it also aimed to develop key NHS information standards, working in collaboration with the Information Standards Board for Health and Social Care to underpin system development.

Delivery of the national programme has not been without controversy or delay, resulting in a further Department of Health informatics review in July 2008. This focused the national programme towards five key deliverables (‘the clinical 5’ – see Table 15.1) identified by the NHS as supporting the Next Stage Review.

Table 15.1 The five key elements for secondary care – 'the clinical five'

Functional requirements

1. A patient administration system with integration with other systems and sophisticated reporting

2. Order communications and diagnostics reporting (including all pathology and radiology tests and tests ordered in primary care)

3. Letters with coding (discharge summaries, clinic and Accident and Emergency letters)

4. Scheduling (for beds, tests, theatres)

5. E-prescribing (including 'to take out' medicines)

It also reintroduced the opportunity for local system development with the advent of local programmes for IT and a more service-led delivery model. It is clear that the ‘replace all’ policy from 2003 is being superseded by a ‘connect all’ philosophy. Whilst this may seem to be a step forward it leaves doubt as to how this is to be managed and how delivery of systems into secondary care is to proceed. At the time of writing, the change of government and the review of IT systems has now been outlined with a consultation document issued by the Department of Health in October 2010 – Liberating the NHS: An Information Revolution. This reiterates the connection and joining up of systems whilst also signalling more of a focus on meeting individual and local needs. It also outlines that the govern-ment will move away from being the main provider of systems, with a greater range of organisations offering services. In essence it looks at information and not systems, leaving further doubt as to what will happen to the existing national contracts for the delivery of systems. It is clear that the strategy of delivering systems via connecting for health is now superseded; what remain to be clarified are how the remaining contracts will be delivered and the impact on local system delivery; given the current financial climate this gives cause for concern.