The Medicines Management Breakthrough

Healthcare needs a breakthrough. Medicines management offers the promise of that breakthrough. Yet some projects will quickly deliver step-change improvements to the cost, quality and safety of care, while others will take too long, cost too much and deliver too little. How do we ensure the success we urgently need? We asked two industry experts for the answers…

The pressing need to achieve a healthcare breakthrough that improves care, while minimising costs, has never been greater. Around the world, many countries are facing the dilemma of unaffordable healthcare as the population grows, chronic disease becomes more prevalent and costs climb along with demand for better care.

However, when healthcare IT has been applied to help solve these problems; the track record of success is mixed. Most of us know all too well about the failed “bridge-too-far” approaches of mega systems. Now focus is

quickly deliver substantial payback. One area receiving particular attention and having enormous potential for a breakthrough is medicines management.

Medicines are a major cost segment in healthcare and nearly ubiquitous in patient encounters. Gillian Honeywell, Chief Pharmacist at the Isle of Wight NHS Trust, said that 97 percent of its patients get at least one medicine. “This is a very typical scenario that clearly illustrates how a strategic solution for medicines management can have a far reaching, powerful effect. You’re dealing with just about every patient, so medicines pathways should be complete and integral in order to optimise care and reduce errors.

For example, medicines which are prescribed but not taken at the optimal time represent huge risks to patient safety,

costs, and a waste of time and resources. In the UK alone, an estimated £300million is

wasted each year on medicines dispensed but then returned to pharmacies. Studies in the U.S. reveal a $1trillion yearly impact of preventable medical errors, with medicines being one of the foremost contributors to this huge cost.

Where Does The Breakthrough Come From?

The process of prescribing, supplying and administering medicines has long been labour-intensive, error-prone, and paper-based. Computerising these tasks to eliminate manual activities has the immediate potential to reduce errors and cut costs. However as experiences of other industries has shown, simply going from paper to computer is not enough to deliver a breakthrough.

Today’s modern supply chain solutions have slashed trillions of pounds of global costs,

even reduced prices of consumer goods. Yet early paper-to-computer transitions

How Strategic Solutions Maximise Success

“Medicines pathway should be complete and integral in order to optimise care and reduce errors.”

www.jac.co.uk E. jonathan.mills@jac.co.uk T. +27 (0) 79 071 9428www.jac.co.uk E. jonathan.mills@jac.co.uk T. +27 (0) 79 071 9428

JAC Medicines Management platform has been able to integrate and automate inventory and dispensing, which has reduced workforce costs and errors, while ensuring the right medicines are delivered to the right patient at the right time. The system also provides an audit trail: who prescribed, supplied and administered what drug to which patient. None of this could be done without informatics and interoperability.”

Interoperability between logical domains of information and processes - from end-to-end with analytics and access to best practices embedded at

04 The Medicines Management Breakthrough

the point of action - is the foundation for a breakthrough and will help ensure continuous improvement.

Delivering the Breakthrough

Slee says that good vision and communication are required to help people understand what is possible through informatics. There are also technology hurdles that must be addressed – e.g. reliable networks and systems which support day-to-day practice and enable access from any location.

One of the biggest challenges is that you have to demonstrate breakthrough

capabilities for three professions with different requirements and priorities: doctors, nurses, and pharmacists.

The nursing staff want to ensure they have the right medicines and

Pharmacists need a quick and easy system to optimise medicines, track supply requests and inventory. And the medical teams want to make sure that a drug is easily and safely prescribed, available and administered in a timely fashion once their prescription is in the system.

There are many challenges to achieving a breakthrough but Honeywell sums up the situation: “Medicines are the most common form of treatment, and there is no medical procedure that will overtake it. If we can’t get this right, we’re going to struggle.”

“Medicines are the most common form of treatment, and there is no medical procedure that will overtake it. If we can’t get this right, we’re going to struggle.”

What’s Different in a Strategic Solution?

• Gain step-change improvements in cost, care and safety – go well beyond just marginal improvements to tactical areas

medicines management versus merely digitising prescriptions

• Provide embedded analytics to continuously optimise processes and immediately identify problems – go beyond simple after-the-fact reporting

– e.g. EDI replacing orders, invoices and all the paperwork with digital documents – initially cost more than they saved. The breakthrough came only when the entire supply chain process became synchronised and optimised.

“Medicines pathway should be complete and integral in order to optimise care and reduce errors.”

Healthcare—and medicines management in particular—seems to be on a similar cusp as the retail supply chain was before experiencing a breakthrough. ePrescribing tools are becoming widely available, but so far they are used mostly to digitise paper processes. The real strategic breakthrough in medicines management is only now being uncovered.

Moving Up To The “Strategic Dimension” In Medicines Management

A breakthrough in medicines management must optimise three areas: supply-chain, care delivery and care outcomes.

Supply-chain solutions encompass inventory management, ordering and logistics. Care delivery is paramount; including ensuring the right medication is prescribed, dispensed and taken/administered correctly. Care optimisation includes interoperability with other systems, access to comprehensive (patient) information and analytics in order to do more of what works while reducing problems and risk

The breakthrough, therefore, comes not just by digitising paper and process, but by adding end-to-end informatics that can used to add value at each stage of the medicines pathway.

Ann Slee, former ePrescribing lead for CfH, explains how the writing of a prescription generates a number of processes whose quality, ef�ciency and productivity all need to be continuously monitored and improved upon.

“A prescription triggers the scheduling of a medicine and a request for supply, but the request processes are mostly paper-based and poorly integrated with inventory management. An environment in which the processes are computerised and the systems interoperable I believe will deliver similar breakthrough bene�ts as you see within the wider manufacturing, retailing and logistics industries.”

“We’re closer to where we need to be but not there yet,” Slee said. “We mostly have the pharmacy department working well but there’s still a gap between what’s going on at ward level, across care settings and how this relates to the wider inventory and logistics picture. The current system of stocking for the ‘just in case’ scenario at ward level particularly is wasteful and costly. And to optimise care we

02 The Medicines Management Breakthrough

“the real breakthroughs come from the process optimisation not the task automation.”

Keys to a Medicines Management Breakthrough

1. Improved healthcare outcomes at same or reduced costs

2. ePrescribing as one component of a comprehensive medicines management platform

3. Informatics to improve compliance, reduce wastage, and optimise decision-making at the point of care

4. Interoperability with other systems to support regional or national requirements

5. The ability to share data and track the patient across the continuum of care

6. Rapid, low-risk, affordable deployment

control costs. According to Honeywell, they’ve been able to reduce excess bed-stays by getting the medicines process right from the very beginning to the very end.

“We know exactly what medicine is given, we know if it’s been missed or delayed, and we have the intelligence built into the system to trace the problem to its source,” Honeywell said.

Honeywell added that the Isle of Wight NHS has also analysed error rates such as adverse drug reactions. (ADR) They’ve discovered that a bleed will cost over £4,000 to treat and that an admission for a stroke costs around £6,000. These costs change with co-morbidities etc., reducing ADRs has a quanti�able saving in patient safety terms as well as �nancial.

need to know when medications are actually taken by a patient—not just when we stocked the patient-side medicines cabinet.”

The Isle of Wight is an excellent proving ground to test out strategic medicines management as all care on the Isle is delivered from a single hospital. As well as using ePrescribing, the Isle of Wight also uses a system that automatically monitors stock and robotically dispenses re-supply via separate bulk, dispensary and ward-based devices. Providing prescribing to administration via a comprehensive supply chain solution, end-to-end medicines management can be achieved for an entire community.

Gillian Honeywell, from the Isle of Wight NHS Trust, agrees with Slee about the need for interoperability. “Every process used to prescribe, administer, and supply medicines is ideally part of a single, comprehensive and seamlessly-connected solution as the real breakthroughs come from the process optimisation not the task automation. The ideal strategic Medicines Management solution has powerful transactional and analytical capabilities, and is fully connected to the myriad of other systems used throughout the broader spectrum of healthcare.”

Interoperability Is Key to Optimising Care

For Slee, a breakthrough medicines management system is one that integrates processes from end-to-end and shares patient records across care settings on-demand. “That’s where most of the information that we need to support optimising care is,” she said. With medicines so broadly used in healthcare, adding interoperability between medicines management and other logical domains that can help transition and coordinate care both ef�ciently and effectively would be another true breakthrough.

For instance, if you �ag a patient for monitoring and give them a form to take a blood test, informatics can alert you if the patient didn’t then have the blood work done. Informatics could also be used to alert practitioners when a patient does not re�ll an important prescription, allowing for quicker intervention. Eliminating errors in care delivery and making better use of information can make a difference in outcome.

The Isle of Wight NHS Trust performs constant reviews and analysis on topics such as drug utilisation, drug-drug interactions, and adherence to formularies—all of which increase safety and help

03 The Medicines Management Breakthrough

With medicines so broadly used in healthcare, adding capabilities that can help transition and coordinate care both efficiently and effectively would be a true breakthrough.

www.jac.co.uk E. jonathan.mills@jac.co.uk T. +27 (0) 79 071 9428 www.jac.co.uk E. jonathan.mills@jac.co.uk T. +27 (0) 79 071 9428