eLearning Needs in NHS Sept 2012 #mobimooc

13 Sep

Mobimooc 2012 is up and running.  2 webinars have been well attended.  Regrettably the timing is not great for me – but the team has recorded the lectures 

By coincidence two new systems are due to launch in my region of UK.  An electronic prescribing system (EPS) and new telephone triage service (NHS 111)

NHS 111

http://goo.gl/ra2IE points to introduction to the system.  The NHS has also provided online introduction with accompanying slideshow here with direct link to the video Introduction to NHS 111

Here is a great example of mLearning in action but the local NHS managers insisted on practice teams send delegates to a meeting somewhere in my town.  Clearly this was a poor use of time for my practice manager.  With such a good presentation created, it is clear to me that the time taken for many people to get to the meeting would be better spent watching the slide show.  How patronising of our service managers!  There is apparently good evidence that the new system will be good for patients and reduce some of the demand on emergency services from (trivial) emergencies.

It does look like no-one locally is aware of mobile learning project management.  Here is  an excellent opportunity which has passed us by!  Notice there is no system on the website to help visitors assess their learning after reading the transcript while watching the slide show.  Why is the slide show an embedded video rather than posted on Slideshare, Brainshark, or other public cloud service?  How hard would it be to have a feedback form?

Whether the UK really needs another emergency number is a moot point now.  As a GP, this system looks to me a threat for the future primacy of General Practice as the first point of contact for health care questions by UK citizens.  This is sad.  In the not too distant future UK may come to regret the demise of the family doctor as an independent gatekeeper to healthcare services.  That is a discussion for a future post.

Electronic Prescribing System

I wish to share the following from my local medical committee concerning the roll out of the new electronic prescribing service because the rational behind it is described and the questions from my representatives focus us on another opportunity for eLearning.

NHS Bedfordshire and NHS Luton are working for Electronic Prescription Service (EPS) Release 2.  This will mean that the PCTs would then be enabled to allow practices and pharmacies to take part in EPS, if the practices and pharmacies want to.  This is part of a national programme.  We were told that EPS has been available in Hertfordshire for some time and that just under 30 practices are taking part in EPS there.  
We’ve seen documentation from Bedfordshire and Luton about what EPS is; what practices would have to do under EPS; what the criteria would be for selecting patients who could use EPS and what participating practices would need to do to support patients in making their choice; how patients would nominate which pharmacy they want to use for EPS and what the participating practice would need to do to facilitate this.

Beds LMC members recognised the positive objectives of the scheme, e.g.
It is supposed to reduce GP work load ultimately
It may be more convenient to the patient
It may reduce waste
It is understood that EPS will be optional for practices.
But Beds LMC members did have some concerns:
To what extent is it a whole new area of unfunded work in general practice?
Beds LMC members thought that EPS would create the following work:
1. GPs will be expected to identify suitable patients.
2. The GP has to look at all applications for it and make sure they do not have any of the exclusions (large groups of patients such as those on controlled drugs, anticoagulants and some others).
3. The GP or GP staff will be expected to promote and explain the process and follow this up in writing and collect a signature 
4. The practice will be expected to telephone suitable patients and offer it to them.
5. Time will be need to train GP staff.  Nothing about backfill for this.
6. All prescribers will have to use smartcards and be wary of prescribing some formulations or brands of medication which do not have a suitable barcode.  Not all practices use their “smartcards” when consulting because they cause their system to run slow and time out.  So clinicians log in and work offline.
Patients with regular repeat prescriptions tend to be patients on chronic disease registers.
On the rare occasions when patients such as this come in “just for a repeat prescription” it gives the GP an opportunity to pick up on preventative care, QoF items and other aspects of the health and wellbeing agenda.  In other words, the aspects GPs do not always have time for when dealing with acute illness in a 10 minute consultation.  Could the use of EPS actually reduce the level of care available for some patients?
Concerns that the EPS will not be a simple scheme, as some items cannot be included in EPS, so there would have to be two prescribing systems for EPS patients: one for EPS-included medications and one for EPS-excluded medications
Is there any evidence that EPS has saved time for GPs or staff in primary care?
If any Hertfordshire practices who are using EPS would be willing to share any of their experiences or would be able to answer any of the specific concerns listed, it would be very interesting to hear from you?

Here is my response:

Wow! How can such a simple idea as electronic repeat prescribing become so complex?

FIrst thoughts: I want nothing to do with a system with more bureacracy to set up. We have enough to deal with without this additional burden.

Second: The system is doomed unless bandwith of broadband connections is increased to cope with the demand from our desktops (and mobile devices). Currently broadband speed is around 10megabits per second down and 0.5 mb/s up, at least in Watford. Divide this by 8 prescription terminals and you can see the speed drop makes the system inoperable.

Third: Barcodes are not immune from corruption; at least several times a week a popup warns there has been a problem and the barcode should be scratched out. How do you do that with an electronic script?

Fourth: The main benefit of EPS is prescribing from mobile devices. With 4G/LTE imminent this seems practical so long as all prescribers have feature phones with the necessary hardware. I fear the powers that be are focussing on the wrong systems. We need secure login systems for iPhones/iPads and android devices to make EPS useful (e.g. prescribing urgent scripts on home visits, or residential facilities)

FIfth: How are pharmacists supposed to be persuaded to adopt this?

Sixth: Prescribing2U is already available. How does this differ from EPS 2?

Seventh: All HCPs who access clinical system must log in with NHS Smartcard. If there are hardware problems managing this, the IM&T teams across our area must fix these before rolling out EPS.

This system is being imposed on us on the background of a longterm agenda to cut the printed script costs.  There is also an agenda to improve security of prescribing.  Since proposed several years ago, IM&T systems and devices have evolved.  Mobile devices are so much more capable than before.  For example, my smartphone (HTC One X) is more powerful computer than my desktop system 10 years ago!

There is nothing in my local medical committee concerns nor in the NHS EPS background documents to indicate any desire to develop a mLearning project to aid in the implementation of this system.


Two new systems are being implemented shortly with the intention of improving patient care in an NHS region.  Two sophisticated organisations are responsible for the roll out of NHS 111 and EPS.  Neither seems to embrace education technology which, in my opinion, would ease the pain involved in changing behaviour of health care professionals and the public.

There is clearly a very long way to go to embed eLearning into the NHS.  This is a terrible state of affairs for a developed society.  It is ironic that some countries with large health care burdens (e.g. sub-Sahara Africa countries; South America countries) may be receiving superb instruction in mLearning systems.

I would love to see some discussion about the particular systems described above – your experiences of similar systems in your country, ideas on how to improve implementation, or anything else you think would be interesting.

Thank you in advance…

3 Responses to “eLearning Needs in NHS Sept 2012 #mobimooc”

  1. Amin September 15, 2012 at 15:52 #

    I’d suggest trying to get people in on the inside to help the reinholders be aware of more effective ways of implementing their plans. Complaints tend to be noted very well, but their addressal usually extends to after the application of the faulty system.

  2. Fiona McDonald November 1, 2012 at 16:49 #

    I wholeheartedly support the idea of more discussion about the Electronic Prescription Service (EPS), partly because there is so much misunderstanding about this new service. As a clinician working on delivering EPS in England and having seen it working in many surgeries and pharmacies I hope I can set the record straight on Beds LMC members’ 6 points.
    1. The vast majority of nominations are being recorded by pharmacies. EPS is suitable for almost all patients, although some will benefit more than others.
    2. GPs do not review “applications” (a patient’s nomination for EPS). A GP can choose to produce an electronic prescription or a paper FP10 based on clinical judgment and patient preference. Anticoagulants and some controlled drugs can be prescribed electronically. Only Schedule 1, 2 & 3 CDs, which account for only 2% of all items prescribed in primary care, are excluded from EPS at present.
    3. Nomination and patient communication is mostly being done by the pharmacy. Surgeries may choose to promote and explain too as it is in their interests to have more patients on EPS as the benefits come from volume. There is no requirement to follow up in writing and most PCTs don’t require GPs to collect a signature.
    4. Most practices see the benefit in discussing EPS with patients when they visit the surgery. There is no expectation that surgeries will phone patients to offer EPS.
    5. Training is very important if the benefits are to be realised and EPS is more about business change than IT. Training is part of local PCT arrangements.
    6. EPS is smart, it will not send excluded items electronically, it will default to an FP10. Using your Smartcard ensures your locally held patient details are synchronised with the national record. The more you use your Smartcard the less time it takes to sync. If your system is still slow contact your helpdesk.
    Regarding your thoughts, I am glad you are giving EPS some attention, here are my views:
    Firstly, patient safety and choice are paramount so there needs to be certain controls. All change requires an investment in effort but EPS does deliver net benefits. Ask those using it.
    Secondly, EPS messages are tiny, about 15 kb, so do not need large bandwidths.
    Thirdly, EPS has been rigorously tested so the electronic message received by the dispenser is identical to the one created by the prescriber. In the unlikely event of the message becoming corrupted in transfer the prescription would automatically become invalid.
    Fourthly, most GP prescriptions are created in the surgery but EPS creates the opportunity for mobile IT to be used more in the future.
    Fifthly, over 60% of pharmacies have upgraded to EPS Release 2 already. As EPS has the potential to benefit pharmacists too, there is considerable enthusiasm to adopt EPS. Ask those using it.
    Sixthly, EPS allows the GP to sign and send the prescription electronically and to cancel the prescription, (or a single item), electronically. It allows the dispenser to get the prescription earlier, endorse and claim for it electronically.
    Seventhly, I agree. It is important to get an EPS Release 2 Smartcard with the right roles on it and look after it.
    Finally, avoid the misinformation and rumour and hear what clinicians and NHS staff who use it say about EPS. Just visit http://www.cfh.nhs.uk/eps
    You can find me on twitter @EPSprescriber if you would like to receive updates.
    Fiona McDonald, Clinical and Patient Lead, EPS, NHS Connecting for Health

    • maturinuk November 6, 2012 at 07:31 #

      Fiona, thank you so much for providing such a detailed answer. I will share with my LMC since most of team there sadly do not use social media to engage with constituency. That is another issue which deserves its own blog post.

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