Finding the 'sweet spot' between customisation and workflows when optimising ePrescribing systems:a multisite qualitative study

OBJECTIVES: The introduction of ePrescribing systems offers the potential to improve the safety, quality and efficiency of prescribing, medication management decisions and patient care. However, an ePrescribing system will require some customisation and configuration to capture a range of workflows in particular hospital settings. This can be part of an optimisation strategy, which aims at avoiding workarounds that lessen anticipated safety and efficiency benefits. This paper aims to identify ePrescribing optimisation strategies that can be translated into hospitals in different national settings. We will explore the views of professionals on the impact of configuration and customisation on workflow. DESIGN: This paper draws on 54 qualitative interviews with clinicians, pharmacists and informatics professionals with experience of optimising ePrescribing systems in eight hospital sites and one health system, in four different countries. Interview transcripts were analysed using an inductive thematic analysis. SETTING: Secondary and tertiary care hospitals in the UK, USA and mainland Europe. PARTICIPANTS: Fifty-four healthcare workers with expertise in clinical informatics. RESULTS: Five identified themes following thematic analysis showed that optimisation of ePrescribing systems can involve configuration and/or customisation. This can be a strategy to combat workarounds and to respond to local policy, safety protocols and workflows for particular patient populations. However, it can result in sites taking on responsibility for training and missing out on vendor updates. Working closely with vendors and other users can mitigate the need for extensive system modification and produce better outcomes. CONCLUSIONS: Modifying an ePrescribing system remains key to enhancing patient safety, and better captured workflow remains key to optimisation. However, we found evidence of an increasingly cautious approach to both customisation and configuration among system users. This has led to users seeking to make less changes to the system

Protocol for a qualitative study to identify strategies to optimise hospital ePrescribing systems

Introduction Electronic prescribing (ePrescribing) is a key area of development and investment in the UK and across the developed world. ePrescribing is widely understood as a vehicle for tackling medication-related safety concerns, improving care quality and making more efficient use of health resources. Nevertheless, implementation of an electronic health record does not itself ensure benefits for prescribing are maximised. We examine the process of optimisation of ePrescribing systems using case studies to provide policy recommendations based on the experiences of digitally mature hospital sites.Methods and analysis Qualitative interviews within six digitally mature sites will be carried out. The aim is to capture successful optimisation of electronic prescribing (ePrescribing) in particular health systems and hospitals. We have identified hospital sites in the UK and in three other developed countries. We used a combination of literature reviews and advice from experts at Optimising ePrescribing in Hospitals (eP Opt) Project round-table events. Sites were purposively selected based on geographical area, innovative work in ePrescribing/electronic health (eHealth) and potential transferability of practices to the UK setting. Interviews will be recorded and transcribed and transcripts coded thematically using NVivo software. Relevant policy and governance documents will be analysed, where available. Planned site visits were suspended due to the COVID-19 pandemic.Ethics and dissemination The Usher Research Ethics Group granted approval for this study. Results will be disseminated via peer-reviewed journals in medical informatics and expert round-table events, lay member meetings and the ePrescribing Toolkit (http://www.eprescribingtoolkit.com/)—an online resource supporting National Health Service (NHS) hospitals through the ePrescribing process

Policy parameters for optimising hospital ePrescribing:An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development

OBJECTIVE: Electronic prescribing systems offer considerable opportunities to enhance the safety, effectiveness and efficiency of prescribing and medicines management decisions but, despite considerable investments in health IT infrastructure and healthcare professional training, realising these benefits continues to prove challenging. How systems are customised and configured to achieve optimal functionality is an increasing focus for policymakers. We sought to develop an overview of the policy landscape currently supporting optimisation of hospital ePrescribing systems in economically developed countries with a view to deriving lessons for the United Kingdom (UK). METHODS: We conducted a review of research literature and policy documents pertaining to optimisation of ePrescribing within hospitals across Organisation for Economic Co-operation and Development (OECD) countries on Embase, Medline, National Institute for Health (NIH), Google Scholar databases from 2010 to 2020 and the websites of organisations with international and national health policy interests in digital health and ePrescribing. We designed a typology of policies targeting optimisation of ePrescribing systems that provides an overview of evidence relating to the level at which policy is set, the aims and the barriers encountered in enacting these policies. RESULTS: Our database searches retrieved 11 relevant articles and other web resources mainly from North America and Western Europe. We identified very few countries with a national level strategy for optimisation of ePrescribing in hospitals. There were hotspots of digital maturity in relation to ePrescribing at institutional, specialisation, regional and national levels in the US and Europe. We noted that such countries with digital maturity fostered innovations such as patient involvement. CONCLUSIONS: We found that, whilst helpful to achieve certain aims, coordinated strategies within and across countries for optimisation of ePrescribing systems are rare, even in countries with well-established ePrescribing and digital health infrastructures. There is at present little policy focus on maximising the utility of ePrescribing systems

Balancing the Local and the Universal in Maintaining Ethical Access to a Genomics Biobank

Background: In policy and governance discussions of genetic and genomic data sharing, the rights of research subjects are often balanced against the scientific benefits of allowing open access to biomedical data. However, this dichotomous focus can obscure other matters that are relevant to the ethical running of the biobank. These include the will and the ability to sustain the resource. We will consider Generation Scotland (GS) as one context in which a global policy agenda favouring open access meets local issues of governance and sustainability. We seek to address gaps in discussion in scientific, law and policy arenas about the means to ensure that open access functions well but often neglects the contextual aspects of Biobanking. In order to explore these aspects we use the case of access to Generation Scotland. Participant recruitment and collection of data from the 24,000 plus participants in this genomics research biobank began in 2006 and a GS infrastructure continues to exist and manage access to a repository more than a decade later. We explore the balancing of data accessibility with ethical considerations and governance for GS in the evolving policy landscape of the past ten years. A time when data sharing and open data access have become increasingly important topics within the biomedical research community. Methods: We carried out a review of policy documents and academic articles drawn from science and bioethics literatures. We focussed on literature covering open access, the protection of data subjects and questions pertaining to sustainability, for example in relation to funding or attribution of credit to repository staff. A further aspect of the methodology is based upon participant-observation within the Generation Scotland Access Committee, of which both authors are members. Results: Using our engagement with GS we foreground the local elements of biorepository governance. Whilst decisions around data access are influenced by global policy objectives, local arrangements for governance and practices such as linkage to health records are also central. At the local level, we argue, moreover, that governance decisions regarding access to the biobank are intertwined with considerations about maintenance and viability. We show that in addition to the focus upon ever more universal and standardised practices, the local expertise and commitment built up when creating and maintaining repositories such as GS must be taken into account. Conclusions: A commitment to open access in genomics research has found broad backing in science and health policy circles. This has led to a focus in science policy literature on facilitating access, at the risk of overlooking the contextual aspects of biobanking. Yet repositories of data and samples from human subjects may have to operate under managed access, to ensure both that the terms of consent are met and that the resource can be managed in a sustainable way. The importance of nurturing what is particular about the biobank in its local context, therefore, ought not to be ignored. A video of this presentation can be viewed at https://media.ed.ac.uk/media/0_bw9i5gm

Data sharing in genomics - re-shaping scientific practice

Author manuscript. Final version published by Nature. Available online at http://www.nature.com/Funding bodies have recently introduced a requirement that data sharing must be a consideration of all funding applications in genomics. As with all new developments this condition has had an impact on scientific practice, particularly in the area of publishing and in the conduct of research. We discuss the challenges that must be addressed if the full benefits of data sharing, as envisaged by funders, are to be realized

Planning for translational research in genomics

Translation of research findings into clinical practice is an important aspect of medical progress. Even for the early stages of genomics, research aiming to deepen understandings of underlying mechanisms of disease, questions about the ways in which such research ultimately can be useful in medical treatment and public health are of key importance. Whilst some research data may not apparently lend themselves to immediate clinical benefit, being aware of the issues surrounding translation at an early stage can enhance the delivery of the research to the clinic if a medical application is later found. When simple steps are taken during initial project planning, the pathways towards the translation of genomic research findings can be managed to optimize long-term benefits to health. This piece discusses the key areas of collaboration agreements, distribution of revenues and recruitment and sample collection that are increasingly important to successful translational research in genomics

Optimising ePrescribing in hospitals through the interoperability of systems and processes:a qualitative study in the UK, US, Norway and the Netherlands

Abstract Background Investment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless ePrescribing systems are further optimised in a local context. Typical barriers to optimal use are often encountered in relation to a lack of systemic capacity and preparedness to meet various levels of interoperability requirements, including at the data, systems and services levels. This lack of systemic interoperability may in turn limit the opportunities and benefits potentially arising from implementing novel digital heath systems. Methods We undertook n = 54 qualitative interviews with key stakeholders at nine digitally advanced hospital sites across the UK, US, Norway and the Netherlands. We included hospitals featuring ‘standalone, best of breed’ systems, which were interfaced locally, and multi-component and integrated electronic health record enterprise systems. We analysed the data inductively, looking at strategies and constraints for ePrescribing interoperability within and beyond hospital systems. Results Our thematic analysis identified 4 main drivers for increasing ePrescribing systems interoperability: (1) improving patient safety (2) improving integration & continuity of care (3) optimising care pathways and providing tailored decision support to meet local and contextualised care priorities and (4) to enable full patient care services interoperability in a variety of settings and contexts. These 4 interoperability dimensions were not always pursued equally at each implementation site, and these were often dependent on the specific national, policy, organisational or technical contexts of the ePrescribing implementations. Safety and efficiency objectives drove optimisation targeted at infrastructure and governance at all levels. Constraints to interoperability came from factors such as legacy systems, but barriers to interoperability of processes came from system capability, hospital policy and staff culture. Conclusions Achieving interoperability is key in making ePrescribing systems both safe and useable. Data resources exist at macro, meso and micro levels, as do the governance interventions necessary to achieve system interoperability. Strategic objectives, most notably improved safety, often motivated hospitals to push for evolution across the entire data architecture of which they formed a part. However, hospitals negotiated this terrain with varying degrees of centralised coordination. Hospitals were heavily reliant on staff buy-in to ensure that systems interoperability was built upon to achieve effective data sharing and use. Positive outcomes were founded on a culture of agreement about the usefulness of access by stakeholders, including prescribers, policymakers, vendors and lab technicians, which was reflected in an alignment of governance goals with system design

Information sharing and confidentiality in social policy: regulating multi-agency working

In recent years, there has been growing concern in the UK that local services aimed at risky or vulnerable people are ineffective, because of persistent failure to share information about their clients. Despite considerable national policy effort to encourage better information-sharing, previous research indicates that there are many cases where information is still not shared when it should be, or where it is shared when it should not be, with potentially devastating results. This article uses data from the largest empirical study of local information-sharing yet undertaken to examine four policysectors where multi-agency working has come to the fore. It shows variations in their information-sharing and confidentiality practices can be explained by neo-Durkheimian institutional theory and uses insights from this theory to argue that current policy tools, emphasising formal regulation, are unlikely to lead to consistent and acceptable outcomes, not least because of unresolved conflicts in values and aims