Making your pharmacy system work for you

Making your pharmacy system work for you

With the escalating usage of the Electronic Prescription Service Release 2 (EPS R2) it becomes even more critical that pharmacy teams get the most out of their pharmacy systems.

PSNC continues to receive feedback about the variation of features and support available amongst the various PMR systems in regards to:

  • usability;
  • functionality;
  • speed/performance; and
  • responsiveness when issues are raised.

All of the EPS R2 PMR systems meet the minimum requirements (laid out by HSCIC and NHS England within ‘specs‘) but suppliers can develop additional functionality. PMR-related EPS enhancements beyond the minimum requirements fall outside of NHS England’s control, however there is flexibility for pharmacy teams, pharmacy trade associations and system user groups to press for enhancements.

It is essential that pharmacy staff engage with system suppliers so that they understand the needs of pharmacy teams so they can then seek to address these needs as they develop their software. PSNC believes there are a range of areas in which further development would assist pharmacy teams; the following list details the priority developments that we would like to see in PMR systems:

Priority development areas: Commonly requested enhancement/roadmaps

There are a range of areas discussed further below in which further development would assist pharmacy teams, and in particular, PSNC receives reports that developments are needed to ensure that systems can allow:

1) ‘Claim amend functionality’ – amendment of a prescription after it has been sent for pricing (or it has been ‘claimed’)

EPS prescriptions should be able to have their endorsement and exemption status amended at any time after claim notification has been sent, and the EPS prescription has been sent to the Pricing Authority, as long as the prescription’s relevant ‘5th of the month’ pricing deadline has not passed (see EPS five day window logic). HSCIC has made amendments to the Spine to allow this functionality to be implemented and one PMR system already has this functionality available to users.

2) Providing confirmation that prescriptions have been sent to the Spine so there is further reassurance the Pricing Authority can access these and then price them

HSCIC has amended the Spine so that PMR systems can be developed to provide confirmation that individual EPS prescriptions have reached the Spine. This functionality would provide reassurance to pharmacy contractors that all the electronic prescriptions they have submitted have been received at the Spine and will go on to be priced by the Pricing Authority.

As of quarter 1 2016, one supplier had added this functionality.

3) Mechanisms to prevent the wrong exemption status being applied

PMR systems should assist users by (1) preventing prescriptions being sent to the Pricing Authority unless an exemption category option has been selected; and/or (2) where needed, asking whether either, the ‘paid’ status is right, or, if instead, the category needs adjusting.

4) Effective alerts so that prescriptions will not reach the 180 expiry period

The Pricing Authority cannot price prescriptions which have passed their 180 day expiry therefore systems must ensure that warnings within the system are sufficient to prevent prescriptions from passing this deadline. For example pharmacy teams may benefit from a regular popup alert stating the number of prescriptions 28 days, and 7 days away from reaching the 180 day limit, if there are any.

5) Controlled drugs (Schedule 2/3)

From 1st July 2015, legislation came into force allowing Schedule 2 and 3 controlled drugs to be prescribed and dispensed using the electronic prescription service (EPS) release 2 messages. Suppliers have been asked by HSCIC to consider when they will be able to implement the changes and until all suppliers provide this feedback, a decision can’t be made regarding implementation timescales.

Status updates

Update: Supplier status regarding enhancements (HSCIC pdf).

Settings/Reporting

Top tip Summary Advice
Working with suppliers to improve system usability Reporting issues by email and requesting a reference might help to resolve issues. Many users discover system settings can be adjusted:

  • e.g. too much clicking where three clicks were needed (Print, OK print preview, OK) to print every dispensing token, a problem that was easily resolved by a call to the supplier who was able to advise on how to change the setting.
  • e.g. bag labels: staff found they had to remember to print bag labels after they had finished dispensing rather than during it as they had done pre-EPS Release 2; this was also a system configuration issue quickly solved by working with their supplier.

Reporting system problems: Not all system usability issues will be able to be resolved so quickly but it is essential to report all problems/issues (and obtain a reference so the issue can be escalated where needed). Reporting by email means there is an audit trail of the communications, and can assist with any escalation (e.g. where an issue requires escalation to an appropriate organisation). Reporting issues and making suggestions for improvement can lead to suppliers building enhancements into workplans for the ongoing development of systems.

Ensuring correct reimbursement

  • Warnings and reports to prevent prescription expiry
  • Sorting prescriptions easily
  • Recording prescription charge exemption information
  • Endorsing and sending prescriptions for reimbursement with correct information
  • Reports with right functionality
Issue Summary

Discussion points to raise with supplier

Warnings and reports to prevent  prescription expiry

 

Where a prescription has been dispensed but reimbursement has not been claimed, it will be removed from the spine after 6 months, even if it has not been claimed and therefore sent to be priced.

After this time, an electronic claim will be rejected and a manual request must be made to the NHS England Area Team (AT) who may speak with NHS Prescription Services on the issue.

  • What reports and alerts will be in place in the system to alert pharmacy staff of the need to claim these outstanding prescriptions when these accidentally go for months without having been claimed?
  • Will there be a regular warning when logging in, advising that there are x number of prescriptions which were marked as dispensed more than three months ago but have not yet been claimed
Sorting prescriptions Does the system support filtering prescription information on-screen?  Can the system easily separate script by category. For example:

  • Release 1 and Release 2 prescriptions,
  • dispensed prescriptions from those that are awaiting collection
  • prescriptions that are endorsed and ready to claim from those with actions outstanding?
Recording prescription charge exemption information In R2, the patient’s exemption status needs to be entered into the electronic claim message. :

  • Recorded at same time: Will the system efficiently support accurate exemption recording of this information where it is obtained at the point of hand-out?
  • Amendment for a period after claiming: Suppliers can introduce the ability for pharmacies to as a last resort also amend this information within certain timescales (before the prescription is ‘locked’ by the pricing agency for pricing)
  • Auto-populating: Will the system support auto-populating this information where the patient holds a valid exemption certificate and staff have recorded this information in the patient record?
  • Preventing submission before exemption status altered: Is there a control to ensure that a prescription cannot be claimed without  the prescription charge status being confirmed either by the user or through auto-population from the patient record?
  • Using exemption expiry dates: Are there controls to ensure that the system only automatically marks an electronic prescription as exempt where the exemption certificate is within its period of validity – risk areas include a PMR system auto-populating a prescription as exempt where no expiry date was recorded locally or where the expiry date for the exemption certificate has passed?
  • Audit reports: What audit reports will the system generate to support checking that staff have entered exemption information where required?
  • Month-end reports to support submission: Does the system generate reports of prescriptions dispensed and exemption status to support a month end audit that staff have entered the information correctly on the system?
Endorsing and sending prescriptions for reimbursement

In R2 submission is electronic. Endorsements must be made electronically.

Missing or incorrect endorsement could lead to the pharmacy being insufficiently reimbursed.

  • Functionality to support efficient endorsement-checking: What functionality will there be in the system to support the pharmacy contractor or pharmacist-in-charge to review this information to satisfy themselves that pharmacy staff have made electronic endorsements correctly?
  • Encouraging that non-Part VIII items are endorsed with information/price: A key reason for prescriptions requiring clarification by the pricing agency in R2 is where the prescription is for a non-Part VIII product and the prescription hasn’t been endorsed with the invoice price, does the system force or advise a user to enter an invoice price where there is no indicative price in dm+d?
  • Confirmations prescriptions reach spine successfully: System suppliers which have not already, can choose to set up receipt acknowledgements so pharmacies are made aware that the prescriptions they claimed were received successfully onto the spine.
Reports What type of reporting features does the system have to support users?

For example is there a report to support completion of the FP34c submission document?

The total number of electronic items needed for month-end calculations will be those EPS prescriptions marked as dispensed during the calendar month which were also claimed by the end of the 5 day of the following month. A breakdown of exempt/paid prescriptions and exempt/paid items will also be needed in order to complete the submission form.

Does the system generate reports of the number of prescriptions dispensed and exemption status to support a month end audit that staff have entered the information correctly on the system?

Supporting an efficient dispensing process?

  • Alternating between paper and EPS
  • Recalling dispense/claim notification messages sent in error
  • Repeat dispensing
  • General Workflow
Issue Summary    Discussion points to raise with supplier
Alternating between paper and EPS Switching between dispensing EPS and paper prescriptions Does your system support you in quickly moving from dispensing a paper to an electronic prescription without having to switch between different modules?
Recalling dispense/claim notification messages sent in error Does the system support recalling dispense notification messages or claim messages which have been sent in error This is now possible for system suppliers to allow recalling:

  • dispense notifications;
  • claim notifications even after the reimbursement claim has been submitted, if it is before the NHSBSA has needed to ‘lock’ the prescription to price it.

Update: Supplier status regarding enhancement (HSCIC pdf).

Repeat dispensing Suppliers have flexibility to put in place scheduling functionality to draw down repeat prescriptions in advance of the patient visiting the pharmacy.  How will the system support this?
General Workflow How does the system integrate EPS with other business processes For example:

  • Such as preparing monitored dosage systems?
Controlled Drugs
System is ready to deal with Schedule 2/3 CDs

CDs and EPS.

Update: Supplier status regarding enhancements (HSCIC pdf).

Supporting pharmacy providing an efficient service for patients

  • On-screen display of patient medication history
  • Nominated patients
  • Communicating information from the right hand side of the prescription
  • Offer a delivery service?
Issue Summary Discussion points to raise with supplier
On-screen display of patient medication history Under paper-based processes, pharmacy staff often view the patient’s history at the same time as generating repeat prescription labels. How will the system support pharmacy staff in efficiently reviewing the relevant history in EPS Release 2?
Nominated patients Patient lists For management purposes will the system support the generation of a list of patients that have recently received prescriptions via nomination?
Communicating information from the right hand side of the prescription In certain circumstances, information from the prescriber that would traditionally have been included on the right hand side of the prescription form may be passed by the pharmacy to the patient. How will the system support staff in passing on this information?

There is currently no standard ‘dosage syntax’ and a problem in Release 1 has been prescribers using abbreviations which are passed through to the pharmacy via the electronic message.

  • Will the pharmacy system ‘remember’ if the pharmacist changed the instructions for the last prescription for the patient to support automatically converting the GP’s abbreviated message to a suggested alternative?
  • Or has the supplier found an alternative way around this problem?

PSNC has received reports that prescribing systems organise repeat medicines into alphabetical order whilst the reported pharmacy system ordered these into their chronological order. This had made reconciliation more difficult.

  • Will the pharmacy system display the repeat medicines into alphabetical order, and if not will they add this onto their development plan?
Offer a delivery service? System flag on patient record to advise pharmacy where home delivery is required?

In some areas home deliveries of patient medication is printed on the patient’s repeat slip. There may be changes in the way this information appears on a printed token or there may not be a token for the patient, removing any visual cue.

Will the system support staff in managing a home delivery service? For example a flag on the patient record and appropriate system alerts to ensure pharmacy staff are aware the medicine is to be delivered.

Dealing with or preventing problems

  • Alerts when the system is down
  • Smooth transition following down-time?
  • Ensuring regular back-ups are taken
  • Feedback
Issue Summary  Discussion points to raise with supplier
Alerts when the system is down Will the system be able to generate alerts for pharmacy staff when the system is down? For example:

  • Alerts when connectivity to the internet is lost or the local system is unable to connect to the spine or message broker?
Smooth transition following down-time? Supporting reconciliation after a connectivity problem
  • If there is a connectivity problem, one option the pharmacy has is emergency supply at the request of a prescriber.
  • Does the system support efficient reconciliation of records on the PMR and downloaded electronic prescriptions once connectivity is restored?
Ensuring regular back-ups are taken. Backing up data is essential since losing locally held data without a back-up could impact on reimbursement and other issues

Monitoring controls might issue alerts if back-ups are not made within a defined time period.

Backups could involve some or both of options:

  • Locally held – pharmacy-managed local daily back-up on to disk or USB stick
  • Centrally managed solutions that support automated secure storage of back-up information at an off-site location every evening.
Feedback Feedback on the use of the system in practice is important for suppliers in the ongoing development of their systems.
  • Will they always provide a helpdesk/query reference so issues raised by phone or email can be escalated where needed?
  • Apart from calling the helpdesk, is your supplier considering any other solutions to support the efficient recording of feedback and suggestions about the system?
  • Is there scope to join a user group?

Choosing/changing a system supplier

Related resources

For more information on the future of EPS click on the buttons below:

eps arrow yellow-previous eps box yellow- home- eps box yellow- future eps eps arrow yellow-next



Latest Contract & IT news

View more Contract & IT news >