One of the largest healthcare organisations in Europe has implemented Orion Health Medicines to provide its clinicians a more complete and up-to-date list of the medications their patients are taking.
NHS Greater Glasgow and Clyde (NHSGGC) has just completed a roll-out at the Queen Elizabeth University Hospital in Glasgow and is now using the system for medicines reconciliation across 11 hospital sites, so doctors can have a more complete picture of the medications a patient is taking when they are admitted.
Orion Health Medicines is also being used to generate electronic immediate discharge letters, so GPs have timely access to information about any treatments that were stopped, changed or prescribed while one of their patients was in hospital.
NHSGGC, which is a long-standing user of the Orion Health clinical portal, intends to integrate Orion Health Medicines with an e-prescribing system over the next few years.
Alastair Bishop, programme lead at NHSGGC, said: “Medicines reconciliation is an important foundation for clinical decision making.
“Orion Health Medicines gives our doctors both a hospital view and a GP view of the medications that a patient is taking and enables them to see how those medications have been changed over time. This can give clinicians a more complete picture on which to make informed decisions about any changes that need to be made.
“Orion Health Medicines also captures those changes in the immediate discharge letter that goes to GPs, so they have an accurate picture of the medications that were stopped, modified or prescribed by the hospital and are able to make informed follow-up decisions without spending time chasing information.”
Orion Health Medicines aggregates medication data from multiple IT systems to display an up-to-date and accurate list of the medicines a patient has been prescribed across care settings.
In NHSGGC, the system pulls demographic information from the Scottish Care Information (SCI) Store. It matches this with medication data from the national Emergency Care Summary, which securely draws information from GP systems.
It then displays this medication data alongside any drug information recorded in the clinical portal from previous hospital admissions. Having two electronic sources of medicines information can support the process of medicines reconciliation, and can highlight specialist drugs prescribed by hospitals, that might not be included in the GP record.
“Clinicians have said it is helpful to be able to see what medications patients were taking last week, six months ago, or last year,” Bishop added. “Being able to see what has changed gives them useful information about how a patient’s treatment has progressed.”
As a patient moves around NHS Greater Glasgow and Clyde’s hospitals, the system adds further information from their patient administration systems.
When a patient is ready to be discharged, it populates the immediate discharge letter including updated discharge medication data.
“Because Orion Health Medicines captures the medications the patient had at admission, and the medications they have at discharge, the system can automatically highlight to the GP what has changed,” Bishop said.
“Previously, stopped medication might be omitted from the discharge letter, meaning it wasn’t clear to the GP whether this medication had been deliberately stopped.
“The GP might phone the hospital to seek clarification, which took time for both the GP practice and the hospital staff. With the Orion Health system, the immediate discharge letter clearly states that a medication has been stopped, including the reason for this.”
Orion Health Medicines was piloted at the Beatson West of Scotland Cancer Centre last November and Inverclyde Royal Hospital in January. The two pilots gave the project team valuable information about how the system worked both in a highly specialised environment and a general receiving hospital.
Orion Health developers spent time on site to better understand clinical staff requirements and key usability challenges. This has guided ongoing improvements to the system.
Following the pilots, work started on roll-out across the rest of the NHS board’s hospitals. Deployment has just completed at the 1,677-bed Queen Elizabeth University Hospital. “Since the pilots, we have rolled out rapidly,” Bishop said. “Bringing around 15 new wards onto the system each week.
“There have been 77,000 immediate discharge letters produced using the system so far, with thousands more each week. There have also been a quarter of a million medicines reviews, and well over two million individual medicines recorded on the system. This illustrates the large scale of NHSGGC’s implementation. The next phase of the rollout will introduce the system across our mental health inpatient areas.
“We’re seeing benefits in that patients’ discharge medicines are reconciled with their admission medicines, hospital clinicians can spend less time manually transcribing medicines information and GPs are not having to chase the hospital to find out why certain decisions around medications have been made during a patient’s stay. The aim is to free up time to focus on clinical decision making.”
The deployment team adopted a new way of training staff to use the new system. Instead of pulling busy clinicians off the wards for classroom based training, they used floor-walkers “on the floor” in clinical areas, training clinical staff as they did their jobs.
Bishop said this approach would be built on and further developed when the NHSGGC deploys a Hospital Electronic Prescription and Medicines Administration System (HEPMA), which is being procured via the Scottish national framework contract.
Aaron Jackson, product director for Medicines at Orion Health said: “This has been a rewarding project for Orion Health, supporting clinicians and eHealth leaders at NHS Greater Glasgow & Clyde in making a significant step towards the digitisation of the hospital care medication record. Transition of care medication reconciliation, discharge prescribing and documentation are complex processes and it has been great collaborating with such a capable and motivated team. We look forward to supporting NHSGGC on the next stage of their journey.”
Bishop summed up, “the new Orion Health system provides clinicians with a better tool to carry out medicines reconciliation at admission, and to manage the process of confirming and supplying discharge medicines. NHSGGC is on a journey to make the most of this tool’s potential to improve clinical processes, and to build on this foundation as we introduce full electronic prescribing and medicines administration.”
