I first worked on the forerunner of what we now call EPS (the Electronic Prescription Service) in 1986, when I wrote an evaluation of a project to using a memory card to transfer prescriptions from GP practices to pharmacy for the then DHSS. However, even this was not quite the beginning of the EPS story as there had been some other projects earlier in the 1980s.
By 1986 most community pharmacies were already computerised (driven by a requirement for typewritten medicine labels and the widespread use of online order entry by the pharmaceutical wholesalers), GP computing was beginning to take off (although still at only about 5% penetration) the Prescription Pricing Authority was computerised and it already seemed obvious that it would be a good idea if prescriptions could flow electronically.
By the early 1990s GP computing had boomed and we had reached the point where 80% of prescriptions reaching community pharmacy were computer generated. With 600 million+ items prescribed annually it seemed an obvious “no-brainer” to try and move from a situation where much of the same information was typed and re-typed in to three different computer systems. The problem also didn’t look too difficult. Prescriptions consist of a small amount of fairly structured data that it would be simple to convert into a computable form that would not make excessive demands on the bandwidth or storage capacity of the then available technologies.
Numerous pilots ensued. These fell into two groups. Firstly those using some form of machine readable token, still physically transported from GP to pharmacy (this included chip cards, smart cards, magnetic stripes, 2D bar codes and optical cards). Secondly, there were those using online communication (either point-point between GP and pharmacy or via some form of email or relay service) There were a couple of attempts to launch a commercial service and I was involved in a project that tried to set up a joint industry owned service (it would have been like BACS but for prescriptions). These projects proved the concept and addressed many of the practical and professional issue involved and with the birth of the NPfIT it picked up the EPS baton in England to take forward what had been learned in this early work.
Twenty Five years after the first work, we have fairly comprehensive infrastructure in place in GP practices and community pharmacies in England and most have software to support EPS release 1, with about a third of prescriptions produced by GPs flowing to the EPS service. However, NHS Prescriptions (the successor organisation to the PPA) is still processing paper prescriptions (although in now uses scanning and OCR rather than manual data entry) and less than 2% of prescriptions are processed using EPS in pharmacies.
Why have we made so little progress in a quarter of a century?
There are a number of reasons, but paramount has been the determination by Government (driven by the pharmacy lobby) that EPS should not be allowed to become a disruptive technology, that could radically alter the medicines supply chain and potential destabilise community pharmacy. This in my view has been a critical error which has denied potentially significant benefits to patients, the NHS and those willing to take advantage of the commercial opportunities to drive efficiency and quality in the supply chain.
However, in the current economic climate
Government can no longer afford to take a protectionist stance and EPS release 2 provides the opportunity to improve both quality and efficiency, mainly by improving the truly dreadful process patients have to follow to get regular medication.
Patient concordance with medication is really poor (see my earlier blog post http://bit.ly/hkdyu8 ) and in the medium term this increases costs, morbidity and reduces patient’s quality of life. EPS can make repeat prescribing more efficient and convenient but more importantly makes repeat dispensing (where the pharmacy takes over responsibility for refills) a much more practical option than in its current paper based form (indeed with EPS 2 repeat dispensing should completely replace repeat prescribing) While supply issues are far from the whole story with regard to concordance they are a big factor and a switch to pharmacy managed repeat dispensing enabled by EPS should have a significant positive impact, not to mention improved patient convenience and efficiency gains, particularly for GP practices.
EPS 2 has only just started to roll-out and achieving the benefits it promises requires action in a number of areas.
- An acceleration of the role-out so that the benefits EPS2 offers “as is” can be realised. We should stop worrying about the commercial impact on community pharmacy and abandon the requirement for a Secretary of State’s Direction for local implementation.
- We need to address those issues that mean not all prescriptions can use EPS.
- We need to address the legitimate concerns of pharmacy with regard to business continuity in an EPS environment.
- We need to address aspects of EPS that have a negative impact on efficiency in community pharmacy and ensure that future releases deliver the key benefits that pharmacy wants (including full automation of the application of exemptions and remissions from prescription charges and automated line-item reconciliation between dispensing and payment).
It’s been a long time in coming, we are nearly there and it would be good to see EPS becoming ubiquitous before I retire.