1. Bob Sugden Centre for Software Reliability University of Newcastle Bob.Sugden@ncl.ac.uk Bob.Sugden@ncl.ac.uk Rob Wilson Centre for Social and Business Informatics University of Newcastle Rob.Wilson@ncl.ac.uk Rob.Wilson@ncl.ac.uk The work described here was carried out by the authors together with a consortium led by the Sowerby Centre for Health Informatics at Newcastle, including the School of Pharmacy and Pharmaceutical Sciences (University of Manchester); the Industrial Statistics Research Unit (University of Newcastle) and QinetiQ ETP + ERDIP = ICRS? Experience of the Evaluation of ETP Pilots

2. Electronic Transmission of Prescriptions (ETP) (aka National Prescription Service) will be supported in Phase 2 (2006-8) of the Integrated Care Record Service (ICRS) or NHS Care Records Service (NCRS) (formerly known as the Electronic Health Record) N.B. Use of electronic means to prepare and issue paper prescriptions is widespread in UK general practice ETP - Terminology

3. ETP was piloted and evaluated in England in 2002 The Department of Health commissioned: -three ETP pilots -in three different health areas -using three different business models -privately financed by private consortia: Flexiscript, Pharmacy2U, and TransScript ETP – Context of Pilots

4. ETP - Stakeholders

5. Although there is a considerable body of literature on electronic prescribing, few refer to electronic transmission from GP to pharmacy, and none to transmission to a body such as the NHS Prescription Pricing Authority (PPA) Studies from the USA and Denmark suggest that ETP confers benefits for GPs, pharmacists, and patients, making the whole dispensing process less time-consuming ETP – Evaluation Literature

6. The evaluation was intended to: explore the socio-technical context assess the change management issues inherent in introducing ETP to general practices, pharmacies and patients develop technical standards The evaluation was planned as a formative exercise to run in tandem with the pilots… ETP – Context of Evaluation

7. ETP – Message Volumes

8. ETP – Message Models

9. Acute Update EPR Print Signed by GP Issued Repeat Check EPR Update EPR Print Rx Choice Issued Query Resolution by GP Signed by GP Dispensed Query Handling by Admin. GP process Patient present Patient absent Admin process Pre-ETP - Current Prescribing Process

10. Acute Update EPR [Print] Signed by GP Issued Repeat Check EPR Update EPR [Print] Rx Choice Issued Query Resolution by GP Signed by GP Dispensed Query Handling by Admin. GP process Patient present Patient absent Admin process GP process Post-ETP - Prescribing Process

11. 1.Political imperative to implement (50% ETP target by 2005) – DON’T PANIC! - be realistic about the difficulties, timescale and cost 2.Numerous stakeholder sensitivities – be clear about the objectives and how they will satisfy the stakeholders 3.Structure, time, finance, and incentive to learn from evaluation - be prepared to spend time & money learning from & rectifying mistakes 4.Technology can deliver – but make sure the problem(s) are understood before building solution(s) 5.And finally - a fruity theory of system evaluation… ETP - Evaluation Learning Points

12. Oh **** its all gone shaped!! Evaluating a …when you thought it was a Pilots Always Bear Fruit