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Shared Electronic Patient Record Access for Community Pharmacists

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Shared Electronic Patient Record Access for Community Pharmacists Shared Electronic Patient Record Access for Community Pharmacists Is there a need and what are important considerations for the design, use and implementation? Dan Burns A dissertation submitted to the University of Dublin, in partial fulfilment of the requirements for the degree of Master of Science in Health Informatics 2017 Author Declaration I declare that the work described in this dissertation is, except where otherwise stated, entirely my own work, and has not been submitted as an exercise for a degree at this or any other university. Signed: ______________________________ Date: _________________ ii Permission to lend and/or copy I agree that Trinity College Library may lend or copy this dissertation upon request. Signed: ______________________________ Date: _________________ iii Acknowledgements I would like to first acknowledge the support, guidance and expertise provided by my supervisors Dr Tamasine Grimes and Ms Gaye Stephens whose insights, challenge and passion for research were invaluable and made the process all the more fulfilling. I would also like to thank course director Dr Lucy Hederman and everyone involved in the MSc in Health Informatics for helping to make the two years such an enriching and rewarding experience. To my MSc classmates, for their good humour and collegiality. In particular, I would like to thank Michelle, for being my library buddy, bringer of coffee and source of advice. And to Tim, for his encouragement, sense of perspective and distraction when it was needed. To my sisters, Mairéad and Síle for their ongoing support and encouragement and my brother Con for his advice and expertise. Finally, to my parents Denis and Phil, who have always been a fantastic support in everything I have done and instilled in me the importance of continuous development and education. iv Abstract Introduction There is a compelling need to improve the effectiveness and efficiency of healthcare and in particular, the quality and accessibility of information being shared among care providers. Shared electronic patient records (shared EPRs) are perpetually updated online summaries of care which can be used to support timely sharing of accurate patient information across care settings. A shared EPR is one of the proposed core components of the Electronic Health Record for Ireland. In England, a shared EPR called the Summary Care Record is already available, with access now extended to community pharmacists. As a pivotal member of the primary care team, community pharmacists have previously expressed a desire to have access to more information about patients. Due to their accessibility and expertise there have been calls for greater involvement of community pharmacists in out-of-hours care, transitions of care and medication reconciliation, with clear benefits to care outcomes demonstrated when this happens. The Pharmaceutical Society of Ireland’s Future Pharmacy Practice in Ireland document recommends that pharmacy should be incorporated in the development of national health IT systems. However, the development and implementation of such systems are complex undertakings that are prone to failure. Therefore, a structured approach should be taken in the development of a shared EPR for Ireland, identifying the need that exists, considering how it should be designed, its potential use and how to successfully implement it in practice. Aims This research reviews existing evidence from which a conceptual framework is developed to support the development of shared EPRs. It describes the Summary Care Record in England and current progress on community pharmacist access. It also surveys community pharmacists in England and Ireland about their views on shared EPRs. In doing so, it aims to learn from community pharmacists in England about their experience of Summary Care Record and provide recommendations for the design, use and implementation of a shared EPR for Ireland, particularly as it applies to community pharmacy. Methods A literature review was conducted and a conceptual framework was developed. Two online questionnaires were created. One was for community pharmacists in Ireland to assess their readiness and willingness for shared EPR access, the other for community pharmacists in England to learn about their experience of Summary Care Record access and their views on implementation of the system. The questionnaires were completed by 201 community pharmacists in Ireland and 57 community pharmacists in England. Data were analysed using frequencies, mean and standard deviation. Chi- square tests and Mann Whitney U tests were used to test for independence and difference. Results The conceptual framework outlines the important considerations to be addressed in shared EPR development under the headings of need, design, use and implementation. Results from the questionnaires showed that community pharmacists in Ireland would like access to more information about patients, particularly in relation to medication history, allergies, diagnoses and rationale for therapy changes. Community pharmacists in England report that access to additional information through Summary Care Records is improving a number of areas of practice, with a greater effect v reported among those using the system frequently. They rate information relating to medication history as most useful. However, Summary Care Record was perceived to be limited in its current form. Community pharmacists in Ireland and England indicate a strong willingness to share information from their systems with other pharmacists and doctors. In general, community pharmacists in England appear to be more conservative about the prospect of sharing such information than their counterparts in Ireland. Discussion & Conclusion This research has shown that a clear need exists for shared EPR access for community pharmacists. The design of shared EPRs must consider the user interface and experience, content of the record and access security. There are a variety of ways in which shared EPRs could be used within community pharmacy to benefit patients and practice, with initial improvements likely to be in efficiency of care and access to information out-of-hours. Implementation of shared EPRs is a large-scale project requiring sociotechnical change and should ensure careful planning, with appropriate consideration given to training, evaluation and impact on role. vi Contents Author Declaration ............................................................................................................................... ii Permission to lend and/or copy .......................................................................................................... iii Acknowledgements ............................................................................................................................. iv Abstract .................................................................................................................................................... v Introduction ..................................................................................................................................... v Aims .................................................................................................................................................. v Methods ........................................................................................................................................... v Results .............................................................................................................................................. v Discussion & Conclusion .................................................................................................................. vi Contents ............................................................................................................................................. vii List of Figures .................................................................................................................................. xi List of Tables ................................................................................................................................... xii List of Abbreviations ...................................................................................................................... xiii Chapter 1 - Introduction .......................................................................................................................... 1 1.1 Background and Motivation .......................................................................................................... 1 1.1.1 Changing healthcare and future role of pharmacy ................................................................ 1 1.2 Research Overview ........................................................................................................................ 2 1.2.1 Developing the Research Question ........................................................................................ 2 1.2.2 Description and Purpose of the Research .............................................................................. 3 1.3 Dissertation Overview ................................................................................................................... 3 Chapter 2 - Literature Review ................................................................................................................. 5 2.1 Introduction..................................................................................................................................
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