OPENeP has selected the HANDI-HOPD to built its initial prototype app. It will provide further proof of concept and is the most ambitious project to be attempted on HANDI-HOPD so far.
OPENeP is an open source project intended to deliver a suite of medicines management apps to improve the safety and efficiency of prescribing and medicines management and demonstrate how new business models can create commercial opportunities for vendors focussed on delivering high quality service.
Medication errors and one of the biggest single cause of harm to patients in NHS Hospitals, causing death, disability and suffering and represent a significant cost to the NHS with wider negative economic impacts. Many errors are amenable to mitigation through the application of digital technology and OPENeP is intended to help address these problems.
There are already a number of digital tools that support various aspects of the medicines management process, most are proprietary products and many of these are of good quality, but they are not designed to fit in the emerging open digital health ecosystem or take advantage of the latest technology.
OPENeP is intended to explore how we build apps for the emerging digital ecosystem and to enhance, not replace, existing EHR and Pharmacy systems and create new opportunities for vendors of such systems, who we hope might include these components to enhance their existing product and service offerings. OPENeP apps will be designed to facilitate integration with PAS, EHR, order communication and pharmacy systems as well as proprietary knowledge and decision support components.
The starting point for OPENeP will be the ePrescribing and Medicines Administration modules of Think!Med Clinical which its creators Marand have agreed to release under the GPL open source licence. This product which is based on OpenEHR provides a proven solution using the latest technology already successfully deployed in a large hospital and gives us a great starting point for our work. Our aim is to develop this to provide the suite of apps described below which will initially be deployable via a common interface (API) as either the eP/eMA component of a OpenMaxims EHR or as a "standalone" solution which will operate on any OpenEHR backend
The focus of OPENeP is on the hospital inpatient setting, where it is intended to integrate with existing systems and other apps to deliver digital care at the beside. However, it is designed so that it can be extended to deliver facilities in other settings.
The currently identified components of the OPENeP suite are:
- Medicines reconciliation – With modules for both the patient and healthcare professionals to ensure an accurate view of a patient’s medication at handovers of care.
- ePrescribing – To help ensure safe, efficient and appropriate prescribing compliant with national guidance and local policies.
- Medicines Administration – To help ensure safe, accurate and timely medicines administration.
- Personal Medication Record – To give patients a view of their medication to support self-care, concordance and the safe and effective use of their medication.
- Medicines Utilisation and Audit – To support pharmacists and others in the review totality of a patient’s medication and monitor and audit medication usage, administration and patient concordance.
- Medicines supply management – To support the transfer of orders for medication both for individual patients and for local stock to pharmacies, including support for orders for discharge medication to hospital or community pharmacy.
The Initial focus with be on prescribing and administration and we intend to use HANDI-HOPD to build some initial prototypes. Like everything on HANDI-HOPD these prototypes will be purely experimental and will not be used with real patient data. However, because HANDI-HOPD uses open standards we expect others to take them and deploy them in an operation environment.
Our priority is to create a user interface (UI) that delivers a user experience (UX) that make the apps a joy to use and in doing some makes the processes they support more efficient, easier and safer. To do this we want to bring together domain expertise in medicines management, frontline clinicians and patients with engineers, designers and informaticians working together using user centred design techniques.
In order to operate effectively and efficiently OPENeP apps will need to interoperate with a range of others systems including:
- GP Systems – To support medicines reconciliation on admission and discharge
- Patient Administration Systems (PAS) - To identify and track patients
- EHR Systems (EHR) – Access the clinical data about patients needed for safe, effective prescribing.
- Hospital Pharmacy Systems – To manage medication orders and supply
- Community Pharmacy System – To support delivery of discharge medication in the community.
We will use existing open interface and define new open interfaces where none exist, ideally in collaboration with target system vendors. The OPENeP apps will be designed to work with FHIR APIs on target systems (with openEHR archetypes mapped to FIHR resource profiles) but we will provide middleware components to allow interworking with APIs based on other standards.
Basic functionality can be implemented without interfaces to most of the above systems, but certain basic EHR data is essential for safe prescribing and OPENeP will provide basic EHR functionality, using openEHR to allow these data to be recorded with within the OPENeP suite when an external EHR data source is not available.
Partners in the project are:
- NHS England Open Source and e Prescribing Programmes
- Fivium http://www.fivium.co.uk/ - A mid-sized SME with experience of delivery solutions based on source to Government in the UK and elsewhere including the provision of the system to operate the Pharmacy Benefit Scheme to the Australian Government. http://www.fivium.com.au/health.html
- First Data Bank http://www.fdbhealth.co.uk/ –The UKs most experienced provider of drug knowledge for use in ePrescribing systems.
- Neova Health www.neovahealth.co.uk/ – A UK based SME successfully delivering open source solution in the NHS include eObs a nursing observation app which is a natural companion to OPENeP at the bedside.
- Marand www.marand-think.com/ – A Slovenian SME that already provides much of the technology for HANDI-HOPD and who have delivered ePrescribing for the Slovenian Health System
- IMS Maxims - http://www.imsmaxims.com/opensource/ - Original authors of OpenMaxims open source EHR