A chance meeting at the HL7 UK conference between Richard Timms, IT manager from West Suffolk Hospital (WSH) and Adam Towler, Bluewire's MD led to our second development partnership.

The hospital had identified a need to effect improvements in the management of the discharge prescription process in order to alleviate the bed-blocking problems associated with delays in patients being able to go home, following their discharge confirmation.

Recognising that replacing their existing paper TTO form (to take out) with improved IT systems would be part of the answer, Mark McNally and Richard Timms from the IT Management Team at WSH invited Bluewire to work with them and the Pharmacy Team to develop a solution that would model and integrate with their existing practices.

The hospital already had a home grown discharge tracking system and a pharmacy stock control system but there was a desire to improve the quality and timeliness of TTO / discharge letters to GPs. It was critical that the system would be acceptable to pharmacy. Ideally, pharmacy would have liked full blown electronic prescribing and drug administration, but there were insufficient resources to fund this. The existing pharmacy system supplier was able to provide a discharge letter module, but this was limited in its scope and offered limited formatting and Microsoft Word integration

The following objectives were identified:

• Provide an effective solution capable of embracing current working practices
• Streamline current working practices
• Improve the overall patient discharge timescales
• Provide electronic TTO request to Pharmacy and reverse communication to the ward regarding the prescription readiness status
• Include Pharmacy approved drugs picking list for prescribers
• Provide audit of TTO prescribing, amendments, dispensing and timescales

Once the objectives were established, the Development Team at Bluewire, working very closely with the WSH Teams, produced a solution ready to trial in just 10 weeks. The acute admissions ward was chosen as a pilot ward for the trial and went live in March 2007. Following a period of evaluation, the system was extended to a second surgical ward, and then a number of further changes were made leading to a second version of the new module in August 2007.

The solution

The eTTO template was designed using the same layout as the existing paper form. This was important to ensure ease and familiarity of use and to minimise the training needed for busy prescribers and pharmacy staff. Bluewire were able to use their existing forms template module, which was a big help maintaining the fast pace of development required. We initially wrote a custom interface to the hospital's existing iSoft PAS system and then jointly wrote an HL7 module to receive ADT data via their Rhapsody integration engine. One of the interesting things about this project was the opportunity for Adam Towler (Bluewire) and Richard Timms (West Suffolk Hospital), who are both members of HL7 UK to co-operate on the HL7 messaging details.

Using the ward or tablet PC, the clinician accesses the patient record and keys in the prescription onto the eTTO form. Fast drug entry was imperative, so Bluewire built a module which would learn individuals' prescriptions. These were then 'vetted' by the Pharmacy department to provide an approved drug formulary used to populate picklists. This significantly reduced the number of corrections pharmacists had to make when processing TTOs. Controlled drugs and non-formulary drugs are indicated by appropriate flags to assist both presbribers and pharmacy and links to the eBNF (British National Formulary) were added. The module also includes flags for drugs in specific cost groups which are can be used to assist them with remuneration claims for selected drugs or combination medications.

Once electronically 'signed' the completed e-TTO prescription form is accessed in the pharmacy department where the status of the supply is added e.g. 'Checked by Pharmacy', 'Ready to collect' etc . and any problems with the prescription can be advised e.g. 'wrong dose', 'unavailable'. This provides the transparency to the ward staff who can see the status on the ward computer and advise the patient, relatives, or hospital transport staff appropriately.

October 2007 - site licence and completion

Following the successful conclusion of the trial, West Suffolk hospital have decided to buy a site licence are extending the use of the system across the whole hospital. BluewireTechnologies have added the e-TTO component to their core epro product. West Suffolk have commented that having bought a site licence, has opened a floodgate of requests to extend the system into other areas and are currently investigating a modules to transfer discharge summaries to GPs electronically, viewing of electronically scanned case notes from archive, and production of clinical out patient letters.