How we’re modernising electronic prescribing

But despite all our gains in primary care, there are only a handful of secondary care providers who currently use the service. Patients who require secondary care prescriptions sometimes need to travel to outpatient clinics to collect them, and it’s not unheard of for clinicians to have to drop off paper prescriptions in person.

But before secondary care providers can start using it, we had to modernise: the underlying technology of EPS hadn’t changed much since it was launched in 2005.

In 2020, we began to move EPS from the HL7v3 data standard to the Fast Healthcare Interoperability Resources (FHIR) standard, as a significant first step in modernising the EPS platform in England.

The aim of this project was to improve interoperability by enabling more efficient and accurate processing of electronic prescriptions through the exchange of more detailed and structured clinical information between the electronic prescribing and medicines administration (EPMA) systems used in secondary care and EPS. This improves patient safety and ensures healthcare providers have access to accurate information.

In the first stage, this modernisation has taken the form of a FHIR façade, which sits in front of the HL7v3 service and allows suppliers to interact with EPS in FHIR in the same way they do in HL7v3. This means suppliers will be able to use HL7v3 and FHIR interchangeably. For example, a prescriber can create a prescription with HL7v3 and a dispenser can release that prescription in FHIR.

The expertise of the interoperability team has helped in moving from HL7v3 to FHIR. This included modelling the interactions within EPS using FHIR resources, mapping all data elements required in the HL7v3 Message Implementation Manual (MIM) to data elements in FHIR and creating an implementation guide to be used by both suppliers and the EPS programme in developing the FHIR façade.

Development work on the FHIR façade for EPS is now complete with the first supplier ready to go live imminently. ‘First of type’ suppliers are currently assessing their capability against the EPS Supplier Conformance Assessment List (SCAL).

Once the FHIR API is released, any new system suppliers that wish to connect to EPS will be onboarded with the FHIR API as part of their onboarding process with the NHS. The onboarding process involves demonstrating that they can communicate with the EPS FHIR API and can consume and interpret FHIR messages correctly.

The EPS team is continuing to expand the capability within EPS to support dental prescribing and prescribing in Wales, where paper prescriptions are still heavily relied upon. The interoperability team is instrumental in helping achieve this by assessing and modelling the changes to the FHIR resources needed to support these prescriber types.

This expansion of the service to more prescribers and prescription types further cements EPS as being the one source of truth for a patient’s prescriptions. 

Going forward, we will be focussing on integrating EPS with the NHS App to help reduce the burden on front-line staff. Patients can already order repeat prescriptions through the NHS App. EPS integration will allow patients to also receive notifications when they are ready to collect.

Fundamental to achieving this is more granular tracking of the prescription lifecycle. The NHS App can then present the prescription token as a barcode, that would allow patients to retrieve their prescriptions from the pharmacy without having to provide their personal details.

NHS England’s Interoperability Standards (IOPS) team provides expertise and guidance to NHS programmes, system suppliers and API consumers so they can develop APIs that conform to and deliver the latest interoperability standards.

By doing this, the burden on development staff to maintain legacy APIs decreases, while increasing capacity for interoperability with a wider range of system suppliers within NHS and beyond.

Ultimately, this means added benefits for patients as their data can be kept accurate, easily accessible, and transferable to health organisations who need the data to deliver appropriate care, eradicating problems raised by paper-based systems.