Service Level Electronic Prescribing (EMIS) - The Challenge

The Tech - EMIS Web

I've used EMIS Web Clinical Services but I know the same logic can be applied in SystmOne

Set up Services

To enable an Independent Healthcare Service Provider (IHSP) to complete Electronic Prescriptions for multiple NHS Partners within a single EPR instance (i.e EMIS Clinical Services) they will need to configure a service for each NHS Partner.  

This will enable the IHSP to make sure any medication costs are re-directed back to the correct ICB.

Below is an example of 3 NHS Partners that have been set up as a Service in EMIS Web Clinical Services:

Each Service can be configured with the Prescribing Cost Centre assigned to the IHSP provided by the Medicine Management Teams at the ICBs.  It also has the parent provider details of the ICB (the patients registered GP Practice ICB).  The examples below are 3 ICBs working with the IHSP.  Each has created a PCC for the IHSP:

EMIS Services

The Problem

Prescribing Clinician

In order to be able to Prescribe, a clinician will need to login to EMIS using a Smartcard (to access the NHS Spine).  This can be a non Prescribing Cost Centre code that sits in the Authentication NACS field in EMIS.

It's recommend that the customer does not have a PCC (Y Code) in the National Code field. This is mainly because of human nature finding the easiest route hence, if there is a Y code in the National Code field, the system will not force them to choose a Service Override (see below) but will allow them to issue under the Y code in the National Code field without any warning.

However, as well as a Smartcard Role, to be able to prescribe, the medical prescriber will either need their DIN/GMP PPD Code (main code for prescribing - i.e. used in the clinicians GP Practice) or a Spurious Code (if clinician is also working outside a GP Practice such as a PCN Hub or for an IHSP):

GP Practice EMIS Settings

IHSP Hub EMIS Settings

A medical prescriber can only prescribe under a single Prescribing Cost Centre - either their DIN/GMP PPD or a Spurious Code.  Non-medical Prescribers can use their normal professional prescribing code.

The problem with Service Level Prescribing is the service uses a PCC (YXXXXX) so it means on the Electronic Prescription there will be a conflict with the GPs Prescribing Code.

Therefore, when a clinician uses Service Override to select the appropriate PCC code to complete an Electronic Prescription:

the Spurious code assigned to the GP in EMIS will always be assigned to the Prescription which would be the incorrect one for that patients service organisation (so the medication costs will not be allocated to the correct ICB).

The Solution?

Ideally there would be an additional field in the Service for a Spurious Code (that sits under the Y Code), that when this service is selected, overrides the master Spurious code from the clinicians EMIS account:

So in the example above, the Spurious Code that appears of the Electronic Prescription is 999777 and not 888444.  

Visual Representation of the solution

ICB Generated Prescribing Cost Centre and Spurious Code

Below is a real example of an ICB creating a Prescribing Cost Centre (Y06664) for an IHSP (LIVI) and a Spurious Code that sits under the PCC for any Clinical Prescriber that works for this service: