In our Artificial Intelligence, Data & Analytics feature, we speak with CMM to find out more how the technologies are being adopted to support healthcare teams.
We explore how CMM has supported the Antibiotic Review Kit (ARK) project, funded by the National Institute for Healthcare Research. We hear from Steve Reggione, Head of Operations at CMM, who takes us through Antibiotic Usage – Data and ARK Decision Support with CMM:
“We were made aware of the Antibiotic Review Kit (ARK) project through a variety of sources – existing customers (NHS Trusts in England, Health Boards in Wales and Scotland), NHS Digital, NHS-X, and NHS Improvement. The ARK project was funded by the National Institute for Healthcare Research to improve hospital antibiotic prescribing. Within the project a network of NHS clinicians led by Prof Martin Llewelyn of Brighton and Sussex Medical School developed and evaluated a new decision aid for prescribers. Ultimately, what brought us to Martin and the ARK team was Ann Slee, Associate CCIO (medicines) at NHS-X as their research was aligned to some of the work that CMM was doing with NHS-X on interoperability and generally improving electronic prescribing solutions.
Over the past 40 years, CMM has acquired about 60% of the pharmacy secondary care marketplace for managing pharmacy medicines on the CMM medicines management platform. The majority of our customers have expressed interest in indication-based prescribing and our strategic roadmap included adding in an indication within our e-prescribing system workflow.
The research and the resulting Decision Aid tool advocating for the addition of an indication at the initial antibiotic prescription was very welcome. The research affirmed our view which sees indication as the basis for more advanced decision support. It is a key parameter of the prescribing process because the indication will influence the treatment choices the clinician will make for the diagnosis. This decision to bring the development of CMM’s advanced decision support forward was also supported by the fact that a mandated set of indications were going to be used. The research findings and the ARK Decision Aid toolkit fitted a number of strategies.
The ARK project had clearly demonstrated that conducting an indication-based prescription was beneficial, thus being able to harness the functionality to deliver this service in a way that would meet the research team’s objectives and the wider objects of the NHS as a whole. The project also provided a framework for CMM to build more options on and demonstrated a great opportunity for collaboration.
We brought together a focus group comprised of NHS-X colleagues, ARK project and other researchers, as well as some of CMM’s clients, to help us consult on prototype design. Martin gave a helpful background and the specific requirements for the ARK Decision Aid toolkit. CMM produced a prototype design and supporting documents, forming the basis of our internal specification.
Further consultations with our focus group followed during which the prototype was refined to meet not only the ARK project principles but also CMM strategic requirements. We wanted to ensure it provided a framework for any medicine applying the same principles as in the ARK: to mandate or request that the clinician puts in the information, with the possibility to audit and subsequently generate data to either support research or inform the organisation on the outcomes for the patient.
We’ve found it very useful working with the ARK team because it has allowed us to talk to a completely different group of people who have different goals and aims, as a result of electronic prescribing. Typically, we’re talking to an end user that looks at their individual needs whereas with the ARK team were really looking to improve the prescribing process for everyone overall, relevant to antibiotic usage by capturing specific information in a standardised way.
Some of the key elements of the research certainly informed the large part of the design of the new workflow and the way in which it was going to work. The timing of when users would input certain information, what would be captured, what would be audited, what would be available for reporting purposes, those key elements were absolutely informed by the aims of the ARK Hospital project. CMM already had some features within the system which would allow us to do what we would refer as a ‘soft stop’.
With regards to antibiotic prescribing, the review of the appropriateness of the treatment is already within our application but this is now combined with the indication [as informed by the ARK toolkit] and the system can be guided to suspend the prescription if the clinician hasn’t performed the required review action. This respects one of the key principles of the ARK i.e. a behaviour shift from “continue unless there is evidence to stop” to “stop unless there is evidence to continue”.
The new upgrade system will be included in the system of our 50 customers that use electronic prescribing. We view this sort of feature as one that all clients will benefit from. It is therefore being offered integrated into the standard application and not as an additional chargeable module. We are confident that our customers will utilise it, not least of all because we anticipate that the NHS is going to mandate that they do this in some way because of the ARK research project. The toolkit effectively provides the standard. There might be some variability in the content collected but the data captured will be generated in a standard format.
As a result, we can provide a standardised data output that other systems could interpret. It would allow us to report on antibiotic usage from our 50 customers [if permissions were there] with the related indications and all the associated audit trails. Being able to capture that information at 50 NHS organisations provides a huge additional amount of supplementary data to help support any further research that the team might want to do. It represents an important set of additional information to capture within the electronic prescribing process to help the NHS in general, improve patient outcomes, and our customers will see it as a valuable feature.”
[Full Article posted by HTN:https://www.thehtn.co.uk/2020/09/25/feature-artificial-intelligence-data-analytics-orion-health-and-wellsky/]