Who is this toolkit aimed at?

This toolkit can be used by anyone who is looking for more information about ePrescribing and Medicine Administration systems in NHS hospitals. It offers resources and tools on a wide range of topics covering technical, financial and managerial issues as well as end-user and patient relevant material. Whether you are a doctor, nurse, pharmacist, allied health professional, part of the IT or implementation team, or a patient, the ePrescribing toolkit is here for you.

Why is this toolkit available?

The toolkit has been put together by a team of researchers from the Universities of Edinburgh, Birmingham and Nottingham, University Birmingham Hospitals NHS Foundation and Harvard School of Public Health, as part of a Research Programme funded by the National Institute for Health Research (NIHR), investigating the implementation, adoption and effectiveness of ePrescribing systems in English hospitals. It includes both findings from the Research Programme as well as many other valuable resources to support the planning, adoption and longer term use of ePrescribing and Medicine Administration systems.

How can this toolkit help me?

There are lots of different types of resources available in this toolkit. From background information, links to news sources and other relevant websites, documents, journal and book references, case studies of hospitals using or soon to use ePrescribing systems, as well as much more hands-on practical tools to plan and evaluate an implementation, the toolkit is designed to support hospitals and its patients every step of the way.

How often does this toolkit get updated?

This is the first version of the toolkit and more resources and content will be added as they become available. We will be updating the toolkit on a quarterly basis to ensure it remains up-to-date with the latest research and developments in the field.


What is the difference between ePMA, CPOE, eP, EPA and HEPMA?

These are a number of different names (and abbreviations) that are used to describe electronic Prescribing systems used in hospitals. The names vary usually from country to country but sometimes vary even within a team or as the implementation progresses. ePMA stands for electronic Prescribing and Medicines Administration, and is widely used in NHS hospitals in England. CPOE is used more frequently in the United States and stands for Computerized Physician (or Provider) Order Entry. eP, short for electronic Prescribing is used in the UK and quite often is used interchangeably with ePMA. The abbreviation EPA, EPrescribing and Administration, has also become a way to refer to ePMA, though this abbreviation is more common in Australia and New Zealand. HEPMA is short for Hospital Electronic Prescribing and Medicine Administration and is frequently used in Scotland.

Why should our hospital move to an electronic prescribing and medicines administration system?

The growing interest in ePrescribing has come from the potential it offers in improving patient safety and the quality of care patients receive. There are many other benefits associated with deploying these systems, which you can read about in various reports in the ‘Understanding ePrescribing‘ section of the Documents Gallery. However it is important to remember that these systems may have unintended consequences which have been discussed in the literature and that these systems cannot fix everything. See our section on what the system can and can’t do  to get some more realistic insights into what to expect.


Who are the current suppliers on the market?

You can view a current list of suppliers for the UK here

What is the difference between the various ePrescribing and Medicines Administration systems?

The main difference is between a standalone system, for example one working in a speciality, and an integrated system. You can read more about this, including the pros and cons for each in this article. NHS England is currently working on the development of a procurement toolkit which will be available soon. Some details of the toolkit are included in the “Support for Sourcing the Marketplace” in the Safer Hospitals, Safer Wards Report.

How can we find out which systems have been selected and/or implemented in other hospitals and how do we get in touch with them?

Our list of suppliers for the UK  has details of where individual systems have been or are due to be deployed. You can also contact us for details of the latest deployments, and contacts within the sites. The discussion forum in our interact area allows you to post questions to other users of the toolkit and may help you get in touch with other hospitals too.

Financial Aspects / Business Case

How can our hospital establish the cost of implementing and/or upgrading a system?

The ePrescribing Research Programme is currently working on a framework to address questions relating to costs and more information will be available soon in the toolkit. Please email our helpdesk if you have any immediate questions that you need help with.

How can our hospital get financial support to move to the next stage in our implementation plans?

Bids for the Safer Hospitals, Safer Wards Technology Fund  have now closed. However more funds are expected to be made available to support the government’s paperless NHS goal.

What information do we need to include in a business case?

You can find details of the key areas a good business case should include in our tools section.

Do you have any examples of business cases?

You can find tools to help put a business case together including an example of a business case, and we will be adding more very soon.

Implementation Strategies and Planning

What benefits should we expect to see from implementing an ePrescribing and Medicines Administration system?

The Documents Gallery of this toolkits contains some helpful material to help better understand ePrescribing. You can also get a quick overview of anticipated benefits from the Safer Hospitals, Safer Wards Report.

How will we be able to measure the benefits?

There are many ways of measuring the benefits, and you can find some tools here to look for example at error rates, safety or efficiency. There are also some evaluation tools that may be helpful too. Some systems allow you to run reports to measure benefits realisation.

How long will it take for us to see the benefits?

This will depend on many factors including the deployment strategy adopted and whether any issues associated with the implementation have been successfully addressed. You can find out more about benefits realisation here. However it is important to remember that there will be a transition period when things may take longer or seem more cumbersome. Once the system has stabilised and use has become more established, the benefits will become more apparent.

What is a phased implementation strategy, and what other options are available?

A phased implementation is when the system is rolled-out in one area, or ward, in the hospital and then in other areas one-by-one. The other option which is sometimes chosen (although less frequently in the UK) is a so called “big-bang” approach, whereby the system goes lives all at once across the whole hospital. The pace of a phased roll-out can be relatively fast, and it is sometimes described as a quick succession of mini-bangs or a semi-phased roll-out. The advantage of a phased roll-out is that problems can be identified in one area of the hospital at a time, and it is therefore seen as a more controlled way of implementing. It also tends to be a much less resource heavy way of implementing, because the support required during the go-live period is concentrated in one area.

How do I map and plan for change?

The planning tools may provide a useful starting point to help you map workflows and process changes.

Which functionality do I implement first and in what area?

There is no set pathway for what or when. There will be local priorities and needs that need to be considered. Much depend on what your hospital already has in place. The Safer Hospitals, Safer Wards Report  explains the building blocks leading to digital maturity.

What are the minimum specifications relating to infrastructure?

See the minimum requirements documents in the tools section for some help with this.

What training will we need to provide?

You will need to look carefully at the needs of the users. There are tools that can help you plan for this and guidelines on standards . We have found that training is important not only to make sure staff have the right skills set to use the system, but also as a form of engagement. See one of our case studies for more on this.

Knowledge Sharing, Engagement and End-Users

How can I get in touch with other hospitals to find out about their experiences?

You can use the interact section of this toolkit, or join the NHS technology strategies communities to get in touch with other hospitals. Attending events run by the ePrescribing Research Programme   also provides an excellent opportunity for networking.

Why is staff engagement important?

Engagement is important as this will ensure that staff are motivated to use the system, appropriately trained, and can provide input and feedback on usability issues whilst flagging up problems. The Safer Hospitals, Safer Wards Report and some of our case studies  explain this in more detail.

How can I get involved in the selection, planning and/or design of the ePrescribing and Medicines Administration system that will be rolled-out at the hospital where I work?

You can get in touch with the team leading the ePrescribing and Medicines Administration project and/ or your IT team to find out how you can get involved. You can also contact our helpdesk and we can help you get in touch with the right person.

Why are my suggestions not incorporated in the system design?

There can be many reasons why a suggestion you make cannot be incorporated in the customisation of the system. Most projects have a defined scope, whereby changes relating to set areas will be dealt with first, and further changes will either have lower priority and/or be made a later stage, or are not seen as critical to the implementation of the system. There may be changes which are not possible to make due to technical constraints. It is also often the case that many different suggestions are made by  end-users as to how to improve the system, not all of which can be satisfied. The implementation team therefore needs to make a compromise or take consensus-based decisions, to accommodate different points of view whilst maintaining the system’s usability and safety. It may be worth talking to your local implementation team to find out about the reasons for their decision not to include your input.

How can I attend training when I’m busy on the ward?

Your hospital will make every effort possible to design training in such a way as to allow every end-user to have an opportunity to undergo training. It is very important that you take part in the training that is offered to you as this will ensure that, once the system goes live, you know how to use it and can carry on doing your job. Training is essential to ensure the safety of patients and as little disruption as possible after the go-live date .

How can I provide high quality patient care if the system is slowing me down?

It is normal for things to slow down a little immediately after the system has been deployed and your hospital will have planned for this transition period. You may find it helpful to discuss your concerns with the implementation team and find out about what additional support may be available during this time, and procedures in an emergency situation as these will vary locally.

Why does the system allow some medications to be prescribed even though they are dangerous?

It is important to realise what ePrescribing systems can and can’t do: they are there to support rather than replace clinical decisions made by Healthcare Professionals. Some systems may allow users to prescribe certain medication, but may have alerted them to any potential risks prior to that. There are different degrees of decision support in the systems on offer, and there is evidence in the literature that too many alerts on a system can lead to so-called “alert fatigue”, so that when frequent alerts are made, they are increasingly ignored. It remains an absolute necessity for users therefore to carry on using their clinical knowledge and expertise, rather than expect too much from the system, to ensure maximum effectiveness and safety.

NIHR Programme Grant for Applied Research, Principal Investigator: Professor Aziz Sheikh
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