GP IT supplier challenges coroner’s warning over EMIS software safety risk
Exclusive The largest supplier of GP IT systems in England has challenged a coroner’s report that warned a feature of its software posed a potential patient safety risk.
Optum (formerly EMIS) received a prevention of future deaths (PFD) report following the death of a patient whose prescription was automatically removed from repeats and recategorised as a past prescription.
Alan Mitchell, 88, died in March last year after suffering a heart attack, having been admitted to hospital on 8 March with evidence of an upper gastro-intestinal bleed.
Mr Mitchell had a medical history which included Barrett’s Oesophagus, diagnosed in 2011, for which he had been recommended lifelong PPI medication and continued surveillance with periodic gastroscopies. He stopped ordering the medication on repeat prescription in 2020.
The inquest into his death heard that a feature in EMIS software means if a prescription is not re-ordered for a specific period – in this case 12 months – it can be automatically removed from repeat prescriptions. Crucially, a GP will not be notified of this nor prompted to authorise the change.
Summarising in the PFD report, Cheshire assistant coroner Alexander Frodsham said that although ‘the removal by the software of Mr Mitchell’s repeat prescription played no causative part’ in his death, Optum should consider the future risk that the automated feature may cause a GP to miss a significant detail of a patient’s medical history.
Now, in a response letter, seen by Pulse, Optum contested the idea that EMIS systems automatically remove medication from the list of repeat prescriptions if it is not re-ordered for a period of 12 months, without the need for a GP’s approval.
Recipients of PFD reports are legally required to respond within 56 days outlining the actions they have taken or plan to take, or explain why no action has been proposed.
In the letter, Optum’s chief clinical information officer Ian Bailey concluded that Optum ‘do not believe there are any software developments beyond the existing functionality in the system that are required to mitigate the specific risk raised in the report’.
The letter said: ‘Repeat medication does not automatically expire unless a system user (who has the appropriate role-based access control authority) configures the setting in EMIS Web for such expiry date … without this configuration, the functionality has a default setting so that the repeat prescription remains active and the system will not automatically cancel repeat medication.’
If the user does configure the setting, the system will ‘end’ the medication course and move it from ‘current’ medication to ‘past’ medications as that is how a system user has configured the functionality, according to the letter.
A GP would still be able access a record of past medications at any time in this situation, Mr Bailey added.
Optum acquired EMIS in 2023, making it one of the two main providers of clinical systems in primary care. It is used by more than 4,000 practices in England – more than three-fifths of all practices.
In August last year, Optum and TPP (the other major GP IT supplier in England) were issued PFD reports after a patient’s relevant surgery history was not available to the GP out-of-hours (OOH) service which misdiagnosed him before his death.
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READERS' COMMENTS [5]
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I can tell you that it does.
Maybe someone in the practice set it up this way once upon a time, without realising that that was what they were doing, and I suspect some transfers from other It systems lock in similar effects, but this DOES happen withot being intended, and I would suggest an instruction should go out to all GP practices on how to amend this set-up item if it is in place – using an assumption that it is in place unless someone has undone it already, or any given surgery’s seyup.
Most practices have this set and I would argue that having it NOT set is itself a safety risk – in general we don’t want patients recording things that they haven’t used for (eg 1 year) without extra scrutiny.
And tangentially the Coroner’s report seems to imply or assume that GPs monitor medications that aren’t re-requested by patients. We don’t.
Again the patient has no responsibility?
It does happen and quite a few consultations are from patients requesting medication that has slipped off the repeat list because they haven’t ordered it for a while. It may be a risk but the problem here seems to be that the patient had stopped using the medication and we can’t follow up every patient late requesting medication, they do have some responsibility for that
The real risk is old unused/inappropriate drugs staying on repeat not the other way round. Ridiculous all round.