GP IT supplier warned software feature could pose patient safety risk
The largest supplier of GP IT systems in England has been warned a software feature which automatically removes repeat prescriptions poses a risk to patient safety.
Optum (formerly EMIS) has been issued with a prevention of future deaths report following the death of a patient whose prescription was automatically removed from repeats and recategorized as a past prescription.
Alan Mitchell, 88, died in March this year after suffering a heart attack, having been admitted to Macclesfield District General 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 eight-month inquest into his death, which concluded last month, heard that a feature in the EMIS software means that if a prescription is not re-ordered for a specific time 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.
When this happens, the GP is required to re-prescribe the medication the system has moved from repeat prescriptions to past prescriptions, which Mr Mitchell’s GP did twice. At a routine medication review in 2021, Mr. Mitchell told his GP that he was not experiencing symptoms which required him to take more than one tablet per month.
Assistant coroner for Cheshire Alexander Frodsham stressed that ‘the removal by the software of Mr Mitchell’s repeat prescription played no causative part in his sad death’.
However, he asked that Optum consider the future risk that the automated feature may cause a GP to miss a significant detail of a patient’s medical history.
‘The alteration to a lifelong prescription without notification (nor any choice being given to) the GP gives rise to the risk that a patient will not be provided with the medication they need.
‘That risk is heightened when patients are elderly and/or prescribed multiple medications and/or when, as here, they do not re-order as they possess medication in reserve’, he said.
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.
A spokesperson for Optum, which has until 30 December to respond to the report, told Pulse: ‘Optum extends its deepest sympathies to the family and friends of Mr Alan Mitchell. We are carefully considering the Prevention of Future Deaths Report sent to us by HM Assistant Coroner and will respond in due course.’
Earlier this year, Optum and TPP (the other major GP IT supplier in England) were issued with prevention of future deaths 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.
The report highlighted confusion among health organisations over the sharing of patient data between GP practice IT systems.
And in June, NHS England approved the Medicus Health GP IT system, describing it as first new entrant to the GP IT market for 25 years and part of reforms to increase competition and innovation.
Note: This article was updated on 15 December to reflect that the software feature in question removes the medication from the repeat prescription view, and reassigns it as a past prescription, but does not delete it from the system.
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READERS' COMMENTS [4]
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Misleading article and I only hope the coroner understood better. EMIS does not remove the patient’s prescription history, it just ends the course of the repeat medication, which then lives in past medications for all perpetuity. This reads like the medication history is deleted, it is not. If this is changed’ what about the risks of people ordering medication that is left on repeat by, but no longer valid but the course hasn’t ended. The whole thinking it too simplistic.
NB: I have no connection to EMIS/Optum as an organisation other than running on their system.
I thought this was referring to the really unhelpful tendency for EMIS to archive medication, so a patient hasn’t had the medication stopped necessarily, but the expired/archived medication no longer appears on the repeat list. We’ve had a couple of experiences where patients haven’t realised it had dropped off list and they’ve not reordered-worse still sometimes not obvious to retail chemists or clinicians either. This is a particularly unhelpful facet of EMIS, and I think it’s still an ongoing problem.
I think it should be left up to the GP surgery to manually remove it from repeats if not ordered for over 12 months, we are SystmOne so this doesn’t happen but it is often helpful when looking at the repeats and you see they haven’t ordered alendrobic acid /aspirin/statin/amlodipine etc for 12 months and can prompt the discussion
There is so much about EMIS that is unsafe. Just a really clunky piece of slow flaky IT that is poorly designed. eg – accidently tapping on authorise and send twice instead of once and it will send the next prescription without you knowing it was ever there to be looked at in the first place whether you have reauthorised it or not (the irony here being that this would be the one useful place a warning might be useful – unlike the endless – “metformin is dangerous in type 2 diabetes” pop ups that litter day to day life).