To ask the Scottish Government, regarding the Scottish Public Health Observatory update, Estimated numbers of people prescribed opioid substitution therapy in Scotland, published on 30 May 2023, what measures are being taken to address any issues associated with Community Health Index (CHI) capture for opioid substitute therapy, in order to ensure more accurate figures for the number of people prescribed these medications.
Following initial discussions, a small number of NHS boards have approached the Pharmacy Service Improvement Team in Practitioner Services Directorate within Public Health Scotland over the past 2 years to obtain data from the Prescribing Information Store (PIS) of the Corporate Data Warehouse, in conjunction with prescriptions images held, and asked for assistance/analysis to support them to increase their levels of CHI capture for OST prescriptions.
Based on various discussions, analysis and findings, the following conclusions were made on the scenarios and conditions that lead to poor CHI capture:-
- EMIS Prescribing System – it was noted that the CHI number prints correctly on GP10(SS) stationery, however, on Nurse prescriptions, GP10N(SS) stationery, the CHI number is printed with spaces, e.g. 0 2 0 2 2 0 x x x x and, therefore, the CHI number is not in the correct format to be captured successfully.
- Prescribing locations:-
- In primary care, there are a number of GP10(SS) printed prescriptions from GP Practices with no electronic support/barcode and the CHI number may not be captured via ICR as a result of the other scenarios detailed below.
- In specialist addiction clinics, there is a wide variation across NHS Boards on how these services have been set up locally and the prescription stationery they use to prescribe, e.g. some specialist clinics operate out of primary care and use GP10(SS)/GP10N(SS) stationery and others use hospital locations and use Hospital Based Addict Prescription pads (HBPA) or printed stationery (HBPA(SS)). It was noted that a significant number of printed HBPA prescriptions also had the CHI number in the incorrect format with spaces and the CHI number was not being captured. However, this has recently been addressed in NHS Ayrshire & Arran.
There are other scenarios that result in poor to no CHI capture when prescriptions are scanned via intelligent character recognition (ICR) for remuneration to community pharmacies and these include:
- The quality of printed output, e.g., low toner/ink and the CHI number is not captured.
- Misaligned or obscured CHI number - if this is not printed in the correct position of the prescription form or is obscured by handwriting.
- The Pharmacy Practice stamp in the CHI area is obscuring part of the CHI number.
- Handwritten CHI numbers – there is a very poor ICR capture rate of handwritten CHI numbers.
- No CHI number printed or incomplete CHI number, where only a DOB has been provided.
Scottish Government and Public Health Scotland are actively considering options to resolve the issues outlined, which focus on updating current systems to improve the consistent formatting of prescriptions, consequently improving the automated capture of information.