Tech needed to fight resistant bugs

The NHS is being urged to deploy technology in the battle against antibiotic resistance to get the “right drug for the right bug”, following the chief medical officer’s warning of an “apocalyptic antibiotic scenario.”

Neil Carmichael MP, secretary of the All Party Health Group at Westminster, this week met with Stroud-based software company ICNet.

The meeting was to discuss how systems that link e-prescribing data with data from lab information systems can help to identify patients who have been given the wrong drug – and switch them over to the right one.

He said: “There is now a growing awareness of the risk of drug resistant infections and the need to identify the risk of potential infection at the earliest opportunity.

“The work of ICNet and other companies in developing software to assist medical professionals in “early alerts” to these risks is clearly important in reducing drug expenditure; patient stays in hospital and costs, and most importantly ensuring patient safety.

“Significant benefits have been felt by the users of such technology, and this is outlined in a recent report commissioned by the Department of Health.”

Mark Laurent, development manager at ICNet, told eHealth Insider that ICNet’s ABXAlert links data from a trust’s e-prescribing system its laboratory information system, patient administration system, and other clinical systems to identify patients where there is a mismatch between results and prescriptions.

It then automatically alerts doctors when, for example, lab results show that they have prescribed an antibiotic to which the patient’s infection is resistant or if the administration route is inappropriate or the dosage incorrect.

They can then change the prescription. ABXAlert is web-based and uses HL7 messaging; although it can accept custom feeds.

“The software is about identifying when things have potentially gone wrong,” he said. “The reality is that doctors often start antibiotics before they know what is wrong with the patient.”

He added: “The antimicrobial stewardship agenda is driven by patient safety but is also about saving money and reducing the use of antibiotics.”

In her annual report released this week, CMO Dame Sally Davies warned that if tough measures are not taken to restrict the use of antibiotics and no new ones are discovered, "we will find ourselves in a health system not dissimilar to the early 19th century at some point.”

The DH expects to release a UK Antimicrobial Resistance Strategy “soon” to champion responsible use of antibiotics, including slowing down the development of resistance.

ICNet’s infection surveillance systems are already used by 45% of English acute hospitals and more widely in Scotland. A number of US and Canadian hospitals are using ABXAlert and some English trusts have prepared business cases for its use, although none has yet gone live.

However, ICNet does depend on a trust having an e-prescribing system – and many English hospitals have yet to implement one.

A recent audit of the global use of e-prescribing by Philip Howard, Consultant Antimicrobial Pharmacist at Leeds Teaching Hospitals, and presented at a meeting in Paris this week shows that the UK has one of the worst records for deploying e-prescribing in the developed world.

Dr Howard told EHI: “We are slightly better than Africa, 1% higher than South America, but lower than the rest of the developed world.”

He said that systems such as ABXAlert had proved their worth in the US, producing financial savings and reducing antibiotic use. “If you can link lab results with what has been prescribed, you can get patients on the right drug,” he said.

Dame Sally’s report calls for better data linkage to monitor infectious diseases. It says: “While many of the surveillance systems that are used for monitoring infectious disease in this country are class-leading, there is significant added value to be gained by making better use of the information collected, particularly through linkage of the data and the systems currently used.”

It calls for Public Health England, the NHS Information Centre and the NHS Commissioning Board to “develop and promulgate clear information standards for surveillance, and interoperability standards for health information systems that will enable data from different sources to be linked efficiently and effectively.

“While this is a technical challenge, the biggest potential issue is ensuring relevant legislation and guidance supports the sharing and linkage of health and social care data for the purposes of public health surveillance.”