Health Information Technology Adoption in Health-System Pharmacy

The domain of pharmacists within a health system includes assuring the appropriate use and timely provision of medications.  Pharmacists will review medication prescriptions for duplicate therapies, drug-drug interactions and allergies to avoid adverse events and medication errors.

Pharmacy departments within health systems have traditionally reliedon automation technology to perform oversight of medication inventory and drug distribution.Annual budgets for a largehospital pharmacycan often exceed 50 million dollars withhundreds of thousands of dollars in medication purchases flowing through a pharmacy daily.  To track medication purchases as well as the distribution of medications throughout the hospital, pharmaciesoften utilizeperpetual inventory software that helps manages the supply chain process.  Intelligent inventory replenishment software canoptimize inventory levels to reduce cost and waste by minimizing purchases of low use medications and quickly replenish high volume stock.  Inventory management systems utilize artificial intelligence (AI) to learn dispensing patterns to optimize purchases of medications through contracted sources. In 2013, the federal government enacted the Drug Supply Chain Security Act to further secure our nation’s drug supply.  It outlined steps required to achieve interoperable, electronic tracing of products at the package level to identify and trace drugs as they are distributed to avoid counterfeit, stolen, contaminated, or otherwise harmful drugs.  Tracing medication pedigree to this level of accountability will require further development of intelligent inventory systems.

Hospital pharmacies have utilized stand-alone automated dispensing machines (ADC)since the late 1980s tostock and track medicationson nursing units, emergency rooms and operating rooms to allowfaster access to medications at the point of care.  Today, these devices are computer-controlledby pharmacy and directly interfaced via enterprise servers with the hospital’s electronic medical record (EMR), admissions/discharge/transfer, and billing systemsto provide a complete record of medication dispensation.  Medication can only be released from the device following the proper authentication of the user and prescription order as verified by a pharmacist.Database management within the ADC system involves maintenance of information integral to ADC workflow such as medications available to be stocked, expiration dates, and discrepancy reports. 

The national opioid epidemic has increased scrutiny within hospitals for potential narcotic diversions by employees.  Statistics from both the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Nurses Association (ANA) suggest that about 10 percent of health care workers are abusing drugs. 

Due to the availability of and ease of access to controlled substance medications in health care organizations, diversion of controlled substances can be difficult to detect and prevent without a comprehensive controlled substances diversion prevention program. Surveillancesoftware are now commonplace in health-systems to identify potential diversion and identify anomalous users that have patterns of behavior that differs statistically from their peers.  As diversion practices become more elaborate, surveillance softwaremust rely on artificial intelligence (AI) to learnsophisticated patterns of diversion to identify potential abusers.

Increased regulatory oversight by state boards of pharmacy of sterile intravenous drug (IV) compounding practiceshas hospital pharmacies implementing integrated IV software to track and document the preparation of sterile compounds in compliance with USP 797 standards. Photographic documentation of the components for the IV preparation can be uploaded and reviewed via a mobile device prior to preparation and stored on electronic compounding logs for review by a state inspector. 

"Continued Advances In Health Information Technology Allow Pharmacists To Gain Greater Visibility In The Patient Medical Information To Improve Patient Care And Reduce The Chance Of Medication Errors"

The digitalization of health and medicine and the availability of electronic health records (EMR) has created limitless opportunities for pharmacists to tap the potential of health information technology, artificial intelligence (AI) and clinical decision support to improve clinical practice. EMRs contain information regarding prescription history, treatment outcomes, allergies, comorbidities, test results and other patient information that can provide pharmacists the necessary information at the time of prescription verification.  Clinical support surveillance platforms interface with the EMR systems to perform meaningful data analysis across the health system to provide alerts when decisions and follow up review is necessary.  For instance, antibiotic stewardship software can alert a pharmacist when a bacterial culture result shows that the prescribed antibiotic is not considered effective against the organism to allow the pharmacist to discuss alternative treatment therapies with the prescriber.  Smart alerts can also be created to alert pharmacists when a patient’s renal function declines to the point where a medication dosage adjustment may be recommended.  The value of early notification alerts will continue to streamline and prioritize pharmacist’s workflow.

Continued advances in health information technologyallows pharmacists to gain greater visibility in the patient medical informationto improve patient care and reducethe chance of medication errors.  Clinical decision support and AI software are among the fastest growing domain for improving the ability of pharmacists to organize workflow and prioritize clinical decision making.  Perhaps the biggest barrier that remains is full interoperability of each IT application with other applications.  While each application works well in silo, get bidirectional flow of data to collateral applications will be the test of true integration and usefulness.