LAS VEGAS—While medication management technologies can overwhelm providers due to the interoperability and personnel complications, health IT can be utilized to mediate the concerns, according to a Feb. 23 presentation during the annual Healthcare Information and Management Systems Society (HIMSS) conference.
Medication functions in the EHR contribute “mightily” to care process, throughput and quality, according to Allen Flynn, PharmD, of Solutions Designer for Health Practice Innovators, and chair of the volunteer section, pharmacy informatics and technology division, American Society of Health System Pharmacists (ASHP).
For the pharmacy’s top 10 things for a CIO to know, he listed:
- Practice change s
- Drug supply chain
- Safety & efficiency
- Pharmacy staffing
- Redundant work
- Saving money
Flynn explained that medications have an oversized footprint in the EHR. The scope extends from admissions to pre- and post-surgery medications, for example, which then need to be transferred from ICU to acute care, to new medications after orders and changes to discharges.
Because of the oversized footprint of medications, Flynn acknowledged that many providers may be overwhelmed by several factors, including:
- Trying to maintain accurate list of active medications;
- Keeping up with order sets for best practices with medications;
- Responding to drug shortages;
- Configuring and maintaining the configuration of CDS; and
- Implementing components.
On the architecture side, the demand for a more intelligent medication-use system will not cease for a generation, according to Flynn, who defined the architecture a few hospital medication use systems as ordering, verifying, dispensing, distribution, administration and monitoring.
Because the architecture can be compared with building a cathedral, Flynn stressed the need for planning, because some components are integrated with an EHR (such as computerized provider order entry [CPOE]), and others are not. He also advised that clinical decision support applies in a variety of different ways, and to consider the role of the pharmacist and key workflows.
“The EHR must support radically transforming the pharmacist’s practice in the hospital,” said Flynn, adding that pharmacists should be IT power-users.
Automation and technical staff will displace some current pharmacist duties, which means documentation components will become even more important, as well as outcome tracking for individual patients and whole populations, he explained.
Due to drug supply chain problems, “it is past time for supply chain engineers to help operate the drug supply chain,” Flynn said. In a 2008 study in the Journal of Nursing Administration , Keohaneet al found that nurses spend 25 percent of their time managing medications, and the largest proportion of that nurse time managing meds (30 percent) is spent “obtaining and verifying medications.”
With the implementation of new health IT systems (CPOE, medication reconciliation, smart IV pumps), Flynn said that the gains in efficiency and gains in safety accrue unevenly amongst stakeholders.
Also, he anticipates acute shortages of pharmacist-analysts capable of optimizing EHRs. Thus, he recommended staff development, which could include pharmacy informatics residency programs, health IT certifications or even computer science coursework. Flynn predicted that approximately 1,600 pharmacy-informatists will be needed across the U.S.
In general, medication information standardization is imperative for success with health IT because there is a lot of redundant information across the databases, according to Flynn. “We cannot afford to have experienced healthcare IT staff doing highly redundant, wasteful, error-prone database upkeep and synchronization.”
In terms of cost control, he said the EMR helps keep drug cost increases to an amount that is less than inflation; however, arriving at real cost savings can be slow going.
“Episodic care was yesterday. Tomorrow is sequenced, always connected, individualized care,” Flynn said. “Thus, clinical care continuity during EHR downtime is a serious area of concern.” The focus needs to be on coordinated, synchronized and standardized pharmacy care, so it flows into the greater continuum, he concluded.