Information Systems; Computerized Pharmacy Evolution Within the past decade, there has been much advancement in technology that is changing the way health care is providing for its patients. Information technologies such as bar coding, personal health records and computerized pharmacy have changed the way health care workers organize patient medical records. In this brief essay, one will learn how the invention and use of computerized pharmacy information has changed health care as a whole, good and bad. History of Computerized Pharmacy
In 1966, the basic computerized information system (CIS) was integrated with an automated hospital information system (AHIS) by the office of Veterans Affairs. This first AHIS as intended to automate manual tasks performed within all VA hospitals. This early AHIS included functions such as order entry, transmission and included subsystems that included a pharmacy. Over the next ten years, updated CIS systems were developed however; many had trouble staying afloat with the ever changing clinical needs in health care.
During the 1970s and 1980s, entrepreneurs and pharmacists began developing independent information systems that were designed specifically to meet pharmaceutical needs in health care settings. Initially, pharmacy information technology was developed to manage the immediate needs of the pharmacy and staff, and to provide data for the growing number of requirements for unit doses per medical unit. Computer information systems were not the most developed programs during this period of time, and because of this, most medical facilities invested in the “best-of-breed” mainframe or stand-alone pharmacy information systems.
A request for proposal purchasing process was used throughout facilities to purchase these mainframes. In the late 1980s to mid 1990s, mainframe-based integrated CISs began to intrigue medical facility administrators whom were seeking a greater integration quality in their hospital computer systems. The value of greater control, the potential of integration and effectiveness of tasks for all employees lured administrators into merging their pharmacy components. By the late 1990s and into the new millennium, pharmacies have gained a greater flexibility in choosing a pharmacy information system by the advancements in technology as whole. Pharmacies and information managers now have the challenge of choosing integrations systems that work best for their individual facilities. Pharmacy Integration There are four main pharmacy information system integration options for medical centers; an all-in-one and pharmacy system, a bidirectional interface between the pharmacy and the medication-ordering system, a unidirectional interface between the CIS and the pharmacy and finally, not using an interface. Depending on the facilities CIS, there are other options for computerized pharmacy solutions as well.
There are many advantages to all four integration options for computerized pharmacies. If a facility chooses to use an all-in-one system, the integration process is quite simple; the pharmacy products are configured at the time of integration. If a facility chooses the bidirectional route, the information generated by the CIS is electronically transmitted to the pharmacy and then exists in the pharmacy information system. This transmittal of information is quick and eliminates most human medical errors.
A unidirectional interface is similar to the bidirectional interface, however, if an error occurs, the pharmacy would have to manually reenter pharmaceutical orders. Advantages to a no interface pharmacy system are the order delivery would be direct, immediate and turnaround for medications would improve; orders would be complete and legibility of the medication orders can be assured. There are several risks and disadvantages to the four main pharmacy information systems. Disadvantages to the all-in-one integration system are “go-live” situations.
Preparing for an all-in-one integration demands a lot of attention to detail, time and analysis from personnel to make sure the “go-live” is smooth and flawless. Bidirectional risks include downtime, staff must be available 24 hours a day for trouble shooting and personnel must develop paper-based systems to manually enter orders in case the CIS goes down. When using a no interface system, even though the advantages seem endless, the disadvantages would mean the medication process would not be used to its optimal potential because of the difficulty to ensure the continual delivery of information between systems.
Uses for Computerized Pharmacy The computerized pharmacy has many uses within medical centers, physician offices, stand alone surgical centers and etc, by allowing pharmacy billing, inventory management and generation of reports consisting of medication labels, fill lists and patient profiles. The data that is transmitted through electronic computerized pharmacy patient profiles includes admission orders; inpatient and discharge summaries and can contain three-month prescription refills. Hospital medical and medication records can be easily access by pharmacy personnel for ease of distribution.
Inaccuracies of Computerized Pharmacy The use of computerized pharmacies has seemed to have decreased the accuracy of medication histories and doses. In a study based out of Florida, medication profiles in inpatient and outpatient medical charts were more than often inaccurate. Little is currently known about the cause and effect of electronic medical records and the accuracy of the patient’s electronic medication history. Large databases are used to assess compliance and drug usage along with insurance databases and pharmaceuticals.
In the study, the databases of medications were inaccurate by 2% increase for each individual studied. In some of the patients record, not all of their medication was accounted for and in other instances, doses of their medication were higher than actually administered. This is a serious problem for computerized pharmacies. The possible potential for fraud and abuse towards insurance companies is a major concern for pharmaceutical organizations that depend on computerized data retrieved from medical center pharmacies.
Patient care in general is a major concern as well, patients must receive the correct dosage or illness and death can occur. Decreasing Discrepancies in Computerized Pharmacy While all of the above inaccuracies do and can occur, there are many ways of eliminating inaccuracies and decreasing medication discrepancies. In 2006, the Joint Commission on Accreditation of Healthcare Organizations (JHACO) regulated a process called “Medication Reconciliation”; a regulation of obtaining and documenting a complete list of patient’s current medications upon hospital admission (Salemi, Charles. Singleton, Norvella. (2007). This information is then entered in the patient electronic medical record which is then integrated in the computerized pharmacy record for later follow-up. Since this JHACO regulation has been set into action, the amount of medication errors has been on a steady decline and the mortality rate due to medication error has significantly decreased. Conclusion While all medical centers are now using some type of computerized pharmacy system, there are many advantages and disadvantages to all integration of systems for pharmaceutical use.
The pharmacy has many components not used throughout an entire medical facility which makes the integration even more challenging. In the United States, there is a need for a greater system wide integration for pharmacy departments which provide better all-in-one solutions, better medication management, ordering systems and a greater efficiency for providers as a whole. While the computerized pharmacy has come a long way in the past 50 years, the possibility for a greater and more advanced pharmacy computer system is endless. References Chaffee, Bruce. , Bonasso, Josephine. (2004).
Strategies for Pharmacy Integration and Pharmacy Information Systems Interfaces, Part I: History and Pharmacy Integration Options. American Journal of Health-System Pharmacy. 2004-03-01. Kaboli, Peter J. , McClimon, Brad J. , Hoth, Angela. , Barnett, Mitchell. (2004). Assessing the Accuracy of Computerized Medication Histories. The American Journal of Managed Care. 2004-11 Salemi, Charles. , Singleton, Norvella. (2007). Decreasing Medication Discrepancies Between Outpatient and Inpatient Care Through the Use of Computerized Pharmacy Data. The Permanente Journal. 2007; Vol. 11 No. 2