Monday, November 14, 2011

With my last post, I leave you all with this....

Why is pharmacy informatics important?

Although still an emerging field, the continued development and integration of technology into health systems will further expand the role of informatics and informatics pharmacists in health care organizations of all sizes.

New technologies to advance patient care and promote the effective delivery of health care services are always being developed. Informatics pharmacists are at the forefront of efforts to refine and improve currently available systems and encourage the creation of newer and even more efficient methods to achieve safer and more effective medication usage.

The use of technologies such as CPOE, BCMA, clinical decision support, robotics, automated dispensing cabinets, intelligent infusion devices and telepharmacy has grown exponentially in the last decade. Such innovations represent a splendid opportunity for the trained informatics pharmacist to integrate his or her clinical skills with knowledge of technology and information systems to improve and streamline the medication use process.

The American Recovery and Reinvestment Act (ARRA) funding and the Meaningful Use discussion have brought considerable attention to the issue of integrating technology into health care delivery. Demand for trained informatics professionals is growing, because implementation of systems such as CPOE and BCMA has accelerated.

Pharmacy students who enjoy working with technology, are detail oriented and who are interested in creating and developing innovations to improve patient care may wish to consider a career in pharmacy informatics. The ideal candidate will be able to integrate his or her understanding of technology with his clinical knowledge to be not only a champion for patient career, but also an advocate for the clinicians who use health care information technology systems.

http://studentdoctor.net/2010/12/career-spotlight-pharmacy-informatics/

Use of pharmacy informatics resources by clinical pharmacy services in acute care hospitals

+Author Affiliations

GREGORY T. MATSUURA, PHARM.D., BCPS, is Assistant Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University (WSU), Spokane, and Clinical Pharmacist, Yakima Valley Memorial Hospital, Yakima, WA. DOUGLAS L. WEEKS, PH.D., is Research Professor, Department of Pharmacotherapy, WSU, and Senior Research Investigator, Inland Northwest Health Services, Spokane.

Address correspondence to Dr. Matsuura at Yakima Valley Memorial Hospital, 2811 Tieton Drive, Yakima, WA 98902 (matsuurg@wsu.edu).

Abstract

Purpose. The use of pharmacy informatics resources by clinical pharmacy services and the presence of a pharmacy informatics specialist in acute care hospitals were evaluated.

Methods. Two hundred randomly selected pharmacies in general medical and surgical hospitals in the United States with at least 100 acute care beds were surveyed via mail. Survey items gathered information regarding facility attributes, opinions about staff pharmacists’ understanding of information technology, and departmental utilization of pharmacy informatics.

Results. Of the 200 surveys mailed, 114 (57%) were returned completed. When asked to rate their departments’ use of pharmacy informatics, 82% indicated that pharmacy informatics use was good or fair, while 12% considered information use to be optimized. A majority of respondents (60%) indicated that a pharmacy informatics specialist was employed within the pharmacy, with 47% indicating that the specialist was a pharmacist. An overwhelming percentage of these pharmacists received informatics training on the job, and roughly half had specialty positions integrated into their pharmacist job description. No significant association existed between the use of pharmacy informatics and facility teaching status (teaching versus nonteaching), geographic location (urban versus rural), or use of computerized prescriber order entry. Employment of a pharmacy informatics specialist was significantly associated with the use of such informatics applications as database mining, renal-dosing-rules engines, antibiotic–pathogen matching-rules engines, and pharmacokinetic-monitoring rules engines.

Conclusion. The use of clinical pharmacy informatics in patient care in acute care hospitals with at least 100 beds was significantly more likely when a pharmacy informatics specialist was present in the pharmacy. However, 4 in 10 hospital pharmacies did not employ a pharmacy informatics specialist.

Index terms:

http://www.ajhp.org/content/66/21/1934.short

An Incremental Pharmacy Informatics Model for Use in a Rural Hospital

Douglas A. Talbert, PhD,^* Edward Roush, BS,^* Luis Velazco, BS,^* and Casey White, PharmD^†

^*Dept. of Computer Science, Tennessee Technological University, Cookeville, TN

^† Dept. of Pharmacy, Cookeville Regional Medical Center, Cookeville, TN

Abstract

We present an implementation model for pharmaceutical computerized decision support (CDS) that enables a hospital to incrementally target specific “high value” projects as needs are identified and support is secured. Our model, which we are currently implementing in a rural medical center, allows the hospital and its staff to quickly reap some benefits from CDS in spite of resource limitations.

Introduction

Limitations in financial, staff, and information technology resources in rural hospitals make the implementation of computerized decision support (CDS) tools difficult to justify.¹ In our case, resource limitations at Cookeville Regional Medical Center (CRMC), a 247-bed hospital in rural Tennessee, hindered the implementation an intravenous-to-oral (IV-to-PO) conversion protocol, in spite of the known benefits of such a tool.²

Prior experience with an incremental approach to implementing pharmacy informatics³ indicated that, once embedded, a tool capable of electronically reviewing orders can support the addition of new decision-support functionality with little demand on resources. Whereas a need to be responsive to an evolving understand of needs motivated [3], a similar model enables a kind of bootstrap approach to CDS in which the savings achieved by the initial effort provide resources that can be used to justify and support the implementation of subsequent functionality. This ability to implement CDS in small increments as justified by a cost-benefit analysis is well suited to rural hospitals.

Model Description

The basic model consists of four elements – (1) sources of patient-specific data, (2) a knowledgebase, (3) an order review tool, and (4) a reporting mechanism. While a relative small team can construct the initial knowledgebase, order review tool, and reporting mechanism, access to accurate and comprehensive patient data in an electronic format may be more difficult to accomplish. Additionally, since we are focused on resource-limited situations, new large-scale data acquisition efforts are unlikely. Thus, the content of existing data repositories will probably dictate which CDS functions are possible. One should also consider the cost-benefit tradeoffs associated with the possible CDS options.

Prior to the initiation of our project, CRMC determined the financial benefits of more effectively transitioning patients from IV antibiotics to PO antibiotics and developed a protocol for determining which patient are likely candidates for that transition. A manual review of all patients by a clinical pharmacist, however, was too time-consuming.

After a brief analysis, we determined that electronic access to most, but not all, of the patient-specific data required to make IV-to-PO recommendations was available, and since that data was adequate to produce a list small enough for the hospital’s clinical pharmacist to manually review within a reasonable amount of time, we concluded that IV-to-PO conversion was an appropriate choice for our initial CDS effort.

Model Implementation

An ability to evolve the functionality as new data sources and needs dictate changes drove many of our design decisions. A layered architecture consisting of a data layer, a data abstraction layer, and a presentation layer helps isolate changes as the IT environment evolves. Furthermore, we designed all the project-specific components (the knowledgebase, the order review tool, and the reporting mechanism) with extensibility in mind. For example, designing each piece of CDS functionality as a separate encapsulated unit reduces the likelihood that new functionality will introduce regression faults. Thus, we pay special attention to coupling and cohesion issues during the software design process to ensure appropriate encapsulation.

Conclusions

We believe this adaptation of a proven incremental model can serve as a good model for CDS implementation in resource-limited situations such as rural hospitals.

References

1. Frisse ME, Metzer J. Information technology in the rural setting: challenges and more challenges.JAMIA. 2005;12:99–100.

2. Teich JM, et al. An Information system to promote intravenous-to-oral medication conversion. Proc AMIA Symp. 1999:415–419. [PMC free article] [PubMed]

3. Talbert DA, Hargrove F. Embedding drug dispensing logic to provide a more intelligent clinician order entry/pharmacy interface. Proc AMIA Symp. 2001

Saturday, November 5, 2011

Robots taking over = More time for MTM by Pharmacists.

UCSF's robotic pharmacy automatically distributes medication, scrutinizes human error (video)

By Sam Sheffer posted Mar 10th 2011 12:47AM

Robots are slowly taking over the world, right? Well, their latest conquest is the pharmacy. The UCSF Medical Center has implemented three robotic pill-dispensing machines that handle and prepare medication that's dangerous to the common human. The process works as follows: doctor writes a prescription, hospital clerk sends it over to pharmacist, pharmacist enters slip into the computer, robot picks up it and does the dirty work. The automated machine will grab the proper dosage, package it and slap a label indicating instructions and patient info. Rather than fearing for their jobs (or lives), the folks at the UCSF at are excited about this robot-takeover 'cause it increases the time care-givers spend with patients while allowing pharmacists to work more efficiently with physicians in determining what medication to supply. The most impressive thing, we think, is that our robot pals have not had a single error since preparing 350,000 doses of meds. Take that, meatbags!

http://www.engadget.com/2011/03/10/ucsfs-robotic-pharmacy-automatically-distributes-medication-sc/?asid=c7e80c0d

Drug Vending Machines?!?!

Drug vending machines start trial in UK, allow awkward videophone conversations with your pharmacist

By Vlad Savov posted August 16th 2010 7:36AM

You've got to imagine the Japanese are green with envy right now, as the BBC report not one, but two different drug vending machines are being tested out under Her Majesty's watchful eye. The first of these experiments is run by supermarket chain Sainsbury's, which has installed a pair of drug dispenser machines in its stores. They identify users by their fingerprint or a unique number, demand PIN verification too, and then finally accept your prescription. Then -- and this is the really silly part -- a pharmacist comes along, picks up your prescription, fills it out, and deposits it in the machine for you to pick up. So it's impersonal and unnecessarily convoluted, great. PharmaTrust seems to have a slightly better idea with its videophone-equipped, ATM-style robo-vendor: it's intended to allow pharmacists to approve prescriptions off-site and out of usual working hours by letting them speak to you via videophone. It could in fact be a big benefit in more remote areas, depending on how patients take to it -- we'll know more when the trial starts up in participating hospitals this winter.

BBC

http://www.engadget.com/2010/08/16/drug-vending-machines-start-trial-in-uk-allow-awkward-videophon/