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Expanding APOPS (Thailand) Network and Smart Oncology
Pharmacist in the AI EraBy Kamonsak R.
BDMS Southern Group
Take Home Massages
• The concept of ‘smart/intelligent hospital pharmacy’
• How the concept would support extending oncology pharmacy roles beyond the traditional roles of supplying medicines and health care advice?
• Where and how to get started?
• Case Studies
Outline
• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital
• Pharmacy department as part of the smart hospital concept
• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals
• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety
• What have been implemented in Thailand and US Case studies
• Opportunities for oncology pharmacists to stay up to date
• Conclusion, Q & A
Outline
• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital
• Pharmacy department as part of the smart hospital concept
• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals
• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety
• What have been implemented in Thailand and US Case studies
• Opportunities for oncology pharmacists to stay up to date
• Conclusion, Q & A
Intelligent Hospital • https://www.youtube.com/watch?v=DcjMKy8pr5A
• http://ihassociation.org/
HIMSS Stage
• CDSS• MIMS
integration
• ClinicalKey
• Some CDSS in Quippe
• Structured documentation
• Quippe / MedDocIntegration
Real Time Location System (RTLS)
Smart/Intelligent Hospital Concept
• Ultimate Goals: Personalized Medicine, Precision Medicine, Preventive Medicine
• Improve safety through reducing/preventing human errors:
• Improve efficiency: reduce cost
• Electronic input, digitalized workflow, data flow
• Value-based healthcare
Outline
• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital
• Pharmacy department as part of the smart hospital concept
• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals
• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety
• What have been implemented in Thailand and US Case studies
• Opportunities for oncology pharmacists to stay up to date
• Conclusion, Q & A
Smart/Intelligent Pharmacy
Patient Tracking / Compliance
Care Manager/Pharmacist
Patient Information / Education
Outcome• Clinical• Service
• (Engage / Experience)
• FinancePatient Portal / Web / CRM
Information Communication
Cost
What info ? How to get that info ?
What info ? How to communicate that info ?
Intelligent/Smart Hospital
EMR / HIS
OutcomeCorrect & AppropriateDiagnosisTreatmentMedicationBilling & Payment
Registration• Self appointment • Self registration
Provide Doctor / Provider information (outcome)
Waiting time
CDSS : ::: CPG ::: Knowledge base::: Pharmacy database
Alert Alarm
My PatientCare Manager portal
Tracking Patient trackingBaby mother matching
Patient PortalExperience Engagement
In room Information ::: Clinical data::: Lab / X-ray result ::: Appointment::: Medication
Patient Education ::: Media portal ::: Knowledge Assessment ::: Tracking
Billing System ::: Cost tracking::: Payment (Prompt-pay)
Third party interfacePatient rightInsurance claim
Enterprise Resource Planning>> link HIS activities to revenue>> Link HIS activities to resources >> resource pooling & distribution
Hospital
Outline
• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital
• Pharmacy department as part of the smart hospital concept
• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals
• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety
• What have been implemented in Thailand and US Case studies
• Opportunities for oncology pharmacists to stay up to date
• Conclusion, Q & A
Intelligent Hospital Pharmacy: Are You Ready?
• Pharmacy as a profession and business continues to face challenges, and how it contributes value to the overall healthcare industry will determine its ongoing success. A key component of that may turn out to be effective use of technology, specifically artificial intelligence.
Reflecting on the past 25 years
• Growing demand for prescriptions, even when faced with pharmacist shortages, growing operating costs, and lower reimbursements.
• leveraging enabling technology automation such as automated dispensing helps
- improve workflow efficiency
- lower operating costs while promoting safety, accuracy, and efficiency
- gives pharmacists more time to engage with a greater volume of patients
- enhance patient health outcomes.
While these successes have helped pharmacy play a key role in patient care, it is still frequently perceived as a transaction-based business dispensing a lot of prescriptions and not having enough time to care for patients
Artificial Intelligence as Game Changer
• Wikipedia defines artificial intelligence — or AI — in healthcare as technology that “uses algorithms and software to approximate human cognition in the analysis of complex medical data.
• The primary aim of health-related AI applications is to analyzerelationships between prevention or treatment techniques and patient outcomes. AI programs have been developed and applied to practices such as diagnosis processes, treatment protocol development, drug development, personalized medicine, and patient monitoring and care, among others.”
Current State of AI in Healthcare
• AI can be of real help in analyzing data and presenting results that would support decision making, saving human effort, time, and money, and thus helps save lives.
• Medical and technological advancements that have helped healthcare-related development of AI include:
• Overall evolution of computers, resulting in faster data collection and more powerful data processing
• Growth in the availability of health-related data from personal and healthcare-related devices and records
• Development of pharmacogenomics and gene databases
• Expansion and industry adoption of electronic health records
• Natural language processing and other advancements in computing that have enabled machines to replicate human certain processes
Current State of AI in Healthcare
• Current technology and its algorithms enable and complement human interaction with patients today.
• AI as the enabling technology, a single platform would collect data from various disparate databases and would sense, understand, act, and learn.
• AI can play a significant role in supporting healthcare initiatives relating to prevention and treatment plans in real time.
• As healthcare value-based outcome demands continue to significantly grow, healthcare manpower will be positioned to respond with AI tools.
Current/Future Use Cases
• Artificial intelligence from technology companies like Microsoft assists doctors in finding the right treatments among the many options for cancer.
• Capture data from various databases relating to the condition and helps physicians identify and choose the right drugs for the right patients.
Current/Future Use Cases
• To support the decision-making processes for existing drugs and expanded treatments for other conditions, as well as expediting the clinical trials process by finding the right patients from a number of data sources.
• To predict with certain accuracy when and where epidemic outbreaks might occur, using AI learning based on a history of previous outbreaks and other media sources.
• To prevent medical errors and reduce hospital readmissions by analyzing patient data from medical and medication errors, readmission root causes, and other internal and external databases.
• To identify and prevent high-risk patients from developing complications, provide prospective care guidance, and diagnostic support, among many other clinical applications.
• Will be useful in workflow optimization and efficiency, helping eliminate redundancy in cost from duplicate or unnecessary procedures.
Promising AI
• Smart Infusion pump
• CDSS: MIMS, Lexicomp
• Order set –pre-printed order
• Robotic pharmacy
• Patient Portal
• Predictive Analysis
• RTLS (Purchasing and Inventory)
Outline
• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital
• Pharmacy department as part of the smart hospital concept
• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals
• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety
• What have been implemented in Thailand and US Case studies
• Opportunities for oncology pharmacists to stay up to date
• Conclusion, Q & A
Concerned points for adopting technology
• To improve safety & clinical outcome• POCT
• Wearable devices
• To improve operational efficiency• Business process improvement by digital transformation
• To improve customer engagement and sustain/increase business
• Find potential customers
• Follow up existing customers (NCD)
• Patient communication
Available current and near future solutions Decision Matrix
To improve operational efficiency:::: Business process improvement by digital transformation
Available current and near future solutions Decision Matrix
To improve operational efficiency:::: Business process improvement by digital transformation
Available current and near future solutions Decision Matrix
To improve operational efficiency:::: Business process improvement by digital transformation
Available current and near future solutions Decision Matrix
To improve operational efficiency:::: Business process improvement by digital transformation
Available current and near future solutions Decision Matrix
To improve customer engagement and sustain business :::: Find potential customers:::: Follow up existing customers (NCD)
Outline
• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital
• Pharmacy department as part of the smart hospital concept
• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals
• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety
• What have been implemented in Thailand and US Case studies
• Opportunities for oncology pharmacists to stay up to date
• Conclusion, Q & A
What has been implemented in Thailand
• Automated Dispensing Cabinet
• CPOE & CDSS
• BCMA & eMAR
• Patient Education: Medication
• Smart Infusion Pump
Robotic Filling
Solution: Closed Loop Medication Management
Manages all aspects of medication therapy
Manages drugs from the moment they are delivered to the hospital to the time they are administered
Integrates many key technology components, including
Computerized Physician Order Entry (CPOE)Automated drug dispensing devicesBar-coded Medication Administration (BCMA)On-line documentation
Bar-coded Medication
Administration/Smart Pump
CPOE/Clinical
Decision Support
CPOE
Closed
Loop
PrescribeTechnology for Physicians: Computerized Provider Order Entry (CPOE)/E-Prescription
Direct transmission
to pharmacy
Eliminates handwriting
and transcription errors
No delay
Clinical Decision Support
System (CDSS)
delivers improved prescribing
by checking for
Allergies
Interactions
Duplicates
Contraindications
Dosage problems
DispenseTechnology for Pharmacists
Pharmacy solutionChecks labs, allergies, existing drug profile, interactions, etc.
Documents clinical interventions
Creates on-line medication profile
Sends medication profile to dispensing machines
Robotic FillingEliminates wrong selection errors
Delivers the bar-coded medications required for Bar-coded Medication Administration
AdministerTechnology for Nurses
Bar-coded Medication Administration
Triple bar-code readNurse
Patient
Each medication
Supports 5 Rights for medication administration
Right drug
Right dose
Right route
Right time
Right patient
Automated dispensing unitsEliminates wrong selection
Provides floor stock inventory for high availability of medications in critical care areas
Point-of-Care BCMA
• Ensures 5 “rights” of
administration using bar codes
• 3-way match at bedside
• Wireless real-time medication
tracking
• Discrepancy alerts
• Online profile/MAR
• Administration planning
• Data for patient monitoring
activities
• Charting and charge capture at
the time of administration, not
dispensing
Jane Doe, RN
CDSS Implementation to support Antimicrobial Stewardship Program (ASP)
• Pop-up Screen to fill the information at point of order entry for those selected antimicrobials: Treatment or Prophylaxis
Antimicrobial Stewardship Program (ASP) Pop-up Screen: Treatment
Antimicrobial Stewardship Program (ASP) Pop-up Screen: Prophylaxis
SMART Pump
• A “Smart pump” is a parenteral infusion pump equipped with IV medication error-prevention software that alerts operators or interrupts the infusion process when a pump setting is programmed outside of pre-configured limits.
• Smart pumps are designed to recognize prescription errors, dose misinterpretations, and keypad programming errors.
ISMP Recommendation for Smart Pump
• Many medication errors resulting in patient harm involve IV infusion devices, with the most common cause of these errors being incorrect programming.
• To deliver safe drug, healthcare organization should make effective use of well-designed technologies. These include Smart Pump technology.
• Pumps with dose error reduction systems is an important way to help prevent medication errors.
Recommended Drugs for Smart Pump
• Chemotherapeutic agent
• Parenteral nutrition
• Narcotic analgesic
• Cardiogenic
• Anticoagulant
• Anticonvulsant
• Insulin
• Concentrated electrolyte
Smart Pump
Smart Pump Benefits
• Enhance patient safety• Prevention of calculation errors
• Notify the programming nurse if the dose is too small or large based on the drug library specifications.
• Supports hospital’s drug delivery practice• Customize for the addition of hospital-specific drug library
Smart Pump Software
• Dose limits have been pre-programmed for the selected drug label.
Smart Pump Software
• If a programmed dose is outside of that label’s limits, a pop-up alert requires dose reprogramming or dose limit override.
Smart Pump Software
• Overrides are displayed as red text over a yellow highlight and stored in the pump’s history log.
The Future of Smart Pump Software
• More functionality• Multipurpose pump
• Multi-step programming
• Time programming
• More connectivity• Wireless
• Integration with various software vendors
The Future of Smart Pump Software
• More user friendly• Prioritize drug list
• Touch screen
• More safety• Tracking system
• Barcode system
• Hard limit setting
• TALLman lettering
• Compatibility checking
Smart Pump
• Development of drug library• Identify the drugs need to be programmed
• Standardize the drug concentration
• Standardize the dose mode prescribing
• Set the soft limits alert
US Case Studies
• Patient Portal
Patient Portal
• Personal Content Delivery Tool
• Interactive platform patient education
• Patient Concierge
• Discharge Planner/Nurse
• Call Center
• Interactive communication platform: Email/Text/Message
• Alert
Patient Portal Case Studies
• Patient Portal: Engaging Patients (and Staff) - My Chart, The Institute for Family Health
• MSKCC (Memorial Sloan-Kettering Cancer Center)
Patient Portal: Engaging Patients (and Staff)
Add “clickable”
Infobutton to
context-specific
M+ resource
MSKCC (Memorial Sloan-Kettering Cancer Center)
Learning from the experience of using e-mail for communicating with patients, the team sought to solve
common problems that patients sometimes experienced.
Difficulties with patient identification
Messages contained urgent issues
Delivery of messages failed
Documentation in the EMR
Responded to the message
Pharmacists/Nurses can capitalize on the ease and efficiency of
secure messaging to communicate with patients.
Improve patient satisfaction.
By offering a the service provides hospital with an advantage over
competitors.
Summary
Allows more frequent and timely communication between
pharmacists/nurses and patients.
The patient portal offers patients timely access to information
about their health care in a secure and safe environment.
Outline
• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital
• Pharmacy department as part of the smart hospital concept
• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals
• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety
• What have been implemented in Thailand and US Case studies
• Opportunities for oncology pharmacists to stay up to date
• Conclusion, Q & A
Learning opportunities
• HIMSS AsiaPac
• HIMSS
• ASHP
• EAHP
Outline
• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital
• Pharmacy department as part of the smart hospital concept
• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals
• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety
• What have been implemented in Thailand and US Case studies
• Opportunities for oncology pharmacists to stay up to date
• Conclusion, Q & A
Take Home Massages
• The concept of ‘smart/intelligent hospital pharmacy’
• How the concept would support extending hospital pharmacy roles beyond the traditional roles of supplying medicines and health care advice?
• Where and how to get started? – Smart pump, Patient Portal
• Case Studies: start with your pain point but quick win & simple project
• Consideration in adopting software/application: Safety, Efficiency, Cost-effectiveness
Q & AThank you