Technology & Automation In Pharmacy- Part 1

Definitions Goals of automation in pharmacy Advantages/disadvantages of automation Application of automation to the medication use

process Clinical decision support systems Computerized physician order entry

Outline

Medical Informatics

The field of information science concerned with the analysis, use and dissemination of medical data and information through the application of computers to various aspects of health care and medicine

Definitions

ASHP. Am J Health-Syst Pharm. 2007;64:200–3.

Pharmacy Informatics

The use and integration of data, information, knowledge, technology, and automation in the medication use process for the purpose of improving health outcomes

Definitions

ASHP. Am J Health-Syst Pharm. 2007;64:200–3.

The pharmacy profession’s transition to pharmaceutical care

Shortages of qualified pharmacists and technicians

Shrinking operating budgets

Increasing Interest in Automation –Why??

Freeing pharmacists from labor-intensive distributive functions

Helping pharmacists provide pharmaceutical care

Reducing costs

Improving operating efficiencies

Growing revenues

Goals of Automation in Pharmacy

Enhancing safety and quality of care◦Automated medication management systems have

been shown to reduce medication errors by between 26% and 81% depending on the setting in which the machines are used

Integrating and managing data

Increasing patient satisfaction with the quality and delivery of care

Goals of Automation in Pharmacy - Cont’d

Improve efficiency (reduce work load)

Improve accuracy, reduce errors

Improve documentation

Enhance security (authorized access only)

Reduce job stress and staff turnover

Improve timeliness for medication delivery

Advantages of Automation

Complexity and function variations

Requires additional staff training and technical help

Downtime, system failure and inflexibility

Cost and space issues

Disadvantages of Automation

Medication Use Process

•Assessing the need for/selecting the correct drug•Individualizing the therapeutic regimen•Designing the desired therapeutic response

Prescribing•Reviewing the order for correctness of dosing and

indication•Compounding/preparing the drug•Dispensing the drug in a timely manner

Dispensing

•Administering the right drug to the right patient•Administering the drug when indicated

Administering

Medication Use Process - Cont’d

•Monitoring & documenting patient response•Reevaluating drug selection, frequency, &

duration

Monitoring

•Communicating and collaborating among caregivers

•Reviewing and managing the patient’s complete therapeutic drug regimen

Systems/Managemen

t Control

Technologies & Automated Devices Applied Throughout The Medication Use Process

Prescribing •Clinical decision support systems(CDSSs)•Computerized prescriber order entry systems (CPOE)

Dispensing •Centralized robotic dispensing technology•Centralized narcotic dispensing and inventory tracking devices•Decentralized automated dispensing devices•Unit dose medication repacking systems

Administering Bar code medication administration technology

Monitoring •Electronic clinical documentation systems•Medication surveillance applications for reporting medication incidents and adverse events

Clinical Decision Support Systems are "active knowledge systems which use two or more items of patient data to generate case-specific advice"  

Clinical DSSs are typically designed to integrate medical knowledge base, patient data and an inference engine to generate case specific advice

Clinical Decision Support Systems (CDSS)

Advice on drug doses, routes, and frequencies. Drug allergy checks Drug-laboratory value checks Drug-drug interaction checks Providing reminders about corollary orders (e.g.

prompting user to order glucose checks after ordering insulin)

Drug guidelines to the physician at the time of drug ordering

Clinical Decision Support Systems (CDSS) Components

Four key functions of CDSS are outlined in :1. Administrative: Supporting clinical coding &

documentation, authorization of procedures & referrals

2. Managing clinical complexity and details: tracking orders, referrals follow-up, and preventive care

3. Cost control: Monitoring medication orders; avoiding

duplicate or unnecessary tests

4. Decision support: Supporting clinical diagnosis and treatment plan processes

Functions of CDSS

DXplain

◦Uses a set of clinical findings (signs, symptoms, laboratory data) to produce a ranked list of diagnosis

◦Provides justification for why each of these diseases might be considered, suggests what further clinical information would be useful to collect for each disease

CDSSs Examples

QMR Quick Medical Reference

◦A diagnostic decision-support system with a knowledge base of diseases, diagnoses, findings, disease associations and lab information

CDSSs Examples

CPOEs are clinical information systems that enables a patient’s care provider to enter an order for a medication, clinical laboratory or radiology test, or procedure directly into the computer

The system then transmits the order to the appropriate department, or individuals, so it can be carried out

Computerized Provider Order Entry (CPOE)

The most advanced implementations of such systems also provide real-time clinical decision support such as checking:

◦Dosage ◦Alternative medication suggestions◦Duplicate therapy warnings◦Drug-drug and drug-allergy interaction

CPOE

Replaces hand-written orders ( solves problems with legibility, completeness, order delay or loss)

Supports ready access to patient data and patient assessment

Can help improve patient safety and prevent medical errors and adverse drug events by checking doses, interactions, allergies.. etc.

Supports improved recording, data trails, quality assurance and error awareness and reporting

Advantages of CPOE

Potential to improve efficiency and resource usage by integrating different departments - laboratory, imaging, nursing and medication records

Cost-effectiveness benefits:

Can reduce costs associated with medication errors Can show test and medication costs - potential to

reduce prescription costs Can reduce the number of duplicate tests

Advantages of CPOE- Cont’d

Cost

Risk of a system generating medication errors e.g. through incorrect configuration or physician input

Systems may need medical terminologies not in local use

User resistance to introduction of computer-based technologies, requires training

Disadvantages of CPOE