Information Technology in the Pharmacy Setting - Orientation

1. Information Technology in the Pharmacy Setting - Orientation July 2012

2. Course Objectives • At the end of this session, participants should be able to: • Describe advantages to a health care organization associated with Information Technology • Explain the importance of accurate IT setup and configuration and the need to respond quickly to errors • Demonstrate ability to navigate basic RPMS menus and conventions and explain basic keyboard shortcuts and Recognize the list manager view and use it efficiently • Discuss Pharmacy List-serv and process for obtaining technical assistance • Identify procedure to get help and submit enhancement requests

3. Pharmacy Informatics • “The scientific field that utilizes a systems approach to medication-related data and information – including its acquisition, storage, analysis, and dissemination – in the delivery of optimal medication-related patient care and health outcomes” • Fox, et al. “Pharmacy Informatics Syllabi in Doctor of Pharmacy programs in the US”. American Journal of Pharmaceutical Education, 2008. 72 (4) Article 89. pp 1-9. Accessed online 5/9/2012

4. Pharmacists and Information Technology1 • Pharmacists have the unique knowledge, expertise, and responsibility to assume a significant role in medical informatics. As governments and the health care community develop strategic plans for the widespread adoption of health information technology, pharmacists must use their knowledge of information systems and the medication-use process to improve patient care by ensuring that new technologies lead to safer and more effective medication use.

5. Pharmacy Informaticists • A pharmacy informaticist is a pharmacist who understands the technology as well as the medication use life cycle. He or she has a Pharm.D. and is ideally residency-trained, and may have a second degree in business, health administration, or information technology • But no matter what your eventual choice of specialty, if you’re going to practice pharmacy, you will use informatics to make decisions, enhance safety, increase efficiency and improve patient outcomes3 ASHP 2008

6. Pharmacy informaticist Role1 (1 of 2) • Leadership. Pharmacists are responsible for patient safety throughout the medication-use process and need to take a leadership role in medical informatics at all levels of health care to ensure that health information technology supports safe medication use. Pharmacy informaticists must use their skills to • Provide leadership to the institution’s committees (e.g., practice, safety and quality, technology, pharmacy and therapeutics) • 1 American Society of Health-System Pharmacists. ASHP statement on the pharmacist’s role in informatics. Am J Health-Syst Pharm. 2007; 64:200–3. http://www.ashp.org/DocLibrary/BestPractices/AutoITStInformatics.aspx accessed 6/29/2011

7. Pharmacy informaticist Role1 (2 of 2) • Collaborate with other health care technology and clinical leaders to ensure that medication-related systems support interoperability and transportability of clinical information while maintaining patient safety and confidentiality • Attain key leadership roles within the health care technology industry, professional practice associations, and health care technology organizations • Lead governmental and regulatory groups to sound conclusions regarding the use of technology in medication management, particularly as it relates to setting standards

8. Benefits of Information Technology in providing medical care1 (1 of 2) • Computerized prescriber-order-entry systems integrated with electronic health records (EHR) and pharmacy information systems. • Clinical decision-support tools that bring best-practice information and guidelines to clinicians at the time they need them and rule-based systems for monitoring, evaluating, responding, and reconciling medication-related events and information • Pharmacy information systems that allow electronic validation of medication orders in real time, provide the data flow needed to update both the medication administration record and order-driven medication dispensing systems, and support such operational activities as supply-chain management and revenue compliance 1American Society of Health-System Pharmacists. ASHP statement on the pharmacist’s role in informatics. Am J Health-Syst Pharm. 2007; 64:200–3. http://www.ashp.org/DocLibrary/BestPractices/AutoITStInformatics.aspx accessed 6/29/2011

9. Benefits of Information Technology in providing medical care1 (2 of 2) • Automated dispensing cabinets and robotics integrated or interfaced with pharmacy information systems • Integrated medication administration management systems that enable the administration of bar-coded medications and use of “smart” infusion pumps • Integrated medication surveillance applications for the reporting of medication incidents and adverse events

10. ISMP Safe Medication Practices Recommendations2 • CPOE • Avoids transcription errors • Automated Dispensing Machines • Assures correct medication is picked • BCMA • Assures 5 “Rights” of medication administration • Avoid Look-alike packaging • Prevents incorrect drug selection • Especially important with high-risk drugs • Standardization/Simplification • Commercial preps, print names, abbreviations, formulations/concentrations 2Institute for Safe Medication Practices, Overview of Safety Recommendations for Medication Management Technology, 2011. http://www.ismp.org/CE/medmanagementtech/Default.asp Accessed 6/29/2011 (This and the next four slides)

11. Medication Management Process • This slide is a graphic representation of the medication management process. • The square boxes define different processes and the various colored circles and ovals represent technologies used at those stages to benefit patient care • One example is the circle touching the right edge of the squares in the top left. The section is “History-Taking” with the left box stating “Obtain Medication-Related History and the second box stating “Document Medication History”. The circle indicates the type of technology: “Wireless devices for medication history capture, etc.”

13. Errors in the Medication Use Process • This image illustrates steps in the medication use process and indicate the rate of errors at the various steps • Identified areas are: • Prescribing with an error rate of 39% • Transcribing with an error rate of 12% • Dispensing with an error rate of 11% • And Administering with an error rate of 38% This chart indicates that the two most problematic steps in this process are creating a medication orders and administering dispensed medications to the patient. Computerized provider order entry and Bar-code medication administration are two technologies designed to reduce medication errors in these two stages.

15. Sources of Harm • This image identifies sources of harm due to medication errors. • This slide also lists two numbers for each stage, one in white which represents the numbers from the last slide, and numbers in red that are illustrated on this slide. • The numbers for errors that caused harm differed from the numbers of errors due to the fact that not every error causes quantifiable patient harm • The numbers are as follows: • Prescribing twenty-eight percent • Transcribing eleven percent • Dispensing ten percent • And administering fifty-one percent This slide makes a great argument for bar-code medication administration

17. Rank Order of Error Reduction Strategies • Error reduction strategies listed in the order of effectiveness from most effective to least effective • Forcing Functions • Automation and computerization • Standardization and protocols • Checklists and double-check systems • Policies and policies • Education and information • This demonstrates that automation and computerization is one of the best ways to reduce errors. The only more effective strategy is to use force to affect compliance

19. Requirements of Medical Information Technology Systems • Security • correct system access • correct user ID • Protect sensitive patient data • Ability to capture and correct information • Patient Information • Patient problems • CPOE

20. Requirements of Medical Information Technology Systems • System data checks • Drug/Drug and Drug/Allergy checks • Ability to communicate to and between users • Notifications • Notes • Ability to track changes

21. RPMS as a Medical Information Technology System • Security • Access and Verify Codes • Access assigned by role • Encryption of data • Ability to capture and correct information • Patient Registration in RPMS (and now GUI) • EHR captures visit elements and patient data • CPOE is a featured element of EHR

22. RPMS as a Medical Information Technology System • System data checks • Drug/Drug and Drug/Allergy checks • Ability to communicate to and between users • Notifications • Notes • Ability to track changes • RPMS records identity of user making changes

23. Find Out More About Informatics • http://www.ashim.org/health-it-certification/compare-health-it-certifications.aspx • http://www.ashim.org/ • http://www.cahiim.org/index.html • http://www.info.com/informatics%20certificate?cb=27&cmp=4416&gclid=CJ6ZluWU9q8CFQLktgodlV8oSQ • http://www.midland.edu/hitt/

24. Questions