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    Bridging pharmacy automation and EMRs


    A seismic shift in the healthcare landscape has accompanied the consolidation of hospitals and health systems. Hospital pharmacy directors now face the task of tackling interoperability between pharmacy automation and electronic medical records (EMRs).

    Chad AlvarezChad AlvarezWhile the dwindling number of vendors of EMR and pharmacy automation may make their lives simpler, pharmacy directors confront many challenges, including connectivity and standardization issues, a shortage of resources, and funding problems.

    "We are living in a big data world, and being able to pull data quickly, stratify it, and then use it at the point of care becomes difficult when you are pooling data in automated systems and EMRs," said Chad Alvarez, PharmD, senior director of Retail Pharmacy/Pharmacy Systems and Support at Carilion Clinic in Roanoke, Va., a not-for-profit healthcare organization that includes a comprehensive network of hospitals and primary and specialty physician practices.

    See also: Five private sector interoperability initiatives to watch

    Conversion challenges

    At Southampton Hospital in South Hampton, N.Y., a new Siemens Computer System was implemented more than a year ago. Jerard West, PharmD, director of Pharmacy, said the EMR comprises three integrated systems: Soarian computerized physician order entry (CPOE), medication administration check (MAK), and Siemens Pharmacy.
    "One of the many challenges we faced is that the hospital's old legacy computer system was not able to transfer information to the new system," said West.

    For example, predefined common orders (PCOs) had to be built from scratch, using a 1,600-medication item master.

    The pharmacy department, said West, had to design its system with regard to current workflow practices, perform a Pyxis conversion to the new EMR, implement bar-coding technology, and assist with order set development for the medical staff. And it had to accomplish all this with limited resources, he said.

    See also: ONC aims for improved interoperability by 2017

    Less staff, more work

    Southampton Hospital is not alone. Lack of resources remains a huge challenge for hospitals. Some industry insiders contend that IT departments in health systems are continually being downsized, while larger portfolios of projects are added to their plates.  "From a pharmacy standpoint, one of the most common things we see from an interoperability challenge is getting IT resources to prioritize pharmacy projects. That’s a constant theme we see across the country," said Kraig McEwen, CEO of Aesynt Inc., a technology company that offers tools for medication management.

    On the plus side, McEwen added, technical complexity has eased somewhat, as many automation vendors and EMR providers have developed better standards and better integration.

    Economy of scale

    "In order to achieve standardization across health-system pharmacy operations, which involves aligning disparate practices across multiple facilities, our workflow and related systems must be redesigned, and that was the reason behind the MedStation Enterprise System and the MedStation ES System," said Dave Swenson, vice president of Clinical Strategy in the Medical Affairs division of MMS (Medication Management Systems) for Carefusion. Becton, Dickinson and Company acquired CareFusion in March of 2015.

    A key component of Carefusion's enterprise approach, said Swenson, is to allow health systems to standardize using one formulary and to manage users across a health system instead of on a hospital-specific basis.

    "This undertaking involved five years of effort and was necessary to enable pharmacists to take advantage of the economy of scale of a health system," he said.

    Anthony Vecchione
    Anthony Vecchione is Executive Editor of Drug Topics.

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    • RayburnVrabel
      I want to clarify further what I meant when I was discussing the two types of interoperability: Drug Data Interoperability refers to a SINGLE reference database/system that is the SOURCE of any type of drug data information needed by any other medication management system used within a given health-system. Having all of the medication management automation from a single vender on a common drug database is NOT Drug Data Interoperability, although it is a good first step. This is only achieved when there is a single source of truth for any and every type of drug data that is used across ALL systems. The users of such a system would only have one "touch point" to make any changes regarding a given drug item across all systems within a health-system. Clinical Interoperability is when disparate medication management systems share data behind the scenes that results in improved workflow for the clinician, instead of the clinician having to look at information from more than one system to accomplish a work task. An example where I was involved with the development, allows a nurse to perform selected automated dispensing cabinet (ADC) tasks (e.g., queuing up drug dispensing and drug returns, or documenting controlled substance waste) from within the patient's EHRs electronic medication administration record (eMAR). This allows the nurse to work from within the eMAR to expedite ADC medication management tasks.