For outpatient pharmacy, Denver Health uses GuardianRx (Carepoint, Charleston, S.C.) - ADT and allergy information flows among Siemens Invision, Siemens Pharmacy and GuardianRx, ensuring these applications are synchronized. The process is as follows: electronic inpatient orders are placed in CPOE and flow to the Pharmacy system (Siemens); get checked by the pharmacist; move to the Pyxis units (Dublin, Ohio-based Cardinal Health) and then, using MAK (medication administration checking bar-coding technology), are administered by the nurse. MAK is also a Siemens product that is integrated with Pharmacy. “It takes, on average, 7.5 minutes to get an order into the Pyxis unit available for administration,” says Veltri.

But is there a downside to the Siemens interface? According to Hess, CIOs need to look at how long it has taken the Invision sites to get Siemens Pharmacy interfaced - although he says the newest release of Soarian will help. “But it's still not the same architecture, and for some CIOs, the fact that Soarian pharmacy isn't being developed means they decide to look elsewhere,” he says. “There are others who say, ‘We'll interface the same way we did to Invision.’”

Veltri says he believes that once Siemens fully delivers all the latest Soarian features and functionalities, the game will change. “You're going to start seeing a shift to people considering Soarian as a contender and player, and you'll see that in two, maybe three years.”

Before deciding to go Soarian, Veltri says he talked to other CIOs and went on site visits. “We wanted to know how painful was the switch from the Invision-Pharmacy interface to the Soarian-Pharmacy interface,” he says. “And in the early days, the Soarian interface didn't work either.”

Those early kinks, he's convinced, have been solved. “I think if you talk to the early adopters, some of them are switching from Soarian (and from Siemens altogether) because they gave up. But for the ones who stuck with it and have upgraded to Soarian C6 consider it an outstanding product,” Veltri adds.

Never easy

Whether interfacing or integrating with a core clinical suite, implementing pharmacy systems is always difficult. “There's a lot of volume in pharmacy. The components of every medication order are huge, and the build is long,” says Comitto. “It took us at least a year.”

Comitto says she brought in outside help to assist. “The pharmacists still had their day jobs,” she says, adding that CIOs need to consider additional staff - and that IT should not pick up the entire burden. And, having gone live with both CPOE and pharmacy at the same time, she says going that route means the build of both systems must be done as a unit, with ownership shared between the clinicians and pharmacists. “There are orders and builds on one side that make sense to clinicians and then the order that comes across to pharmacy has to make sense to the pharmacists. They have to work together,” she says.

At Denver Health, Veltri says he used a rapid improvement project management style for pharmacy implementation. “We put nurses and doctors in a room for a week designing screens and workflows, and we haddesigners from Siemens in as well,” he says. “The nurses put in 7,200 hours to design the screens and everything that changes their process of care.”

That process of care for pharmacy, whether from the clinical core vendor or not, means taking a look at the workflow. Most agree it is the change in workflow that will make or break the implementation.

“Technology enables bad processes to be really bad processes if you don't change the workflow,” says Veltri. “Anytime you try and put electronics on top of anything, you've got to change the workflow. And people still ignore that.”

Is there any future in standalones? According to Hess, they are continuing to sell in small community hospitals, though the main reason is usually financial.

But the question remains as to whether CIOs will ditch their clinical offering if it doesn't have pharmacy. Comitto believes the answer is probably not. “When you make a huge investment in an EMR, what else can you do but make it work? I know my fellow CIOs, and no one is going out there and admitting defeat,” she says.