A lot has changed in the clinical informatics world in the past five years, and the landscape around clinical IT implementations looks quite different now. With the meaningful use requirements under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act pushing patient care organizations to work with clinical data in ever-more-integrated ways and to comprehensively implement successful computerized physician order entry (CPOE) systems; and with mandatory programs under federal healthcare reform forcing hospitals to more efficiently gather and act on data in order to reduce avoidable readmissions and document and improve clinical outcomes, the old interfacing is out, and integration and interoperability are in.
Indeed, the landscape has been altered to such a degree that a strategic IT choice that might have made sense five years ago—to implement a new pharmacy information system from a completely different vendor from one’s new core electronic health record (EHR)/CPOE system—just doesn’t make sense anymore, except in exceptional cases.
At the same time, healthcare IT leaders and industry experts report, the quality of the pharmacy components being offered by the largest EHR vendors has steadily improved. On the one hand, the reality remains that some of these components are still separate products, even as they’re marketed as being elements in integrated wholes. On the other hand, the functionality of these pharmacy IS products is improving to the point where these products are eliciting greater satisfaction on the part of CIOs, CMIOs, and other healthcare IT leaders—not to mention end-users. For example, according to the “Top 20 Best in KLAS Awards” report released late last year by the Orem, Utah-based KLAS Research, 100 percent of those surveyed regarding the Epic Willow product from the Verona, Wis.-based Epic Systems Corp. said they’d buy that product again; 86 percent of the users of Allscripts Sunrise Pharmacy, from the Chicago-based Allscripts, would use that system again; 82 percent of those using Cerner Millennium PharmNet from the Kansas City-based Cerner Corp. said they’d buy that product again; and 78 percent of those using GE Healthcare Centricity Pharmacy from the Chalfont St. Giles, U.K.-based GE Healthcare said they’d use that product again.
So where does that leave CIOs, CMIOs, and other healthcare IT leaders working everything out in the trenches? It’s definitely a mixed picture, depending on where individual hospital organizations are with their overall clinical IS implementations. First, some hospital organizations are still struggling along with old legacy standalone pharmacy systems, even as they’ve moved forward on EHR/CPOE. The healthcare IT leaders at those organizations face significant issues, should they choose to try to maintain their legacy pharmacy systems for any length of time going forward. More commonly, as hospital organizations replace their core EHR/CPOE systems, they’re facing issues around the degree to which the pharmacy components coming from the same vendor are truly integrated/interoperable, or are in fact “interfaced under the covers,” as some refer to the situation in which the pharmacy and EHR products bear the same corporate name, but are not interoperable at the level of software coding.
Moving Forward in Minnesota
Brian Patty, M.D., and Brad Rognrud are certainly familiar with the latter situation. As the CMIO and director of pharmacy informatics at the four-hospital, 650-bed HealthEast Health System in St. Paul, Minn., they are living with the day-to-day reality of interfacing the pharmacy IS and EHR from the same vendor, in this case, the Atlanta-based McKesson Corp. “We chose right from the get-go to go with our pharmacy component from our core vendor,” Patty reports, “though the decision predated me; but Brad was here.”
Several years ago, “We were using McKesson’s ClinicPac system, and there were a lot of advantages in terms of speed,” Rognrud says; “but it didn’t offer everything we needed. So we included McKesson’s Horizon Pharmacy system in our EHR implementation.”
Was it a compromise for the pharmacists accepting McKesson’s pharmacy component over a standalone solution? “We had also considered Mediware Worx Suite” (from the Lenexa, Kan.-based Mediware), says Rognrud. “Ten years ago, they were a fairly popular system. When we put that system up against McKesson’s Pharmacy Horizon system, they came up about the same. So the advantage went to McKesson. Of course, the reality is that the McKesson system was—and to this day, still is—interfaced, not integrated. So there are a lot of challenges, even though it’s McKesson on both sides.
“At least there’s only one vendor involved, so they can’t point fingers at anyone else if something’s not working,” Patty notes. Also, Rognrud adds, “When you’re talking about integration or interfacing with the EHR, the core really is between CPOE and eMAR” (the electronic medication administration record).