Pharmacy Fast-Forward

Drilling down one more level, Patty offers his thoughts about some of the complex issues that CMIOs, CIOs, and pharmacy IT specialists will be struggling through over the next few years in hospital organizations nationwide. “When you’re talking about closed-loop meds administration management,” he says, “from the time the med is ordered until the time it’s administered, you have multiple potentials for problems, because you have the order going to the pharmacy and then to the eMAR. The route that that initial order travels between the time it’s ordered by the physician and is then delivered to the patient, can cross multiple, multiple systems, so it is a challenge; kudos to Brad and his team for making it seem seamless” to the organization’s end-users.

Brian Patty, M.D.

What’s more, Patty says, “Anything you do that’s not on your core vendor’s platform can create challenges and force workarounds that create the potential for error. I’ve always been a strong proponent of sticking with your core vendor if at all possible, for such things.” He and Rognrud both strongly urge healthcare IT leaders to stick with one core vendor for EHR, pharmacy, and eMAR; and then, Rognrud says, “There are other decisions that need to be made, in terms of, how do I integrate with my pharmacy automation? One area is your unit-dose automation, and that’s where you get to the Pyxis and other systems; but there’s an IV component as well, and that’s an area that’s really starting to grow right now. So the workflow of your IV preparation within your pharmacy—making sure that that process is going well in preparation for barcoded meds administration.”

Step by Step in New Jersey
One of the core challenges in all this is of course a very complex set of issues around timing and process, as Gene Grochala, CIO of the two-hospital Capital Health system based in Trenton, N.J., knows well from experience. In his case, managing multiple transitions over time has brought into high focus the challenges of working out pharmacy IS/EHR interoperability.

Essentially, Grochala says, what happened at Capital Health is that, “In our city hospital in Trenton, Capital Health Regional Center, we went with Keane and iMed, which is from Keane, and kept the old legacy pharmacy system, called MediWare. In the newer hospital, we went live with the EMR in 2009, and just went live with the pharmacy IS in May, switching from MediWare to the new Keane pharmacy component on May 20.” Meanwhile, the new suburban facility, Capital Health at Hopewell, opened on Nov. 5, 2011, and opened with both Keane’s EHR, and soon afterward, its pharmacy IS. In other words, the organization’s flagship hospital spent three years interfacing the Keane EHR to the iMed pharmacy IS, with Capital Health’s leaders knowing that they would transition everything once the new suburban hospital had opened and gone live with the new EHR and pharmacy system from the same vendor.

All this necessarily involved making some IT and workflow compromises, but it’s been working, Gorchala says. And, the reality, he adds, is that “MediWare’s Worx Suite product was a great product, and a lot of our pharmacists didn’t want to give it up, but they saw the future.”

Most importantly, Grochala says, “under the Stage 2 requirements of meaningful use, you’re going to have to have CPOE at 60 percent, and you’re going to have to have your pharmacy system integrated,” so there really was no choice about what course of action to take in this instance. In any case, he said, “True CPOE is really about the medications; and it’s through medication ordering, when you get the clinical decision support on adverse drug events, etc., where CPOE proves its value,” which is the whole point of the meaningful use process to begin with.

One industry expert who has a firm grasp on the broader context of all this is Jane Metzger, research principal in the Waltham, Mass.-based Global Institute for Emerging Healthcare Practices of the Falls Church, Va.-based CSC. “If we look back in history, people tended to entertain the concept of a separate pharmacy system when there was limited CPOE happening, and also when there was more limited eMAR than today,” Metzger notes. Years ago, of course, “niche vendors had much deeper functionality for the pharmacy, as in so many other areas.” But as the entire overall architecture of clinical information systems advanced in sophistication, particularly with regard to CPOE, Metzger says, “ultimately, the definition of a core clinical information system came to include a pharmacy component.”