Reconciling Pharmacy Systems

Jeffrey Firlik, R.Ph, principal consultant with the Health Delivery Group at the Falls Church, Va.-based CSC, says interfacing systems can be done, but it is a big challenge that might not always go smoothly. He remembers one assessment he did three years ago on an institution pondering whether to switch to an integrated system, which emphasized how cumbersome interfacing systems can be. In this organization's pharmacy, pharmacists had two different computers on their desks, one that accessed the pharmacy system, and one that ran the EHR. “Even though those orders were supposed to flow back and forth, they just didn't,” Firlik says.

“[Interfacing] can be done effectively, but it's very time consuming, and I think it's fraught with a lot of opportunities for errors or issues in keeping those systems exactly in sync,” says Cindy Williams, R.Ph, system director of pharmacy at the five-hospital Newport News, Va.-based Riverside Health System. She cites one opportunity for error when it comes to accessing different vendors' drug databases, which don't always contain the same drug information-for example, the Kansas City-based Cerner Corp.'s Multum drug database, versus that of First DataBank (which Siemens and other vendors use).

INTEGRATION ADVANTAGES

Beyond limiting the amount of interfacing, implementing an integrated pharmacy system can provide an added measure of patient safety. When Orlando Health's Schooler was quizzing pharmacists on his informatics team, they all cited the possibility for data entry errors when there are separate systems for ordering and prescribing. What can happen often is interfaces don't gel 100 percent, and additional data entry is needed at the ordering and verification phases, “which could open up opportunities for inconsistent information,” says Schooler. He notes the benefit of having one complete record of the patient that allows pharmacists to know what was ordered and dispensed. He also points out that nurses can act on a change in a physician's note, and unless the pharmacist has access to that clinician point-of-care system, the pharmacist won't be able to see how the drug was administered to the patient.

Firlik brings up another patient safety point: having integrated systems unites drug order catalogs, which gives the pharmacy more control to influence prescribing and improving outcomes. “The pharmacy can influence formulary compliance, and use more drug use evaluation data to influence prescribing through order sets and algorithms,” Firlik says. This helps create a closed loop medication strategy, which is enhanced with an integrated system. “The two greatest places where errors occur are ordering and administration,” he adds. “With the barcode medication administration, it can reduce administration errors, so patient safety is huge.” Firlik gives the example of both pharmacists and prescribers taking advantage of built-in closed looped lab alerts for drugs to be aware of any dosing, allergy, or drug-interaction problems.

CREATING EFFICIENCIES

Having an integrated pharmacy/core clinical system also introduces many efficiencies for the pharmacists' daily activities, according to those interviewed. Schooler mentions that not having data in one consistent place makes decisions more difficult when a pharmacist has to check two separate systems to seek information. He also knows that many healthcare organizations' pharmacy departments are “staffed to bone,” so 30 seconds here or a minute there checking multiple sources for relevant information really takes time away from lean pharmacy departments.