The challenges involved in interfacing pharmacy systems with core clinical information systems are propelling IT leadership to seek an enterprise approach and move towards integration.
The demands of meaningful use under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act for transforming clinical data into usable information are compelling CIOs and other healthcare IT leaders towards a more integrated, enterprise-wide approach to clinical information systems.
IF YOU DON'T HAVE A PHARMACY SYSTEM THAT IS FULLY TIED INTO THAT [ENTERPRISE SYSTEM], THAT PHARMACY SYSTEM CANNOT TAKE ADVANTAGE OF THE CLINICAL ALERTS THAT WOULD FIRE, SO YOU'D FIND YOURSELF HAVING TO INTERFACE ALERTS. -RICK SCHOOLER
This is especially true around the issue of pharmacy systems. Increasingly, the demands involved in interfacing standalone pharmacy systems with core EMRs-interfacing two separate systems, separate formularies, and separate allergy lists-are becoming unsupportable for the IT leaders of many hospital-based organizations. In recent years, according to a 2009 report from the Orem, Utah-based KLAS Research, patient safety concerns and frustration with system interfacing have motivated healthcare organizations to integrate their pharmacy systems with their core clinical solutions.
INTERFACING DISPARATE SYSTEMS
Rick Schooler, vice president and CIO of the 1,780-bed Orlando Health, knows the difficult challenges involved in interfacing pharmacy and core clinical systems. His hospital is four months away from replacing its standalone McKesson (San Francisco) pharmacy IS that has been in place for 15 years, with the Allscripts Sunrise pharmacy component from the Chicago-based Allscripts, to match the health system's core Allscripts EHR. After signing the contract eight years ago for Eclipsys Sunrise Pharmacy, Schooler says his organization has been waiting for Allscripts (formerly Eclipsys) to build the product so Orlando Health can make the final switch. Eclipsys's pharmacy unit has been dogged with being seen as the least integrated on the market and as a weak link in its offering, according to 2009 KLAS report “Pharmacy Information Systems: In the Age of Integration.”
Many difficulties can result from integrating pharmacy with core clinical systems. Not only can an interface “introduce a stop in the information flow” if and when it goes down, according to Schooler, standalone pharmacy systems create duplicative work for clinicians having to enter the same information into two systems. Schooler also notes that maintaining two different formularies with drugs in one that are not in the other can be problematic, as well as interfacing drug-food, drug-drug, and drug-allergy alerts. “If you don't have a pharmacy system that is fully tied into that [enterprise system], that pharmacy system cannot take advantage of the clinical alerts that would fire, so you'd find yourself having to interface alerts,” he 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. -CINDY WILLIAMS, R.PH
Furthermore, Schooler says, CIOs need to take a real “buyer beware” approach when it comes to balancing out the natural desire to select a particular vendor product based on feature-function characteristics with the need to integrate systems. “For all the feature-function you think you're going to get in the pharmacy department [when purchasing a standalone pharmacy IS], you're going to now require a lot of interfaces of workflow that you won't need if you're integrated,” he says.
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.