The landscape around pharmacy information system implementation has changed so much in the past five years, it’s virtually unrecognizable from half a decade ago. And of course, that means that healthcare IT leaders, now compelled forward by meaningful use under the HITECH Act, and by data collection, reporting, and analysis mandates under federal healthcare reform, are working in a continuously changing environment, one that always has the potential to upend the best-laid plans of mice and medical informaticists.
As I wrote in my August cover story package, "Pharmacy Fast-Forward," the healthcare IT leaders at even the most advanced patient care organizations are finding all of this challenging. As Brian Patty, M.D., CMIO of the four-hospital, 650-bed HealthEast Health System in St. Paul, Minnesota, told me, he and his colleagues have had no regrets about implementing the pharmacy IS from the McKesson Corporation, whose electronic health record their core EHR, even though McKesson’s EHR and pharmacy IS are in fact interfaced under the covers, not fundamentally integrated. As Dr. Patty and his colleague Brad Rognrud explained, working with a completely standalone system (something that is simply becoming a non-possibility for most patient care organizations these days anyway because of shifts in the vendor market reflecting shifts in the policy and regulatory spheres), is rapidly becoming untenable. “At least there’s only one vendor involved” when one has an interfaced set of systems from the same company, Patty said, “so they can’t point fingers at anyone else if something’s not working.”
Even so, as Patty, Rognrud, and their colleagues have found, completing the implementation of closed-loop medication administration supported both by an eMAR and barcoded meds administration, and given a foundation with EHR and CPOE, and an updated pharmacy IS, is inherently complicated, with multiple systems involved and, as Patty puts it, “When you’re talking about closed-loop meds administration management, 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.”
And, if such implementational work is challenging even to advanced organizations like HealthEast, whose IT and clinician leaders have already spent a number of years moving forward with alacrity on clinical IS planning and implementation, imagine how difficult all this will be for less advanced teams.
The good news is that a number of strong models for architecting all of this have been emerging, among advanced organizations like HealthEast, and elsewhere as well. Over the next couple of years, we’ll see the majority of patient care organizations, including community hospitals, academic medical centers, and integrated health systems, putting together infrastructures around medications and pharmacy that work, and work well. And those infrastructures will encompass more and more of the continuum of care, including the outpatient bands on that spectrum. My advice to CIOs, CMIOs, and other healthcare IT leaders, based on my conversations with pioneers in this field? Make sure that all three core clinical disciplines in this area—medicine, nursing, and pharmacy—are well-represented, and figure out how to get pharmacist informaticists—at whatever level of participation is possible—strongly into the mix. It’s going to be a hard slog, but in the end, not only will it be doable, it’s simply got to get done. “Got pharmacy IS?” If not, there’s no time to waste in figuring this all out.