Integrated system will clean up patchwork problems
Everyone will work with the same data
Most hospital pharmacy directors can only dream of having an integrated computer system in which doctors' prescriptions are automatically translated into a format that makes the pharmacist's job more efficient and easy.
The conventional system interfaces the hospital pharmacy's older computer software with new hospital order entry software, leaving both doctors and pharmacists a little frustrated at times.
El Camino Hospital of Mountain View, CA, has made the dream a reality by using cutting-edge software to create an integrated system in which medication orders will be made clearer with less duplicates and less fragmented orders, says Eric A. Pifer, MD, chief medical information officer.
"Instead of system where you have to order 5 mg of Coumadin® and then another 2 mg of Coumadin, where you have two orders, and it becomes unclear what the pharmacist is supposed to get, all [prescriptions] will have one order with one particular drug," Pifer says.
The new system is being built with the help of all relevant disciplines, and it's expected to be launched in about a year, Pifer says.
"It will take us that long to build a formulary and build an order entry system so that it works well," he says.
"The new pharmacy system will perfect the order in a smarter way," Pifer adds. "So if you order 60 mg of a drug, the pharmacy system will be smart enough to know it has 40 mg and 20 mg in stock."
The old system would instruct pharmacists in this situation to dispense 40 mg of a drug and cut a second 40 mg unit in half. The new system will tell the pharmacist that this order contains a 40 mg unit and 20 mg unit, he explains.
Flexible system key for pharmacy
Hospital computer software systems need to be more flexible for pharmacists, and El Camino's new system will give the pharmacy department a much clearer work cue, he adds.
The main problem with interfaced systems is that the software had to translate between two different pieces of software and this leads to orders not coming across clearly, says Charles Ho, PharmD, pharmacy operations manager and assistant director of pharmacy at El Camino Hospital.
"It can be very frustrating because on the nursing side they see one set of data and on our side we see something different," Ho says. "We have to explain why we don't see what they see."
Physicians will use the same software the pharmacy uses and nurses use, and everyone will work off of the same document, which greatly improves workflow, Ho says.
"This will reduce the phone calls about orders that have a height, weight, and drug allergy information that doesn't crossover to the pharmacy's system, and the pharmacy can't verify the drug without this information," Ho says. "The majority of phone calls we receive are asking us to verify this drug, and we say, 'We see the information, but we have no allergy drug information,' and we ask them to enter it again."
Plus the existing pharmacy software system at El Camino is the oldest and has been the weakest link, Ho adds.
The pharmacy typically faces challenges posed by the existing system, including having orders listed alphabetically and not chronologically, Ho says.
An alphabetized order list doesn't make sense from the pharmacists' perspective because what they really need to see is a priority list of medication orders, he explains.
"We prioritize orders based on the order entry time, depending on when a nurse calls us or if the pharmacy happens to know which order is more important," Ho says.
To view the orders alphabetically makes it challenging to decipher, he adds.
"I never figured out why the program was that way," Ho says. "Whoever writes health care-related software needs to be someone in the health care practice who understands the needs of each person, including the pharmacist, physician, and nurse."
Another common problem involves the way prescriptions are entered.
For example, a physician will write a prescription for a drug and include a dosage, leaving it up to the pharmacist to figure out how to create the correct dosage, Ho says.
"With the new system, we want to build it smart so if a physician says, 'I want 40 mg of this drug,' then the system will be smart enough to put in the amounts of milligrams [adding up to 40 mg] that make sense for the pharmacist," Ho explains.
For instance, the El Camino Hospital pharmacy once received a physician order for 40 mg of dexamethasone, a drug that comes in a variety of strengths, Ho says.
"It so happened that a 1 mg tablet was picked, and when that order was translated to our side it meant the pharmacy had to pick up 40 tablets to give a one-time dose," Ho says. "The pharmacist had to correct the order to select 20 mg doses, so we would only need to dispense two of these."
This type of change would be automatic under the new system. This will reduce the potential for human error, and it can have built-in parameters that correct a mistake on the doctor's part.
"So say a physician forgot the correct or typical dosage for a drug, because of the parameters, the physician can't go too far out of the boundary," Ho says. "It has defining guard rails so physicians don't go outside those guard rails."
Pifer has worked with several pharmacy software systems and interfaces and clearly understands how the old systems force physicians and pharmacists to make bad choices when entering data.
"The entry order systems only came on the market in the late 1990s, and there still is a low acceptance of them," Pifer says. "Doctors don't want to use them."
Real-world usage part of design
One of the problems is that when new software is introduced, there is no one from the clinical side providing information about how it might work in the hospital's real world.
"What happens with these implementations is someone will make a decision, and that decision will be to build a pharmacy system or order one in a certain way, and no one on the work team is experienced enough to know what the doctors will think," Pifer explains.
At El Camino Hospital, Pifer has the dual experience and role as a physician who also is a medical information expert, and he is overseeing the change to the integrated system.
"My role is to say, 'We're not doing it that way because the doctors will hate it,'" he says. "That's an important part of my job, and that's why they have me in a leadership role."
"It's unusual to have people who have my background, but it's becoming more prevalent and more needed," he says.
There also will be a full-time pharmacy information professional, who is both a pharmacist and has management experience, who will help make the software operational from the pharmacy's perspective, he adds.
Another potential benefit to the new integrated system is that the dispensing system will work better, Ho says.
"Most hospitals have an automated dispensing cabinet, and we use Pyxis," he says. "We're very automated and technology-driven, so we want the software to be very smart and know what's in those cabinets and what's already out on the floor in Pyxis, so we won't have to have [a person] dispense it."
For example, if the Pyxis dispenser stocks 10 mg or 20 mg tablets, and an order comes in for 40 mg, then the new software system will tell Pyxis to dispense two of the tablets for an intended dose of 40 mg instead of having the pharmacist sit at a terminal and manually put in two 20 mg tablets, Ho explains.
"The current system does some automation, but not enough," he says.
"So what we're trying to do is make all of our technology talk to each other."
Most hospital pharmacy directors can only dream of having an integrated computer system in which doctors' prescriptions are automatically translated into a format that makes the pharmacist's job more efficient and easy.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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