Technology & Automation In Pharmacy- Part 1

1. Technology & Automation In Pharmacy- Part 1

2. Outline • Definitions • Goals of automation in pharmacy • Advantages/disadvantages of automation • Application of automation to the medication use process • Clinical decision support systems • Computerized physician order entry

3. Definitions • Medical Informatics The field of information science concerned with the analysis, use and dissemination of medical data and information through the application of computers to various aspects of health care and medicine ASHP. Am J Health-Syst Pharm. 2007;64:200–3.

4. Definitions • Pharmacy Informatics The use and integration of data, information, knowledge, technology, and automation in the medication use process for the purpose of improving health outcomes ASHP. Am J Health-Syst Pharm. 2007;64:200–3.

5. Increasing Interest in Automation –Why?? • The pharmacy profession’s transition to pharmaceutical care • Shortages of qualified pharmacists and technicians • Shrinking operating budgets

6. Goals of Automation in Pharmacy • Freeing pharmacists from labor-intensive distributive functions • Helping pharmacists provide pharmaceutical care • Reducing costs • Improving operating efficiencies • Growing revenues

7. Goals of Automation in Pharmacy - Cont’d • Enhancing safety and quality of care • Automated medication management systems have been shown to reduce medication errors by between 26% and 81% depending on the setting in which the machines are used • Integrating and managing data • Increasing patient satisfaction with the quality and delivery of care

8. Advantages of Automation • Improve efficiency (reduce work load) • Improve accuracy, reduce errors • Improve documentation • Enhance security (authorized access only) • Reduce job stress and staff turnover • Improve timeliness for medication delivery

9. Disadvantages of Automation • Complexity and function variations • Requires additional staff training and technical help • Downtime, system failure and inflexibility • Cost and space issues

10. Medication Use Process

11. Medication Use Process - Cont’d

12. Technologies & Automated Devices Applied Throughout The Medication Use Process

13. Clinical Decision Support Systems (CDSS) • Clinical Decision Support Systems are "active knowledge systems which use two or more items of patient data to generate case-specific advice"   • Clinical DSSs are typically designed to integrate medical knowledge base, patient data and an inference engine to generate case specific advice

14. Clinical Decision Support Systems (CDSS) Components • Advice on drug doses, routes, and frequencies. • Drug allergy checks • Drug-laboratory value checks • Drug-drug interaction checks • Providing reminders about corollary orders (e.g. prompting user to order glucose checks after ordering insulin) • Drug guidelines to the physician at the time of drug ordering

15. Functions of CDSS • Four key functions of CDSS are outlined in : • Administrative: Supporting clinical coding & documentation, authorization of procedures & referrals • Managing clinical complexity and details: tracking orders, referrals follow-up, and preventive care • Cost control: Monitoring medication orders; avoiding duplicate or unnecessary tests • Decision support: Supporting clinical diagnosis and treatment plan processes

16. CDSSs Examples • DXplain • Uses a set of clinical findings (signs, symptoms, laboratory data) to produce a ranked list of diagnosis • Provides justification for why each of these diseases might be considered, suggests what further clinical information would be useful to collect for each disease

17. CDSSs Examples • QMR Quick Medical Reference • A diagnostic decision-support system with a knowledge base of diseases, diagnoses, findings, disease associations and lab information

18. Computerized Provider Order Entry (CPOE) • CPOEs are clinical information systems that enables a patient’s care provider to enter an order for a medication, clinical laboratory or radiology test, or procedure directly into the computer • The system then transmits the order to the appropriate department, or individuals, so it can be carried out

20. CPOE • The most advanced implementations of such systems also provide real-time clinical decision support such as checking: • Dosage • Alternative medication suggestions • Duplicate therapy warnings • Drug-drug and drug-allergy interaction

21. Advantages of CPOE • Replaces hand-written orders ( solves problems with legibility, completeness, order delay or loss) • Supports ready access to patient data and patient assessment • Can help improve patient safety and prevent medical errors and adverse drug events by checking doses, interactions, allergies.. etc. • Supports improved recording, data trails, quality assurance and error awareness and reporting

22. Advantages of CPOE- Cont’d • Potential to improve efficiency and resource usage by integrating different departments - laboratory, imaging, nursing and medication records • Cost-effectiveness benefits: • Can reduce costs associated with medication errors • Can show test and medication costs - potential to reduce prescription costs • Can reduce the number of duplicate tests

23. Disadvantages of CPOE • Cost • Risk of a system generating medication errors e.g. through incorrect configuration or physician input • Systems may need medical terminologies not in local use • User resistance to introduction of computer-based technologies, requires training