Integration and standardization are still stumbling blocks in healthcare

Jerry Fahrni — Wed, 19 Aug 2009 19:13:18 +0000

I spent a good chunk of my morning in meetings and workgroups for the implementation of our barcode medication administration system (BCMA). Most of these sessions are dominated by nursing as many consider BCMA a nursing system.

The largest piece of the puzzle for pharmacy is getting the medications barcoded and ready for scanning prior to dispensing. When the district wide barcode initiative was designed, the department of pharmacy evaluated various options, made a decision, installed a barcode system from Talyst (AutoPharm, AutoCarousel, AutoPack, AutoLabel ) and haven’t looked back. That was over 18 months ago.

Fast forward to today where our organization continues to wrestle with implementation of the “nursing” pieces of the puzzle. Most of the delay surrounds issues with policy and procedure. The meetings I attend are often “lively” as nursing units throughout the hospital debate the best way to handle certain issues. I am always surprised to hear the number of ways that nursing units interpret the medication administration process. Each unit thinks they are unique. In fact, that was the battle cry of the day; “we’re different”.

In addition to the range of ways to do things, many of our units utilize systems that are poorly integrated with the rest of the hospital. L&D, ED and OR all use stand alone systems to document and chart patient information. Because these systems are not integrated with the rest of our systems, the information is not immediately retrievable from other areas of the hospital. Being the lone pharmacy representative, I had to ask how the information was made available to nurses and physicians when the patient was transferred. The answer was simple, yet staggering; they print the records out and send them with the patient. Huh? We pride ourselves on being on the cutting edge of technology (for hospitals), but provide paper copies of information that is already available in an electronic format. <*sigh*>

As we move in the direction of a complete electronic medical record, this becomes an unacceptable practice. Segregation of systems based on practice environment, i.e L&D, ED, OR, pediatrics, etc., must be eliminated if we really expect to develop a universally accepted electronic medical record. Electronic records should contain all pieces of information and be readily accessible from any computer at any time. Access should be independent of operating system, browser, or device.

Beyond patient safety with technology and automation

Jerry Fahrni — Tue, 07 Jul 2009 02:35:53 +0000

I had reason to do some thinking about healthcare automation over the weekend, and after much thought decided that healthcare, specifically pharmacy, was a little strange in several ways. As an industry, healthcare rarely looks beyond patient safety when talking about technology and automation. Let’s face it, patient safety is the rally cry for any department in need of a jumpstart to complete a project that has stalled for one reason or another. Unfortunately the investment of time, energy and capital resources typically stops immediately after implementation secondary to meeting the patient safety goal. However, this model seldom allows for technology and automation to be taken to the next logical step.

In general, technology is ideal for improving patient safety, but it can do so much more. Technology and automation offer several other benefits including:

Freeing up pharmacist’s time so they can move to the bedside. Technology can decrease time spent in the pharmacy by streamlining processes that require a pharmacist’s attention. In addition, technology like tablet PCs, mobile phones, and anytime/anywhere access to drug information and evidence based medicine resources via “the web” make the mobile pharmacist a reality. Literature has shown that a pharmacist at the bedside is better for the patient in several ways, including decreased drug related administration errors, fewer adverse events and more cost effective drug therapy. This is not only good for the patient, but can save thousands of dollars in avoided adverse events.

Enhanced workflow. Continued implementation and use of automated systems such as those available from Talyst (AutoPharm, AutoCarousel, AutoLabel, AutoPack), clearly impact the efficiency and standardization of workflow in the pharmacy. If you’ve ever been in an inpatient pharmacy, then you’ll understand the importance of workflow. Unfortunately system improvement typically stops immediately after implantation. It is often difficult to convince those in healthcare to continue developing these systems after deployment secondary to the “if it ain’t broke, don’t fix it” mentality. It is important for hospital administration to realize that an efficient pharmacy not only saves money in labor costs, but helps move pharmacists toward the bedside as mentioned above.

Inventory control and drug security. This may seem obvious to everyone, but often times continued development and advancements in technology are necessary to stay ahead of the “work-arounds”. Human nature and willful disregard for procedure frequently trump our technology. Doing the wrong thing needs to be harder than doing the right thing. This leads to better control of inventory and less diversion (i.e. it saves money).

Improved technology can lead to better integration of various healthcare systems. It seems like every department in the hospital has a system specifically designed for them and no one else. This leads to an increased need for support personnel in the IT department as well as resources dedicated to upgrading and maintaining those systems. Integration is a key component to decreasing healthcare costs, and one area that I believe is frequently overlooked.

While it may be important to think of patient safety as the primary reason for the implementation of new and advanced technology, one must not forget the fringe benefits that can save healthcares systems thousands of dollars both directly and indirectly through pharmacy intervention at the bedside, increased efficiency in the pharmacy, and integration with existing system resulting in less time required for maintenance and upgrades. Technology can do so much more.

Jerry Fahrni » Integration

Integration and standardization are still stumbling blocks in healthcare

Beyond patient safety with technology and automation