Integration and standardization are still stumbling blocks in healthcare

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.