Epic will eventually control IV workflow management

Pulling another article from the notebook archive, penned March 20, 2020.

I have seen the future of IV workflow management systems (IVWFMS). Spoiler alert, EPIC wins. And before people start calling me an Epic fanboy, I should make it clear that I do not like Epic, as a company or a product. I believe healthcare will rue the day they relinquished all their power to a single company. 

Those that know me or have read anything I have written in the past decade, know that I am an advocate for technology in the IV room. People are imperfect creatures, they make mistakes. Don’t believe me? Google Emily Jerry death or St Charles rocuronium. That will tell you all you need to know about the dangers associated with injectable medications. Compounded sterile preparations are the most dangerous medications within the four walls of a hospital. Seems logical that such dangers would receive the utmost attention. Inexplicably, they do not. Many reasons are given for ignoring the issues, but it boils down to poor planning and the inability to prioritize in the face of budgetary and political restraints. 

Technology, while far from perfect, adds a level of protection to a complex, error-prone, and dangerous process. Adding a little common-sense technology to the IV medication process, like an IVWFMS*, is the quickest and most cost-effective way to improve safety.

Implementing these systems is a no-brainer, but that hasn’t stopped people from ignoring them. The problem has been, at least from my perspective, a complete failure by pharmacy leadership to recognize and prioritize IV room safety and efficiency. Nowhere else but in the IV room can a single mistake result in significant harm or death. Yet the IV room seems to get a fraction of the attention it should. Unfortunately, it often takes a tragic error like those noted above before folks take notice. 

With that said, there is some good news. I have witnessed an uptake of IVWFMS in recent years. More hospitals seem to be adding these systems to their workflow. While a welcome trend, the increased numbers don’t appear to be secondary to some altruistic good will or common sense, but rather because of Epic. The monolithic EHR vendor has unwillingly changed the landscape of the IVWFMS market, forever. Big pharmacy technology companies refuse to admit it, but the writing is on the wall. When asked what technology a hospital is using in the IV room, I used to hear “nothing” or “DoseEdge” with an occasional “MedKeeper” thrown in. Now, more often than not, I hear “Dispense Prep”.**

Why the shift? No mystery here, the answer is simple: the barrier to entry is low and the integration within the platform is amazing. 

For healthcare systems already using Epic, it is as easy as flipping a switch. The implementation requires a bit of legwork, and some minor equipment, but nothing like that required when implementing a third-party system like DoseEdge, BD Cato, etc. I have been involved with both Epic and third party IVWFMS implementations, there is little comparison in time, energy, effort, and cost. Epic Dispense Prep (EDP) wins in all those areas, easily, every single time. 

The ease of EDP implementation is tied directly to the modularity and integration of the overall system. It shares databases, labels, user experience, dashboards, and so on. EDP is already part of the EHR, so it requires no additional contracts, no additional maintenance agreements, no third-party vendor helpdesks, no “integration” within the EHR, no crazy implementation schedule and checklists, no weird upgrade schedule or downtime, and so on. 

EDP implementation requires far fewer pharmacy resources than other IVWFMS and has the added benefit of being nearly transparent to pharmacy personnel. Most of the build is handled behind the scenes by dedicated IT resources — the ever present Epic Willow Build Team. Pharmacy resources are kept to a minimum, which decreases impact on the department. Contrast this to something like DoseEdge, which requires a significant investment in time and effort from pharmacy personnel. I can attest from personal experience that the overhead for a third party IVWFMS implementation can be hundreds of hours of dedicated pharmacist time. EDP, on the other hand, requires a fraction of that time. This alone makes it an easy choice for pharmacies strapped for resources, which describes nearly all inpatient pharmacies. 

None of this means that EDP is the best IVWMS on the market. Not even close. While it offers full integration across the entire enterprise, barcode scanning, image capture, robust tracking, and is seamlessly tied into the billing system — something I care little about but is a top priority for healthcare systems — it falls short in other areas. As I write this, I can think of at least three products off the top of my head that I believe are better than Dispense Prep. They are more flexible, more feature rich, have better hardware, have better software, and so on. Most even eclipse EDP in the quality of the basics, like image capture. But it doesn’t matter if they are never implemented. The best IVWFMS is the one you are using. While Dispense Prep may not be the best, it is better than nothing. Love the one you’re with, you know?

While not an accident per se, I believe Epic won the battle of IV workflow management systems without trying. Several large IDNS have already converted to Epic, giving them an obvious competitive edge in the IV room. As facilities with Epic gravitate toward Dispense Prep for the reasons outlined above, the market will inevitably begin to contract, forcing third party vendors to compete against one another for a smaller piece of the pie. It may take some time – things always do in healthcare – but companies marketing IVWFMS will feel the pressure. I believe some already have. I have personally witnessed facilities that have uninstalled DoseEdge in favor of EDP, and some that have elected to with Epic over an outside vendor. The pressure is on. 

To the IVWFMS out there, I wish you good luck. The long game is not in your favor.

=========================== 

*Robotics has its place in the IV room. Products continue to get better every year. While it may not be for everyone, I can see use cases where robotics would be a viable option. 

**EPIC Dispense Prep (EDP) is the IVWFMS module inside the Epic EHR System. It is an incredibly well integrated piece of the overall Epic medication distribution model. Dispense Queue [a dashboard of everything waiting to be prepared] → Dispense Prep [capture all data during compounding] → Dispense Check [Pharmacist Review] → Dispense Tracking [track product from pharmacy to bedside]. While I do not care for Epic, in general, one has to admire the vision and design.

ASHP Section of Pharmacy Practice Managers has a new strategic plan

A little more than a week ago the most recent ASHP Section of Pharmacy Practice Managers Chair’s Message(1) landed in my inbox. I don’t typically read these messages carefully as they’re mostly full of the same old rhetoric. However, this particular message caught my attention because it included information on the ASHP Section of Pharmacy Practice Managers new strategic plan for 2015-2016.

According to the email:

“…the Executive Committee recently completed an extensive update to the Section’s strategic plan, which is now available on the Section webpage.  Our intent was to set a structure that would help us continually remain focused on the most important needs of practice managers. We have worked to carefully align the Sections plan with the overall ASHP Strategic Plan. This alignment eliminated the need for separate Section goals, which greatly streamlined the plan.  We also identified critical areas for practice managers.  The critical areas identified for 2015-16 are:

  • Leadership Development
  • Innovation Management
  • Management of the Pharmacy Enterprise
  • Patient Care Quality
  • Multi-Hospital Health System Pharmacy Executives”

These are all great areas of focus.

Much more detail can be found the actual strategic plan document, which can be found here. I read through the document, much of which is what you’d expect, but there are some interesting items in the strategic priorities and goals section. Three bullet points caught my attention: 1) Expand pharmacy practice in ambulatory clinics and other primary pharmacy care settings, 2) Produce an Innovative and Timely Professional Journal, Website, Drug Information Compendium, and Other Publications that Meet the Needs of Members and Other Customers, 3) Improve the Discoverability of ASHP Digital Content Assets.

Expand pharmacy practice in ambulatory clinics – There was a time when I thought all pharmacists should practice in a hospital setting, but my views on that have slowly changed over the years. The most appropriate time for pharmacists to have a meaningful impact on patient care is before they’re hospitalized, i.e. in the ambulatory care environment. We are the medication experts, and nowhere is there more inappropriate medication use than in the outpatient setting. I think it is wise for pharmacy managers to spend more time focused on this practice area.

Produce innovative and timely information – Times have changed. The amount of readily available information is growing at an exponential pace. Unfortunately not all information is reliable. ASHP has made only small strides in the past several years in improving speed and access to information. Information affecting practice areas like operations, management, and technology should be made available at breakneck speed as it does not require the same rigorous vetting that clinical information does. It is no longer acceptable to wait a year for someone to present their findings at ASHP Midyear, or for AJHP to take months to publish something that is relevant now.

Improve discoverability of ASHP digital content – This would be a welcome change. ASHP has created a mountain of valuable information, but it’s scattered and difficult to find, cross reference, etc. I could go on and on about this, but suffice it to say I would love to see an improved content management style.

Let’s hope that Dr. Hoffman is able to make good on his promises. I’m going to hold him to his word.

——

  1. The ASHP Section of Pharmacy Practice Managers new chair is James M. Hoffman, Pharm.D., M.S., BCPS, FASHP. With all those initials after his name he must be good.

Saturday morning coffee [April 20 2013]

MUG_IndianapolisSo much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug to the right comes straight from Indianapolis. I was there for work as part of a multi-city five hospital rampage through that section of the country. It was pretty nice for the most part, but trying to get home turned out to be a bit of a nightmare. Indianapolis was hit by severe thunderstorms the day I was supposed to leave – high winds, lightning, hail, and so on – which caused all sorts of chaos and delays at the airport. The delays made me miss my connection in Denver, which just happened to be the last flight out to Fresno on the night in question. I got lucky as the last flight to Los Angeles from Denver had been delayed by an hour so I grabbed an available seat and headed for the city of Angels. I landed at LAX about 1:00AM Friday morning, rented a car, got a hotel room, stole a few hours of sleep and finally drove the short four hours home. Total travel time from Indianapolis airport to my front door: approximately 20 hours. Not how I planned it. When I talk to the sales guys they tell me this is “no big deal”. If you were to talk to me I’d tell you it sucks.
Continue reading Saturday morning coffee [April 20 2013]

Center for the study of pharmacy automation and technology [idea]

MadScientistEarlier this week I put up a post about a Prezi created by Dr. Robert Hoyt called Evidence Based Health Informatics: Replacing Hype with Science. It was a great presentation about a lot of the technology that healthcare has adopted over the years without any real evidence to back it up. I wish you could all see it, but it appears that someone has pulled it down. The link I have for the Prezi is dead. Bummer

Anyway, the Prezi got me thinking about how we have many technologies in pharmacy that have precious little, or no data to support their use. We use carousels, high-speed packagers, tabletop packagers, robotic medication distribution, robotic IV preparation along with other IV room technologies, smart IV pumps, automated storage cabinets, and so on. The data we do have for these items is typically provided by the manufacturer’s themselves, which makes it biased in the best of situations and completely worthless in the worst cases.

Pharmacy is in desperate need of an academic center for the study of pharmacy automation and technology. The center would study the use of pharmacy technology in different use cases, collect data, and provide the pharmacy community with the information. Look at robotics versus carousels for distribution. Analyze cross contamination in high-speed packagers versus tabletop models. Perform time-motion studies on cart fill vs. automated dispensing cabinets for medication distribution, and compare the safety of one over the other. Analyze pharmacy inventory costs of one technology over the other. And so on, ad infinitum.  Conclusions wouldn’t be necessary as simply presenting the information in an easy to understand format would suffice. Let the end users draw their own conclusions. Every practice setting is slightly different, and what may work for one may not work for another. But understanding how a piece of technology or automation fits into a particular practice model might be a significant benefit to many.

The center would tear the automation and technology apart, both figuratively and literally to unveil all there is to know about each and every piece.

Such a place would have to exist at a well respected academic research center as it is the only way to ensure some semblance of impartiality.

How would it be funded? Ah, there’s the rub. Getting funding for such an endeavor would be difficult at best. A lot of this equipment is expensive. Of course the best place to troll for money would be the pharmacy technology vendors themselves. After all, they have all the equipment that would be needed to perform the research. Unfortunately this is unlikely to happen as most companies will not be willing to drop resources into a project that they have no control over. What if the outcome of such research reflected poorly on their products? That would not only be embarrassing, but could potentially hit them in the pocketbook. No, they couldn’t risk it. How about the federal government? Perhaps, but that might be like getting blood out of a turnip these days.

Getting the equipment and funds would definitely be the hardest part. There’d be no shortage of pharmacists interested in doing that type of work. What pharmacist could resist playing with giant toys all day long?

Time to get out my crayons and start drafting a proposal….

Patient collected information and the role of pharmacists

I had an interesting phone conversation this morning with Kevin Sneed, Pharm.D.(@DeanSneed), Dean at the University of South Florida College of Pharmacy (USF COP). I’ve been trying to connect with Dr. Sneed for a while now, but as you can imagine his schedule is pretty full. Fortunately for me I was able to grab about 30 minutes of his time this morning. And what a great 30 minutes it was. I was so impressed with what he had to say that I’m planning to visit USF COP sometime in the next couple of months to continue the conversation and get a first hand look at what’s going on there.

While I could expound on our conversation for several pages, one comment that Dr. Sneed made struck me as so profound that I thought I would quickly share it.

During the conversation we started talking about data, and where it’s coming from. Pharmacy is a data driven science, but never has the data come from so many directions. Dr. Sneed commented that patients are taking control of information these days, and not only are they more informed, but they are generating much of the information that will be used in their care. Patients are becoming connected more and more. This is especially true with the advent of mobile technologies that wirelessly transmit tons of data for everything from exercise regimens, to weight, glucose readings, heart rate measurements, and so on. Dr. Sneed sees a future where patients will present this information not only to physicians, but other healthcare professionals such as pharmacists as well; it will be used as currency to start conversations and facilitate care. I’ve heard people in healthcare refer to data as currency before, but I never really made the connection until now.

It’s clear that we’re in a new age of heatlchare, and pharmacists need to be prepared to collect this information and utilize it to provide better pharmaceutical care. This may sound superficial on the surface, but it is a very important point. Think of a time, not so far in the future, when pharmacists will have a lot more information about patients at their fingertips. This will likely occur across all pharmacy environments, i.e. outpatient, long term care, acute care, etc. This information will give pharmacists an ever increasing role in direct patient care.

Something to think about as pharmacists prepare for a future healthcare model that is rich in information provided by their patients. Exciting opportunities lie ahead if we’re prepared to accept them.

Transforming pharmacy technicians for the future

I support the use of pharmacy technicians in many roles inside acute care pharmacies. I believe that they are a valuable tool and, when properly utilized, pharmacy technicians can not only improve pharmacy operations and patient safety, but can also give pharmacists freedom to focus on clinical duties and patient care.

This is why I found a recent article in Pharmacy Practice News so interesting. The article describes a program at Inova Alexandria Hospital in Alexandria, Virginia where the department of pharmacy has developed a system to educate their technicians for expanded roles.

The program outlined in the article is quite extensive and involved. Why would Inova Alexandria Hospital undertake such a task? It’s simple really. As stated in the article: “The implementation of automation means expanded roles for technicians. Automation promotes safety and accuracy, and when used properly, it can save valuable time, freeing up technicians to work in other areas of patient care and enabling pharmacists to act as direct care providers. The American Society of Health-System Pharmacists’ (ASHP) Pharmacy Practice Model Initiative cites technicians as a cornerstone of the future of pharmacy practice and recommends increased educational requirements for technicians in the future.” I couldn’t agree more.

The program consists of monthly sessions targeted at educating technicians about medications and disease states. It is designed to promote interactive discussion and teamwork, and appears to have paid off in spades for Inova. According to the article, “The benefits of the technician education forum are numerous. Technicians have become more engaged and accountable for their work and have reported an increased job satisfaction. Furthermore, teaching technicians about correct dosing and safety allows them to become a second set of eyes for pharmacists. Technicians present concerns or questions during daily activities based on topics and concepts previously presented.”

The article presents examples of how to present clinical information to technicians, and even includes a chart for tips on starting a technician education program of your own. It’s a great article and I encourage everyone involved in pharmacy to take a few minutes to read it.

The future of pharmacy remains uncertain, but it is clear that technicians are an underutilized commodity in acute care pharmacy. Expanding the role of pharmacy technicians can only improve pharmacy practice and serve as a springboard to launch pharmacist into more patient centric activities.

cross-posted at Talyst.com

Why pharmacy continues to fail

I’ve been a pharmacist since 1997. The profession of pharmacy, and therefore the basic principals of the practice, haven’t changed in that time. During my career I’ve worked in six different hospitals (1 in operations, 2 as a clinician, 2 general practice, 1 informatics), one long-term care pharmacy, once as a consultant pharmacist in long term care, in retail for two different retail chains, one community pharmacy and as a relief pharmacist for about a year. Looks pretty bad when I put it in writing. What can I say, I get bored.
Continue reading Why pharmacy continues to fail

Webinar: Effective Pharmacy Interactions with ‘The C-Suite’

I think a key for the future of pharmacy will be for pharmacy leaders to learn how to engage the C-Suite within their own healthcare system. That makes the content of this webinar from Pharmacy OneSource particularly interesting.

Wednesday, December 14th: "Effective Pharmacy Interactions with ‘The C-Suite’"
Jim Jorgenson, RPh, MS, FASHP

Reserve your Webinar seat now at:
https://www2.gotomeeting.com/register/340160290

Jim Jorgenson, Chief Pharmacy Officer and Vice President of Indiana University Health, will provide the pharmacist with background information about the current healthcare environment, with an emphasis on how the hospital/health-system and priorities of the C-Suite are affected. The overall goal is to enable the pharmacist to gain knowledge and confidence in preparation to present to the C-Suite on topics affecting pharmacy and the medication use process. Specific case examples of presentations that worked and did not work will be provided.
Effective Pharmacy Interactions with ‘The C-Suite’
Date: Wednesday, December 14, 2011
Time: 12:00 PM – 1:00 PM ET
Register: https://www2.gotomeeting.com/register/340160290

Why regulatory compliance is killing innovation in healthcare

Anyone that’s worked in healthcare knows about regulatory compliance. If not, then they should because it takes up about 50% of everyone’s time, energy and effort. I understand the theory behind regulations, i.e. protect the patient, but I think most of the time all additional regulations do is is create work for people that are already over burdened.

Ask a nurse how much time they spend documenting and double documenting things to meet some arbitrary rule or regulation. You’ll be surprised by the answer. Now ask a pharmacist or a physician. You’ll get the same ugly responses. I know a lot of my time as a clinician was spent generating documentation to cover my ass rather than helping care for a patient.

Unfortunately the need to comply with government agencies and silly rules inside the walls of healthcare has generated an unwanted side effect – lack of innovation. Why? Because all that innovative energy is spent on regulatory compliance instead of other, more useful things.

I’ve been involved in several conversations over the last month dealing with how to best use pharmacy automation and technology to increase efficiency and solve problems. Would you like to venture a guess as to what most of those conversations centered on? Yep, how to automate some documentation process or create technology to meet some new regulatory compliance. None of the discussions have been about providing better, safer, more complete patient care.

If you don’t think this is a major problem, think again. I was reading a blog by John Halamka last night in which he discusses the ‘Burden of Compliance’. In the blog John states that “[a]s we draft new regulations that impact healthcare IT organizations, we need to keep in mind that every regulation has a cost in dollars, time, and complexity.” Just remember, there is a finite amount of dollars and time floating around in healthcare these days. If a majority of those dollars and time are gobbled up by regulatory compliance, what does that leave for innovation to actually improve medication distribution, safe administration and better patient care? Precious little if you ask me.

The ASHP Summer Meeting 2011 continues … (#ashpsm)

ASHP 2011 Summer Meeting and Exhibition

I had planned on blogging daily during the Summer Meeting, but obviously that didn’t happen. Perhaps it was the big dinner I had yesterday evening followed by the insanely good gelato that put me into a food comma, or then again maybe it was just laziness. Regardless, I skipped a day.

The Summer Meeting continues to roll on with some great sessions and lots of interesting conversation. All-in-all between yesterday and today I’ve attended the following:

Continue reading The ASHP Summer Meeting 2011 continues … (#ashpsm)