Get a jump-start on improving your informatics

The Internet may provide a partial solution

The transition into the digital information world has not been smooth for most hospital pharmacists — or health care in general.

"If you look at the ability for integrated information systems to allow the power that can be brought on by both information technology and automation to make people more efficient and effective, pharmacists like every other health care provider are struggling to bring their practice into fully supported digital workflow and workload," says Bill G. Felkey, MS, professor of pharmacy care systems at Auburn (AL) University.

Felkey made a presentation at the 2005 meeting of the American Pharmacists Association in April about how to best use supportive technology.

Initially health care leaned in the direction of using large mainframe computers, he says. Because of the need for better clinical department support, however, health care went to more stand-alone departmental solutions. Now the pendulum is swinging back to where the pharmacy’s information provision needs to become more completely integrated in the whole information system.

The system should have the ability to have a multidisciplinary care team approach, in which work is sent for the pharmacist to do electronically, Felkey says. "If a prescription or medical order requires specific dosing, it would be more appropriate for that to be turfed to the pharmacist," he says. "Other things like documentation systems, pharmacokinetic calculations, and clinical references all need to become more integrated so that the support that is needed arrives more in a just-in-time manner."

Pharmacists may have had the will, but not always the ability to make changes to their information systems. "One of the biggest barriers is that because of the diverse hardware, software, and operating systems, we have a variety of information standards," he says. "With new HIPAA [Health Insurance Portability and Accountability Act of 1996] concerns, we have systems that are not talking well to each other."

Information barriers also exist that keep health care from meeting coding requirements that are necessary for truly integrating resources, he adds.

Even when vendors pass on their vision of what can be possible in information technology, pharmacists may be disappointed in the implementation. For example, computerized prescribed order entry can be useful for helping patient safety, Felkey reports. Some health systems have adopted it, but without first acquiring an electronic medical record. The result has been frustration. "We all know what is possible, but it is not necessarily implemented at the level it can be," he says.

Pharmacists now can have everything become more "Net-centric," which describes those things that operate on web browsers and the Internet. The Internet may become one component of the solution since it involves a smaller set of standards than other information systems.

A pharmacist who has a Macintosh computer at home, for example, would be able to use an Internet browser on his or her own machine to talk to the hospital system. A thin client (low-level workstation) is all that it takes to make this type of communication possible. Similarly, if pharmacists have patient responsibility and are sitting in a restaurant with their pocket PCs or Palm handheld operating systems, they should be able to connect to the system and get the information they need to reduce their uncertainty when making clinical decisions, Felkey says.

"We need a pervasive computing platform — and the Internet does provide that, to be able to move those data to where they are needed for better use and better timeliness of the information," he says.

Whatever they decide, pharmacists need to keep heading toward a solution, Felkey advises. "There is enough change in the technology that it would be detrimental to wait until the perfect system has been developed and then move to it. It’s better to look for areas right away where you can get a return on investment and to keep piloting interesting technology so you can keep your pharmacy department moving and used to change. Look for new solutions on a continual basis, knowing that the systems are getting better.

"Redirecting an organization that is already moving is easier," he concludes, "than taking one that is at a total standstill and trying to get it jump-started."