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PHARMACY INFORMATICS

ALLAN MARC A. LENA, RPh.


Modern Pharmacy Practice vs. TRADITIONAL
PHARMACY PRACTICE
Introduction: Pharmacy Informatics
The application of computers to the storage,
retrieval, and analysis of drug information.
Helps the pharmacist manage including but not
limited to medical insurance records of patients,
drug interaction data, as well as prescription
data.
This is also the study of interactions between
natural and engineered systems within health
care with a focus on applying technology to
pharmacists.
Also referred to as pharmacoinformatics.
Pharmacy Informatics: New Role for
Pharmacists
In today's world of global connectivity and
increased communication, pharmacy is yet another
profession benefiting from technological advances,
which are evident in almost every corner of
pharmacy practice. Introduction of the electronic
medical record (EMR), computerized physician order
entry (CPOE), and robotics has eased the
pharmacist's work flow considerably, but human
input
is
still
required
for
development,
maintenance, and evaluation of these systems.
Pharmacists today can play a vital role in the
development and maintenance of information
technology. Input of clinical data must remain under
the control of a pharmacist if all the benefits of the
technology are to be realized, according to experts.
Additionally, pharmacists should be involved in the
interpretation of data collected from the new
systems.
Pharmacists are the ideal candidates for designing
and implementing systems that reduce medication
errors,
medication
cost,
and
medication
mismanagement. It is important for someone
pursuing a career in pharmacy informatics to be a
very detail-oriented person and the key is learn, to
identify where problems exist, knowing what the
current process is, and enhancing patient care and
services without negatively affecting the current
workflow.
Informatics and the Medication Use Process
The majority of technology acquisitions have
consisted of basic stand-alone computer systems ,
which were primarily used for data input to increase
each departments efficiency with financial
accountability measures

But even as improving technologies have emerged


allowing for seamless integration of information to
occur , most organizations have shown little
interests to incentive to incur the huge cost
associated with replacing their nonintegrated
computer system.
Roots of Informatics within the Information Sciences
Health informatics emerged as a distinct specialty
within healthcare over time as health professionals
and visionaries applied innovative developments in
the computer and information sciences to complex
problems in healthcare.
Computer science brings to health informatics the
technology and software coding required for this
specialty while information science contributes the
procedures and processes needed to develop and
process data information, and knowledge.
Computer Science is the systematic study of
algorithmic
methods
for
representing
and
transforming information, including their theory,
design, implementation, application and efficiency.
Information Science is a discipline that investigates
the properties and behavior of information, the
forces governing the flow of information, and the
means of processing information for optimum
accessibility and usability.
Computerized Provider Order Entry
Key Concepts:
1. Alert a patient-and-context-sensitive warning
presented to the ordering provider at the time
an order is being entered.
2. Clinical reminder a context-sensitive
electronic prompt to the provider to perform an
intervention or procedure, based on the
patients specific clinical data as applied to a set
of logical conditions.
3. Computerized Provider Order Entry direct
entry of medical orders into a healthcare
systems
EHR
by
licensed
independent
practitioners or other staff with specific ordering
privilieges, and not by clinical or administrative
support staff.
4. Corollary Orders orders entered as adjuncts
to a primary order eg. Orders for laboratory
tests to monitor effects of a medication order,
orders for special diets in preparation for a
medical procedure.
5. Downtime- the period of time during which the
healthcare facilitys computer system is
unavailable and electronic order entry is not
possible.
6. E latrogenesis patient harm caused at least
in part by the application of health information
technology.
7. Electronic Health Record (EHR) Systems
software programs designed for use by
healthcare systems to electronically place,
store, and retrieve clinical orders, results, notes,

reports and other information related to the care


of patients.
8. Order Menu a listing of orders from which
clinicians may select individual orders,
organized to support a specific purpose,
ordering environment or type of order.
9. Order set a group of medication and
procedure orders that can be accessed and
ordered from a single source in the EHR, to
facilitate entry of multiple orders and
standardize ordering for a specific purpose.
10. Quick order a pre configured order in which
the components are specified, allowing for
faster order entry and limiting opportunities for
entry orders.
Computerized Provider Order Entry
This is the direct entry of clinical orders into a
healthcare systems electronic health record (EHR)
by licensed independent clinicians or others with
ordering privileges.
This has the potential to dramatically reduce these
sources of order errors and significantly improve
patient care overall.
Orders may be entered by physicians, physicians
assistants, nurse practitioners and other licensed
independent practitioners as well as other clinical
staff whose scope of practice or protocols grant
specific prescribing privileges.
A healthcare system can have a comprehensive
electronic health record maintained by pharmacists,
laboratory and radiology technologists, nurses etc.,
who are not ordering providers.
Items frequently ordered together, such as
medications and monitoring laboratory tests, may
be grouped together into an order set to both
facilitate the ordering process as well as enhance
patient safety by prompting the provider to order
these corollary items.
Quick orders and order sets may be grouped
together in order menus to facilitate navigation to
correct orders.
Barriers that lead to ineffective
communication of medication orders:
1. illegible handwriting
a. -common cause of prescribing errors and
patients injury and death
2. Use of dangerous abbreviations
3. Dose designations
4. Verbal and faxed orders
Potential enhancements that a basic CPOE
system can offer:
Ambulatory care setting or both
Allow prescribers to access records and enter
orders from their office or home
Prescriber selectable standardized single orders
or order sets

Implementation of organization-specific
standing orders based on specific situations
such as before or after the procedures
Menu-driven organization-specific lists of
medications on formulary
Passive feedback systems that present patientspecific data in an organized fashion such as
test results, charges ,reference materials and
progress notes or active feedback systems to
provide clinical decision-making tools by
providing specific assessments or
recommendations through alerts and reminders

Importance of CPOE
With this system, impressive patient safety benefits
can be achieved.
CPOE can remind the ordering clinician of a
patients allergy to a specific medication and
suggest alternatives or how to manage a
reaction.
This can alert the clinician of drug-drug
interactions, educate on the severity and
mechanism of action, and provide advice on
managing them.
Can check dosages against the patients
physical parameters, laboratory parameters,
and previous dosing history and then warn the
clinician of potential problems and how to alter
a course of therapy.
CPOE system for medications that is integrated
with diet orders and diagnoses can alert
providers of dangerously incongruent ordering
scenarios.
This can facilitate appropriate monitoring with
any potentially risky therapy.
CPOE can promote safety at the point of order
selection by detaching sound-alike drugs into
separate
order
menus
organized
by
pharmacological class.
To Err is Human, the Leapfrog Group was
convened. Leapfrog Group is a consortium of
purchasers of healthcare plans whose members
base their purchases on quality improvement and
consumer involvement.
10 Leapfrog Safe Practices Score
1. Drug allergy alert
2. Drug drug interaction alert
3. Drug laboratory result alert
4. Drug monitoring laboratory test
5. Drug diagnosis alert
6. Drug diet interaction
7. Individual dose checking
8. Cumulative dose checking
9. Physical Incompatibilities
10. Preventative health clinical reminders

In promoting safe ordering, CPOE can realize other


benefits for the health care system. Through the
use of electronic access and signatured codes,
electronically-enabled identification cards, and
biometric devices utilizing optical or fingerprint
scanners.
CPOE can verify the identity of the ordering
provider and prevent order forgery and other
sources of diversion and fraud.

It can cross the-check the ordering providers


privilieges and scope of practice against the orders
he is attempting to place and limit the provider to
types of orders within his clinical specialty.