Formulary management guiding principles for automated systems.

PURPOSE: Structural and financial changes in US healthcare are the driving forces reshaping care delivery and the technologies that clinicians use in their practice. Structural-level changes in healthcare organizations bringing facilities varying in size, systems, and complexity under the new integrated care delivery networks create unprecedented challenges. This paper develops guiding principles for formulary management in automated systems that facilitate medication management and alignment of medication information technology (IT) solutions in healthcare organizations ranging in size from a single facility to very large enterprise/multifacility networks. SUMMARY: This paper describes formulary management best practices for healthcare organizations as they follow crucial medication management processes: formulary item builds, urgent and nonformulary medication requests, and formulary item build testing and maintenance. As medication management practices are embedded in automated technologies that are similar yet nuanced, we pay special attention to practices and change control processes that maximize coordination among systems while preserving medication data integrity and reducing medication errors. CONCLUSION: For increasingly complex healthcare systems with multiple medication management system demands, formulary drug database builds and maintenance are challenging and time-consuming. Formulary item build, testing, and maintenance processes involve multifunctional teams collaborating to ensure the integrity of data, prevent unexpected system incompatibilities, and improve patient safety by reducing medication errors. Ideally, formulary item build, testing, and maintenance processes produce consistent final drug records in IT systems meeting user needs.

Integrating pharmacogenomics into electronic health records with clinical decision support.

PURPOSE: Existing pharmacogenomic informatics models, key implementation steps, and emerging resources to facilitate the development of pharmacogenomic clinical decision support (CDS) are described. SUMMARY: Pharmacogenomics is an important component of precision medicine. Informatics, especially CDS in the electronic health record (EHR), is a critical tool for the integration of pharmacogenomics into routine patient care. Effective integration of pharmacogenomic CDS into the EHR can address implementation challenges, including the increasing volume of pharmacogenomic clinical knowledge, the enduring nature of pharmacogenomic test results, and the complexity of interpreting results. Both passive and active CDS provide point-of-care information to clinicians that can guide the systematic use of pharmacogenomics to proactively optimize pharmacotherapy. Key considerations for a successful implementation have been identified; these include clinical workflows, identification of alert triggers, and tools to guide interpretation of results. These considerations, along with emerging resources from the Clinical Pharmacogenetics Implementation Consortium and the National Academy of Medicine, are described. CONCLUSION: The EHR with CDS is essential to curate pharmacogenomic data and disseminate patient-specific information at the point of care. As part of the successful implementation of pharmacogenomics into clinical settings, all relevant clinical recommendations pertaining to gene-drug pairs must be summarized and presented to clinicians in a manner that is seamlessly integrated into the clinical workflow of the EHR. In some situations, ancillary systems and applications outside the EHR may be integrated to augment the capabilities of the EHR.

Eligibility requirements for advanced health informatics certification.

AMIA is leading the effort to strengthen the health informatics profession by creating an advanced health informatics certification (AHIC) for individuals whose informatics work directly impacts the practice of health care, public health, or personal health. The AMIA Board of Directors has endorsed a set of proposed AHIC eligibility requirements that will be presented to the future AHIC certifying entity for adoption. These requirements specifically establish who will be eligible to sit for the AHIC examination and more generally signal the depth and breadth of knowledge and experience expected from certified individuals. They also inform the development of the accreditation process and provide guidance to graduate health informatics programs as well as individuals interested in pursuing AHIC. AHIC eligibility will be determined by practice focus, education in primary field and health informatics, and significant health informatics experience.

ASHP national survey on informatics: assessment of the adoption and use of pharmacy informatics in U.S. hospitals-2013.

PURPOSE: Results of the 2013 ASHP national survey on informatics are presented. METHODS: Pharmacy directors from all types and sizes of U.S. hospitals were included in the sample of 4893 individuals invited to participate in an online survey. The survey contained over 600 data elements that addressed the adoption and use of a variety of pharmacy informatics and technology. Data were analyzed by hospital type and size, accounting for sampling procedures and differences in response rate. RESULTS: Of the 4893 surveys distributed, 465 usable surveys were returned, yielding a response rate of 9.5%. Nearly 33% of hospitals reported having a complete electronic health record (EHR) (i.e., no paper charts). Adoption rates for computerized prescriber order entry, clinical decision support, electronic prescribing, and bar-code-assisted medication administration indicated that these technologies are clear priorities. Nearly half of respondents indicated using solely paper-based medication reconciliation processes, while almost as many reported using processes that combined electronic and paper methods. Overall, automated dispensing cabinets were more common in U.S. hospitals than were carousels and dispensing robots. The adoption of patient portals and personal health records is becoming common. Technologies identified as enablers of the Pharmacy Practice Model Initiative (PPMI) were found in at least 25% of hospitals. The average total number of pharmacy information technology full-time equivalents was 3.12. CONCLUSION: This survey found widespread use of pharmacy informatics and technology across the entire medication-use process. Considerable progress was demonstrated in meeting meaningful-use measures for EHRs and meeting the recommendations of the ASHP PPMI.

Implementation of the Pharmacy Practice Model Initiative within comprehensive cancer centers.

PURPOSE: The progress made by cancer centers across the United States adopting the goals and measures of the Pharmacy Practice Model Initiative (PPMI) was studied. METHODS: In collaboration with ASHP, the official PPMI hospital self-assessment (HSA) questionnaire and a 10-item supplemental survey specific to oncology pharmacy services were disseminated via e-mail to all 41 National Cancer Institute designated comprehensive cancer centers in the United States. RESULTS: The HSA results of 26 (63%) of the 41 institutions surveyed were included in the analysis. Of the 26 participating institutions, 15 (58%) also completed the supplemental survey. Advanced pharmacist roles are highly prevalent among comprehensive cancer centers, with all institutions giving pharmacists discharge counseling responsibilities and deploying pharmacists to patient care units. Twenty-five institutions (96%) provide some level of pharmacist-driven drug therapy management services in at least some areas or situations and most often in the inpatient setting. Implementation of automation and technology in the areas of dispensing and order entry has occurred in over 80% of institutions. Advancement of pharmacy technician roles has received the least attention, with only 13 centers (50%) giving technicians sole responsibility for traditional dispensing functions, and 11 (42%) allowing technicians three or more advanced responsibilities. Only 12 institutions (46%) have established mechanisms to hold their pharmacists accountable for medication-related outcomes. CONCLUSION: Based on the survey results, suggested areas of improvement include the provision of drug therapy management in the outpatient setting, advancement in technician roles, utilization of automation and technology particularly at the point of administration, and implementation of mechanisms to hold pharmacists accountable for medication-related outcomes of their patients.

ASHP national survey on informatics: assessment of the adoption and use of pharmacy informatics in U.S. hospitals--2007.

PURPOSE: Results of the 2007 ASHP national survey on informatics are presented. METHODS: All types and sizes of hospitals in the United States were included in the sample of 4112 pharmacy directors surveyed using an online data collection tool. The survey included over 300 data elements and was designed to assess the adoption and use of pharmacy informatics and technology within the medication-use process. RESULTS: In this national probability sample survey, the response rate was 25.9%. Hospitals appear to be moving toward an enterprise approach to information technology adoption and away from a best-of-breed approach. Although nearly half of hospitals have components of an electronic medical record (EMR), a complete digital hospital with a fully implemented EMR is far in the future, with only 5.9% of hospitals being fully digital (without paper records). An estimated 12.0% of hospitals use computerized prescriber-order-entry systems with decision support, 24.1% use bar-code medication administration, and 44.0% use intelligent infusion devices (smart pumps). Many of these technologies were not optimally configured, and significant advances must be made for hospitals to fully realize the benefits of these technologies. Hospitals have implemented many technologies in drug distribution, with 82.8% of hospitals having automated dispensing cabinets, 10.1% having robots, and 12.7% having carousel systems to manage inventory. Finally, most hospitals reported plans to adopt most of these technologies. CONCLUSION: This survey found that informatics and medication-use system technologies are widely present in all steps of the medication-use process. These technologies touch all health care professionals in the hospital and demonstrate the significant responsibility the pharmacy department holds for these technologies.