Transcript Hot Topics in the ASHP Section of Pharmacy Informatics and

Hot Topics in the ASHP Section
of Pharmacy Informatics and
Technology
Karl F. Gumpper, BS, BCPS, FASHP
Director, Section of Pharmacy Informatics &
Technology
American Society of Health-System Pharmacists
Email: [email protected]
Objectives
Discuss Section initiatives and its impact on VA
pharmacy informatics practitioners
 CPOE Guidelines
 Drug-Drug Interactions Survey
 Incorporation of Informatics and Medication Safety into
Pharmacy Residency Training
 “Meaningful Use” EHRs
Determine areas of collaboration for VA and
ASHP to improve the medication use process
ASHP Guidelines on Pharmacy Planning for
Implementation of Computerized Provider Order
Entry Systems in Hospitals and Health Systems
In development since 2003
 Complexity of the topic
 Scope
Work Group – Revitalized Process on the SOPIT –
Section Advisory Group on Clinical Information
Systems
Should be approved by ASHP Board of Directors
– Summer 2010
CPOE Guidelines
Purpose and Scope
CPOE and the Electronic Health Record
Planning for Transition to CPOE
Developing an Interdisciplinary Planning and Implementation
Team
Developing a Vision for the CPOE System
Defining Goals and Objectives
Establishing Baseline Data
Establishing Post-Go-Live Metrics
Re-engineering the Medication-Use Process
CPOE Guidelines (Continued)
Describing the Current Medication-Use Process and System
Design
Developing the Future Medication-Use Process and System
Design
Planning for CDS
Elements of a Safe CPOE System
Medication Orderable Design and Build Considerations
Pharmacy Department Considerations
Communication Between Departments
Education and Training of Health Care Providers
Conclusion
ASHP Statement on Bar-code Verification
during Inventory, Preparation, and
Dispensing of Medications
stocking of inventory both in the pharmacy and in other
locations from which patient medications may be dispensed
(e.g., an automated dispensing device);
manual packaging of oral solid and liquid medications;
compounding, repackaging, and labeling processes (e.g.,
scanning of source ingredients);
retrieving medications from automated dispensing devices; and
dispensing from the pharmacy to any location.
Other ASHP Resources
Guidelines
 Remote Medication Order Processing
 Safe Use of Automated Dispensing Devices
Others in development
 Drug-Drug Interaction Recommendations
 Electronic Prescribing
 Electronic Formulary Management within multiple applications
Drug-Drug Interaction Survey
Launched October 2009
 Sent to Listserv subscribers 13,975
 Response Rate of 11.6% (n = 1621)
 Data Currently under review
Preliminary Findings
 86% - Pharmacy Information System
 63% - EHR
 43% - CPOE
 27% - e-Prescribing
 5% - Not applicable
DDI Survey
Do you feel that there are there too many alerts for drugdrug interactions (DDI) in your electronic system?
1 – Not
Enough
Alerts
2
3
4
5 – Too Many
Alerts
3%
5%
27%
37%
27%
DDI Survey
Please rate your level of agreement with the following
statements?
Strongly
Disagree –
1
2
3
4
Strongly
Agree - 5
There are too many
insignificant alerts
causing overriding or
ignoring of alerts.
1%
9%
4%
34%
51%
Alert fatigue is a
phenomenon that
describes our drugdrug interaction
system alerts.
1%
9%
8%
37%
45%
The greatest problems with DDI software,
as reported by respondents appears to be:
Too many alerts that are classified too severely
The inability to customize alerts
Poor quality of information on DDI that is presented
Too many alerts that are classified too lightly
Inability to limit who receives alerts
Alert fatigue
Vendor misclassification of alerts
Not enough alerts due to system not catching all interactions
Non-accurate or clinically insignificant interactions
Issues with the override process
Interactions that don’t take patient factors into account
Limitations with CPOE
Patient safety issues such as the lack of hard stops
The most important issues that the ASHP
informatics group should be working on include:
Standardizing alerts, severity and DDI information among databases and software
Addressing alert fatigue or number of insignificant alerts
Improving the ability to customize the software
Enhancing the quality of information provided with alerts
Establishing prioritization according to significance of alert
Addressing programming issues
Providing alternative therapy options or stating what pharmacists should do when receiving the
alert
Developing a national standard for minimum information or "Best Practice."
Making sure that the information and systems are updated regularly
Creating a list of truly significant drug-drug interactions
Recommending best practice for CPOE on who should receive alerts(physicians vs pharmacists vs
nurses)
Providing more education around drug-drug interactions
Hard Stops
Improving the override and documentation process
Pharmacy Informatics and Medication
Safety in Residency Training Survey
Overall Response Rate: 29%
# of Surveys
Res Type
625 PGY1 Pharmacy
Responses
Response Rate
190
30%
14
26%
35 PGY1 Managed Care
8
23%
32 PGY2 Health System Admin
6
19%
7 PGY2 Informatics
6
86%
6 PGY2 Med Safety
0
0%
3
27%
54 PGY1 Community
11 PGY2 Drug Info
Is there an experience dedicated to informatics in your
postgraduate training program (PTP) for
residents/fellows?
Response
%
No
43
21%
No; but informatics principles are integrated
within other experiences
93
45%
Yes; it is a required Concentrated Experience (less
than 4 weeks)
13
6%
Yes; it is a required Traditional Experience (4-8
weeks)
8
4%
Yes; it is a required Longitudinal Experience (more
than 8 weeks)
15
7%
Yes; but it is an Elective Experience
35
17%
Total
207
100%
Will your current resident gain experience (by either reviewing the
existing literature and/or general application of the technology) to
better understand the benefits and limitations of each of the
following technologies/automations:
Answer
Response
%
Automated Dispensing Cabinets (ADC)
159
78%
Auto Packaging Machines
94
46%
Bar Code Scanning (pharmacy)
136
67%
Bar Code Scanning at the point of care (nursing)
104
51%
Carousels
67
33%
Clinical Decision Support (CDS)
107
52%
Computerized Prescriber Order Entry (CPOE)
134
66%
eMedication Administration Record (eMAR)
147
72%
e-prescribing
74
36%
Pharmacy Information Systems (PIS)
127
62%
Robotic Dispensing Systems
79
39%
Smart Pumps
126
62%
7
3%
None of the above
“Meaningful Use” Electronic Health Records
Comments
 ASHP, Pharmacy Groups Push Agencies to Include Pharmacists in
Medication Reconciliation Definition
 ASHP Pushes CMS to Recognize Pharmacists' Roles in Meaningful Use
Incentive Program
 ASHP Urges Clarification of Standards Supporting Meaningful Use
 ASHP to DEA: Create Standardized Format for Internal Codes Number
Systems
Educational Programming
 Summer Meeting 2010
What You Need to Know About the American Reinvestment and Recovery Act
(ARRA) and Health Information Technology (HIT) but Were Afraid to Ask
Achievement of Meaningful Use with EHRs
Get Involved with ASHP!
Submit Content Proposals for MCM 2011
 Deadline usually February 1st
Submit an Informatics Pearl – MCM 2010
 Lynn Sanders will be the Meeting Chair
 Due Summer 2010
Request Appointment for Section’s Advisory
Groups
 Deadline April 30th
 http://www.ashp.org/sag
Section Advisory Groups & Committees
SAG on Ambulatory Care Informatics
SAG on Clinical Information Systems
SAG on Pharmacy Informatics Education
SAG on Pharmacy Operations Automation
Educational Steering Committee
Committee on Nominations
Other ASHP Resources for Informatics
Bar Code Resources
Computerized Provider Order Entry (CPOE) Resources
Clinical Decision Support Systems (CDSS)
Must Read Articles
Pharmacy Automation Medication Management Technologies
eHealth Initiatives
Midyear Pearls of Informatics
Other Pharmacy Informatics Technologies
Other HIT Organizations
Career Development