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Expanding APOPS (Thailand) Network and Smart Oncology

Pharmacist in the AI EraBy Kamonsak R.

BDMS Southern Group

Take Home Massages

• The concept of ‘smart/intelligent hospital pharmacy’

• How the concept would support extending oncology pharmacy roles beyond the traditional roles of supplying medicines and health care advice?

• Where and how to get started?

• Case Studies

Outline

• HIMSS (Healthcare Information Management Systems Society): EMR Adoption Model, Smart/Intelligent Hospital

• Pharmacy department as part of the smart hospital concept

• New technologies that have impacted pharmacy and healthcare in recent years and future trend & challenges that new technologies can pose to pharmacists and other healthcare professionals

• Adopting new technology – What we should concern: improve pharmacy efficiency and patient safety

• What have been implemented in Thailand and US Case studies

• Opportunities for oncology pharmacists to stay up to date

• Conclusion, Q & A

Intelligent Hospital • https://www.youtube.com/watch?v=DcjMKy8pr5A

• http://ihassociation.org/

https://www.youtube.com/watch?v=DcjMKy8pr5A

http://ihassociation.org/

HIMSS Stage

• CDSS• MIMS

integration

• ClinicalKey

• Some CDSS in Quippe

• Structured documentation

• Quippe / MedDocIntegration

Real Time Location System (RTLS)

Smart/Intelligent Hospital Concept

• Ultimate Goals: Personalized Medicine, Precision Medicine, Preventive Medicine

• Improve safety through reducing/preventing human errors:

• Improve efficiency: reduce cost

• Electronic input, digitalized workflow, data flow

• Value-based healthcare

Outline








Smart/Intelligent Pharmacy

Patient Tracking / Compliance

Care Manager/Pharmacist

Patient Information / Education

Outcome• Clinical• Service

• (Engage / Experience)

• FinancePatient Portal / Web / CRM

Information Communication

Cost

What info ? How to get that info ?

What info ? How to communicate that info ?

Intelligent/Smart Hospital

EMR / HIS

OutcomeCorrect & AppropriateDiagnosisTreatmentMedicationBilling & Payment

Registration• Self appointment • Self registration

Provide Doctor / Provider information (outcome)

Waiting time

CDSS : ::: CPG ::: Knowledge base::: Pharmacy database

Alert Alarm

My PatientCare Manager portal

Tracking Patient trackingBaby mother matching

Patient PortalExperience Engagement

In room Information ::: Clinical data::: Lab / X-ray result ::: Appointment::: Medication

Patient Education ::: Media portal ::: Knowledge Assessment ::: Tracking

Billing System ::: Cost tracking::: Payment (Prompt-pay)

Third party interfacePatient rightInsurance claim

Enterprise Resource Planning>> link HIS activities to revenue>> Link HIS activities to resources >> resource pooling & distribution

Hospital

Outline








Intelligent Hospital Pharmacy: Are You Ready?

• Pharmacy as a profession and business continues to face challenges, and how it contributes value to the overall healthcare industry will determine its ongoing success. A key component of that may turn out to be effective use of technology, specifically artificial intelligence.

Reflecting on the past 25 years

• Growing demand for prescriptions, even when faced with pharmacist shortages, growing operating costs, and lower reimbursements.

• leveraging enabling technology automation such as automated dispensing helps

- improve workflow efficiency

- lower operating costs while promoting safety, accuracy, and efficiency

- gives pharmacists more time to engage with a greater volume of patients

- enhance patient health outcomes.

While these successes have helped pharmacy play a key role in patient care, it is still frequently perceived as a transaction-based business dispensing a lot of prescriptions and not having enough time to care for patients

Artificial Intelligence as Game Changer

• Wikipedia defines artificial intelligence — or AI — in healthcare as technology that “uses algorithms and software to approximate human cognition in the analysis of complex medical data.

• The primary aim of health-related AI applications is to analyzerelationships between prevention or treatment techniques and patient outcomes. AI programs have been developed and applied to practices such as diagnosis processes, treatment protocol development, drug development, personalized medicine, and patient monitoring and care, among others.”

Current State of AI in Healthcare

• AI can be of real help in analyzing data and presenting results that would support decision making, saving human effort, time, and money, and thus helps save lives.

• Medical and technological advancements that have helped healthcare-related development of AI include:

• Overall evolution of computers, resulting in faster data collection and more powerful data processing

• Growth in the availability of health-related data from personal and healthcare-related devices and records

• Development of pharmacogenomics and gene databases

• Expansion and industry adoption of electronic health records

• Natural language processing and other advancements in computing that have enabled machines to replicate human certain processes

Current State of AI in Healthcare

• Current technology and its algorithms enable and complement human interaction with patients today.

• AI as the enabling technology, a single platform would collect data from various disparate databases and would sense, understand, act, and learn.

• AI can play a significant role in supporting healthcare initiatives relating to prevention and treatment plans in real time.

• As healthcare value-based outcome demands continue to significantly grow, healthcare manpower will be positioned to respond with AI tools.

Current/Future Use Cases

• Artificial intelligence from technology companies like Microsoft assists doctors in finding the right treatments among the many options for cancer.

• Capture data from various databases relating to the condition and helps physicians identify and choose the right drugs for the right patients.

Current/Future Use Cases

• To support the decision-making processes for existing drugs and expanded treatments for other conditions, as well as expediting the clinical trials process by finding the right patients from a number of data sources.

• To predict with certain accuracy when and where epidemic outbreaks might occur, using AI learning based on a history of previous outbreaks and other media sources.

• To prevent medical errors and reduce hospital readmissions by analyzing patient data from medical and medication errors, readmission root causes, and other internal and external databases.

• To identify and prevent high-risk patients from developing complications, provide prospective care guidance, and diagnostic support, among many other clinical applications.

• Will be useful in workflow optimization and efficiency, helping eliminate redundancy in cost from duplicate or unnecessary procedures.

Promising AI

• Smart Infusion pump

• CDSS: MIMS, Lexicomp

• Order set –pre-printed order

• Robotic pharmacy

• Patient Portal

• Predictive Analysis

• RTLS (Purchasing and Inventory)

Outline








Concerned points for adopting technology

• To improve safety & clinical outcome• POCT

• Wearable devices

• To improve operational efficiency• Business process improvement by digital transformation

• To improve customer engagement and sustain/increase business

• Find potential customers

• Follow up existing customers (NCD)

• Patient communication

Available current and near future solutions Decision Matrix

To improve operational efficiency:::: Business process improvement by digital transformation

Available current and near future solutions Decision Matrix

To improve customer engagement and sustain business :::: Find potential customers:::: Follow up existing customers (NCD)

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What has been implemented in Thailand

• Automated Dispensing Cabinet

• CPOE & CDSS

• BCMA & eMAR

• Patient Education: Medication

• Smart Infusion Pump

Robotic Filling

Solution: Closed Loop Medication Management

Manages all aspects of medication therapy

Manages drugs from the moment they are delivered to the hospital to the time they are administered

Integrates many key technology components, including

Computerized Physician Order Entry (CPOE)Automated drug dispensing devicesBar-coded Medication Administration (BCMA)On-line documentation

Bar-coded Medication

Administration/Smart Pump

CPOE/Clinical

Decision Support

CPOE

Closed

Loop

PrescribeTechnology for Physicians: Computerized Provider Order Entry (CPOE)/E-Prescription

Direct transmission

to pharmacy

Eliminates handwriting

and transcription errors

No delay

Clinical Decision Support

System (CDSS)

delivers improved prescribing

by checking for

Allergies

Interactions

Duplicates

Contraindications

Dosage problems

DispenseTechnology for Pharmacists

Pharmacy solutionChecks labs, allergies, existing drug profile, interactions, etc.

Documents clinical interventions

Creates on-line medication profile

Sends medication profile to dispensing machines

Robotic FillingEliminates wrong selection errors

Delivers the bar-coded medications required for Bar-coded Medication Administration

AdministerTechnology for Nurses

Bar-coded Medication Administration

Triple bar-code readNurse

Patient

Each medication

Supports 5 Rights for medication administration

Right drug

Right dose

Right route

Right time

Right patient

Automated dispensing unitsEliminates wrong selection

Provides floor stock inventory for high availability of medications in critical care areas

Point-of-Care BCMA

• Ensures 5 “rights” of

administration using bar codes

• 3-way match at bedside

• Wireless real-time medication

tracking

• Discrepancy alerts

• Online profile/MAR

• Administration planning

• Data for patient monitoring

activities

• Charting and charge capture at

the time of administration, not

dispensing

Jane Doe, RN

CDSS Implementation to support Antimicrobial Stewardship Program (ASP)

• Pop-up Screen to fill the information at point of order entry for those selected antimicrobials: Treatment or Prophylaxis

Antimicrobial Stewardship Program (ASP) Pop-up Screen: Treatment

Antimicrobial Stewardship Program (ASP) Pop-up Screen: Prophylaxis

SMART Pump

• A “Smart pump” is a parenteral infusion pump equipped with IV medication error-prevention software that alerts operators or interrupts the infusion process when a pump setting is programmed outside of pre-configured limits.

• Smart pumps are designed to recognize prescription errors, dose misinterpretations, and keypad programming errors.

ISMP Recommendation for Smart Pump

• Many medication errors resulting in patient harm involve IV infusion devices, with the most common cause of these errors being incorrect programming.

• To deliver safe drug, healthcare organization should make effective use of well-designed technologies. These include Smart Pump technology.

• Pumps with dose error reduction systems is an important way to help prevent medication errors.

Recommended Drugs for Smart Pump

• Chemotherapeutic agent

• Parenteral nutrition

• Narcotic analgesic

• Cardiogenic

• Anticoagulant

• Anticonvulsant

• Insulin

• Concentrated electrolyte

Smart Pump

Smart Pump Benefits

• Enhance patient safety• Prevention of calculation errors

• Notify the programming nurse if the dose is too small or large based on the drug library specifications.

• Supports hospital’s drug delivery practice• Customize for the addition of hospital-specific drug library

Smart Pump Software

• Dose limits have been pre-programmed for the selected drug label.

Smart Pump Software

• If a programmed dose is outside of that label’s limits, a pop-up alert requires dose reprogramming or dose limit override.

Smart Pump Software

• Overrides are displayed as red text over a yellow highlight and stored in the pump’s history log.

The Future of Smart Pump Software

• More functionality• Multipurpose pump

• Multi-step programming

• Time programming

• More connectivity• Wireless

• Integration with various software vendors

The Future of Smart Pump Software

• More user friendly• Prioritize drug list

• Touch screen

• More safety• Tracking system

• Barcode system

• Hard limit setting

• TALLman lettering

• Compatibility checking

Smart Pump

• Development of drug library• Identify the drugs need to be programmed

• Standardize the drug concentration

• Standardize the dose mode prescribing

• Set the soft limits alert

US Case Studies

• Patient Portal

Patient Portal

• Personal Content Delivery Tool

• Interactive platform patient education

• Patient Concierge

• Discharge Planner/Nurse

• Call Center

• Interactive communication platform: Email/Text/Message

• Alert

Patient Portal Case Studies

• Patient Portal: Engaging Patients (and Staff) - My Chart, The Institute for Family Health

• MSKCC (Memorial Sloan-Kettering Cancer Center)

Patient Portal: Engaging Patients (and Staff)

Add “clickable”

Infobutton to

context-specific

M+ resource

MSKCC (Memorial Sloan-Kettering Cancer Center)

Learning from the experience of using e-mail for communicating with patients, the team sought to solve

common problems that patients sometimes experienced.

Difficulties with patient identification

Messages contained urgent issues

Delivery of messages failed

Documentation in the EMR

Responded to the message

Pharmacists/Nurses can capitalize on the ease and efficiency of

secure messaging to communicate with patients.

Improve patient satisfaction.

By offering a the service provides hospital with an advantage over

competitors.

Summary

Allows more frequent and timely communication between

pharmacists/nurses and patients.

The patient portal offers patients timely access to information

about their health care in a secure and safe environment.

Outline








Learning opportunities

• HIMSS AsiaPac

• HIMSS

• ASHP

• EAHP

Outline








Take Home Massages

• The concept of ‘smart/intelligent hospital pharmacy’

• How the concept would support extending hospital pharmacy roles beyond the traditional roles of supplying medicines and health care advice?

• Where and how to get started? – Smart pump, Patient Portal

• Case Studies: start with your pain point but quick win & simple project

• Consideration in adopting software/application: Safety, Efficiency, Cost-effectiveness

Q & AThank you