pharmacy informatics and technology facilitating practice model change karl f. gumpper, bs, bcps,...

71
Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology American Society of Health-System Pharmacists [email protected]

Upload: herbert-henry

Post on 05-Jan-2016

224 views

Category:

Documents


3 download

TRANSCRIPT

Page 1: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Pharmacy Informatics and Technology Facilitating Practice Model Change

Karl F. Gumpper, BS, BCPS, FASHPDirector, Section of Pharmacy Informatics & TechnologyAmerican Society of Health-System Pharmacists

[email protected]

Page 2: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Objectives

1. Discuss the impact of technology on pharmacy practice models

2. Review ASHP Resources3. Discuss Key ASHP HIT Initiatives4. Discuss opportunities for Clinical Information

Systems to support future pharmacy practice

Page 3: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

What are all these abbreviations?

CPOE

BCMA

POC

CCHIT

ONC

HITSP

AHICHIMSS

AMIA

eRX

ADC/ADM

AHRQ

NHIN

RHIO

HL-7

RxNorm

SNO-Med

CDSS

EHR

PHR

NCPDP

X-12

CCD/CCR

ICD-10

Page 5: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Who are pharmacy Informaticists?

• Anyone who works in pharmacy or related fields that support the flow of information to better take care of patients.

• Dedicated specialists involved in the computerization and automation of the medication-use process– Directors of Pharmacy and Managers– Clinical Pharmacists– Industry/Vendors– Pharmacy Technicians– Specially trained and on-the-job trained Practitioners

Page 6: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

What is Pharmacy Informatics?

The use and integration of data, information, knowledge, technology, and automation in the medication-use process for

the purpose of improving health outcomes.

Page 7: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Pharmacists’ responsibilities to support our role

• Participation• Leadership• Education• Research

Page 8: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

What is Pharmacy Informatics?

• ASHP Resources – Webinar, August 2010– http://www.ashpmedia.org/webinar/SOPIT/2010-

08-2316_21SOPIT.wmv (20 Minutes)

• Student Brochure– http://www.ashp.org/DocLibrary/MemberCenter/

SOPIT/InformaticsBrochure.aspx

Page 9: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Definitions

• Integration: seamless interaction of various applications from a single vendor that forms a larger more complex system. Does not need interfacing to allow them to pass information between the applications.

• Pharmacy examples of integrated systems: Cerner, Eclipsys, MEDITECH, etc.

• Real world example: Microsoft OfficeDraft – ASHP Section of Pharmacy Informatics & Technology – Section Advisory Group on Pharmacy Operations Automation (2/2011)

Page 10: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Definitions (Continued)

• Interfacing: a method of communication using a standard language that allows different systems from different vendors to share information. An interface can be either uni-directional (one-way) where information only flows in one direction, or bi-directional (two-way) where information flows in both directions.

• Pharmacy example of a bi-directional interface is the pharmacy information system (PIS) passing order information to automated dispensing cabinets or robotic devices and receiving billing information back.

• Real world examples: synching of data between computer and hand held device (bi-directional interface); submitting an order online but only receiving order confirmation via snail mail.

Draft – ASHP Section of Pharmacy Informatics & Technology – Section Advisory Group on Pharmacy Operations Automation (2/2011)

Page 11: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Definitions (Continued)• Interoperability: allows a specific product or system to work with one

or many different product(s) or system(s) without additional effort on the part of the customer. This is usually accomplished by a combination of integration and/or interfacing.

• Pharmacy example: retail pharmacy receiving eRx from various prescribing systems (hospital based, private practice based, etc.) and sending information back (dosing changes, refill requests, etc.)

• Real world example: electronic banking/finance (direct deposit, online bill pay, electronic transfers, using any ATM anywhere in the world - even from a different banking institution)

Draft – ASHP Section of Pharmacy Informatics & Technology – Section Advisory Group on Pharmacy Operations Automation (2/2011)

Page 12: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

What will the future look like?

Page 13: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

What the Section of Pharmacy Informatics & Technology Suggests:

• Problems with current pharmacy practice– An obsolete practice model– Increased scope of knowledge– Clinical services as an opportunity for quality improvement (VA Experience)

• An alternative model– Rational formulary management and drug use– Prospective involvement in the design of medication therapy for each and every

patient– Continuous management of each patient’s medication therapy– Assessment and management of the quality of the overall medication-use system

• Technology support for an alternative practice model• Barriers to an alternative practice model

Page 14: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

ASHP’s Practice Model Initiative

• Vision– The summit will create passion, commitment, and action among hospital and

health-system pharmacy practice leaders to significantly advance the health and well being of patients by optimizing the role of pharmacists in providing direct patient care. By describing patient care services and activities that support the safe and effective use of medications, corresponding models can be adopted that optimize the full potential of pharmacist, technician, and technology resources.

• Invitational Conference• November 7-9, 20100 – Dallas, TX

Page 16: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

What is a “Practice Model”?

• Describes how pharmacy department resources are deployed to provide care

• One size doesn’t fit all• Does include:

How pharmacists practice and provide care to patients; How technicians are involved to support care; andUse of automation/technology in the medication use

system

AJHP 2010;67:542

Page 17: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Examples of Practice Models

• Drug-Distribution-Centered Model

• Clinical Pharmacist-Centered Model

• Patient-Centered Integrated Model

AJHP 2010;67:542

Page 18: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Technology Focus for PPMI

Page 19: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Topics Discussed in Briefing Paper

• Current state of medication-use supporting technologies• Current barriers and challenges• Current state of HIT quality and safety claims• Current context for HIT• Overcoming HIT challenges• The preferred future state of pharmacy information

technology– Supporting pharmacists as clinical medication managers– Management of medication distribution– Informatics infrastructure

Page 20: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Overcoming HIT challenges

1. Recognize that HIT will have a major impact on pharmacy practice.

2. Accept that current and emerging technologies could supplant roles traditionally performed by pharmacists.

3. Resist waiting for the perfect solutions to become available before pursuing any HIT applications.

4. Continue to seek HIT solutions that yield incremental gains and ensure that those gains are aligned with institutional goals and ideal HIT strategic objectives.

5. Articulate an ideal vision and strategy for an IT-enabled medication-use process.

Page 21: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Overcoming HIT Challenges (Continued)

6. Influence regulatory groups, HIT vendors, and health-system leaders to pursue sound methods for achieving optimal HIT approaches to medication management systems.

7. Work collaboratively with community and health-system pharmacy leaders to achieve a higher level of medication-system connectivity and integration by advocating for technical and semantic medication standards that support system interoperability.

8. Build and strengthen relationships with internal and external stakeholders that influence HIT development.

9. Pursue leadership positions within the HIT industry.10. Advocate for new professional roles for pharmacists in informatics and

clinical analytics.

Page 22: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Conclusion

1. standardized around models other than those that have evolved in the current marketplace

2. better integrated and interoperable to permit successful clinical use of acquired data

3. driven by consistent product-coding structures4. designed by informaticists who understand

technology both from a technical and a human perspective.

Siska MH and Tribble DA. Opportunities and challenges related to technology in supporting optimal pharmacy practice models in hospitals and health systems. Am J Health-Syst Pharm. 2011; 68:1116-26.

Page 23: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C. Advancing the application of information technology in the medication-use process

Page 24: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C1. In most hospitals and health systems, improvements in technology will be required for pharmacy departments to fully achieve optimal deployment of pharmacist and pharmacy technician resources.

Page 25: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C2. The following technology solutions in hospitals and health systems are important enablers in the development of optimal

pharmacy practice models:

• C2a. Electronic medical records systems.• C2b. Inpatient computerized prescriber-order-

entry (CPOE) systems. • C2c. Outpatient CPOE systems. • C2d. Clinical decision support integrated with

CPOE.

Page 26: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

26

Electronic Health Record (EHR)

Complete EMR(no paper charts)

Partial EMR(some paper)

No EMR(all paper)

Characteristic % % %Staffed beds

<50 22.1 54.7 23.250-99 15.4 61.5 23.1100-199 8.2 73.8 18200-299 15.9 66.7 17.4300-399 30.9 63.2 5.9400-599 24.3 68.6 7.1600 35.8 60.4 3.8

All hospitals – 2012 18.6 62.9 18.5All hospitals - 2011 8.0 58.7 33.3All hospitals – 2010 7.7 50.9 41.4All hospitals – 2009 8.8 47.1 44.1All hospitals – 2007 3.8 37.2 59.0

ASHP National Survey Data - 2012

Page 27: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Computerized Prescriber Order Entry*

2005 2006 2007 2008 2009 2010 2011 2012 <50 50-99 100-199

200-299

300-399

400-599

>=6000%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

4%9% 10% 11%

15%19%

34%

54%51% 52% 53% 54%

68%

61%

83%

# of Staffed BedsYear

% H

ospi

tals

* With clinical decision support

ASHP National Survey Data - 2012

Page 28: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C2. The following technology solutions in hospitals and health systems are important enablers in the development of optimal

pharmacy practice models:

• C2e. Order management and review organized around drug therapy management services.

• C2f. Real-time monitoring systems that provide a work queue of patients needing review and possible intervention.

• C2g. User interfaces that are optimized for drug therapy management services.

• C2h. A work queue that provides documentation and management tools for drug therapy management services.

• C2i. Automated systems to notify pharmacists when serum medication concentrations or other clinically important laboratory test values fall outside of a therapeutic or normal range.

Page 29: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C2. The following technology solutions in hospitals and health systems are important enablers in the development of optimal

pharmacy practice models:

• C2j. Use of bar-code technology during the inventory, preparation, compounding, and dispensing processes.

• C2k. Automated dispensing/robotics. • C2l. Use of bar-code technology during medication

administration.• C2m. Integration of intelligent infusion devices into a

closed loop medication-use process (i.e., CPOE–electronic medication administration record–bar-code-assisted medication administration).

Page 30: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

30

Bar Code Medication Administration

2005 2006 2007 2008 2009 2010 2011 2012 <50 50-99 100-199

200-299

300-399

400-599

>=6000%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

9%13%

20%

25%27%

35%

50%

66%

60%

66%

72%

65%

72%

67%

60%

# of Staffed BedsYear

% H

ospi

tals

Page 31: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

31

Smart Infusion Pumps

2005 2006 2007 2008 2009 2011 2012 <50 50-99 100-199

200-299

300-399

400-599

>=600

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

32%37%

41%

59%56%

68%

77%

63%

75%

90%

78%

91%87%

96%

# of Staffed BedsYear

% H

ospi

tals

ASHP National Survey Data - 2012

Page 32: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C2. The following technology solutions in hospitals and health systems are important enablers in the development of

optimal pharmacy practice models:

• C2n. Automatic capture of information on pharmacist interventions.

• C2o. Systems that efficiently capture and report pharmacy metrics, outcomes data, and pharmacists’ value.

Page 33: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

33

Improvement in Electronic Tools Necessary to Promote Monitoring

2000 2003 2006 2009 20120

10

20

30

40

50

60

70

80

90

100

7378

8793

98Readily Available Computer Access to Laboratory Data

% h

ospi

tals

Page 34: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

34

Tablet Computers and Smart Phones

Use tablets Patient data(smart phone)

Characteristic % %Staffed beds

<50 8.5 5.350-99 10.8 1.6100-199 13.1 3.3200-299 29.0 0300-399 16.2 1.5400-599 26.1 20.3600 49.1 13.2

All hospitals – 2012 15.2 4.5

ASHP National Survey Data - 2012

Page 35: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

35

Uses for tablet computers

Use Percentage

Drug information 97.5

Laboratory data 71.0

Order review and entry 62.9

Documenting interventions 59.4

Communication with other healthcare providers 42.9

Adverse drug event reporting 34.8

Notification of alerting orders 32.3

Medication reconciliation 30.7

Drug shortage monitoring 21.5

Other 5.2

ASHP National Survey Data - 2012

Page 36: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C3. No hospital should be exempted from compliance with technology-related

medication use safety standards.

Meaningful UseJoint CommissionState Boards of Pharmacy

Page 37: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Health Information Technology

Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity.

Better healthcare

Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care.

Better health

Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries.

Reduced costs

$

Health IT: Establishing the Foundation

37

Page 38: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

HITECH Framework: Meaningful Use at its Core

Medicare and Medicaid Incentives and Penalties

Health IT Practice Research

Improved Individual & Population Health

Outcomes

IncreasedTransparency &

Efficiency

ImprovedAbility to Study &

Improve Care Delivery

ADOPTIONADOPTION

EXCHANGEEXCHANGE

State Grants forHealth Information Exchange

Standards & Certification Framework

Privacy & Security Framework

Regional Extension Centers

Workforce Training

MEANINGFUL USEMEANINGFUL USE

38

Page 39: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

39

• 52% percent of office-based physicians intend to take advantage of EHR incentives

• The percentage of primary care providers who have adopted EHRs in their practice has doubled from 20% to 40% between 2009 to 2011

• ONC’s Regional Extension Centers (RECs) have signed up more than 100,000 primary care providers

• This means that roughly one third of the nation’s primary care providers have committed to meaningfully using EHRs by partnering with their local REC. Momentum is building!

• Hospital adoption has more than doubled since 2009, increasing from 16% to 35%

• Most (85%) of hospitals intend to attest to Meaningful Use by 2015

Meaningful Use Takes Off

Page 40: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C4. Sufficient pharmacy resources must be available to safely develop, implement, and maintain

technology-related medication use safety standards.

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

Page 41: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C5. Telepharmacy technology, to enable remote supervision, should be available for use in

pharmacy departments.

2005 2006 2007 2008 2010 2011 20120%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

30.1 32.3 33.8 35.9 34.538.7 37

3.1 2.55.0

4.9 8.8

11.1 15.9

5.37.5

6.5 6.29.8

11.712.9

1.93.6

3.1 2.2

3.6

1.92.3

59.654.0 51.6 50.9

43.436.7

32

No reviewOn callAffiliated HospitalCompany24 hour service

Page 42: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C6. Telepharmacy technology that allows pharmacists to interact with patients from a remote location

should be available for use in pharmacy departments.

http://www.ndsu.edu/telepharmacy/

Page 43: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C7. Electronic medical records must be designed to align pharmacists’ documentation outlining care provided as well

as a method to trace and ensure the quality of care provided.

• Examples– NHSN Reporting– Antimicrobial Stewardshi

p– Healthcare-associated In

fections– Increasing Interventions– Pharmacy/Infection Prev

ention Collaboration– Surgical Site Infections– Controlling Costs

*Not a complete list

Page 44: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C8. Human factors engineering principles should be employed to design and optimize safety, efficiency,

and effectiveness of technology.

http://pqaalliance-org.cranstonassoc.com/files/ForumArchives/PQA%20MAY%2027%202010%20Lecture_Advancing%20Pharmacy%20Practice....pdf

Page 45: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology
Page 46: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Health IT and Patient Safety: Building Safer Systems for Better Care

• Highlights– Critical Knowledge Gaps and

Barriers – Fostering a Systems Approach

• enhance workflow, perhaps by automating mundane tasks or streamlining work, without increasing physical or cognitive workloads;

• allow easy transfer of information to and from other organizations and providers; and

• cause no unanticipated downtime.

http://www.iom.edu/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx

Page 47: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C9. Technology in medication-use systems should be designed to demonstrate the impact of pharmacy

services on patient outcomes.

Page 48: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

A Hospital Med Use System Architecture?2nd

Distrib

ution

Dispen

sing

Mon

itorin

g

Order

ing

Verif

ying

AutomatedProduct

SelectionCDS

DOSE, TIMING

SMARTIV PUMPS

ADESURVEILLANCERULES ENGINE

CPOE PHARMACYSYSTEM LABELS

AUTOMATEDDISPENSINGCABINETS

(ADCs)

eMAR LABSHX, DX

EHR

AUTOMATEDDOSE PICKING

SYSTEMS

AUTOMATEDADC PICK-N- REPLENISH

ORDERSETS

CDSBUG-DRUG,

CORE MEASURES,P-KINETICS

CDSINDICATION,

DOSE, DDI, DFI,UTILIZATION

BAR CODESCANNING

AT COMPOUND& DISPENSE

BCMA

EHR FOUNDATION

LAYER I

LAYER II

LAYER III

INHERENTORDERING

SAFETY

AUTOMATEDTREATMENT

FAILUREIDENTIFICATION

PHARMACISTPATIENT TRIAGESYSTEM

AUTOMATEDCOMPOUNDING

ROBOTS

CDSCOMPATIBILITY,

ADMINISTRATION

LAYER IV

P P P

Adm

inist

ratio

n

DISPENSEDPRODUCTLOCATIONTRACKING

CProduct Supply Chain

Clinical Focus

C

BEG

IN

EN

D

Supply Chain Integration into Medication-Use Cycle

C

EHR

C

AUTOMATEDPRESCRIBING

OUTCOMETRACKING

AUTOMATEDORDER

VERIFICATION

PROACTIVEIV DRIPREFILLS

LAYER V

PATIENT-SIDEDELIVERYSYSTEMS

CDSDDI/ALLERGY

COMPUTERASSISTEDIV FLUID ANALYSIS

EHR EHR

Page 49: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Key Pharmacist Longitudinal Workflows2nd

Distrib

ution

Dispen

sing

Mon

itorin

g

Order

ing

Verif

ying

EHREHR FOUNDATION

LAYER I

LAYER II

LAYER III

LAYER IV

Adm

inist

ratio

n

BEG

IN

EN

D

EHR

LAYER V

EHR EHR

Pharmacist Charting / Certain medications have pharmacist notations

Keep Medication List / All meds documented w/Medication Reconciliation

Indication Management / Every med has documented indication(s)

Plan Pharmaceutical Care / Outcome objectives listed for all meds

Medication Therapy Management / RPh-led disease management

Page 50: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Clinical Decision Support & Inherent Safety2nd

Distrib

ution

Dispen

sing

Mon

itorin

g

Order

ing

Verif

ying

CDSDOSE, TIMING

CDSBUG-DRUG,

CORE MEASURES,P-KINETICS

CDSINDICATION,

DOSE, DDI, DFI,UTILIZATION

CDSCOMPATIBILITY,

ADMINISTRATION

Adm

inist

ratio

n

CDSDDI/ALLERGY

Why “fall in” to “climb out”?

ALLERGIES> Dynamic order catalogs

Page 51: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Clinical Decision Support Design2nd

Distrib

ution

Dispen

sing

Mon

itorin

g

Order

ing

Verif

ying

CDSDOSE, TIMING

CDSBUG-DRUG,

CORE MEASURES,P-KINETICS

CDSINDICATION,

DOSE, DDI, DFI,UTILIZATION

CDSCOMPATIBILITY,

ADMINISTRATION

Adm

inist

ratio

n

CDSDDI/ALLERGY

DOSING IBUPROFEN TABLETS> On-screen ranges

0

1600

800

1200

Dose:

Page 52: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C10. Technology in medication-use systems should be designed to support pharmacy processes to improve patient outcomes.

• Clinical Documentation– Coding– Data mining– Outcomes– Communications

• Medication Reconciliation

Page 53: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Overview

53

Page 54: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Collaborative Members

•9 Professional Pharmacy Associations

•Represents over 250K members in all practice settings

Founding Organizations

•AACP-ACCP-ACPE-AMCP-APhA-ASCP-ASHP-NASPA-NCPA

Members

54

Page 55: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Collaborative’s HIT Focus

55

•Facilitate the provision and enhance the quality of patient care services provided by pharmacists

Facilitate Quality of Care

•Address the profession’s HIT needs and functionality to provide, document and bill for pharmacist-provided patient care services in all care settings.

Address HIT Needs

•Influence HIT policy through unified, consistent communications to the Office of the National Coordinator for Health Information Technology (ONC) and other HIT organizations about pharmacist-provided patient care services and pharmacists’ contributions to the ONC defined meaningful use (MU) of EHR

Influence Policy

•Ensure that resources, technical standards, and provider knowledge are aligned with the nation’s growing need for pharmacists’ services

Ensure Resources are

Aligned

Page 56: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Objectives

•Through the consensus work of expert panelists define the minimum data set and functional Pharmacist/Pharmacy Provider electronic health record (PP-EHR) capabilities. Facilitate actions to entrench the PP-EHR into the national HIT initiatives in order to deliver, document, and bill services provided by pharmacists in all patient care settings through the meaningful use of HIT

PP-EHR & MTM

•Form a structured group consisting of organizations and individuals interested in creating a consensus-based Roadmap. Disseminate the Roadmap to policymakers and the healthcare industry. The Roadmap should ensure medication related technology is meaningfully used in an efficient and effective manner for pharmacists to affect improved medication use

Roadmap

•Ensure the PP-EHR becomes a model through the technology standards development organizational process; criteria for certification are defined; and becomes certified and adopted by the pharmacy community

Certification

•Facilitate a unified voice of pharmacy representation on key HIT‐related committees and workgroups to influence the recognition of pharmacists and the services they provide. As pharmacy practitioners are more engaged with HIT policymakers, the influence of other health professionals defining HIT platforms that impact pharmacy HIT will be lessened

One Voice

56

Page 57: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

The Roadmap for Pharmacy Health Information Technology Integration in U.S. Health Care

Pharmacy e-Health Information Technology Collaborative

Page 58: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

About the Roadmap

• Goals are numbered by process and not by priority

• The Collaborative will contribute to aspects within the Roadmap that are aligned with the scope, goals, objectives, and strategies of the Collaborative

• Areas outside the scope of the Collaborative will be addressed by pharmacy organizations

Page 59: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C11. Colleges of pharmacy should be required to provide informatics training for all pharmacy students to ensure

graduates’ success in optimal pharmacy practice models.• Knowledge, Skills, and Resources for Pharmacy Informatics

Education – AJPE

http://www.ajpe.org/doi/pdf/10.5688/ajpe75593

Page 60: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C12. Hospitals and health systems and colleges of pharmacy should collaborate to ensure that appropriate pharmacy informatics principles are embedded in the curriculum.

http://www.ashp.org/Import/MEMBERCENTER/Sections/SectionofPharmacyInformaticsandTechnology/CareerDevelop/ResidenciesRotations.aspx

Page 61: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C13. Pharmacy residency programs should provide informatics training to ensure residents’ success in

optimal practice models.

• Informatics and Medication Safety Survey – ASHP Section of Pharmacy Informatics and Technology Survey – 2010 (n=227/770, 29%)

Page 62: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

C14. Advanced training in pharmacy informatics with residencies and postgraduate education

should be expanded.• PGY-2 Pharmacy Informatics Residencies – 15 programs• PGY-2/PGY-1 Combined Pharmacy Informatics – 1 program• Fellow Ship Training – 2 programs•Unaccredited Training Programs – 2-3 programs•Medication Use Systems & Operations – 1-2 programs

Page 63: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Pharmacy Practice Model Initiative and the PPMI National Dashboard

Page 64: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

64

Pharmacy Practice Model InitiativeOverview

Imperative for a better defined practice model identified by members.

Planning commences for summit: assumptions developed, ASHP members, thought leaders, and participants queried, briefing papers developed.

Demonstration and resident research

grants issued

Consensus summit held resulting in 147 recommendations to better define characteristics of the optimal practice model for the future.

National dashboard developed to measure

progress

Briefing document webinar series conducted

Hospital Self-Assessment (HSA) developed,

launched

Presentations at MCM, SM, Residency Conferences

PPMI Website with resources, links

launched

Summit Proceedings published in AJHP

Complexity tool developed

Policy issues from summit addressed

Page 65: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Pharmacy Practice Model Initiative

SummitRecommendations

Hospital Self-Assessment (HSA)

National Dashboard

National Dashboard Goals and Measures

147

105

26

5

Page 66: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Goal 1

Pharmacist roles, practices, and activities will improve medication use and optimize medication related outcomes.

Goal 2

Pharmacy technicians will prepare and distribute medications and perform other functions that do not require a pharmacist's professional judgment.

Goal 3

Pharmacists and pharmacy technicians will have appropriate training and credentials for the activites performed within their scope of practice.

Goal 4 Goal 5

Pharmacists will demonstrate leadership in exercising their responsibility for medication use systems and will be accountable for medication-related patient outcomes.

PPMI National Dashboard

Pharmacy departments utilize available automation and technology to improve patient safety and improve efficiency.

Page 67: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

67

GOAL 4: Pharmacy departments utilize available automation and technology to improve patient safety and improve efficiency.

Measure 2012 Change

4.1. Percentage of hospitals/health systems using a computerized prescriber order entry (CPOE) system with clinical decision support for inpatient medication orders (e.g., rules that integrate order information, patient information, and clinical practice guidelines into computer system logic that provide feedback to prescribers). [C2b, C2d]

54.4%

4.2. Percentage of hospitals/health systems that routinely use machine readable coding (e.g., bar coding technology with or without a robot) in the inpatient pharmacy to verify doses during dispensing. [C2j] 47.3%

4.3. Percentage of hospitals/health systems that use automated dispensing technologies (e.g., automated dispensing cabinets, robotics). [C2k] 89.1%*

4.4. Percentage of hospitals/health systems who have smart infusion pumps that are integrated into a closed loop medication-use process (i.e., where CPOE/pharmacy information system is integrated with pumps, and administration is documented on eMAR). [C2m]

7.0%

4.5. Percentage of hospitals/health systems that use machine-readable coding (e.g., Bar-Code Medication Administration [BCMA] system) to verify the identity of the patient and the accuracy of medication administration at the point-of-care. [C2l]

65.5%

Composite Score: 52.7% (from 43.9% in 2011)

Page 68: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Goal 1

Pharmacist roles, practices, and activities will improve medication use and optimize medication related outcomes.

Goal 2

Pharmacy technicians will prepare and distribute medications and perform other functions that do not require a pharmacist's professional judgment.

Goal 3

Pharmacists and pharmacy technicians will have appropriate training and credentials for the activites performed within their scope of practice.

Goal 4 Goal 5

Pharmacists will demonstrate leadership in exercising their responsibility for medication use systems and will be accountable for medication-related patient outcomes.

XX%

PPMI National Dashboard

Pharmacy departments utilize available automation and technology to improve patient safety and improve efficiency.

4060

20

1000

80

60.0%

40

40 40 4060 60 60

60

10

3050

70

90

20

1000

80

18.6%

20

1000

80

25.9%

20

1000

80

52.7%

20

1000

80

46.7%

10 10 10 10

303050 50 50 50

7070 70 70

9090 90 90

606060 604040 40 403030

Page 69: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

http://www.ashp.org/informatics

Page 70: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Virtual Participation

Page 71: Pharmacy Informatics and Technology Facilitating Practice Model Change Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology

Questions, Answers, Discussion