Managing Pharmacy 15 Automation and Informatics Dennis A. Tribble and Mei-Jen Ho CONTENTS Framework for Health-System Pharmacy Automation .......................................... 270 Technology is a Tool ......................................................................................... 271 Be Careful: Technology Will Change the Way the Work is Performed ............ 271 Technology Requires Infrastructure .................................................................. 271 The Adoption of Pharmacy Technology Requires the Involvement of Stakeholders Outside of the Pharmacy .........................................................272 Technology Platforms are Less Important than What the Technology Can Do ...................................................................................................................272 Technology Systems Should Operate from a Single, Reliable Source of Truth on All Data .......................................................................................... 273 Interoperability is the Key to Success .......................................................... 273 Regulation of Technology and Medical Devices ................................................... 274 Other Regulatory Considerations ...................................................................... 276 State Laws .................................................................................................... 276 Drug Enforcement Agency (DEA) Regulations ...........................................277 Privacy and Security of Patient Information ................................................277 Purchasing Technology ..........................................................................................277 Bar Code Applications ........................................................................................... 278 Bar Code Medication Administration ...............................................................280 Bar Code Medication Preparation ..................................................................... 281 Dose Tracking ................................................................................................... 281 Employee Identification .................................................................................... 281 Robotics ................................................................................................................. 281 Prescription-Filling Robots ...............................................................................282 Unit-Dose Cart-Filling Robotics .......................................................................283 IV Admixture-Preparing Robotics ....................................................................283 Cytotoxic-Preparing Robotics ...........................................................................284 Delivery Robotics ..............................................................................................285 TPN Compounding Systems ..................................................................................285 Workflow Systems .................................................................................................285 Automated Dispensing Cabinets ............................................................................286 269 270 Leadership and Management in Pharmacy Practice IV Administration Devices.....................................................................................289 Electronic Medical Records/Computerized Prescriber Order Entry/Electronic Medication Administration Record ........................................................................292 Medical Record .................................................................................................292 Computerized Prescriber Order Entry ...................................................................294 Electronic Prescribing ............................................................................................296 Case Scenario .........................................................................................................296 CPOE versus e-Prescribing ...............................................................................296 e-Prescribing History ........................................................................................297 Physician’s Role of e-Prescribing .....................................................................298 Pharmacist’s Role of e-Prescribing ...................................................................298 e-Prescribing not for Every Drug .................................................................299 References .............................................................................................................. 301 Appendix A: Request for Purchase for a Robotic IV System ................................303 Appendix B: Exercise Answers and Discussions ...................................................306 Learning Objectives: After reading this chapter and working through the cases, the reader will be able to: 1. Define three tenets of a general framework for approaching automation 2. Define computerized prescriber order entry (CPOE) and its relationships to pharmacy practice 3. Describe two uses for bar codes in pharmacy practice 4. Describe at least one limitation to the use of bar coding in pharmacy practice 5. Describe bar code medication administration (BCMA) and its relationships to pharmacy practice 6. Describe two key differences between CPOE and electronic prescribing (eRx) 7. Define three key requirements of the privacy and security regulations under the Health Information Portability and Accountability Act of 1996 (HIPAA) 8. Define changes to the HIPAA regulations arising from the HITECH Act 9. Define at least one additional requirement for automation that may arise as a result of that automation being classified as a medical device by the FDA 10. Define a request for proposal (RFP) and key elements of an RFP Downloaded by [University of South Florida] at 17:14 27 June 2017 11. Describe three considerations for deploying “smart” IV pumps FRAMEWORK FOR HEALTH-SYSTEM PHARMACY AUTOMATION The application of automation to pharmacy spans a wide variety of systems and applications which have in common their potential ability to improve both patient safety and staff productivity. The pharmacist who wishes to implement technology must ensure that the technology to be adopted is consistent with the goals and capa- bilities of the pharmacy being automated. To that end, it is important to develop and apply a conceptual framework within which technology is to be evaluated. While each pharmacy should construct its own framework, the following sections highlight points of consideration that can be applied to constructing that framework. Managing Pharmacy Automation and Informatics 271 TECHNOLOGY IS A TOOL1 The acquisition of technology should not be an end in itself, but should become the acquisition of a set of tools intended to address specific needs of the pharmacy in accomplishing its mission or missions within a health system. As such, when acquir- ing technology, the pharmacy must identify the job (or jobs) in which the technology will be applied, and determine whether or not the technology is capable of perform- ing those jobs. For example, 1. What portion of the workload is the technology expected to carry? Will the technology be able to meet the demands implicit in carrying that workload? This is a function of both workload (the total amount of work the technol- ogy is expected to perform) and timing (the period of time within which that workload must be performed). 2. What kind of staffing will be required to install, maintain, and operate the technology? 3. Do the current pharmacy personnel have the requisite skills to operate the technology? If not how will the requisite skills be acquired and maintained? 4. Can the pharmacy provide the physical space and facilities required by the technology? 5. How will the pharmacy know that the technology has been successfully installed and is meeting its intended purpose? BE CAREFUL: TECHNOLOGY WILL CHANGE THE WAY THE WORK IS PERFORMED Technology is not only a tool; it is a power tool. If it does not change the way work is performed, it is unlikely to be worth the time and expense necessary to acquire and install it. The adoption of technology requires change management skills and planning. Pharmacy staff will have become accustomed to an established, and prob- ably manual, method of performing the tasks the technology is intended to perform. They will have to unlearn old work habits and practices and acquire a new set of habits and practices around the technology. The management of this change will require planning and will likely require temporary additional staffing. One of the most common mistakes made when adopting technology is insisting on inserting the technology into a current manual set of work processes. Manual pro- Downloaded by [University of South Florida] at 17:14 27 June 2017 cesses are more often evolved than planned, and are often incompletely understood. When applying technology to work processes, it is worthwhile to spend the time to map the current workflow, to consider how work should be performed in the pres- ence of the new technology, and to construct new work processes that appropriately leverage the capabilities the technology has to offer. The exercise of mapping current workflow will expose workflow issues that need to be accommodated (or discontin-