 Definitions  Goals of automation in pharmacy  Advantages/disadvantages of automation  Application of automation to the medication use process  Clinical decision support systems  Computerized physician order entry

 Medical Informatics The field of information science concerned with the analysis, use and dissemination of medical data and information through the application of computers to various aspects of health care and medicine ASHP. Am J Health-Syst Pharm. 2007;64:200–3.

 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 ASHP. Am J Health-Syst Pharm. 2007;64:200–3.

 The pharmacy profession’s transition to pharmaceutical care  Shortages of qualified pharmacists and technicians  Shrinking operating budgets

 Freeing pharmacists from labor-intensive distributive functions  Helping pharmacists provide pharmaceutical care  Reducing costs  Improving operating efficiencies  Growing revenues

 Enhancing safety and quality of care ◦ Automated medication management systems have been shown to reduce medication errors by between 26% and 81% depending on the setting in which the machines are used  Integrating and managing data  Increasing patient satisfaction with the quality and delivery of care

 Improve efficiency (reduce work load)  Improve accuracy, reduce errors  Improve documentation  Enhance security (authorized access only)  Reduce job stress and staff turnover  Improve timeliness for medication delivery

 Complexity and function variations  Requires additional staff training and technical help  Downtime, system failure and inflexibility  Cost and space issues

Assessing the need for/selecting the correct drug Individualizing the therapeutic regimen Designing the desired therapeutic response Prescribing Reviewing the order for correctness of dosing and indication Compounding/preparing the drug Dispensing the drug in a timely manner Dispensing Administering the right drug to the right patient Administering the drug when indicated Administering

Monitoring & documenting patient response Reevaluating drug selection, frequency, & duration Monitoring Communicating and collaborating among caregivers Reviewing and managing the patient’s complete therapeutic drug regimen Systems/ Managemen t Control

PrescribingClinical decision support systems(CDSSs) Computerized prescriber order entry systems (CPOE) DispensingCentralized robotic dispensing technology Centralized narcotic dispensing and inventory tracking devices Decentralized automated dispensing devices Unit dose medication repacking systems AdministeringBar code medication administration technology MonitoringElectronic clinical documentation systems Medication surveillance applications for reporting medication incidents and adverse events

 Clinical Decision Support Systems are "active knowledge systems which use two or more items of patient data to generate case-specific advice"  Clinical DSSs are typically designed to integrate medical knowledge base, patient data and an inference engine to generate case specific advice

 Advice on drug doses, routes, and frequencies.  Drug allergy checks  Drug-laboratory value checks  Drug-drug interaction checks  Providing reminders about corollary orders (e.g. prompting user to order glucose checks after ordering insulin)  Drug guidelines to the physician at the time of drug ordering

 Four key functions of CDSS are outlined in : 1.Administrative: Supporting clinical coding & documentation, authorization of procedures & referrals 2.Managing clinical complexity and details: tracking orders, referrals follow-up, and preventive care 3.Cost control: Monitoring medication orders; avoiding duplicate or unnecessary tests 4.Decision support: Supporting clinical diagnosis and treatment plan processes

 DXplain ◦ Uses a set of clinical findings (signs, symptoms, laboratory data) to produce a ranked list of diagnosis ◦ Provides justification for why each of these diseases might be considered, suggests what further clinical information would be useful to collect for each disease

 QMR Quick Medical Reference ◦ A diagnostic decision-support system with a knowledge base of diseases, diagnoses, findings, disease associations and lab information

 CPOEs are clinical information systems that enables a patient’s care provider to enter an order for a medication, clinical laboratory or radiology test, or procedure directly into the computer  The system then transmits the order to the appropriate department, or individuals, so it can be carried out

 The most advanced implementations of such systems also provide real-time clinical decision support such as checking: ◦ Dosage ◦ Alternative medication suggestions ◦ Duplicate therapy warnings ◦ Drug-drug and drug-allergy interaction

 Replaces hand-written orders ( solves problems with legibility, completeness, order delay or loss)  Supports ready access to patient data and patient assessment  Can help improve patient safety and prevent medical errors and adverse drug events by checking doses, interactions, allergies.. etc.  Supports improved recording, data trails, quality assurance and error awareness and reporting

 Potential to improve efficiency and resource usage by integrating different departments - laboratory, imaging, nursing and medication records  Cost-effectiveness benefits:  Can reduce costs associated with medication errors  Can show test and medication costs - potential to reduce prescription costs  Can reduce the number of duplicate tests

 Cost  Risk of a system generating medication errors e.g. through incorrect configuration or physician input  Systems may need medical terminologies not in local use  User resistance to introduction of computer-based technologies, requires training