When Kelly Selby graduated from Southwestern Oklahoma State University 's pharmacy program in 1981, 75% of his time was spent on basic operational chores. Like most of his colleagues, he used a typewriter to create labels and consulted massive reference books to check for possible adverse interactions and dosage errors. He counted tablets and capsules on a counting tray, poured them into bottles, pasted on the labels, and filed the written prescriptions manually onto patients' paper charts. After double-checking everything, he rang up the sale and started the process all over again with the next prescription.

Selby, the owner of Community Pharmacy in Denton, Texas , would have preferred spending more time with patients. But the logistics of running a pharmacy made that impossible. "Still, that was pretty much the expectation we had at that time of what our duties would be," Selby said.

But times have changed. Today Selby employs four pharmacists and fills 250 prescriptions per day--20% more than the national average of 191--and is supported by an extensive portfolio of systems from various vendors that have dramatically altered his daily workload. A PC-based pharmacy management and point-of-sale system manages workflow, flagging potential negative drug interactions and dosage errors. An interactive voice-response (IVR) system allows patients to refill prescriptions by phone and automatically routes calls to the right pharmacy employee. A Web-based e-prescription service allows physicians to send prescriptions electronically directly to the pharmacy management system, and a robotic dispensing system automatically counts pills and fills bottles.

As a result, Selby spends quality time consulting with patients, using his extensive clinical knowledge to help them understand the expected outcomes, side effects, and possible lifestyle implications of the medications they have been prescribed.

"Technology has allowed me to cut the time nearly in half that I spend on manual procedures," says Selby. "I also get out into the community and meet with physicians, take them to lunch, get to know them personally, and generally develop relationships that help me grow my business."

Emerging from Isolation
Technology is helping pharmacists, physicians, and other health care professionals emerge from the functional "silos" that make it difficult for them to communicate with each other, according to Michele Vilaret, Director of Telecommunications Standards for the National Association of Chain Drug Stores.

"Because miscommunications are dramatically reduced, the point of sale at retail pharmacies becomes a counseling rather than a sales event where pharmacists do what they do best: use their clinical knowledge to explain the particulars of the medication to the patient," said Karla Anderson, a Managing Director for BearingPoint Life Sciences, one of the world's largest management and technology consulting firms.

Pushing for True Partnerships
The goal is to integrate the many different types of systems available to pharmacists, physicians, HMOs, hospitals, and pharmaceutical companies. This includes what many believe is the holy grail of health care technology: electronic health records. When integration occurs, all health care providers will have secure and transparent access to all the information they need to better serve patients. This is likely to have an enormous impact on pharmacists.

"Although all the pieces won't be in place for some time, with the help of technology, pharmacists are finally becoming full-fledged members of the clinical patient support team," said Barry P. Chaiken, Associate Chief Medical Officer for BearingPoint, which provides design and implementation of next-generation systems for health care organizations.

"[Pharmacists] possess extraordinary amounts of clinical knowledge," remarked Chaiken. "They are bright, intelligent, and highly motivated and should be having a tremendous impact on the practice of health care. By embracing technology--as many of them are doing--their ability to become partners with other clinicians should easily be achievable."

Pharmacists couldn't agree more. "I didn't go to pharmacy school to count to 100," said Richard Ost, pharmacist and owner of the Philadelphia Pharmacy. He employs three pharmacists and fills 750 prescriptions a day, an astounding 292% over the national average, for 3,800 customers each month. Since he has a small staff, he relies on an automated pharmacy workflow system that makes it possible for him to handle his heavy volume. "The more that technology can take over basic operations and facilitate communications with other health care professionals, the better job I can do serving patients," noted Ost.

The Evolving Physician–Pharmacist Relationship
It's not just pharmacists' own automation efforts that are enabling professional transformation. The increasingly sophisticated point-of-care (POC) systems being installed in physicians' offices are also having a dramatic effect on pharmacists' lives.

Such systems typically include comprehensive drug and even insurance formulary data, in addition to electronic patient records, diagnostic aids, and treatment guidelines. By consulting these systems before writing prescriptions, physicians eliminate the "ping-pong" phone calls that were previously needed to clarify, modify, and correct prescriptions.

Initially, many pharmacists felt threatened by these systems, perceiving them as usurping their professional responsibilities, but now they welcome the technology. "The pharmacist is still the expert in medication therapy and is invaluable in aiding the doctor to pick the best pharmacological regimen for that patient," commented Mitch Rothholz, Vice President of Professional Practice and Member Services at the American Pharmacists Association. "It is fast becoming a two-way conversation, thanks to better technological support."

Dr. Salwan AbiEzzi agrees. An internist at the Palo Alto Medical Foundation in Palo Alto, California , AbiEzzi has access to a sophisticated POC system that puts in-depth drug data at his fingertips. Yet, he is more involved with pharmacists than he ever was in the past. "I now know pharmacists on a first-name basis, something that never happened before," AbiEzzi said. "It's much more of a collaborative relationship. If I have a question about a certain medication or a specific adverse reaction, I fire off an email message to a pharmacist, and they respond immediately."

"We're actually visible now," said Stephanie Svoboda, Pharmacy Director of the Ridgeview Medical Center, an independent, 129-bed acute care hospital in Waconia, Minnesota . "We're out on the floors, side by side with the physicians as they are writing orders. We can catch any problems at the time, rather than reacting to them later. Before, the attitude was ‘Oh, that's just a pharmacist,' but now we get a lot more calls and pages asking for clinical help," noted Svoboda, whose facility is in the process of implementing an ambitious automation project, including automated dispensing cabinets, fax imaging modules, e-prescription capabilities, and bar code packing. Additionally, a pharmacy information system available to both physicians and pharmacists will perform screening for allergies, dosages, and interactions. Svoboda said the technology installed thus far has already freed up 40% to 50% of her time.

Installing the latest technology is also turning out to be a valuable marketing tool for many other pharmacists. "Increasingly, doctors are asking us the type of technologies we use and whether we are signed up for e-prescribing and other automation services," said Gary Melnick, Director of Pharmacy Operations at Duane Reade, a 230-store retail pharmacy chain serving the metropolitan New York area, which realized $161 billion in sales in 2005. The company has installed computer-assisted ordering, kiosks at 80 different locations, e-prescribing and e-fax capabilities, IVR, automated refill reminders, bar code readers, and a central database that allows patients to access their medical records from any Duane Reade retail store. In addition, Duane Reade is beginning to install robotic dispensing machines. "Physicians are as conscious as we are about the efficiency and increased patient safety that automation offers," Melnick said.

Alice LaPlante is a freelance writer specializing in technology issues. She is based in Palo Alto, California .

In 2003, it was time for Children's Hospital of Wisconsin, a 236-bed facility located in Milwaukee, Wisconsin , to replace its decentralized medication cabinets in 21 nursing stations. A multidisciplinary team of pharmacy, information technology, and nursing staff was assembled to select a new vendor. The team's primary focus in acquiring technology was to enhance patient safety, although each member had disparate needs and concerns. After a thorough analysis of the pros and cons of several systems, the group unanimously agreed on one system engineered with medication safety at the top of its functionality. Factors like built-in access controls and true unit-dose dispensing greatly impressed Children's Hospital. The new cabinets have not only saved the hospital time and money, they have also improved the satisfaction of the nursing staff, who report that the units help them do their jobs more efficiently.

Thomas J. Lausten, Director of Pharmacy, Distribution and the Wisconsin Poison Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin

An Expectation of Excellence
As the only stand-alone children's hospital in its state, Children's Hospital of Wisconsin is a highly respected and technologically advanced facility. It was named one of Child magazine's 10 best hospitals for children in 2007. In the 247-question survey of the National Association of Children's Hospitals and Related Institutions, Child magazine examined many facets of the organization, including efforts to reduce medical errors.

A prime example of technology for patient safety is automated medication dispensing cabinets. Three years ago, the system at Children's Hospital was in need of an update. The old SureMed system no longer met our needs. I headed the selection process. I had previous experience with MedSelect while serving as Director of Pharmacy (DoP) for Milwaukee 's Covenant St. Francis Hospital. It was clear that the MedSelect organization (owned by AmerisourceBergen) put a premium on security, accuracy, and ease of use. However, it would have been unwise to make a unilateral decision for all of Children's Hospital based solely on one person's input.

I engaged a multidisciplinary committee. We sent out requests for information, and then I stepped into the background. The committee--composed of pharmacy, IT, and nursing staff--examined all the products on the market from three well-known vendors. The group conducted a thorough analysis of the advantages and disadvantages of each system and overwhelmingly voted for MedSelect.

Children's Hospital began installing MedSelect cabinets in February 2004, and AmerisourceBergen was a very helpful partner in the process. The company helped design the right solution for each floor and ultimately installed units in 21 locations. A new narcotic vault system was also installed in the pharmacy that included 10 MedSelect cabinets plus MedSelect's Centrack software. On average, each nursing station is composed of about four modules. The normal configuration is a Display Terminal with a touch screen, bar code reader, and badge scanner for safe access; a Unit-Dose Module; a Drawer Module; and a Supply Cabinet. Overall, we have more than 100 MedSelect cabinets in our hospital in 21 nursing units and the Central Pharmacy.

The Features We Need and Then Some
The number one reason we chose MedSelect is that it enhances medication safety. We are a very patient safety–oriented hospital. That is our primary focus for investing in technology.

In addition, MedSelect is easy to use. It takes 30 to 60 minutes for a nurse to become familiar with it. It probably takes less than 30 seconds to get a medication out of the system. We receive daily reports to streamline the stocking process. Although stocking all the cabinets is inherently a laborious procedure, we are confident that restocking the MedSelect units is faster than it would be with other systems.

The ease of use and time saved make Med­ Select popular with our nursing staff. Of great importance is Med­ Select's ability to manage unit-dose medications through the Unit-Dose Module. With this module, nurses do not need to do counts with each dispense. Medications that are stocked in the Unit-Dose Module no longer require end-of-shift counts. It used to take two nurses on every shift at least 30 minutes per person to run counts at all 21 medication rooms. That added up to plenty of hours, money, and productivity that we have saved due to using MedSelect.

When Children's Hospital was originally built, the medication rooms were very small and not standardized across units. On some nursing floors, the limited space allows only a display terminal and the minidrawer module cabinets to store medications. But on other floors, there is more space. We felt MedSelect's modular designs helped address our space issues much better than the other vendors' systems. Overall, the capability to design the MedSelect cabinets to suit our size requirements makes MedSelect a much better choice in terms of utilization of space compared with the other options we considered.

When MedSelect was installed, AmerisourceBergen was receptive to our suggestions and made some useful modifications to the system, as well as other improvements and updates that have had a significant impact. Most notably, Centrack software has helped us do a good job handling our controlled substances. In addition, every unit-dose product is bar coded. The medication must be matched to the storage slot before restocking. Additionally, dispense verification, a built-in control that prevents errors, provides another check. Dispense verification was a unique feature to see in cabinets and is a safe process.

AmerisourceBergen also added biometric access, which is working well. Nurses can scan their badges and use the biometric scanner to have almost instant access. This new biometric feature allows each user to register multiple fingers. All it requires is a badge swipe and a finger swipe, and the nurse is in and out, usually in less than five seconds.

We have not had any problem integrating and interfacing MedSelect with any of our information systems. At Children's Hospital, some of our requirements included limiting access to orders to create a safer environment. That was already built into the MedSelect MedOrder interface. Pharmacy can control access to scheduled medications by a due and late window.

The Examiner data analysis and reporting functionality (provided with the MedSelect System) is much more robust than what we had seen from other vendors. When we must produce or analyze data quickly, we have it all at our fingertips. There are some useful features in MedSelect's data-collecting, sorting, and filtering, such as the breadth of reports, the ability to easily learn and master the system without much training, and the capability to create reports specific to our organization. Although the canned reports are good, we can also modify any of the more than 100 standard reports available from the extensive report-writing catalogue. The ability to store the data as a Microsoft Excel file and manipulate it even further is also a great feature, not to mention that the information is stored for up to five years. We can track staff members' medication dispensing history over time and across locations when needed and chart trends and outliers.

I wasn't surprised that the addition of MedSelect cabinets has gone so well. I believe I speak for the others who were part of our original interdisciplinary selection team when I say that the MedSelect cabinets and software were the right technology to bring onto our nursing floors.

Talyst has introduced AutoCool, the first refrigerated storage system to combine access control with inventory tracking. AutoCool is driven by AutoPharm, software that integrates pharmacy bar coding, storage, inventory, ordering, and clinical systems.

"Hospital pharmacies of all sizes told us they needed a better solution for managing the valuable inventory in their refrigerators," said James E. Torina, President and Chief Executive Officer of Talyst. "When a single vial of an injectable drug can have a value in the hundreds, even thousands of dollars, managing inventory based on real-time data becomes critical."

Each AutoCool unit stores up to 84 items, and multiple units can be daisy-chained to automate all, or a portion of, refrigerated items. Compartments automatically rotate to appear behind seven secure doors that have automated lock releases and lighted indicators. AutoCool limits access to a single item at one time, providing an audit trail for all storage and retrieval activities (personnel access can be controlled by password security). It supports bar code confirmation of all stocking and picking activities, with pick-to-light indicators that guide pharmacy staff through such activities. Twin thermistor sensors provide constant temperature control of refrigerated medications. AutoCool can be installed in remote locations, with remote temperature sensing for the host-workstation.

"Pharmacies are full of inventory silos, with medications and data stored in multiple locations. The refrigerator is one of those silos, separate from the bulk of the inventory data," said Ron Strandin, President of Talyst's Acute Care Group. "AutoCool is a breakthrough in tying the physical security to the real-time pharmacy inventory."

Lexi-Comp, Inc. offers health care providers with constant connectivity to vital point-of-care information using Lexi-Comp ON-HAND for BlackBerry.

Lexi-Comp ON-HAND allows users to access the following databases and software packages from their BlackBerry handset: Lexi-SELECT, Lexi-Drugs, Lexi-Interact, Lexi-NBCA (Nuclear, Biological, and Chemical Agent) Exposures, Dental Lexi-Drugs, Lexi-Natural Products, Nursing Lexi-Drugs, Pediatric Lexi-Drugs, Perioperative Nursing Lexi-Drugs, Lexi-Pharmacogenomics, Lexi-Poisoning and Toxicology, and Lexi-Lab and Diagnostic Procedures.

Frequently accessed content can be stored on the BlackBerry handset. Real-time updates can be automatically and securely accessed by the user via the BlackBerry handset's wireless Internet connection as new content is published.

Individual subscribers, such as family physicians, nurses, pharmacists, and students, can personalize content on their BlackBerry handsets by selecting the information they want to view or hide.

"The installation process is very simple, with no desktop computer required. And since BlackBerry handsets are built to run Java, the customization capabilities are really limitless from a development standpoint, both for Lexi-Comp and for the user," said Steven Kerscher, President and COO of Lexi-Comp.

ScriptPro, in collaboration with TeleManager Technologies, offers advanced functionality for the Refill TeleManager Interactive Voice Response System (IVR) through ScriptPro's SP Central Workflow System. This product allows patients to access information about the status of their prescriptions and enables pharmacists to know in real time the status and location of every prescription.

With the newly integrated IVR/workflow product, patients can call the pharmacy and input a prescription number to order a refill. In addition, patients can find out the status of a prescription on the phone (i.e., if the doctor has authorized the refill yet or if the prescription is ready to be picked up). Pharmacists can view all prescription orders coming through the IVR and see their status on the SP Checkpoint or SP Station workflow screen. With the use of multimedia graphics, pharmacists can view, listen, enter data, or transcribe on the screen. Because SP Central logs all pharmacy calls during the past week, pharmacists can check the log to investigate any discrepancies. In an effort to optimize patient service, the enhanced IVR system will make outbound calls to remind patients to pick up or refill their prescription medications.

PACMED strip packaging, available from Parata, generates personalized unit-of-dose medication pouches, a new approach from traditional packaging systems. The strip packaging can be customized with up to 19 lines, intended to enhance compliance with information on every dose, such as patient name and location, medication and dosage, and timing of dosage (i.e., 8 am or "breakfast"). The packaging system helps caregivers verify compliance of each dose. It is also an option for a pharmacy's existing patients who take three or more medications per day. Class A compliance packaging enables most unused drugs to be returned to stock, reducing inventory costs.

"PACMED's packaging takes the guess work out of administering long-term care patients their medications. It is so much safer," according to Sharla Valdez, a hospice nurse from Valmed in Amarillo , Texas . "You know the right patient is getting the right medication at the right time, every time."

The packaging technology processes 50 multidose or 60 unit-dose packages per minute and handles PRN and prepacks. Bar code verification helps ensure accuracy of replenishment. Parata's Server+ software provides drag-and-drop, user-friendly functionality, tracking lot and expiration data. PACMED is available in three volume-based options:a C3 model for pharmacies with low volumes, a box unit for 100 to 240 medications, and a slide unit for 350 to 500 medications.

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