Technology in the Pharmacy The use of technology has greatly advanced the field of pharmacy. Many tedious task that were long, cumbersome and time consuming have now be replaced by computers, electronics, and Robotics

Automated Dispensing Machines Industry Standards: Omnicell® Pyxis Medistation® Consists of medication storage area and a central keyboard terminal Pharmacist profiles a medication for a patient which is electronically transmitted to the ADM or ADC. Nurse retrieves the medication at the required time ADC are very cost effective and helps to maintain inventory and assists with billing by charging issues and crediting returns Supports the decentralized pharmacy model Allows the storage of unit specific medications on the unit (i.e. cardiac drugs are in the CICU unit’s omnicell) Allows for documentation of drug wastes and returns Systems have a barcode scanning feature that assists in correct dispensing and medication filling Pyxis CII Safe: a electronic system for monitoring movement of controlled substances through out the institution Omnicell CSM (Controlled Substance Module): a electronic system for monitoring movement of controlled substances through out the institution Provides for security by requiring passwords and username at the terminal Also uses biometrics (like fingerprint scanner)

Automated Dispensing Machines Example of Omnicell Cabinet

Bar Code Systems Provides for medication checks to increase medication safety. Bedside Bar-coding act as a final check in the medication verification process. RN scan the barcode on his/her ID badge, then scans the patient’s wristband ID barcode and finally scans the barcode of the medication’s packaging. The transaction is recorded in the patient’s MAR also called “paperless charting” commonly used systems are Intellidot ® and Patient Safe Solutions ®

Health Information Technology HIT encompasses a wide range of services from computer physician order entry CPOE systems to barcode systems to pharmacy order profiling systems Designed to increase patient safety in the medication ordering and fill process Systems often provided dose, drug, drug to drug interactions, and allergies alerts to prescribers and pharmacist. This aspect simplifies drug utilization review (DUR)

Computerized Physician Order Entry Systems Also known as CPOE Completely eliminates the “paper order” Eliminates the use of dangerous drug abbreviations, codes and handwriting that may not be clear Uses a technology called “clinic decision support system” or CDSS Assists prescriber in proper drug selection based on condition of the patient as well as labs and pertinent medical data Assists in dosage calculations Provides for drug allergies and interactions check Well known standard is Allscript Eclipsys ® Sunrise Clinical Manager (SCM)

Electronic Health Record EHR Patient’s medical information generated by an encounter that used to be kept in written form known as the patient’s chart Digitalized electronic version of the “patient’s chart” Consists of patient demographics, medication orders, nursing orders, labs, MD progress notes Interfaces with the CPOE to facilitate drug order entry Implementation on a nationwide basis encouraged by HIPAA and MMA of 2003

National Council for Prescription Drug Programs Also known as NCPDP Works to establish standards in the electronic transfer of prescription information and Pharmacy reimbursements from third party payers Standardized adjudication coding for pharmacy claims payment (known as the rejection codes) Establishes the SCRIPT coding standard for E-Prescribing Covers Transactions types Billing units Member enrollment verification Electronic signatures Future improvement include Ability to verify lab values Formulary inquiries to insurance Prescription transfers Works with PSTAC (Pharmacist Services Technical Advisory Coalition) to establish HIPAA compliant CPT codes for MTM services

Electronic Prescription Known as eRx (E-Prescribing) Involves generating, transmitting, and filing a Rx electronically Begins with the prescriber processed to a “transaction Hub” which a cloud based platform that integrates the prescriber, pharmacy and the third party payer Benefits include: Real time communication between prescribers, pharmacies and other agencies Eliminates the issue of illegible Rx’s Phone calls for Rx refill authorizations Reduces data entry Can be used on mobile devices , desktop computers, PDA’s and tablet computers Increases security by electronic encryption of data and eliminate risk of stolen paper Rx’s Disadvantage Pharmacy is charge a fee for the transactions by the eRx vendor Federal law permits the eRx of controlled substances so long as the Rx is maintained electronically

A Very Basic Electronic Prescription Flowchart Prescriptions, refill responses, Eligibility Checks, Medication status Eligibity checks Pharmacy Benefits Manager Prescriber eRx vendor hub Pharmacy Prescriptions, refill responses Refill requests

Electronic Prescription Vendor Software Companies Industry Standards General Electric (GE) Centricity Physician’s Office software HealthFusion Meditouch EHR software AdvancedMD EHR software eClinicalWorks CareCloud Practice Management