1. 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

2. 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)

3. Automated Dispensing Machines
Example of Omnicell Cabinet

4. 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 ®

5. 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)

6. 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)

7. 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

8. 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

9. 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

10. 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

11. 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