Hot Topics in the ASHP Section of Pharmacy Informatics and Technology

1. Hot Topics in the ASHP Section of Pharmacy Informatics and Technology Karl F. Gumpper, BS, BCPS, FASHP Director, Section of Pharmacy Informatics & Technology American Society of Health-System Pharmacists Email: kgumpper@ashp.org

2. Objectives • Discuss Section initiatives and its impact on VA pharmacy informatics practitioners • CPOE Guidelines • Drug-Drug Interactions Survey • Incorporation of Informatics and Medication Safety into Pharmacy Residency Training • “Meaningful Use” EHRs • Determine areas of collaboration for VA and ASHP to improve the medication use process

3. ASHP Guidelines on Pharmacy Planning for Implementation of Computerized Provider Order Entry Systems in Hospitals and Health Systems • In development since 2003 • Complexity of the topic • Scope • Work Group – Revitalized Process on the SOPIT – Section Advisory Group on Clinical Information Systems • Should be approved by ASHP Board of Directors – Summer 2010

4. CPOE Guidelines • Purpose and Scope • CPOE and the Electronic Health Record • Planning for Transition to CPOE • Developing an Interdisciplinary Planning and Implementation Team • Developing a Vision for the CPOE System • Defining Goals and Objectives • Establishing Baseline Data • Establishing Post-Go-Live Metrics • Re-engineering the Medication-Use Process

5. CPOE Guidelines (Continued) • Describing the Current Medication-Use Process and System Design • Developing the Future Medication-Use Process and System Design • Planning for CDS • Elements of a Safe CPOE System • Medication Orderable Design and Build Considerations • Pharmacy Department Considerations • Communication Between Departments • Education and Training of Health Care Providers • Conclusion

6. ASHP Statement on Bar-code Verification during Inventory, Preparation, and Dispensing of Medications • stocking of inventory both in the pharmacy and in other locations from which patient medications may be dispensed (e.g., an automated dispensing device); • manual packaging of oral solid and liquid medications; • compounding, repackaging, and labeling processes (e.g., scanning of source ingredients); • retrieving medications from automated dispensing devices; and • dispensing from the pharmacy to any location.

7. Other ASHP Resources • Guidelines • Remote Medication Order Processing • Safe Use of Automated Dispensing Devices • Others in development • Drug-Drug Interaction Recommendations • Electronic Prescribing • Electronic Formulary Management within multiple applications

8. Drug-Drug Interaction Survey • Launched October 2009 • Sent to Listserv subscribers 13,975 • Response Rate of 11.6% (n = 1621) • Data Currently under review • Preliminary Findings • 86% - Pharmacy Information System • 63% - EHR • 43% - CPOE • 27% - e-Prescribing • 5% - Not applicable

9. DDI Survey Do you feel that there are there too many alerts for drug-drug interactions (DDI) in your electronic system?

10. DDI Survey Please rate your level of agreement with the following statements?

11. The greatest problems with DDI software, as reported by respondents appears to be: • Too many alerts that are classified too severely • The inability to customize alerts • Poor quality of information on DDI that is presented • Too many alerts that are classified too lightly • Inability to limit who receives alerts • Alert fatigue • Vendor misclassification of alerts • Not enough alerts due to system not catching all interactions • Non-accurate or clinically insignificant interactions • Issues with the override process • Interactions that don’t take patient factors into account • Limitations with CPOE • Patient safety issues such as the lack of hard stops

12. The most important issues that the ASHP informatics group should be working on include: • Standardizing alerts, severity and DDI information among databases and software • Addressing alert fatigue or number of insignificant alerts • Improving the ability to customize the software • Enhancing the quality of information provided with alerts • Establishing prioritization according to significance of alert • Addressing programming issues • Providing alternative therapy options or stating what pharmacists should do when receiving the alert • Developing a national standard for minimum information or "Best Practice." • Making sure that the information and systems are updated regularly • Creating a list of truly significant drug-drug interactions • Recommending best practice for CPOE on who should receive alerts(physicians vs pharmacists vs nurses) • Providing more education around drug-drug interactions • Hard Stops • Improving the override and documentation process

13. Overall Response Rate: 29% Pharmacy Informatics and Medication Safety in Residency Training Survey

14. Is there an experience dedicated to informatics in your postgraduate training program (PTP) for residents/fellows?

15. Will your current resident gain experience (by either reviewing the existing literature and/or general application of the technology) to better understand the benefits and limitations of each of the following technologies/automations:

16. “Meaningful Use” Electronic Health Records • Comments • ASHP, Pharmacy Groups Push Agencies to Include Pharmacists in Medication Reconciliation Definition • ASHP Pushes CMS to Recognize Pharmacists' Roles in Meaningful Use Incentive Program • ASHP Urges Clarification of Standards Supporting Meaningful Use • ASHP to DEA: Create Standardized Format for Internal Codes Number Systems • Educational Programming • Summer Meeting 2010 • What You Need to Know About the American Reinvestment and Recovery Act (ARRA) and Health Information Technology (HIT) but Were Afraid to Ask • Achievement of Meaningful Use with EHRs

17. Get Involved with ASHP! • Submit Content Proposals for MCM 2011 • Deadline usually February 1st • Submit an Informatics Pearl – MCM 2010 • Lynn Sanders will be the Meeting Chair • Due Summer 2010 • Request Appointment for Section’s Advisory Groups • Deadline April 30th • http://www.ashp.org/sag

18. Section Advisory Groups & Committees • SAG on Ambulatory Care Informatics • SAG on Clinical Information Systems • SAG on Pharmacy Informatics Education • SAG on Pharmacy Operations Automation • Educational Steering Committee • Committee on Nominations

19. Other ASHP Resources for Informatics • Bar Code Resources • Computerized Provider Order Entry (CPOE) Resources • Clinical Decision Support Systems (CDSS) • Must Read Articles • Pharmacy Automation Medication Management Technologies • eHealth Initiatives • Midyear Pearls of Informatics • Other Pharmacy Informatics Technologies • Other HIT Organizations • Career Development