By Mark J. Harris, PharmD

AS HOSPITAL PHARMACISTS, WE ARE INTEGRAL players in the overall patient care process. It is a role that has expanded greatly in recent years, due in part to the emergence of increasingly complex medication regimens and the subsequent increased potential for adverse drug interactions. At the same time, we are under pressure to reduce costs, maximize efficiency, and demonstrate the significance of our clinical contributions.

The problem is, historically, we have been limited in our ability to provide a quantitative financial measure of our clinical interventions and time spent maximizing the safety and efficacy of drug therapy. In an environment that is increasingly reliant on the electronic capture and exchange of information, pharmacy has been largely overlooked – despite the fact that our expanded responsibilities go hand-inhand with an increased need for real-time, real-dollar measures of the effectiveness of our interventions and interchange initiatives.

Not so long ago, at Alegent Health Mercy Hospital in Council Bluffs, Iowa, our own pharmacy documentation “system” involved little more than checking off tasks and topics on paper forms as we completed them. It was an inefficient, time-consuming process, and it certainly did not provide the kind of quantifiable measures we needed to demonstrate the role we played in the care process. Sadly, our pre-software situation was anything but unique. That is why progressive hospital pharmacists breathed a sigh of relief when clinical intervention documentation and reporting systems came on the scene.

Designed specifically for pharmacists, these programs arm us with the tools we need to effectively document clinical interventions, drug consults, medication errors, and adverse drug reactions at the point of care, as well as clinical activity in the pharmacy for staffing and administrative purposes.

The majority of the systems on the market today target hospital-based pharmacists, although they are quickly finding a place in the long-term, subacute, and ambulatory care markets as well. Their growing popularity can be attributed to one simple fact: These systems enable us, for the first time, to definitively demonstrate the impact our contributions have on both quality and cost of care.

Selecting the Software
Clinical intervention documentation software is relatively new, so the market is far from saturated. While this means the number of products out there for consideration is relatively low, it does not lessen the need for careful evaluation to ensure the product you ultimately select meets your specific needs and expectations.

The first step in the selection process should take place even before identifying programs for evaluation. It involves determining exactly what you expect to achieve from implementing a clinical intervention documentation system and the kinds of data you will be collecting to attain those outcomes.

Most facilities share a common goal: to capture data and record activities so pharmacy can share the tangible results of our efforts, while maximizing resources and optimizing efficiency and costeffectiveness. Specifically, we want to:

• Better understand and document our clinical activities and how they contribute to reducing costs in both hard and soft dollars
• Document instances of medication errors or instances of adverse events or reactions
• Document patientor practitioner-centric consultations
• Improve formulary management
• More closely review drugs, including therapeutic substitutions
• Develop pharmacist coaching plans
• Identify physicians who may need to be detailed

Once you have a comprehensive understanding of your needs and expectations, the next step is to identify those programs that most fully meet your objectives. Evaluate each application to determine which offers the most comprehensive capabilities, as well as the best methods for capturing, storing, and reporting information.

The latter capability is perhaps the most important. The software you implement should make it very easy to input the data. Look for templates that can be customized according to your organization’s procedures and enable single-click intervention documentation. The program should also make it very easy to extrapolate the information in the format you need, when you need it, so it can be delivered to administration in a meaningful, timely way. In our case, we submit comprehensive quarterly reports to our P&T Committee – a process that has been dramatically simplified and streamlined by our clinical intervention documentation system.

Also important is the hardware you will need to run the system efficiently. Most of the stand-alone clinical intervention documentation systems available today are Internet-based. As such, data can be entered from any computer with Internet access and is securely stored in a database that is hosted on the vendor’s server. Many systems can also be used with wireless hand-held devices, allowing you to document on-the-fly at the point of care. Internet-based applications require very limited intervention by the IT department. System requirements are also limited: access to the Internet, a Web-browser, and enough RAM to run the features and reports at a suitable speed.

You will also want to look at the types of reports each program can generate to ensure they address all your needs. At our hospital, we use our clinical intervention documentation software to generate a variety of graphical, detailed reports in real-time, including quarterly summary and corporate roll-up reports, executive and global summaries, customizable pharmacist and room lists, and drug analyses.

Other reports to look for include intervention type, therapeutic category, ADR and medication error, drug information consults, medical department, physician analysis, and pharmacist results and rank – the key tools you need to illustrate your contributions and identify avenues to improve care and increase productivity and efficiency.

Finally, make sure the vendor will provide the level and quality of support you need. Some questions to ask include:

• Will you be assigned a single point of contact to manage your needs?
• Will they provide assistance with implementation and, if so, at what level?
• Is end-user training provided and, if so, for how long?
• Are help desk hours in synch with the hours the program will be in use by the pharmacy staff?
• What kind of response time can you expect when help is needed?

If you have gone through all the steps, but are still wavering between products, ask about any value-added services and features. For example, do they provide benchmark analysis so you can see how you compare to other similar facilities nationwide? That analysis can be a huge plus, because it adds to the value of the information you are presenting.

Furthermore, do they offer any assistance with generating the reports themselves, or will you be left to your own devices? Some vendors will actually run the various reports you need and deliver them to you according to a pre-set schedule in a specified format, such as in a PowerPoint presentation or printed and bound – a huge benefit for time-strapped pharmacists.

Maximizing the Benefits
The benefits derived from the right clinical intervention documentation software are significant. In our case, it has allowed us to generate a more realistic picture of our productivity. We can easily quantify interventions, account for and document the time we spend involved with other functions throughout the day – such as interdisciplinary rounds, meetings, and formulating answers to questions such as which physicians are involved with the use of unapproved abbreviations – and provide a comprehensive, dollar-based accounting of our time and contributions. It even helped us successfully make the case for expanding our pharmacy staff.
Clinical intervention documentation programs can help identify gaps and/or inefficiencies in processes so they can be addressed. In general, the programs provide a snapshot of what pharmacy does, so we can improve workflow processes and identify meaningful ways to expand our roles and contributions.

It is important to note that the realization of the software’s benefits and the achievement of expected outcomes are direct results of end-user adoption. Data that is not entered cannot be quantified, and activities that are not recorded cannot be factored into the overall productivity picture. Therefore, it is important to communicate to your staff the importance of incorporating the use of the software into their daily workflow process.

In fact, its importance goes beyond justifying our existence within our own facility. Because the future of health care will emphasize information-sharing and collaboration, implementing tools to quantify our contributions, streamline our workflow processes, and enhance our productivity will help ensure that pharmacy continues to have a voice in that future.

Mark J. Harris, PharmD, is the clinical coordinator of Alegent Health Mercy Hospital in Council Bluffs, Iowa. The facility is one of nine acute care hospitals and 100 sites of service that make up Alegent Health (www.alegent.org).