By Tim Hipp, RPh, MSM

IF THERE WERE A POPULARITY CONTEST FOR HEALTH CARE IT COMPONENTS, the pharmacy information system (PIS) likely would finish in last place. Most of the time, the PIS runs dependably in the background, unremarkable, unsung, and untapped. Yet, when fully harnessed, the power of the integrated PIS elevates the performance of multiple software and automation solutions. It is time for the PIS to get its due.

At AnMed Health, we stretched our PIS—Horizon Meds Manager (HMM) from McKesson—to act as a single, dynamic platform that enables us to follow a systems approach across all of our medication management IT. We now approach all clinical systems workflow with a more holistic view, allowing us to drive best practices, ensure optimal process change, enhance communications, and enable the best care possible. On a more practical level, this systems approach means:

• One system to use and maintain
• One interface to install
• One support desk to call
• Solutions that grow together

The outcomes are demonstrable improvements in quality and lowered cost of care—results that capture the attention and support of our board of trustees—even if the PIS remains largely unnoticed in the background.

System Integration
AnMed Health is a not-for-profit, community-based provider located in Anderson, South Carolina. Our flagship facility is AnMed Medical Center, a 461bed, acute-care community hospital. The pharmacy is open 24 hours, seven days a week. We have a hybrid medication dispensing philosophy. More than 90% of our medications are provided to nurses from the central pharmacy in bar coded, patient-specific form via automation technology. Nurses retrieve narcotics, PRNs, and some first doses from medication cabinets. This frees our pharmacists from intense, manual dispensing tasks, and enables us to be involved with patient prescribing patterns on the front end of the medication-use process.

Where to Start?
The greatest challenge to implementing PIS as a communications hub, is determining where to start. While every hospital situation is unique, my recommendation is to focus on the patient and work your way back. Starting at the bedside will ensure that you keep patient safety continuously at the forefront of
every one of your initiatives. For instance, our PIS integrates with our medication dispensing cabinets and our pointof-care medication scanning systems, resulting in productivity improvements. Here are several examples of current and future functionality:

Goal #1: Enhance Medication Safety

• Reduces potential for adverse drug events: The drug formulary interface between our PIS, dispensing cabinets, and bar coded medication administration platform establishes consistent drug formulary support throughout the hospital. This minimizes data configuration requirements and reduces caregiver phone calls, and significantly reduces the potential for adverse drug events (ADEs) that can be caused by disparate information.
• Reduces override communication breakdowns: Cabinet override notices are sent directly into the PIS work queue for prompt pharmacist review.
• Enables dose-level holds in accordance with compliance recommendations: Our cabinets support “hold dose” orders from the PIS work queue. This feature supports ISMP/Joint Commission recommendations to hold drug doses, rather than drug therapies. After the hold expires, the order is automatically reactivated.
• Provides pharmacists with insight into actual administration times: With caregivers using a bar coded medication administration platform, pharmacy can use our PIS to view administration times and results. This helps the pharmacist to monitor and report on missed doses, and also aids the pharmacist in making clinical decisions based on actual administration.

Goal #2: Optimize Medication Cabinet Inventory

• Saves pharmacy FTE time: Our PIS gives pharmacy a real-time view into medication inventory inside our automated dispensing cabinets. Pharmacists can monitor quantity-on-hand updates at the end of each order, and know when inventory replenishment is complete. Our PIS can also send a dispensing request to the appropriate filling device and inventory location, maximizing refill efficiencies. The real-time interface between our PIS and our cabinets ensures that our pharmacy will have the most current, up-to-date inventory information.

Goal #3: Give Nurses More Time for Patient Care

• Eliminates redundant login steps: System integration simplifies our process for adding caregivers to the system. Temporary nurse users can be entered into the system for both Horizon Admin-Rx and AcuDose-Rx with one security set.
• Ensures needed meds are always available: Our cabinets automatically notify the pharmacy of caregiver actions—such as dispensing and administration overrides, missing medications, and refill requests—via the PIS work queue. This expedites order verification for overrides, ensures medications are available when needed, and reduces caregiver phone calls to pharmacy.

Goal #4: Maximize IT Investment

• Reduces the number of potential failure points: Establishing a single platform for clinical and automation system integration minimizes potential failure points and maintenance time and costs.
• Ease FTE burdens on IT: All of our McKesson automation systems employ user-file synchronization, ensuring consistency and simplifying table builds and ongoing maintenance across applications.

Increasing Our Clinical Pharmacist Activities
These advancements have enabled us to escape the boundaries of the pharmacy and perform more clinical work throughout the hospital. Our inpatient monitoring activities include risk reduction, conducting physician consults, and promoting cost-effective medication substitutions aligned on evidencebased guidelines. At AnMed Medical Center, we average about 10,000 pharmacist-patient interventions per year. In 2006, our total combined IV-to-PO and renal interventions saved our hospital system more than $220,000.

We know that there is even more we can do with our PIS hub approach. Some of the projects we are currently working on include enhancing the pharmacy work queue, providing tighter integration with “link” orders, establishing dose-level tracking, and evaluating all of our current manual processes.

Since we have begun to think more holistically in terms of clinical systems workflow, we have made great strides in terms of safety, quality, and cost reduction. In spite of its low profile, we know that our pharmacy information system is a significant contributor to these improvements.

Tim Hipp, RPh, MSM, is the pharmacy systems manager for AnMed Health System in Anderson, South Carolina. He has worked at AnMed for 16 years and been in his present position for the last six years. Hipp has a BS in pharmacy from the University of South Carolina and a MS in management from Southern Wesleyan University.