Life is about risk and rewards, balancing the positive with the negative, and taking the good with the bad. Advances in health care technology such as computerized physician order entry (CPOE) and electronic medical records (EMRs) free up pharmacists’ time by automating certain tasks so they can dedicate more time to patients. Technology systems also provide a place to document pharmacy activities that improve patient care across the health system. However, technology also challenges pharmacists to revise traditional roles and embrace change, which can be risky endeavors.
Meeting the criteria for meaningful use of EMR technology is quickly becoming a top priority for hospitals and health systems. The American Recovery and Reinvestment Act provides substantial incentives for hospitals and health systems that adopt, implement, upgrade, or demonstrate meaningful use of certified EMR technology. These incentives are causing a dramatic increase in the adoption rate of health care technologies. In addition, facilities are turning to technology to track new service models, workflows, outcomes, and productivity in order to gain reimbursement. “We are approaching a time where the EMR will essentially become a standard of care as opposed to just an option,” said Kevin Scheckelhoff, BSPharm, MBA, Area Vice President at McKesson Corporation.
As the implementation of EMR technology gains momentum, the impact technology will have on pharmacy practice remains open to interpretation. Several experts from various facets of the pharmacy industry gathered at the 2012 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exposition to discuss the opportunities and threats technology poses to pharmacists and their role in patient care.
Brent Fox, PharmD, PhD, Associate Professor at Auburn University in Auburn, AL, discussed the opportunities and threats to pharmacists if certain tasks are delegated to automation. According to Fox, technology will allow pharmacists to do what they are trained to do such as advanced clinical decision making and interdisciplinary collaboration. “If we accept the proposition that we can delegate some orders to automation, then that allows [pharmacists] to have other opportunities to acquire [other functions] on an interdisciplinary care team,” said Fox, whose background is in teaching, research and outreach.
Fox also believes that technology can bring community and hospital pharmacy closer together by creating opportunities to increase communication during hand-offs of care. The EMR would allow inpatient, outpatient, and community pharmacists to document and share their activities and information. “If we can leverage technology to improve what we do for patients, then philosophically it [should] be an opportunity that we engage in,” said Fox.
He also highlighted a handful of barriers that pharmacists need to overcome. “Regardless of what the EMR looks like … people don’t like change,” said Fox. Although technology can free us up to do other things, we’re still talking about changing what people do, he added.
Another possible threat, noted Fox, is whether patients want pharmacists to be more involved with their care. Many patients don’t know what we do in the first place. If some of the pharmacist role is delegated to the EMR, then there needs to be patient education to demonstrate what pharmacists do, he added.
Fox also mentioned a decreasing threat—resistance to an increased pharmacist role from other health care providers. “I believe we are seeing an increase in engagement from other professions to be more involved in care, so the threat of others resisting what we do is decreasing,” said Fox.
James Stevenson, PharmD, Chief Pharmacy Officer, at the University of Michigan Health System in Ann Arbor, MI, discussed technology threats and opportunities for pharmacists from the perspective of a large academic medical center where a CPOE system, e-prescribing, and significant automation are already in place.
“Technology can provide tremendous opportunities to advance pharmacist practice by reducing time in order verification and the drug distribution process,” said Stevenson. Technology can help us find a way to redesign practices and reallocate time to transitions of care, patient education, quality improvement and ideal patient experiences, and advanced clinical pharmacy services, noted Stevenson.
“One [area] that comes to mind right now is that there is a tremendous opportunity to develop pharmacy services related to pharmacogenomics and personalized medicine,” said Stevenson. “Those are things that are going to take [up] our time over the next decade and we need to find a way to be very effective in that.” (See page HSE 2 of the May 2013 issue of Pharmacy Today for more information.)
He believes that technology can also improve the quality and safety of care. “We have an awful lot of reliance on [human] performance, and clinical judgment varies among different pharmacists,” said Stevenson. “This human variance in knowledge and performance leads to variable actions. By using electronic systems we can improve the quality and safety of our systems.” On the flip side, poorly designed systems could actually reduce safety and quality of care. “Some of the clinical decision support [systems] that we deal with right now are still very crude and not very sophisticated or robust,” he said.
Stevenson sees enhanced monitoring capabilities as an opportunity created by technology. As health care moves toward patient-centered medical homes and accountable care organizations, “there’s going to be a lot more emphasis on population management,” he said. “In order to do that effectively, we’re going to need to have better control and better data to work with in measuring how we [manage populations].”
Stevenson believes that the threat of financial pressures could result in a loss of pharmacy jobs unless leaders are skilled at reallocating resources to new pharmacy responsibilities. “We need to be willing to move into different types of practice and do things that are more high-value activities,” said Stevenson. Additionally, Stevenson sees a need for highly trained technical staff to manage more extensive automation and informatics roles. Otherwise, “[we won’t be] successful in moving pharmacists into roles that they want to be in,” he said.
Dennis Tribble, PharmD, Director of Medical Affairs at Baxter Healthcare Corporation, represented an industry perspective, where the hope is that technology will open new doors for new products and services. “The notion of getting to the point where there is enough data out there in the marketplace where we can knowledgeably bring products and services to the [pharmacy] profession to help them do their jobs better based on the knowledge of what would actually work is pretty exciting for us,” said Tribble. He is also looking forward to advances in robotics, remote access, and workflow systems that remove pharmacists from the routine distribution of medications, allowing them to spend more time on providing advanced clinical care.
As a profession, pharmacists need to become “articulately insistent about the things we really want and need” because that’s what’s going to drive developing the products that help their business and their patients, said Tribble.
Robert Weber, PharmD, Senior Director of Pharmaceutical Services at Wexner Medical Center at the Ohio State University believes that an integrated EMR gives pharmacists an opportunity to move closer to patients. At Wexner, which received a Healthcare Information and Management Systems Society Analytics Stage 7 Award (the hospital is truly paperless), technology allows pharmacists to integrate information between acute and ambulatory stays and provides documentation for pharmacist billing, credentialing, and privileging. Pharmacists’ use of the EMR system promotes them as an independent pharmaceutical care provider, which is a big deal, noted Weber.
“[One] of the threats is that we have to demonstrate that our activities result in a positive return on investment,” said Weber. There is also the threat that decision support provided by technology may be a replacement for the clinical reasoning of pharmacists.
As technology implementation continues to evolve, pharmacists are at the forefront of capitalizing on new models for patient care and overcoming potential threats. Pharmacists can use technology to not only improve patient care, but to document their contributions toward meaningful use and reimbursement. “We have to show [organizations] that as we use the EMR, we’re having an effect on admissions, reducing adverse drug events, and promoting patient satisfaction,” said Weber.