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January 1, 2005
by Louis Hyman
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A mobile, wireless electronic order entry system offers valuable transactional and communication extensions to traditional institutional pharmacy services, and serves as the foundation for an approach that begins at the point-of-care.”

On May 6, 2004, departing Health and Human Services Secretary Tommy Thompson appointed David J. Brailer, MD, PhD, one of the nation's preeminent authorities on electronic healthcare, as the first National Health Information Technology Coordinator. Dr. Brailer's duty is to execute the Executive Order of April 27, 2004, calling for the universal deployment of electronic medical records systems within ten years. Dr. Brailer has since indicated that a primary target will be electronic organization of the institutional pharmacy process within three years.

The urgency shouldn't be surprising in that institutional pharmacy operations are among the most cumbersome and potentially dangerous management challenges in long-term care. The traditional process finds the pharmacy receiving often- handwritten medication orders from the facility via fax, manually entering the data into a computer system, verifying sometimes inaccurate or illegible prescriptions from far-flung physician offices, printing out orders and labels, and eventually shipping the drugs to the facility. With residents each averaging well upwards of a half-dozen prescriptions per day, the opportunity for error—and significantly life-threatening error, at that—is vast.

Enter the newest array of e-prescribing vendors and their products, many of which have been introduced to the market only within recent months. What do they have to offer? What do facilities need to bring to the table? What will it take to make a three-year adaptation anywhere near reasonable?

Recently, key officials from several such vendors answered questions along these lines posed by Nursing Homes/Long Term Care Management. Those interviewed included:

Gary Duty, President and CEO, Millennium Pharmacy Systems

Louis Hyman, Chief Technology Officer, HealthRamp, Inc., CareGiver and CarePoint mobile product suites

David Blackburn, Director of Specialty Care and Life Sciences, Cardinal Health, Pyxis Products

Rohan Coelho, President and CEO, Daverci Solutions, Inc., manufacturer of the Toccaré system

Product-specific statements are for informational purposes only and in no way imply endorsement by Nursing Homes/Long Term Care Management.

What general comment would you offer about the prospects for e-prescribing in nursing homes and assisted living facilities?

Gary Duty, Millennium Pharmacy Systems: It is long overdue. The paper-based fax transmission of physician orders has been, and continues to be, the first trigger point for error in the traditional provision of pharmacy services in skilled nursing and assisted living. Electronic order entry, the critical first step in a fully integrated medication management solution, has been accepted and embraced by our customer base in both sectors.

Louis Hyman, HealthRamp, Inc., CareGiver and CarePoint: A mobile, wireless electronic order entry system offers valuable transactional and communication extensions to traditional institutional pharmacy services, and serves as the foundation for an approach that begins at the point-of-care. Computerized physician order entry capabilities—including e-prescribing—fit ultimately within the broader context of a comprehensive information technology infrastructure for long-term care. A complete IT solution will encompass preadmission screenings and admissions management; wireless order entry; asynchronous order approval for attending physicians; electronic, HIPAA-compliant charting; tracking of activities of daily living; MDS editing and scheduling; care planning; automatic fee calculation based on regional rates and resident-specific scoring; and third-party billing.

Electronic prescribing can significantly enhance resident safety through the reduction of medication errors. Complications caused by illegible handwriting are prevented through the secure delivery of precise electronic prescriptions directly to the institutional pharmacy. Automatic checks for negative drug interactions will avert the occurrence of adverse drug events—a critical capability, given the prevalence of residents with chronic and acute conditions that require multiple concurrent medications. In addition, e-prescribing can reduce costs by improving workflow efficiency and eliminating the administrative burdens associated with prior authorization compliance.

David Blackburn, Cardinal Health, Pyxis Products: Because of cost reduction needs, as well as the benefits of standardizing behavior, I believe the prospects of e-prescribing bode well for nursing facilities. The challenge will be getting physicians to adopt this technology and align their institutional incentives correctly to accomplish this.

Rohan Coelho, Daverci Solutions, Inc., the Toccaré system: Previous efforts by other companies have not succeeded in practice because nurses and med-aides found that the earlier “solutions” didn't add value and in fact increased their workload rather than decreasing it. The best way to make e-prescribing successful is to tie it in with the medicine administration process (eliminating the extra data entry steps). When this is accomplished, the prospects for e-prescribing are good, provided that the following ingredients of success are addressed:

  • The system is easy to use by people with little or no experience with computers (because many med-aides fall into this category).

  • The system is easy to learn (because it will need to be used in a high-turnover environment).

  • The system must be easy to support in facilities that don't have dedicated IT resources.