The Research Paper is submitted in partial fulfillment for degree Course: Course: Healthcare Mgmt/Admin Tech System
15 June 2010
Table of Content:
2.Implementation of IT in pharmacy
3.Evolution in the practice of pharmacy
4.Challenges facing the pharmaceutical industry
5.Drug Distribution Introduction
Today information technology has become a key factor in all the businesses, may it be manufacturing industry, service industry or healthcare industry. Information technology is a must in order to be updated with the trends and to be highly competitive in today’s world. Like all other industries, pharmacies have also been advance in using information technology in operating their day to day functions. It is not only helpful in managing the data of the patient’s or customers but it makes the work easier and efficient. Today pharmacies are using many new technologies in order to overcome many challenges. Patient care is very important and pharmacies play a major role in delivering high level of customer service. “The US government has called the years from 2004-2014 as Health Information Technology (HIT) decade”. The health care organizations and technology industry are working together to enhance and expedite HIT nationwide and pharmacies will have to enhance their knowledge and experience to cope up with numerous opportunities and challenges and advancement of technology, created by the new era of electronic health care. As the health organizations and the technology industry is at the core of the use of medication process, pharmacists will face handling of multidirectional flow of all heath care related data and various automated dispensing and billing process. From electronic prescribing to point of sale technology, mostly all the pharmacies will soon be connected electronically to other health care providers and patients. In order to develop technical integration solutions, pharmacists will have to work with their “Pharmacy Management System (PMS)” vendors, keeping their day-to-day workflow and will have to communicate electronically with other health care providers through PMS. The objective of information technology in pharmacy will be to increase overall quality, safety and efficiency with fewer medical errors and decrease cost and expand patient’s access to affordable health care. Implementation of IT in Pharmacy:
Pharmacists have been using computer systems for many years now, mainly for dispensing, billing, reimbursement purposes, and fully integrated software-as-a-service to MTM systems. Vendors offer PMSs and software for workflow management, e-prescribing, e-signature capture, POS(Point of Sale) solutions, inventory management, card processing, pricing and printing services, interactive voice response, accounts receivable, long-term care, e-medication administration records, claims processing, flexible spending account/health reimbursement account handling, compounding, 340B reporting and more. Out of various technologies, one of the most important technologies used by the pharmacies is Automation. Automation is the automatic operation of a process, equipment, or system or the techniques and equipment used to achieve this. “Automation has the potential to relieve more than half of pharmacies’ prescription volume at higher speeds and with greater accuracy than manual filling (Wechsler, 2009).” Automation helps the pharmacy to allocate more of their time and resources on patient’s health care. One of the best examples of automation is E-prescribing. E-prescribing is the paperless communication from computer to computer among prescribers, pharmacies and the insurance companies. The important thing to notice here is this communication is not done through email. E-prescribing connects health providers, patients and pharmacies in the real time and can share medication history and messages regarding new prescriptions, changes or cancellation in prescriptions, refill requests and other prescription information. E-prescribing is beneficial to both, the patient and the physician as it saves time and money and it is very efficient. It takes less time of pharmacy’s staff to process the new prescriptions and refill requests. E-prescribing reduces medical errors, handwriting interpretation errors, reduces data entry and phone calls between pharmacies and physicians, decrease pharmacy costs, improve administrative efficiency of both pharmacies and physicians, develops electronic records in order to make sure that prescription information is not lost and expedite refill requests of prescriptions. It also helps physician to have an access to patient’s insurance coverage information, potential drug, drug allergy etc. Wireless Temperature Monitoring System: This system provides fully automated and real-time wireless temperature monitoring. This system is very useful and necessary to the hospital pharmacies, in order to ensure that all the medication, vaccines and other pharmaceutical products are maintained according to the recommendations of storage and transport conditions for delivering the highest level of patient care. The device can be stored in freezers, refrigerators and in the laboratories and its main function is to maintain the required temperature in. The sensor attached to the device monitors the temperature as it moves through the facility. If the temperature increases or decreases, it gives a signal or an email or a flashing PC alert. It easily connects to the existing infrastructure and can access real time data from any location. All in all this device makes it possible to monitor, record and alarm temperature data accurately and cost-effectively. Automated Compounding Device: This device is regularly used by the pharmacists to parenteral nutritive admixture. This device helps to provide admixture compounding in and more accurate manner as it is a complex procedure to prepare the admixture and pharmacists have to be trained as they are legally responsible to perform this task. This device arrives to an improved automated compounding with the use of fluid pumps and software that controls the compounding pump. The system has in-built safeguards which helps detect the inappropriate proportions of mixture, detect the situations of wrong delivery of mixture and has the ability to keep incompatible source solution separate. The automated compounding software helps the pharmacists in developing physically and chemically compatible parenteral nutrition formulations. It also alerts the pharmacists when any wrong formulation is done while preparing the mixture. Another example of automation is “Automated Drug Dispensing System (ADDS)”. This system is like an ATM machine which is placed in the clinic or physician practice to make it possible for patients to get needed drugs at the point of care and at the time of prescribing in a "one-stop shopping" model. With ADDS the physician can ensure that the patient prescriptions are filled and initiated in a timely manner with less personal hassle. It is estimated that about 80% of drugs required for practicing medicine can be dispensed from an ADDS. Following are the benefits of ADDS. Easy to use: It is preferred by pharmacists and hospitals as it is user friendly and it provides quick, secure and convenient access to medicines and robust reporting tools with the touch of few buttons. Guiding Lights: The system guides the user accurately with the guiding lights to the specification of each medicine or supply during dispensing, returning or restocking. Flexible and Modular system: The system has a wide array of drawer combination that offers customized options to suit the needs of each patient. Cost: It helps achieve the lowest operating cost providing the necessary medicines to the patients as and when needed. Other technologies used in pharmacies are Barcode labeling and scanning. For example, General data offers a wide range of barcode labeling, scanning, printing and wireless data collection products and solutions for pharmacies (General data is a premier business partner with industry-leading hardware and technology providers). General data helps the pharmacies in many ways: Prescription fulfillment and Tracking: Barcode printing reduces the possibilities of wrong prescriptions to the patients. It enables all the pharmacies to process more orders with fewer errors by doing reliable printing of bar-coded prescription orders, vial labels and paperwork. This helps the pharmacists to track the bar-coded prescriptions by scanning them every time. It also secures the access and storage of medicines with the help of radio frequency identification (RFID) technology. Medication Repackaging/Relabeling: General data barcode media and printing solutions enable pharmacies to comply with the requirement of Food and Drug Association (FDA) of identifying all the prescriptions and over the counter medications by linear barcodes. This reduces medication administration errors and enhances security with the help of RFID smart labels. Receiving/Inventory Management: The barcodes can help identify the stock and where it is stored. Barcode labeling and scanning also helps in controlling order and replenishment to manage inventory and stock outs. Barcode also helps in scanning shipments and update inventory. Evolution in the practice of pharmacy— not a revolution!!
In the last 15 years, the pricing and other competitive approach of pharmaceutical companies have been changed by revolutionary developments in information technology, new state drug substitution laws, federal legislation, and the emergence of market institutions that include health maintenance organizations (HMOs) and pharmacy benefit managers (PBMs). Competitive dynamics of pharmaceutical markets subject to ongoing informational, institutional, and structural changes and the changes in health care delivery, the pharmacy profession is experiencing noteworthy growth and development. Traditionally, pharmacy was regarded as a transitional discipline between the chemical and health sciences and as a profession ensuring the safe use of medication. The current shift involves an expansion of the scope of pharmacy practice and, in some influence, the assumption of the authority to prescribe medications in defined situations. Several prescribing models for pharmacists have been developed internationally. Technology has restructured the work of pharmacy on many levels. From preparing a medication, reviewing patient profiles, and checking drug interactions to adjudicating insurance forms, it almost seems that less time slip away than it takes to click a mouse. Challenges facing the pharmaceutical industry
Pharmaceutical industries need to catch up with developments in information technology. It has been lagging behind. The invasion of data from genome research means major changes in the computational input into drug R&D. companies are now tackling more complex diseases using more sophisticated scientific tools. Regulatory authorities are enforcing tighter safety controls too. Pharmacists have been bearing an increase number of challenges making it difficult to survive and succeed in the environment that has become more complicated and uncertain, Characterized by rapid developments in science and technology, and organizational change. Some of the challenges are explained below: \Medicare part D: This is federal program to fund the costs of prescription drugs for Medicare beneficiaries in the United States. This program was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Medicaid Reimbursement Cutbacks: pharmacies have the restriction to set the retail prices faced by cash-paying customers which include the uninsured. Theoretical models propose that the pricing assessment may be influenced by payments from customers with mandated reimbursement levels (e.g. Medicaid). Medicaid cuts will result in higher prices for the uninsured. Competition: The cutting the costs of research and speeding drugs to market together represent just one route to increasing efficiency. Companies need to aim to maximize profits, once they are on the market Drug Distribution Introduction
The drug distribution in the United States is mainly divided into two systems, prescription and nonprescription which is also known as over-the-counter (OTC). The two-class distribution system is relatively particular across the world in comparison with other nations with traditional pharmacy distribution system which means that medicine is only available in pharmacies. However, with centuries’ development of healthcare, many countries have realized the fast increasing demands for safe and effective distribution. Some countries have been changed into following the trend to provide more convenient medication access. The following paragraphs are going to illustrate the two-class distribution system in the United States. OTC Distribution
1.Definition of OTC Distribution:
“Over-the-counter (OTC) medicines are drugs you can buy without a prescription. Some OTC medicines relieve aches, pains and itches. Some prevent or cure diseases, like tooth decay and athlete's foot. Others help manage recurring problems.” (http://www.nlm.nih.gov/medlineplus/overthecountermedicines.html) 2.Advantage of OTC medicines
OTC medicines are convenient for customers to get what they need in retail outlets, such as CVS, Walgreen and Rite Aid, as well as in those without pharmacies in the United States. There are over 750,000 retail locations in rural and urban areas, and some locations are even open during weekends and late nights. Customers can easily find a medicine to relieve their ailments without waiting too long in a line or driving miles to reach a drugstore. Apart from the convenience of OTC market, affordability is also an important benefit for US customers to choose from a wide range of products which are safe enough regulated by the Food and Drug Administration in the United States. When it comes to medicines, buyers should never take OTC medicines longer or in higher doses than the instructions. Because of the strict regulation by the U.S. government, those medications sold in the market have a wide enough safety margin that can be safely and effectively taken without the help of a professional. Prescription Distribution
1.Pharmacy Prescription Errors
According to the Food and Drug Administration (FDA), there are about 1.3 million people are injured annually from drug mistakes. For some people, the errors cause serious problems. The major factor to have these errors is hundreds of similar spellings and pronunciations. Under the control of FDA, these numerous spellings and pronunciations for possible problems make patients get sicker after taking the mistaken medicines. Most these mistakes attributes to human errors, including doctors, pharmacists, poor handwriting and incorrect reading, or the pharmacist may also get two medicines mixed up, and then he dispenses the wrong one without realizing it is the wrong drug. Sometimes, the prescriptions are transferred by phone, but the phone receiver makes mistakes. Other types of prescription errors occur too, such as incorrect dosage, drug conflicts and drug allergies. All of these mistakes bring serious consequences to patients. How do we avoid prescription errors? 2. E-Prescription System
One of the big concerns for patients is to ask whether they have got what was prescribed. For pharmacies, how they manage and avoid potential drug errors is always a repeated discussing topic. In recent years, many doctors have been using e-prescriptions to avoid potential problems caused by sound-like medical words on the phone. E-prescriptions are computer-based prescriptions entered by doctors and sent directly to a specific pharmacy. By e-prescribing, patients are able to save extra trip and time to pick up their medicines, because the prescription arrives at a designated pharmacy before a patient leaves doctor’s office. For doctors, it makes easier for them to prescribe a high-cost medicine on the basis of patient’s insurance. In addition, e-prescription helps avoid pharmacist to interpret paper handwriting. However, a report from Surescripts found that although there was significant improvement in application of e-prescribing, some challenges still exist. The use of e-prescription still only account for about 25 percent of total office-based doctors. One of the challenges to introduce electronical prescription is successful implementation. For example, e-prescribing process is complicated. It requires several steps to finish a prescription before the computer, including patient identification, review of patient information, verification and transmission of the prescription to the pharmacy. Therefore, it is not a simple updating current program, but a combination of training, consuming and supporting issue.
According to the scale pharmaceutical industry is ranked sixth worldwide in generating innovation after aerospace and defense, automotive, electrical/electronics, chemicals and IT hardware. The average pharmacy company is twice effective as delivery innovation as software and IT service industry. The process of innovation in pharmaceutical industry has special characteristics mostly regulatory environment impacting developing time and marketing opportunities. Modern information technology has dramatically increased efficiency and effectiveness in pharmacy innovation phase. Thus by improving workflow and minimizing distractions, technology- from automated prescription dispensers to interactive voice response to comprehensive pharmacy management systems-do the drudge work for pharmacists. State-of-the-art equipment will raise the speed and accuracy in dispensing and will allow pharmacists more face-to-face time with patients.