The role of information technology in pharmacy practice is dynamic and not likely to lose

relevance in the coming years. To some degree, pharmacists are interested in information
technology because we can envision it increasing efficiency in our daily tasks and improving our
access to vital information. However, federal legislation is also driving adoption of Health
Information Technology (HIT) for its potential impact on patient safety. This is not a new
concept, as the role of HIT in reducing medical errors has been discussed on the national stage
since

To Err is Human

.
1

What is new is our profession’s most recent initiative to evaluate our practice model. The
American Society of Health-System Pharmacists’ (ASHP’s) Pharmacy Practice Model Initiative
(PPMI) presents a unique opportunity to evaluate the delivery of pharmaceutical care in such a
way that incorporates safe and effective adoption of HIT.2 It is pertinent at this time to consider
evidence supporting PPMI recommendations related to HIT as well as barriers to successful
implementation and utilization of HIT to support innovative pharmacy practice models.

According to the Office of the National Coordinator, HIT is defined as the application of
information processing involving both computer hardware and software that deals with the
storage, retrieval, sharing, and use of health care information, data, and knowledge for
communication and decision making.3 The first of 2 reports from the Institute of Medicine
(IOM), To Err is Human, suggests that if implemented appropriately, HIT should:

 Reduce reliance on memory

 Standardize terminology
 Use constraints, forcing functions, protocols, and checklists
 Minimize data handoffs

This report, among other things, encouraged careful consideration of information technology as a
means of improving patient safety. Specifically, the IOM report promotes adoption of a proactive
approach by examining processes of care for threats to safety and redesigning them before
accidents occur, inclusive of HIT processes. Ancker et al describe the “Triangle Model” for
evaluating the effect of HIT on quality and safety.4 This model acknowledges the interactions
between technology, providers, and an organization to influence quality and safety outcomes,
with patients at the center of the model.

Two years after To Err is Human, the second IOM report, Crossing the Quality Chasm, which
was broader in scope than the first report, recommended that HIT be used to improve access to
clinical information and support clinical decision-making. The report also recommended a
national health information infrastructure. This infrastructure would not be some sort of
centralized government database, as may be a common misconception. Rather, it could be
described as “rules for the road.” Crossing the Quality Chasm defines the infrastructure as a set
of technologies, standards, applications, systems, values, and laws that support all facets of
individual health, health care, and public health. This standardization would support
communication across the continuum of care and improve access to health information.

In keeping with the theme of standardization, the legislative response to these 2 reports, starting
with the Medicare Prescription Drug Improvement and Modernization Act of 2003, aimed to
increase interoperability and standardization by requiring Medicare Part D programs to support
electronic prescribing.5 This prompted the creation of technical communication standards.
Following in 2004, the Health Information Technology Adoption Initiative, an executive order,
established the position of National Heath Information Technology Coordinator within the
Department of Health and Human Services.6 This coordinator:

 Ensures that needed information is available at the time and place of care
 Improves health care quality, reduces medical errors, and advances the delivery of
appropriate, evidence-based medical care
 Reduces health care costs resulting from inefficiency, medical errors, inappropriate care,
and incomplete information
 Promotes more effective health care marketplace through widely available, accurate
health information
 Improves the coordination across the continuum of care
 Ensures that patients’ individually identifiable health information is secure and protected

It was not until the Health Information Technology for Economic and Clinical Health (HITECH)
Act of 2009 that legislative efforts gained “teeth” in the form of requirements for incentive
payments and reimbursement.7 This act empowered the national coordinator, established
standards and certifications, encouraged protection and privacy for health information, and
established Meaningful Use criteria.

Stage 1 of meaningful use involves optional participation with incentive payments beginning in
2011. Institutions adhere to 20 “core” requirements, and choose 5 out of 10 “menu” items. In
2015, Medicaid and Medicare reimbursement adjustments are made in lieu of incentive
payments. Stages 2 and 3 begin in 2013 and 2015, respectively, and each builds upon the
previous stage in terms of requirements. Not all measures for each stage have been decided at
this point, but each is meant to ensure that health care providers are making meaningful use of
health information technology.
Overriding themes from the IOM reports and legislative response include human factors
engineering, health information infrastructure, meaningful use of HIT, improved access to health
information for decision making, and protection of health information (Table 1).

Unfortunately, the rate of implementation of HIT, specifically those aspects that affect the
practice of pharmacy, is still less than ideal. As of 2007, some HIT has been widely adopted.
Greater than 80% of institutions surveyed had adopted automated dispensing cabinets and
repackaging automation.8 However, implementation of pharmacy information systems that
interface with other HIT was only 51% and use of bar-code medication administration or
electronic medication administration record was only 46%. Perhaps most alarming, as of 2010,
only 14% of institutions surveyed utilized inpatient computerized provider order entry with
decision support. Since 2007 and 2010, implementation has improved as described in the ASHP
2011 survey, but this information was not available prior to the PPMI summit.8

In 2011, Siska and Tribble described challenges related to HIT and performed a gap analysis
based on the ideal future state of pharmacy HIT adoption.9 Barriers identified include cost,
adverse effects, resistance to change, insufficient staffing, interoperability issues, and privacy
concerns. Although some of these are only perceived barriers, most are real and significant.
However, many can be overcome or mitigated through proper evaluation and careful
implementation, which are supported by the evidence reviewed thus far in this article. The gap
analysis describes a future state laden with terms such as continuum of care, standardization,
interoperability, track, audit, and evaluation. These concepts are supported by the IOM reports
and legislative response, but how do PPMI recommendations match up?

PPMI recommendations are displayed in Table 2, and have been displayed in 2 different groups
for the purposes of discussion. The first are recommendations related to specific HIT. Although
the use of these technologies is supported by the reports and legislation reviewed here, the
overriding themes and the future state described in the HIT gap analysis focus less on specific
technologies and more on the general approach to HIT implementation and utilization.
Each of these technology solutions is part of a larger recommendation simply stating that they
enable the advancement of practice models. All other recommendations are very much in line
with the concepts discussed here. Not only do PPMI recommendations address human factors
engineering, HIT design, and patient safety, but they also add to the discussion by addressing the
concept of training pharmacy students, residents, and practicing pharmacists on the proper use of
HIT.

In conclusion, it would seem that technology-related PPMI recommendations are in line with
patient safety efforts as evidenced by the IOM reports and federal regulation. As pharmacists, we
are fortunate to be evaluating our practice model at a time when legislation is requiring health
care providers to make meaningful use of HIT to care for patients in a safe and financially
responsible way. It is encouraging that we have reached consensus in such an important time in a
way that is supported by other best practice statements as well as legislative initiatives.

4 Important Technology Advancements in

Pharmacy
Technology is only getting better and more convenient. Now, instead of driving to visit your
doctor for a check-up, you can connect with them through video chat. Need to track your
medication routine? Simple, there’s an app for that. Every piece of health-related technology has
an eye on improving the overall patient experience, while making the entire process more
convenient and personalized.

But beyond patient-related technology, like apps and step trackers, pharmacy has been making
big moves to make the entire profession much more advanced. The first major shift in
technological advancements were focused on keeping track of prescriptions, minimizing
paperwork, automating prescription refills, and a new form of record keeping.

Now, technology allows pharmacies to create programs that fully automate a patient’s
prescription refill history and check into other prescriptions filled at different pharmacies, giving
pharmacists the ability to monitor and better track the patient’s overall health and safety.

These four pharmacy advancements are diverse and cross-functional.

Automated Dispensing Units/Cabinet

An automated dispensing cabinet (ADC) is a computerized drug storage device or cabinet

designed for hospitals. ADCs allow medications to be stored and dispensed near the point of care
while controlling and tracking drug distribution. This allows for a reduction in human error,
increase in fill time, and allows staff to focus on patient contact rather than filling the
prescription.

Prescription Drug Monitoring Programs (PDMP)

PDMPs, which collect state-specific controlled substance prescription data, are operational or
under development in most states. Checking the PDMP database before filling a controlled
substance prescription is optional in most states, but highly encouraged. The information
contained in a state’s PDMP can help doctors and pharmacists ensure the safety of all patients
when prescribing and using controlled substances.

Currently, IWP has access to PDMPs nationwide. This allows our pharmacy team to verify
patient safety and any potential risk of overuse or misuse. Since 2011, we have gone above and
beyond to report daily to all PDMPs, far more frequently than the weekly to monthly reporting
required by law.

Medication Therapy Management (MTM)

MTM, an online platform to manage a patient’s medication, is a review provided by a pharmacist

to the patient. The pharmacist will review all medications prescribed to the patient by all
prescribers providing care, along with any over-the-counter and herbal products, to identify and
address medication problems.  Problems may include medications not being used correctly,
duplication of medications, unnecessary medications, and the need for medication for an
untreated or incorrectly managed condition.

The pharmacist is then able to provide medication-related education, consultation, and advice to
the  patient or their caregiver to help assure proper use of medications.

Medication Reminder Devices

There are many devices on the market that provide smart medication reminders to patients.
Technology for these include reminder devices that lock after taking the correct dose, alarms and
flashing lights when patient requires a dose, and a patient compliance dashboard that can show
your next scheduled dose.

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