The Use of Digital Technologies in the Workplace; Improving Pharmacy Efficiency

Introduction

The performance of pharmacists is largely affected by the environment within which they work and the kind of resources available to them which facilitate the execution of their roles (Hilde, 2008). The motivation and satisfaction for work among pharmacists is often influenced by the availability of digital technologies, equipment, staff, and workload among other factors (Hilde, 2008). These are the core resources that enable pharmacists to deliver their duties such as dispensing and other patient care practices. Since these resources improve workplace environment and pharmacy efficiency, they have the potential to increase quality of patient care, pharmacists’ satisfaction, and productivity (Hilde, 2008). It is particularly important to embrace digital technologies which have multiple safety checks in managing pharmacy workplace and the entire healthcare system. This element is not only imperative in ensuring medication safety but also the efficiency and effectiveness of the workplace conditions to the pharmacists and other healthcare workers. The need for redundant safety checks in pharmacy environment is to prevent the errors which often occur during the practice of medication dispensation Hilde, 2008. Through these checks, pharmacists are able to dispense medicines in a safe and timely manner and thus increase patient satisfaction. This paper takes a review of authoritative and scientific published journals that have a focus on the use of digital technologies in the workplace for the purpose of improving pharmacy efficiency.

Narrative Literature Review

In the literature review, “Implementing technology to improve medication safety in healthcare facilities: A literature review.”, Hilde (2008), describes medication errors as otherwise preventable events which in some instances present outcomes such as serious bodily harm in affected patients. These are errors caused during the preparation of prescriptions, drugs dispensation at pharmacies or in the process of administering medicine to patients. Medication errors also include avertable events which essentially may lead to incorrect prescriptions, dispensing or administering of a particular medication. This led the American Congress to make an attempt to reduce such incidences through the enactment of the Health Information and Quality Improvement Act (2001) as well as the Medication Error Reduction Act (Hilde, 2008). The passing of these two Bills supported the need to incorporate better and more advanced technology systems into the health sector as well as provide training to medical personnel to a tune of over 1 billion dollars.

A range of technology based programs were integrated into the healthcare system to keep cases of medication errors to a minimum as well as enhance efficiency in the process. These include computerized physician order-entry (CPOE)system, electronic medication administration record (eMAR) as well as hand held computers, automated decision support systems and automated medicine dispensing cabinets (Hilde, 2008). Hilde (2008) also recommends that any technology applied within the health care system be considered as a safety precaution. The use of such systems should not in any manner be considered as foolproof and thus should not be construed as being able to overshadow human intellect or intuition.

Hilde (2008) concludes that positive outcomes resulting from this initiative were realized through improved quality assurance outcomes though the negative effects were felt in the technicality of making such systems work effectively. Hilde (2008) pointed out that an over reliance by medical practitioners on such system could lead to neglect of simple manual steps to ensure the quality of health services provided.

According to Seger, Churchill, Keohane, Belisle, Wong, Sylvester, Chesnick, Burdick, Wien, Cotugno, Bates and Rothschild (2012), antineoplatic therapy provides for a particular class of medication with regard to medication due to the high levels of toxicity as well as a relatively low window for alternative therapeutic options. These present both a risk to medical practitioners as well as patients (Seger et al, 2012). This medical procedure involves several stages presenting several phases of prescription, preparation, and medication administering creating a risk to both the medical practitioners and the patients.

These many steps present a level of vulnerability in issues which could result in medication errors. Technological advancements have brought about a profound improvement in medical safety as well as an increased efficiency in work processes (Seger, et. al, 2012). Medical technology solutions such as medical provision order entry, bar cording of prescribed medication and the use of smart drug infusion pumps have greatly enhanced the provision of medical care. Robotic compounding environments provide for a cost effective and remarkably safe means for the preparation of adjuvant and antineoplastic medication (Seger, et. al, 2012).

“Technologies to Reduce Errors in Dispensing and Administration of Medication in Hospitals: Clinical and Economic Analyses” a report prepared from May 2009 to April 2011, was a period in which a study conducted at Brigham and Women’s/ Dana-Faber Cancer Care Center approved by the institutions review board provided results on safety both to the staff as well as patients, unintended consequences in the use of new technology, medication accuracy as a result of using robotic intervention in medication preparations, medication preparation workflows as well as ancillary materials and labor costs (Perras, Jacobs, Boucher, Murphy, Hope, Lefebvre, McGill and Morrison, 2009). Results from this study showed that robotic compounders for antineoplastic and adjuvant agents did not realize a significant change in medication errors (ME) but staff safety was enhanced considerably. The mechanical and software glitches witnessed were considered to pose no ME threat to patients due to control measures instituted but the glitches resulted in workflow efficiency as well as medication wastages.

Another observation was that use of robots enhanced accuracy, reducing failure rates by more than 10%. Robots eliminated the need for pharmacy staff to exposure during medication preparations bring about a reduction in ancillary costs (Perras, et. al, 2009). Results from this study showed that robotic intervention served to reduce staff events but the change in ME occurrence remained the same. It was concluded that robots will in future play a greater role medical preparations due to their accuracy and cost effectiveness.

In a report prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH),  on the assessment of clinical and economic implications of employing new technologies in health care settings so as to reduce the chances for medication errors and staff safety. Results from two studies conducted on automatic dispensing devices at the pharmacy levels showed that employing new technology in both cases reduced medication errors in dispensing medication (Perras, et. al, 2009). The use of barcodes in the management of blood banks, it was found out that the use of this new technology brought about a decrease in blood transfusion errors. In an instance where 50 units were transfused one erroneous transfusion was detected and avoided (Perras, et. al, 2009).

From an economic standpoint, the use of new technologies in the healthcare sector has resulted in more time being realized by healthcare providers such that they are able to offer patients better healthcare services in terms of quality. As a matter of fact it was found out that through the use of robotic pharmacy dispensing devices less space was required (Perras, et. al, 2009). In the United States, studies have shown that the use of automated systems have an overall effect of realizing savings. For instance, healthcare institutions employing automated billing systems, robotic medication preparation, dispensing and the administering of medication realize more savings in terms of money, time and staff retention (Perras, et. al, 2009). This report concluded that from a clinical view point, the application of new technologies such barcoding in medication dispensing arrangements, in administration systems and the synchronized use of technology allows for a reduction in medication errors in a healthcare setting.

A report titled “High Rates of Adverse Drug Events in a Highly Computerized Hospital” looked into studies which suggested that use of computerized interventions lead to an actual reduction in medication errors (Nebeker, et. al, 2005). However, some of these studies looked into cases of adverse drug events also referred to as (ADE’s) in every phase of the computerized medication systems and processes. These included assessments from the computerized physician order entry medication ordering as well as medication systems (Nebeker, Hoffman, Weir, Bennett and Hurdle, 2005). Pharmacists in this study chose to classify inpatient ADE’s from possible day to day reviews electronic medical data from random samples of total admissions made over a 20 week period.

Results from this study showed that of the nearly 940 admissions, over 480 ADE’s among the inpatients were acknowledged translating to just over 50% for every 100 admissions as well as a frequency density of 70 likely ADE’s in every 1000 patient days (Nebeker, et. al, 2005). 25% of all admissions had one ADE with less than 10% of the ADE’s resulting in serious harm, over 20% requiring further monitoring and intervention, over 30% in intervention and 11% of ADE’s reported in monitoring (Nebeker, et. al, 2005). ME’s contributed to more than a quarter of all reported ADE’s. These were over 60% in ordering, over a quarter in monitoring, nearly 15% in administration and 1% in medication dispensing.

The reported high prevalence rate of ADE’s as well as the seriousness of the problems posed by ADE’s provided the empirical justification for better improvements with regard to the adopted computerized interventions for pharmacists. One recommendation put across was the need for the CPOE systems to look in to prophylaxis and dosing errors as well as those recorded to arise from monitoring systems (Nebeker, et. al, 2005). This can be achieved through setting of benchmark standards through automation strategies.

The use of barcode systems in the administering of medication provides data on dosages as well as enhancing effectiveness for as prescribed medication to be entered as computerized programs such as for medical titration for diabetes patients who need insulin or pain relievers such as narcotics (Nebeker, et. al, 2005). Checks and balances for drug orders should also be revised to place less emphasis drug-drug interactions that are known to be rare and place more emphasis on interactions arising from common drug to drug relationships.

According to an article titled “Security Concerns In E-Prescribing” published in the Review of Business Information Systems journal, 2011, the National Association of the boards of Pharmacy (NABP)  e-prescribing is intended to ensure that the correct medication get to the intended patient at the expected time (Nataraj, 2011). Electronic prescribing (e-prescribing) is defined as the process of using digital means to send prescriptions to pharmacies directly from a medical practitioner to a registered pharmacist. It has brought about the enhancement of safety as well as improving the efficiency in the use of medication (Nataraj, 2011). E-prescribing systems have the potential to reduce adverse drug events experienced by outpatients through the provision of automated warning alerts where medical information on outpatients is updated at the moment of e-prescribing.

E-prescribing involves the medical practitioner as the e-prescription creator, traffic director and the pharmacist as the end receiver. The patient is centrally to the entire process as the system is there to serve him or her. A physician will use a digital device such as a desktop, laptop, PDA to get access to the system (Nataraj, 2011). The physician will enter the patients name in the system, assess the patient’s medication list and search the pharmacy data base for medication to be prescribed. In the system provides the physician with drug information, interactions between various drugs as well as insurance coverage. The patient has the ability to choose the location he or she intends to collect the medication.

Security concerns arise from the inherent possibility of hackers infiltrating information in the system to access patient information which can be used for fraudulent activity. The US Congress passed into law the 1996 Health Insurance and Portability and Accountability Act in an to ensure that patient information is protected in the best possible way (Nataraj, 2011). This law set the standards necessary to ensure a stable, effective and secure health information system.

 However, a report “E-Prescribing Grows Quickly, Suffers from Data Problems” provides further insights to the challenges being experienced by pharmacists and other stakeholders in the healthcare industry with regard to the adoption of new digital technologies (Reinke, 2011). Such challenges have been attributed to problems emanating from prescribers according to expert analysis from the American Pharmacists Association (APhA). A study carried out by the Center for Health Systems Change point out the physician, referred to as prescribers in this report fail to follow procedures set in preparing e-prescriptions as they tend to bypass important features with regard to digital health records which are essential in facilitating patient care (Reinke, 2011).

Surescripts, a company that directs traffic from prescribers to pharmacists reported that the numbers in e-prescribing information increased rapidly in 2011 where when compared to the volume of transactions in 2009, there was a 22% increase (Reinke, 2011). This growth has been realized notwithstanding concerns as to the functionality of the entire system and data accuracy as it is sent through the system. According to the Center for Health Systems Change, two factors undermined the ability by doctors to use the facility to offer better and faster health services to patients. These included cumbersomeness of the digital devices in displaying historical medical data or the rapid decay in posted patient data. These shortcomings are as a result of features that fail to fit into doctor workflow schedules (Reinke, 2011). Pharmacists on the other hand describe challenges faced in using the e-prescribing system as due to disparities arising from overpopulation of patient data from the doctor’s end all over the pharmacists’ records database with information moving to and fro such that data fields fail to match. Errors arising from such challenges result in wrong patient or drugs implying that information from a doctor may have to be input all over again. This presents challenges in medication reconciliation for pharmacists as a result of duplicated prescriptions records arising from adjudicated claims figures and data from health plans (Reinke, 2011).

Challenges in effective implementation of electronic prescribing are consistent with first generation software. Improved connectivity translated to the reduction of current challenges. Prescription clearinghouses are migrating into more stable exchanges dedicated to health information with the capacity to accommodate digital medical data (Reinke, 2011). This will imply that pharmacy electronic health records will improve dispensing abilities for pharmacies which will enable more comprehensive medical reconciliation.

According to the report titled “Pharmacy implementation of HIT. Health information technology: A new world for pharmacy.” This report was published in the Journal of the American Pharmacists Association in 2010 and commended pharmacists for being at the fore front of adopting new digital technology more so with the implementation of Health Information Systems (HIT) (Webster & Spiro, 2010). Professional pharmacists boast good experience in diverse types of computer software systems.

A challenge likely to face pharmacists will result from the need to adapt to present software systems which call for an interoperability with other professionals within the healthcare sector. As much as that a relatively low number of pharmacies presently have computer software systems which are integrated to work with other HIT systems, there exists a number of ‘off the shell, solutions readily available at pharmacy management systems vendors. These software systems offer pharmacists the ability to integrate into current PMS for drug database management, e-prescribing as well as electronic health records (Webster & Spiro, 2010).

The journal also recommends that large community chain pharmacies send cash purchases data from patients to Surescripts so that data can be input to improve patient history data for purposes of e-prescribing (Webster & Spiro, 2010). Such recommendations present pharmacists with the need to fully implement a host of digital processes so as to conform to the contemporary health care environment. It is therefore imperative that pharmacists should closely work with PMS developers and vender to allow for better technical integration development for software solutions built with the pharmacist’s workflow in mind. In their daily operations, pharmacists have to utilize the PMS so as to digitally make communications with fellow healthcare providers (Webster & Spiro, 2010). Such e-communication requires seamless connectivity through flexible interfaces to ensure efficiency and effectiveness.

A report titled “New technology changing R.Ph.s, not just workplace,” appreciates the fact that the application of robotics technologies and pill counting innovations have led to a better provision of pharmaceutical services by retail pharmacies (Sipkoff, 2007). Pharmacy in itself is a rather complex profession and the main goal of automating some of the procedures carried out by pharmacists is to simplify such procedures. Systems available for use by pharmacists have been very efficient for the past 2 decades but are this time around being developed pharmacy management systems are being developed to adopt more sophisticated features such as robotics (Sipkoff, 2007).

At present, there are a number of organizations developing automated systems which have integration capabilities necessary to serve the smaller autonomous pharmacies as well as the large chain pharmacies. The Thomsen group is said to value robotic dispensing units at $100,000 with the most expensive unit going for $250,000 (Sipkoff, 2007). The application of digital technologies in pharmacies has greatly improved operational efficiency and effectively improved on patient care. A pharmacy which estimates to fill an average of 400 prescriptions daily can through the use of an automated medical care system effectively enhance prescription filling as well as prescription location times  (Sipkoff, 2007). This implies that pharmacy owners intending to honor the needs of America’s ageing population will continue to effectively automate their operations with pill counting technologies, innovative robotics as well as centralized fulfillment facilities which will include digital workflow systems. This has played an important role in ensuring that patient care is enhanced through effective and efficient services which are both correct, for the right patient and are received at the needed time  (Sipkoff, 2007).

In a dissertation titled “Explaining pharmacists’ intentions to use personal digital assistants as clinical resources during patient care” interventions pharmaceutical care is referred to as the philosophical practice in pharmacies such that pharmacists feel a greater sense of professional as well as personal responsibility with regard to how their health care roles affect patient outcomes (Fox, 2005). Medication intervention documentation is one of the means used to ensure professional responsibility for patient healthcare as require in pharmaceutical technology. The personal digital assistant (PDA) was a revolutionary technological device introduced in the 90’s. PDAs were quickly adopted by pharmacists as an innovative way for recording interventions (Fox, 2005).

The PDA is a touch sensitive device operated with the use of a stylus pen. It is both light and handheld making it portable making it quite effective in recording interventions as and when they occur (Fox, 2005). It is preloaded with software referred to as personal information manager with features such as a calendar, address book and memo pad. It also has the ability to accommodate other software such as internet browsers, a generic form of Microsoft office as well as expense tracking programs (Fox, 2005).

This report goes on to define clinical pharmacists as those who work collaboratively with other healthcare providers such as in a hospital setting. Several methods for ensuring that medication interventions were properly documented arose with the acceptance of digital technologies such as personal computers, bar code readers and scanners, intranets, local area networks, pharmacy and hospital records as well as electronic medical records (Fox, 2005). Adoption and use of these new technologies greatly increased the volume of documented interventions which with the use of intranets and computer mainframes improved the retrieval and access of this information. This greatly improved the efficiency of healthcare providers including pharmacists greatly improving the quality of patient quality of life (Fox, 2005).

In the paper titled “On-Line Pharmacies: E-Strategy and Supply Chain for Pharmaceutical Products,” contends that the resultant effect from online pharmacies will be far much on informal supply chain as compared to the supply chain for physical pharmaceutical products. This will require for strategies that will allow online pharmacies to focus on providing information to customers while also putting up internet and website features to ensure competitiveness.

It is important to note that online pharmacies will cause a profound change in pharmaceutical products supply chain. Information flow will enhance interactions between medical practitioners and pharmacists, pharmaceutical companies and patients as well as between pharmaceuticals and patients through e-commerce operations. The internet is a primary source of information for every product and service. Online pharmacies depend on how well informed patients are informed about the products on sale. The online environment is endowed with resources to help in the access information needed to understand the suitability of a drug to treat an ailment. FAQ sections, search engines as well as online communication with support staff through internet chat rooms is one of the ways online pharmacies and patients communicate on drugs on offer. Pharmacists on the other hand will set up information requests links on their websites where patients can seek professional advice given in a professional manner.

It is important to note that the internet is home to both authentic online pharmacies as well as rogue pharmacies which swindle patients as they have no ethical code to play by. As such, a study conducted in the US has shown that security levels have a relatively high level of vulnerability, interface design and privacy management. These are however, expected shortcomings of the internet as it continues to develop and mature putting checks and controls to mitigate such challenges.

According to an article titled “How do new technologies impact on workforce organization?” accessed for www.skillsforhealth.org.uk innovative technical, communication and information technologies have resulted in the development of innovative work processes and more conclusive research in the field of medical healthcare (www.skillsforhealth.org.uk. 2011). All through this paper, literature reviews have been centered round how such technologies have enabled pharmacists to be more effective towards improving patients’ quality of life.

In the UK, studies as to the impact of technology in the healthcare setting have shown that medical staffs are failing to apply new technologies in a structured manner (www.skillsforhealth.org.uk. 2011). Reasons for such outcomes may be compounded by factors such as time, technological knowhow, human factors, inadequate information and access to materials as well as financial constraints. The impact of every new technology has its own discrete challenges, advantages and disadvantages. It is important to remember that pharmacists are in many occasions in the fore front of adopting new technologies (www.skillsforhealth.org.uk. 2011). In as much as this is always a step in the right direction, major challenges arise. Common challenges include time taken to adapt to new technologies, resistance to change, as well as practical implementation pitfalls all which need to be addressed concurrently.

Conclusion

The introduction of new technologies calls for some radical changes in the workplace for such initiatives to bring about the desired impacts. These changes include people re-engineering and the formulation of processes which will encourage an exponential increase technology value in the healthcare setting such that operational costs fall to encouraging levels compared to those before new technology was employed. Technology has thus become an integral part for healthcare retransformation. Such that leadership improves, there is better accountability for financial resources, organizational relationships as well as personal relationships are positively transformed.

 

 

References:

Fox, B. I. (2005). Explaining pharmacists’ intentions to use personal digital assistants as clinical resources during patient care interventions. Retrieved March 12, 2013 from http://etd.auburn.edu/etd/bitstream/handle/10415/1106/FOX_BRENT_19.pdf

Hilde, U. (2008). Implementing technology to improve medication safety in healthcare facilities: A literature review. Journal of the New York State Nurses Association, Fall/ Winter 2007-2008.

Landry, B. & Mahesh, S. (2005). On-line pharmacies: E-strategy and supply chain for pharmaceutical products. Retrieved March 12, 2013 from http://www.academia.edu/1342308/ON-LINE_PHARMACIES_E-STRATEGY_AND_SUPPLY_CHAIN_FOR_PHARMACEUTICAL_PRODUCTS

Nataraj, S. (2011).Security Concerns In E-Prescribing. Review of Business Information Systems–First Quarter 2011 Volume 15, Number 1. Retrieved March 11, 2013 from http://journals.cluteonline.com/index.php/RBIS/article/view/3994/4047

Nebeker, J. R., Hoffman, J. M., Weir, C. R., Bennett, C. L. and Hurdle, J. F. (2005). High Rates of Adverse Drug Events in a Highly Computerized Hospital. Arch Intern Med. 2005;165(10):1111-1116. doi:10.1001/archinte.165.10.1111. Retrieved March 11, 2013 from http://archinte.jamanetwork.com/article.aspx?articleid=486572

Perras, C., Jacobs, P., Boucher, M., Murphy, G., Hope, J., Lefebvre, P., McGill, S. and Morrison, A. (2009). Technologies to Reduce Errors in Dispensing and Administration of Medication in Hospitals: Clinical and Economic Analyses. (Technology report; no.121]. Ottawa: Canadian Agency for Drugs and Technologies in Health 2009. Retrieved March 11, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411151/

Reinke, T. (2011). E-Prescribing Grows Quickly, Suffers From Data Problems. Retrieved March 11, 2013 from http://www.managedcaremag.com/archives/1106/1106.medmgmt.html?page=7

Seger, A. C., Churchill, W. W., Keohane, C. A., Belisle, C. D., Wong, S. T., Sylvester, K. T.,  Chesnick, M. A., Burdick, E., Wien, M. F., Cotugno, M. C., Bates, D. W., and Rothschild, J. M. (2012). Impact of Robotic Antineoplastic Preparation on Safety, Workflow, and Costs. Journal of Oncology Practice. Retrieved March 11, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500478/

Sipkoff, M. (2007). New technology changing R.Ph.S, not just workplace. Retrieved March 12, 2013 from http://drugtopics.modernmedicine.com/news/new-technology-changing-rphs-not-just-workplace?id=&sk=&date=&pageID=3

Webster, L. & Spiro, R. F. (2010). Pharmacy implementation of HIT .Health information technology: A new world for pharmacy. Journal of the American  Pharmacists Association. 2010;50:e20-e34. doi:10.1331/JAPhA.2010.09170. Retrieved March 11, 2013 from http://japha.org/article.aspx?articleid=1043709

 www.skillsforhealth.org.uk. (2011). How do new technologies impact on workforce organization? Skills for health. Retrieved March 12, 2013 from http://www.skillsforhealth.org.uk/component/docman/doc_view/1834-how-do-new-technologies-impact-on-workforce-organiastion-082011.html

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