Posted on March 15, 2015 in: Pharmacy Technology
by Brian DeSmet, Pharm.D., M.S., MSHP Pharmacy Informatics and Technology Committee, and Sanjeev Kumar, MHSA, Henry Ford Hospital
Implementation of an entirely paperless electronic health record (EHR) is a vast undertaking for a health system. In order for the process to be successful, it requires months of planning, weeks of coordination, and hours of communication. In addition, did I mention that it takes blood, sweat and tears? Henry Ford Health System (HFHS) began this journey in late December 2012, implementing its new EHR in select outpatient services. The first of four system hospitals was brought online in August 2013 and all Henry Ford sites were live by May 2014. Having such a demanding timeframe for rolling out something that affects every patient and employee in a health system was ambitious, to say the least. It could not have been done without an extraordinary amount of teamwork between all parties involved: remote vendor support staff; on-site vendor implementation teams; key representatives from clinical, operational, IT infrastructure and administrative teams; and ‘boots on the ground’ end users.
The concept of an EHR was nothing new to clinicians at HFHS. Prior to the current EHR, the system had been using home-grown electronic record-keeping software called ‘CarePlus Next Generation’ (CPNG). CPNG’s primary purpose was serving as a repository for clinical information related to patients’ stay at the hospital, of which the most important to pharmacy included all inpatient and outpatient medications a patient received. The software was basic and relative to the new EHR, simpler in its database design and stored information with far fewer data tables on the back-end. This posed continued and significant challenges in terms of reporting as well as fell short of meeting stricter compliance laws and meaningful use requirements. To address these problems, HFHS made a large capital investment to purchase Epic from Epic System Corporation of Wisconsin. With Epic, the system has been able to identify, record and track many of the metrics that earlier were extremely cumbersome to do, if not impossible. Previously, many of these activities would require manual recording by personnel who could otherwise be providing direct patient care.
Pharmacy IT Infrastructure in an EHR World
Comparable to other available ‘all-encompassing’ EHR systems like Cerner, VistA, Allscripts or Eclipsys, Epic enables us to track a medication from the time it was ordered to when it was verified, dispensed and later administered. This seamless tracking of medication orders has helped us identify aspects of our drug delivery process related to wasteful spending and allowed us to decrease operational overhead costs. The data obtained out of Epic has also led to many performance improvement projects, which has allowed our Pharmacy Department to increase the overall efficiency in many functional areas. One such example is a comparison of oral and intravenous antibiotics for outpatient extended spectrum beta-lactamase urinary tract infections, utilizing laboratory, microbiology results and ICD-9 diagnosis. Another example is gauging pharmacists’ performance and contribution to the clinical team through assessment of specialized progress notes. Both of these projects became much easier to analyze due to the integration of all necessary information in one place that is the hallmark of an EHR.
Concept of a Health-System Pharmacy
Another powerful element Epic has provided to the pharmacy leadership is the ability to look at pharmacy from a ‘system perspective.’ This does manifest as a major undertaking, however, the resulting outcomes may improve the financial bottom line. We can now track orders from across the entire system, across multiple hospitals and across the ambulatory patient care area, and link them to other key variables as well. These variables such as length of stay and number of readmissions, when tied with medication orders, can help pharmacy learn more about where it is having the maximum impact and, more importantly, identify service areas where closer attention is needed.
Due to ever-tightening health care budgets on the horizon and the need to provide the most cost-effective care to our patients, it’s no surprise that health systems nationwide have begun to adopt some sort of electronic record keeping system. Government financial incentives and penalties for noncompliance almost make the decision a no-brainer. Regardless of which EHR is in place or coming to your institution, the potential benefits that can be obtained with truly integrated, cohesive data such as improved accuracy in medication delivery through barcode technology, enhanced patient participation in their own care through web-based portals and multidimensional reporting capabilities, far outweigh the alternative.