NLMA
members recently received a President's
Letter regarding the proposed Newfoundland and Labrador Pharmacy
Network being planned by the Newfoundland
and Labrador Centre for Health Information. Previous articles
about the Pharmacy Network in Nexus have concentrated on what a
province-wide pharmacy information system is and the planning
process NLCHI is undertaking. In the most recent issue the emphasis
has been placed on how the Pharmacy Network will help physicians
provide better patient care because of the improved information they
will have about each patient.
Drugs that are prescribed, dispensed and
consumed appropriately are one of the most cost-effective
interventions available in today's health care system. They enable
patients to remain active, avoid hospital stays and maintain
productivity. Building the Pharmacy Network will enhance the quality
of care provided by physicians and other health care providers,
facilitate accountability, assist in cost containment of
prescription drugs and improve the ability to measure the outcomes
of care.
The
Pharmacy Network
The Pharmacy Network is a provincial
pharmacy information network which will offer on-line, real-time,
province wide patient drug usage profiles, as well as a
comprehensive drug information and interaction database. The network
will operate 24 hours a day, 7 days a week, supporting prescribers
and pharmacists through authorized access to medication histories
and providing decision support tools to improve the delivery of
medication therapy.
The
Pharmacy Network will offer clinical, educational, administrative
and financial benefits. Authorized health care providers will use
the Pharmacy Network through a secure Intranet application. The
system will reduce the risks of misused medications. The proposed
categories of information to be maintained in the pharmacy network
include:
- Patient drug profiles
including all drugs dispensed and the ability to record over the
counter and natural medications
- Allergies
- Patient clinical
conditions (diagnoses)
- Patient demographics
including Unique Personal Identifier (UPI), name, address,
gender and date of birth
- Patient Demographics
include accurate MCP number and eligibility
- Drug information
resources
Functionality
The Pharmacy Network will link doctors,
hospitals, pharmacists and other authorized health stakeholders
together into an electronic data network. Proposed functionality
includes:
- On-line comprehensive
active medication profile
- Electronically supported
prescriptive service
- Prescription monitoring
program supported on-line
- Drug interaction
checking
- Contra-indication
checking
- Best choice drug
suggestions
- Adverse drug event
recording
- On-line drug monographs
- On-line provider lookup
and
- On-line patient lookup
Health
Benefits
The Pharmacy Network will be used by health
care providers to deliver better care and provide increased patient
safety. The Pharmacy Network will support health care providers in
making better medication choices, counselling on the use of
medications, reduction of medication errors and other ways.
Better Medication Choice
Access to each patient's complete medication
profile including over-the-counter and, natural medications,
immunizations and sample medications will:
- Help prevent duplicate
medications
- Help prevent drug
interactions
- Help detect missed
medications
- Help alleviate the
reliance on patients' memory and interpretation of their
medications
Better Counselling on
the Use of Medication
The Pharmacy Network will provide the tools
to better counsel patients on how to use medications.
- Drug information,
including natural medications and antidotes for poisonings, will
be readily available, allowing for consistent and holistic
counselling and avoidance of patient confusion
- Complete medication
profiles will allow for faster detection of potential misuse,
such as unfilled prescriptions or prescriptions that are
refilled too early
Reduction of Medication
Errors
- Helps health care
providers avoid errors due to misunderstandings
- Provides universality of
medication information
- Provides seamless
movement of medication information across traditional health
care boundaries, i.e. institution to community clinic
- Facilitates patient
transfer between health care facilities throughout the
province
- Provides medication
information in situations where the patient cannot communicate,
i.e. intoxication, coma, confusion, etc.
- Helps health care
providers to overcome the challenges of an unreliable system of
paper-based prescriptions
- Medication orders
will be in a clear and legible form
- Instant drug
interaction, allergy and dose checking
In
addition to the health benefits, the Pharmacy Network will enable
accountability and administrative efficiencies such as:
Trial Prescription
Program
The purpose of a Trial Prescription Program
is to reduce the incidence of drug-related problems and minimize
medication waste through increased patient monitoring and follow-up.
The program allows the physician to order or the pharmacist to
dispense a limited quantity of a prescribed medication to the
patient and have it recorded in the patient's profile. The trial
period of seven to ten days is used to evaluate the patient's
tolerance to the medication. The limited quantity dispensed allows
the patient to try the medication without the purchase of the entire
prescription. If the medication agrees with the patient, the balance
of the prescription is dispensed in the usual manner.
Reasons to implement a trial prescription
program include:
- Improving the health of
patients by decreasing the incidence of drug related side
effects and intolerance of medications
- Enhancing the role of
health care providers through increased patient monitoring and
increased communication between the prescribers and the
pharmacist
- Acting as a cost saving
measure to minimize drug wastage
Decrease in
Hospitalization Due to Adverse Drug Events
The definition of an adverse drug event (ADE)
is an event or circumstance involving a patient's drug treatment
that actually or potentially interferes with the achievement of an
optimal outcome. It includes poor compliance, inappropriate
self-medication, inappropriate prescribing and drug interactions.
Adverse drug events account for 2% to 11% of
all hospital admissions each year and this increases to 28% for
people aged 65 and older. It has been estimated that 1%-4% of all
visits to emergency rooms are due to inappropriate use of
medications.
The most common cause of an adverse reaction
is linked to failure to disseminate drug knowledge. The Pharmacy
Network will provide an efficient reduction of the incidences of
ADEs by enhancing the collection, organization, retrieval and
display of data.
Seamless Care
The most important element in the provision
of seamless care is an efficient and accessible information system.
Errors are made in patient care because not all members of the
health-care team have access to updated, patient-specific
information.
One potential target group for a seamless
care model is the elderly as they are more susceptible to ADEs
because of their decreased ability to tolerate incorrect dosages.
Currently, 10% of all admissions to the emergency room and 28% of
all hospital admissions of the elderly are directly related to drug
noncompliance and drug misadventure. In many cases making their
medication profiles available can prevent this.
Benefits
as an Applied Research Tool
The Pharmacy Network has enormous potential
as a complement to clinical trials. Analyses of pharmacy databases
have been used to monitor medication use, to study disease
prevalence or incidence and to monitor inappropriate under- or
overuse of medications. Accurate information on drug costs and
utilization can be analyzed to assess patterns of drug use as well
as the economic health-related effect of changes in medical or drug
therapy.
Professional
Benefits
The Pharmacy Network will support an
environment of teamwork and enhanced scope of practice,
including:
- Access by authorized
health care providers to patient medication information from
various sites of practice
- Reduction in unnecessary
interruptions for medication order clarifications
- Future linkages with
other components of the Electronic Health Record
Electronic
Prescribing
A fully implemented Pharmacy Network will
enable physicians to enter and transmit medication orders on-line.
This is a powerful tool for preventing medication errors due to
misinterpretation of hand-written orders. It can ensure that the
dose, form and timing are correct and can also check for potential
drug-drug or drug-allergy interactions.
Drug choice becomes more efficient as
regimens and guidelines are available on-line and can be
instantaneously updated. Evidence suggests that physicians will
significantly improve their ordering practices in response to
electronically delivered recommendations.
Next
Steps in Building the Electronic Health Record
The Pharmacy and laboratory functions of the
Electronic Health Record are intimately related. For example,
abnormal renal or hepatic laboratory results often necessitate
altering drug regimens. Many medications require laboratory
monitoring, the results of which have an impact on subsequent
prescribing. NLCHI's business plan includes implementing information
systems for laboratory and diagnostic imaging functions as part of
the Electronic Health Record.
The Pharmacy Network, if approved by the
provincial government, will be implemented in stages that will see
some of the benefits early in its development and others over a
longer timeframe.
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