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Hospital technology efforts will increase in coming years
Federal funding will give giant push
Hospitals across the United States are expected to increase their investments in electronic medical records and other new technology as they absorb the new federal stimulus package funds.
The American Recovery and Reinvestment Act, signed by President Barack Obama on Feb. 17, 2009, provides $1.5 billion to health centers for construction, renovation, equipment, and the acquisition of health information technology systems.1
But even without the added incentive, hospitals and their pharmacies have been moving in that direction, experts say.
U.S. hospital pharmacies increasingly have adopted a variety of new technologies in recent years, according to a new national survey by the American Society of Health-System Pharmacists (ASHP) in Bethesda, MD.2
For instance, 44% of hospitals responding to the ASHP survey reported using smart pump technology, and 24% reported use of barcode administration, says Karl F. Gumpper, BSPharm, BCNSP, BCPS, FASHP, director of the section of pharmacy informatics and technology at ASHP.
While the use of these technologies definitely is on the rise, they still lag far behind the increasingly ubiquitous use of automated dispensing cabinets, which an estimated 83% of U.S. hospitals now have, Gumpper notes.
"Of hospitals with less than 50 beds, about 75% use automated dispensing cabinets," he adds. "But among the hospitals with greater than 800 beds, 100% use them."
The ASHP survey found that only about 12% of respondents used computer physician order entry (CPOE), Gumpper notes.
"The issue with CPOE is you need a large, multidisciplinary process to make it happen," he explains. "This includes educating pharmacists, nurses, physicians, nurse practitioners, and physician assistants on how to use the system and how to create orders for everything — not just medication."
The infrastructure complexity makes this type of technological endeavor more difficult and somewhat dependent on whether the hospital employs physicians or contracts with them, Gumpper adds.
Now that the reinvestment act likely will motivate more hospitals to move toward CPOE and more fully integrated electronic medical records, hospitals will need to establish protocols and implementation programs to make certain employees are on board with technological changes.
"If you look at why information technology projects don't succeed, there are a lot of shortcomings early on," says John Manzo, BS, PharmD, FASHP, managing consultant with IBM Healthlink Solutions of Armonk, NY.
"Maybe you didn't identify 'Gotchas' or understand how new technology was going to affect your staff or workflow," Manzo explains.
Often the problems with technological change are not that a health system needs more machines or a wireless system, but that there is a need for the organization's culture to transform, he adds.
"The staff is so resistant to change that they won't accept it," Manzo says. "Those cultural issues tend to be tougher to identify and mitigate than the other problems of not having enough printers or devices."
This is why hospital pharmacies first need to assess their organization's readiness for any major technology change.
"When implementing a project it's important that you have a good scope and definition of what you're going to do in your project," says Michael D. Schlesselman, PharmD, FASHP, director of information technology program management at Lawrence & Memorial Hospital in New London, CT.
"So as you go along in your project you won't develop scope-creep and find that you can never get it implemented," Schlesselman says. "You have to make sure everybody agrees up front with what you're going to implement."
Hospital pharmacists should make sure that any technology change involves a collaboration of pharmacists and nurses, he notes.
"They both need to be working toward the same goal so it's not just a nursing-driven project or a pharmacy-driven project," Schlesselman adds. "You need to make sure you have a commitment and buy-in by both groups."
Hospital professionals have a main goal of taking care of patients and trying to get their work done as efficiently and as safe as possible, Gumpper notes.
"By putting technology in the mix we have to be careful we don't totally disrupt their workflow," he explains. "And if we have a bad process to begin with, and we throw technology on top of it, then we have to make sure the technology will fix the problem."
This is why it might be a good thing that the adoption of technology is slower in health care than in other industries, Gumpper adds.
"I think that means we're stepping back and making sure that what we do implement is done in a safe and effective manner," he says.
The ASHP technology survey found that hospital progress toward electronic medical records (EMRs) is incremental.
Of the responding hospitals, nearly 43% have partial EMR, while 5.9% have complete EMR.2
Although 90.7% have pharmacists view the complete EMR, only 56.7% of hospitals with EMR allowed pharmacists to document in the electronic record, which means its use in facilitating communication between health care practitioners could be improved.2
Similarly, among the nearly 21% of hospital respondents that have ePrescribing systems, only 37% of these systems made clinical patient information beyond the electronic prescription available to outpatient pharmacies.2
The survey also found that about 10% of responding hospitals used a robotic distribution system that automates the dispensing of unit-dose inpatient medications in a centralized distribution system.2
The use of robotics varied according to the hospital's type. For instance, Veterans Affairs hospitals, general hospitals, and children's medical-surgical hospitals with 200 or more beds were most likely to have a robot.2
Hospitals that have the resources to implement robotic automation for preparing IV medications typically will use the technology, Gumpper says.
"There are a lot of different types of automation and robotics that hospitals are using," he says.
Overall, ASHP's research shows that even smaller hospitals are implementing some forms of technology.
"One thing we noticed within the survey was that barcode administration seemed to have a higher uptake in implementation in some smaller hospitals, and CPOE had better uptake in larger hospitals," Gumpper says.
"We don't have a good explanation for that," he adds. "The presumption is that the number of medications dispensed at larger hospitals on a daily basis is a large number, and, therefore, the repackaging and relabeling that has to go with barcode administration might be a lot for some pharmacies to deal with at the start."
Although the survey paints a point-in-time picture of how well U.S. hospitals are using advanced technologies, it's difficult to predict how quickly continued technological changes will take place.
"Health care is difficult in the sense that you're balancing the role-out of technology with changing scientific knowledge," Gumpper says. "And you need to make sure you balance those discoveries with the technology you're implementing."