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Trenfield SJ, Awad A, McCoubrey LE, Elbadawi M, Goyanes A, Gaisford S, Basit AW. Advancing pharmacy and healthcare with virtual digital technologies. Adv Drug Deliv Rev 2022; 182:114098. [PMID: 34998901 DOI: 10.1016/j.addr.2021.114098] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/07/2023]
Abstract
Digitalisation of the healthcare sector promises to revolutionise patient healthcare globally. From the different technologies, virtual tools including artificial intelligence, blockchain, virtual, and augmented reality, to name but a few, are providing significant benefits to patients and the pharmaceutical sector alike, ranging from improving access to clinicians and medicines, as well as improving real-time diagnoses and treatments. Indeed, it is envisioned that such technologies will communicate together in real-time, as well as with their physical counterparts, to create a large-scale, cyber healthcare system. Despite the significant benefits that virtual-based digital health technologies can bring to patient care, a number of challenges still remain, ranging from data security to acceptance within the healthcare sector. This review provides a timely account of the benefits and challenges of virtual health interventions, as well an outlook on how such technologies can be transitioned from research-focused towards real-world healthcare and pharmaceutical applications to transform treatment pathways for patients worldwide.
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Perera UT, Heeney C, Sheikh A. Policy parameters for optimising hospital ePrescribing: An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development. Digit Health 2022; 8:20552076221085074. [PMID: 35340903 PMCID: PMC8941697 DOI: 10.1177/20552076221085074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Electronic prescribing systems offer considerable opportunities to enhance
the safety, effectiveness and efficiency of prescribing and medicines
management decisions but, despite considerable investments in health IT
infrastructure and healthcare professional training, realising these
benefits continues to prove challenging. How systems are customised and
configured to achieve optimal functionality is an increasing focus for
policymakers. We sought to develop an overview of the policy landscape
currently supporting optimisation of hospital ePrescribing systems in
economically developed countries with a view to deriving lessons for the
United Kingdom (UK). Methods We conducted a review of research literature and policy documents pertaining
to optimisation of ePrescribing within hospitals across Organisation for
Economic Co-operation and Development (OECD) countries on Embase, Medline,
National Institute for Health (NIH), Google Scholar databases from 2010 to
2020 and the websites of organisations with international and national
health policy interests in digital health and ePrescribing. We designed a
typology of policies targeting optimisation of ePrescribing systems that
provides an overview of evidence relating to the level at which policy is
set, the aims and the barriers encountered in enacting these policies. Results Our database searches retrieved 11 relevant articles and other web resources
mainly from North America and Western Europe. We identified very few
countries with a national level strategy for optimisation of ePrescribing in
hospitals. There were hotspots of digital maturity in relation to
ePrescribing at institutional, specialisation, regional and national levels
in the US and Europe. We noted that such countries with digital maturity
fostered innovations such as patient involvement. Conclusions We found that, whilst helpful to achieve certain aims, coordinated strategies
within and across countries for optimisation of ePrescribing systems are
rare, even in countries with well-established ePrescribing and digital
health infrastructures. There is at present little policy focus on
maximising the utility of ePrescribing systems.
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Affiliation(s)
- Uditha T Perera
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Catherine Heeney
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
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Zheng WY, Lichtner V, Van Dort BA, Baysari MT. The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Res Social Adm Pharm 2020; 17:832-841. [PMID: 32891535 DOI: 10.1016/j.sapharm.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Technology in the form of Automated Dispensing Cabinets (ADCs), Barcode Medication Administration (BCMA), and closed-loop Electronic Medication Management Systems (EMMS) are implemented in hospitals to assist with the supply, use and monitoring of medications. Although there is evidence to suggest that these technologies can reduce errors and improve monitoring of medications in general, little is known about their impact on controlled medications such as opioids. OBJECTIVES This review aimed to fill this knowledge gap by synthesising literature to determine the impact of ADCs, BCMA and closed-loop EMMS on clinical work processes, medication safety, and drug diversion associated with controlled medications in the inpatient setting. METHODS Eight databases (Medline, Pubmed, Embase, Scopus, Web of Science, PsycINFO, CINAHL, and ScienceDirect) were searched for relevant papers published between January 2000 and May 2019. Qualitative, quantitative, and mixed-methods empirical studies published in English that reported findings on the impact of ADCs, BCMA and/or closed-loop EMMS on controlled medications in the inpatient setting were included. RESULTS In total, 16 papers met the inclusion criteria. Eleven studies reported on ADCs, four on BCMA, and only one on closed-loop EMMS. Only four studies focused on controlled medications, with the remainder reporting only incidental findings. Studies reported the elimination of manual end-of-shift counts of controlled medications after ADC implementation but cases of drug diversion were reported despite introducing ADCs. Three quantitative studies reported reductions in medication errors after implementing BCMA, but medications labelled with wrong barcodes and unreadable barcodes led to confusion and administration errors. CONCLUSIONS More quality, targeted research is needed to provide evidence on the benefits and also risks of implementing technology to safeguard against inappropriate use of controlled medications in the inpatient setting. Processes need to be in place to supplement technological capabilities, and resources should be made available for post-implementation evaluations and interventions.
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Affiliation(s)
- Wu Yi Zheng
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Charles Perkins Centre, Sydney, New South Wales, Australia.
| | - Valentina Lichtner
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia; Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Bethany A Van Dort
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences, Charles Perkins Centre, Sydney, New South Wales, Australia
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Alexander E, Butler CD, Darr A, Jenkins MT, Long RD, Shipman CJ, Stratton TP. ASHP Statement on Telepharmacy. Am J Health Syst Pharm 2017; 74:e236-e241. [DOI: 10.2146/ajhp170039] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | | | | | - Colleen J. Shipman
- Department of Pharmacy, Oregon Health and Science University, Portland, OR
| | - Timothy P. Stratton
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, MN
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Ratwani R, Fairbanks T, Savage E, Adams K, Wittie M, Boone E, Hayden A, Barnes J, Hettinger Z, Gettinger A. Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation. Appl Clin Inform 2016; 7:1069-1087. [PMID: 27847961 PMCID: PMC5228144 DOI: 10.4338/aci-2016-06-r-0105] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/27/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. MATERIALS AND METHODS Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. RESULTS We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. DISCUSSION Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. CONCLUSION Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation.
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Affiliation(s)
- Raj Ratwani
- Raj Ratwani, PhD, National Center for Human Factors in Healthcare, MedStar Health, Washington D.C.,
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Truitt E, Thompson R, Blazey-Martin D, NiSai D, Salem D. Effect of the Implementation of Barcode Technology and an Electronic Medication Administration Record on Adverse Drug Events. Hosp Pharm 2016; 51:474-83. [PMID: 27354749 DOI: 10.1310/hpj5106-474] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospitals have attempted to reduce adverse drug events (ADEs) by investing in new technologies, but data regarding their efficacy are lacking. OBJECTIVES This study evaluates the effects of the implementation of barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on the profile of ADEs in a hospital setting. METHODS We conducted a before-and-after study examining the effects of the implementation of BCMA and eMAR technology on the profile of ADEs at a 400-bed academic medical center by using incident reports. We compared reported ADEs in pre- and post-implementation periods of 5 months to determine whether there was a reduction in the rate of ADEs within medication use phases. We further examined the severity of errors and described changes in the distribution of types of errors. RESULTS A total of 775 electronic error-reporting system reports were included in this study: 397 (51%) in the pre-implementation period and 378 (49%) in the post-implementation period. The rate of ADEs significantly decreased from 0.26% to 0.20% after implementation of the technology (relative risk [RR], 0.78; 95% CI, 0.67-0.89). The rate of transcription errors decreased from 0.089% to 0.036% (RR, 0.40; 95% CI, 0.30-0.54), which was largely attributed to reduction of "wrong time" errors. The rate of administration errors was identical in both groups at 0.017% (RR, 0.98; 95% CI 0.58-1.66). The mean severity level of administration errors significantly decreased from 4.44 to 3.23 (p = .005). CONCLUSION The implementation of eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors. These technologies also reduced the harmful impact to patients caused by administration errors.
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Huang YH, Gramopadhye AK. Recommendations for health information technology implementation in rural hospitals. Int J Health Care Qual Assur 2016; 29:454-74. [DOI: 10.1108/ijhcqa-09-2015-0115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to investigate violations against work standards associated with using a new health information technology (HIT) system. Relevant recommendations for implementing HIT in rural hospitals are provided and discussed to achieve meaningful use.
Design/methodology/approach
– An observational study is conducted to map medication administration process while using a HIT system in a rural hospital. Follow-up focus groups are held to determine and verify potential adverse factors related to using the HIT system while passing drugs to patients.
Findings
– A detailed task analysis demonstrated several violations, such as only relying on the barcode scanning system to match up with patient and drugs could potentially result in the medical staff forgetting to provide drug information verbally before administering drugs. There was also a lack of regulated and clear work procedure in using the new HIT system. In addition, the computer system controls and displays could not be adjusted so as to satisfy the users’ expectations. Nurses prepared medications and documentation in an environment that was prone to interruptions.
Originality/value
– Recommendations for implementing a HIT system in rural healthcare facilities can be categorized into five areas: people, tasks, tools, environment, and organization. Detailed remedial measures are provided for achieving continuous process improvements at resource-limited healthcare facilities in rural areas.
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Cochran GL, Haynatzki G. Comparison of medication safety effectiveness among nine critical access hospitals. Am J Health Syst Pharm 2014; 70:2218-24. [PMID: 24296844 DOI: 10.2146/ajhp130067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The rates of medication errors across three different medication dispensing and administration systems frequently used in critical access hospitals (CAHs) were analyzed. METHODS Nine CAHs agreed to participate in this prospective study and were assigned to one of three groups based on similarities in their medication-use processes: (1) less than 10 hours per week of onsite pharmacy support and no bedside barcode system, (2) onsite pharmacy support for 40 hours per week and no bedside barcode system, and (3) onsite pharmacy support for 40 or more hours per week with a bedside barcode system. Errors were characterized by severity, phase of origination, type, and cause. Characteristics of the medication being administered and a number of best practices were collected for each medication pass. Logistic regression was used to identify significant predictors of errors. RESULTS A total of 3103 medication passes were observed. More medication errors originated in hospitals that had onsite pharmacy support for less than 10 hours per week and no bedside barcode system than in other types of hospitals. A bedside barcode system had the greatest impact on lowering the odds of an error reaching the patient. Wrong dose and omission were common error types. Human factors and communication were the two most frequently identified causes of error for all three systems. CONCLUSION Medication error rates were lower in CAHs with 40 or more hours per week of onsite pharmacy support with or without a bedside barcode system compared with hospitals with less than 10 hours per week of pharmacy support and no bedside barcode system.
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Affiliation(s)
- Gary L Cochran
- Gary L. Cochran, Pharm.D., S.M., is Assistant Professor, Department of Pharmacy Practice, College of Pharmacy; and Gleb Haynatzki, Ph.D., is Professor, Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha
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Crawford SY, Schumock GT, Ursan ID, Ursan JD, Walton SM, Donnelly AJ. Comparison of pharmacy services at critical access hospitals and other rural and small hospitals in Illinois. Am J Health Syst Pharm 2014; 70:1313-21. [PMID: 23867488 DOI: 10.2146/ajhp120442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The results of a survey evaluating pharmacy services and technology use at critical access hospitals (CAHs) and other small and rural hospitals in Illinois are reported. METHODS A mail survey was sent to pharmacy directors at 86 CAHs and other rural and small hospitals in Illinois not designated as CAHs. Independent sample t tests and chi-square statistics were used to compare CAHs and non-CAHs in areas such as pharmacy services, staffing, use of technology, and sterile compounding practices. RESULTS The survey response rate was 46.5%, with usable data received from 40 hospitals. Analysis of the survey data indicated that hospitals designated as CAHs were significantly less likely than non-CAHs to have automatic therapeutic interchange policies (p = 0.012) and more likely to conduct pharmacist-provided educational programs on medication costs for physicians and other health care personnel (p = 0.037). Relative to non-CAHs, CAHs were significantly less likely to have automated dispensing cabinets (p = 0.016) and to out-source the preparation of sterile products to offsite vendors (p = 0.012); pharmacy directors at CAHs were less likely to report the use of technology for remote medication order entry or review (p = 0.038). At both types of facilities, pharmacists typically have both distributive and clinical responsibilities, and patient-specific clinical pharmacy services (e.g., patient education or counseling, other drug therapy monitoring, medication reconciliation, pharmacokinetic consultations) are offered at similar frequencies. CONCLUSION A survey of pharmacy departments at small and rural hospitals in Illinois determined that there were more similarities than differences between CAHs and non-CAHs. The survey indicated significant differences in dispensing processes, the use of technology and drug policy tools, and outsourcing of sterile product preparation.
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Affiliation(s)
- Stephanie Y Crawford
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago (UIC), Chicago, IL 60612, USA.
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Schumock GT, Ursan ID, Crawford SY, Walton SM, Donnelly AJ. Pharmacy practice in small and rural hospitals in Illinois—2011. Am J Health Syst Pharm 2013; 70:1144-52. [DOI: 10.2146/ajhp120437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | - Surrey M. Walton
- Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago (UIC)
| | - Andrew J. Donnelly
- University of Illinois Hospital & Health Sciences System, Chicago, and Clinical Professor, Department of Pharmacy Practice, College of Pharmacy, UIC
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Abstract
CONTEXT Critical access hospitals (CAHs) play a crucial role in the US rural safety net. Current policy efforts have focused primarily on helping these small, isolated hospitals remain financially viable to ensure access for individuals living in rural areas in the United States; however, little is known about the quality of care they provide or the outcomes their patients achieve. OBJECTIVES To examine the quality of care and patient outcomes at CAHs and to understand why patterns of care might differ for CAHs vs non-CAHs. DESIGN, SETTING, AND PATIENTS A retrospective analysis in 4738 US hospitals of Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI) (10,703 for CAHs vs 469,695 for non-CAHs), congestive heart failure (CHF) (52,927 for CAHs vs 958,790 for non-CAHs), and pneumonia (86,359 for CAHs vs 773,227 for non-CAHs) who were discharged in 2008-2009. MAIN OUTCOME MEASURES Clinical capabilities, performance on processes of care, and 30-day mortality rates, adjusted for age, sex, race, and medical comorbidities. RESULTS Compared with other hospitals (n = 3470), 1268 CAHs (26.8%) were less likely to have intensive care units (380 [30.0%] vs 2581 [74.4%], P < .001), cardiac catheterization capabilities (6 [0.5%] vs 1654 [47.7%], P < .001), and at least basic electronic health records (80 [6.5%] vs 445 [13.9%], P < .001). The CAHs had lower performance on processes of care than non-CAHs for all 3 conditions examined (concordance with Hospital Quality Alliance process measures for AMI, 91.0% [95% CI, 89.7%-92.3%] vs 97.8% [95% CI, 97.7%-97.9%]; for CHF, 80.6% [95% CI, 79.2%-82.0%] vs 93.5% [95% CI, 93.3%-93.7%]; and for pneumonia, 89.3% [95% CI, 88.6%-90.0%] vs 93.7% [95% CI, 93.6%-93.9%]; P < .001 for each). Patients admitted to CAHs had higher 30-day mortality rates for each condition than those admitted to non-CAHs (for AMI: 23.5% vs 16.2%; adjusted odds ratio [OR], 1.70; 95% confidence interval [CI], 1.61-1.80; P < .001; for CHF: 13.4% vs 10.9%; adjusted OR, 1.28; 95% CI, 1.23-1.32; P < .001; and for pneumonia: 14.1% vs 12.1%; adjusted OR, 1.20; 95% CI, 1.16-1.24; P < .001). CONCLUSION Compared with non-CAHs, CAHs had fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with AMI, CHF, or pneumonia.
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Affiliation(s)
- Karen E Joynt
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
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