Optimizing Pharmaceutical Care Health Information Technology and LTC Settings

1
Optimizing Pharmaceutical Care Health
Information Technology and LTC Settings

• Dianne Tobias, Pharm.D., CGP
• Tobias Consulting Services
• Davis, CA detobias_at_aol.com
• ASCP

2
LTC Environment Medications

• Pharmacy is distance away
• Prescriber often off-site
• 2 Pharmacists involved
• Lack of continuity of information between care
  settings
• Numbers and complexity of medications is
  increasing

3
LTC Medication Usage Trends
From Tobias TCP 121997 TCP 152001 TCP 2003
4
SafetyMedication Errors/ADRs

• ADEs in LTC 41-51 ADEs judged preventable
• 72 most serious judged preventable
• Errors which led to preventable events most often
  found in ordering and monitoring phases of med
  use process
• (Gurwitz Am J Med 2005, 2000)

5
Goals of HIT The Medication Perspective

• Increase Safety
• Increase Quality of Care
• Increase Efficiency
• Bring clarity to reimbursement chaos
• Increase interdisciplinary satisfaction

6
HIT in Medication Use Process

• Assessment signs/symptoms, prior care
• Quality, efficiency
• Prescribing
• Safety, coverage
• Dispensing
• Safety, efficiency
• Administration
• Safety, efficiency
• Monitoring
• Quality, efficiency

7
E-Prescribing

• Clinical Quality
• Patient variables integrated into patients
  database, e.g., weight, renal function
• Database geriatric-focused
• Timely
• Safety/Med Errors
• decrease transcription errors, time
• Formulary integrated
• whats covered, whats not, whats required for
  coverage

8
Transfers are ChallengingOur residents are
vulnerable!

• Transcription errors
• Errors of omission
• E-prescribing can help
• Continuity of care/communication with ID Team
• Prior important but next even more important

9
CPOE and CDS The answer?

• CPOE system can cause errors
• Koppel, JAMA 2005
• Flurry of response
• CPOE/CDS providing alerts
• Prescribers/staff showed low response to
  alerts Judge, J Am Med Inform Assoc 2006
• CPOE/CDS can prevent ADRs in LTC
• Case study showing potential of HIT
• Rochon, CMAJ 2006
• Current systems in LTC

10
HIT is more than e-prescribing!

• Dispensing Pharmacy
• Full knowledge of regimen
• Consultant can really be a consultant!
• Interdisciplinary Possibilities
• Assessments
• Collaboration
• Communication

11
Using HIT to Improve Care Resident Approach

• Continuum of care
• Before/After LTC
• Beyond Lists of meds
• Monitoring/Trending Progress
• MDS, ID input, etc.
• Identifying ADE
• Triggers, Natural Language Processing (NLP)
• QI

12
Using HIT to Improve Care Population Approach

• Measure care to standards
• Medication-related indicators
• atrial fib pts receiving anticoagulant
• anticoagulant therapy within therapeutic range
• Identify priority areas based on prevalence
• Immediate change in process
• Further investigation
• Inservices
• QAA Committee

13
Need to be careful technology can.

• dull the senses..bar coding gives false sense of
  security, dont see the forest for the trees
• be so detail heavy..to lead to errors
• lead to cookbook medicine, e.g., care plans

14
In the end.
It is inevitable that new technologies will
emerge as we shuttle patients through a
(hospital). How we implement these new
technologies should not rest solely with a
consultant, a vendor, or a committee. Our
technology solutions should be looked upon in the
same way that we care for patientsfrom head to
toe Corporate Strategies for Computerization
Edward C Wu, Nirav Shah, MD, MPH Ann Int Med, 27
April 2006