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Received: November 6, 2015 / Revised: December 9, 2015 / Accepted: December 18, 2015 / Published: December 24, 2015
Specialty Pharmacy Continuum
Many gaps in the current pharmacotherapy system hinder the full dissemination of standardized, electronically identifiable regimens, as well as a uniform approach to pharmacotherapy management for pediatric patients. The Pharmacy Health Information Technology Collaborative (Pharmaceutical HIT) has identified six components that may be of direct importance to pharmacies related to pediatric medication use. This article discusses the key areas within the information technology (HIT) infrastructure where electronic repositories of pediatric compounded products (pCNPs) and medical supplies are best placed to facilitate the distribution of electronic prescriptions. (eRx) from start to finish. In addition, the document outlines key deployment requirements to ensure maximum interoperability of electronic deployment systems to minimize disruption to the continuum of care.
Pediatric patients receive drug treatment with off-the-shelf products until pharmacists temporarily prepare these products for dispensing . The United States Pharmacopoeia (USP) refers to these products as non-combined synthetic products (CNPs) . As shown in other articles in this special issue, many gaps in the current medication administration system, including these products, prevent the full dissemination of standardized and electronically identifiable forms and a unified approach to therapy management services with medicines (MTM). ) for pediatric patients .
The Pharmacy Health Information Technology Collaborative (Pharmaceutical HIT) was formed in 2010 by nine national professional organizations, integrated by practice, education and accreditation, as well as system providers, e-prescribing networks and standards development groups, to facilitate the integration of the pharmacy. practices and medication management become part of the evolving health information technology (HIT) infrastructure . The strategic plan was developed in 2011 and recently updated through 2017. Six of the 10 goals recommended in the Pharmacology HIT roadmap have direct relevance to clinical pharmacy practice related to pediatric patients . These include: (1) ensuring that HIT provides pharmacists with healthcare services; (2) achieving integration of clinical data with electronic prescription (eRx) information; (iii) ensure that the HIT infrastructure includes and supports MTM services; (4) integrate the vaccinations delivered by the pharmacist in the electronic medical record; (5) achieve recognition of pharmacists as meaningful users of EHR quality measures; (6) achieve the agreement of pharmacies and pharmacists to exchange health information . Within each of these goals, Pharmacy HIT developed a list of strategies to help optimize pharmacists’ participation in HIT-related functions and processes (Table 1). Although scientifically validated CNP formulations do not address specific patient parameters such as age, disease or medication management issues, the initiative provides a comprehensive framework for collaborative action on issues and concerns related to HIT related to pharmacy.
Develop white papers describing the appropriate flow of important electronic information between health care providers, including pharmacists, to protect patient privacy.
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Join and participate in organizations, task forces, and task forces that set standards to improve email-related electronic exchanges.
Collaborate with organizations that define the pharmacist’s MTM role in HIT, such as the Association of Pharmacists, PSTAC, MTM Brokers and NCPDP, to ensure that pharmacist-defined MTM principles and guidelines are integrated into the national HIT infrastructure.
Ensure pharmacists are involved in defining and implementing meaningful use of EHR quality measures related to medications and medication-related activities.
Collaborate with policymakers, including the National Institutes of Health, ONC, CMS, HHS, and other members of the healthcare industry to promote the importance of pharmacists participating in HIEs.
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The purpose of this paper is to identify key areas within the health information technology infrastructure where an electronic pharmaceutical administration repository related to pediatric compounded products (pCNP) and information sharing is best integrated to facilitate the dissemination of electronic prescriptions. (eRx) from start to finish. In addition, the article outlines key deployment requirements for these repositories to provide interoperability with electronic medication management systems to minimize disruption to the continuum of care.
In 1994, a major program competition sponsored by the US National Institute of Standards and Technology initiated the production of health and medical information infrastructure. The aim of this public-private partnership was to allow the integration of information between companies in the health sector . The components of this infrastructure, designed according to user requirements, include: (1) reliable storage and collection of complex medical information for different applications; (2) data-driven practical treatment decisions; (3) real-time data entry by mobile medical professionals; (4) transport complex medical records globally accurately, quickly and securely; (5) computer-based medical training, diagnostic and reference tools; Many of the system’s components have further developed efficiency-enhancing technologies, such as reliable user interfaces and user databases. Major awardees of funding related to HIT infrastructure include the C. Everett Koop Institute ($45 million), Health Data Science Inc. ($22.5 million) and First Data Health Systems Inc. ($14 million). Over the past 20 years, the Office of the National Health Information Technology Coordinator has reported great progress in electronic health information connectivity and information technology interoperability . However, ONC recently stated that eRx functionality in the drug use and administration system is “not yet fully realized.” Figure 1 shows a high-level representation of the eRx system architecture.
Within the current configuration of the electronic medication management system, a number of special circumstances specific to children affect the safety and efficacy of their medication , and are addressed elsewhere in this special issue [11 , 12]. The entry point for ERx is at the provider’s office or at an institution such as a hospital. In addition to fixed location-based delivery, Ventola has investigated the multitude of medical applications deployed on mobile devices . Many providers have eRx generation software that is an extension of their stationary location, such as an office, and can be dispensed on-site from a tablet or smartphone. Agarwal and colleagues recently published a summary of medical topics related to the use of mobile devices in quality settings: (1) eRx as a tool to improve efficiency and effectiveness; (2) predict new eRx practices; (3) eRx is the core of the clinical workflow; (4) be an eRx administrative tool; (5) eRx: artifacts (6) eRx is a necessary evil; (7) eRx as an unwanted distraction . Regardless of the topic, it is clear that the vast majority of providers do not write the majority of their prescriptions by hand. However, in the context of pediatric pharmacotherapy, most eRx children generate free text and are not useful for sensitivity screening, drug range monitoring, treatment duplication, or clinical dosing decision support /neurology. Necessary requirements for safe and effective drug administration .
At the institutional level, a 2013 US hospital pharmacy survey found that 60% of hospitals had a CPOE system with the ability to deliver eRx to the ambulatory [ 16 ]. In these systems, the hospital formulary is often used as the database for creating outpatient eRx orders. Formula lists are encoded with site-specific formula identifiers that are not shared or recognized by external systems. Thus, when eRxs are generated in hospital settings, dissemination is hindered by the lack of uniform product codes and descriptors. As Gracy et al note, “Usable EHR systems typically do not
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