Informatics Interchange

Informatics Interchange

Formulary and database synchronization typically a manual process even though

facilities within a given integrated health

A utomation provides many tools for

conducting pharmacy and medica-
tion management operations. Examples
attributes between multiple networked
pharmacies or hospitals, nor do they al-
low easy interfacing by “foreign” systems
care delivery network (IHDN) may have
a common pharmacy and therapeutics
committee and shared formulary. Even
include order-entry systems, automated (i.e., solutions from different vendors). when the PIS is integrated within the
medication dispensing cabinets, carousel Further, in the case of automated medi- IHDN so that the drug formulary is
drug storage units, high-speed bar-code cation dispensing cabinets, some vendors shared, each pharmacy department must
packaging devices, robotic dispensing have limited the number of devices each manually update the formulary database
devices, robotic i.v. preparation devices, server can support, requiring that each of any automated devices. In some cases,
bar-code-assisted medication adminis- health care facility install and maintain a the PIS within the IHDN may be man-
tration (BCMA) systems, and intelligent separate server and formulary. aged at the facility level, posing addition-
i.v. infusion pump al safety concerns
technology (smart and maintenance
pumps). Accurate costs. This manual
drug information is process consumes
necessary for each significant time and
of these systems or resources and can
devices to function have a negative effect
effectively, requiring on patient safety. A
that a formulary and mistake in entering
other types of data- the unique identifier
bases (e.g., a database of a medication can
of users, bar codes, lead to dispensing,
or dosage forms) be medication admin-
built and maintained. istration, bar-code,
However, rarely are and billing errors.
the systems and de- In addition, manual
vices integrated to formulary mainte-
p rov i d e d a t a b a s e nance can lead to de-
continuity. scription discrepan-
Pharmacy information systems (PISs) Automated medication systems and cies among facilities, systems, or devices.
and automated distribution systems have devices with formulary databases require Bar-coding and National Drug
gained widespread use over the past 15 intensive maintenance due to the dynam- Code issues. The problems associated
years,1 but vendors of these systems have ic nature of institutional formularies; with manual formulary maintenance
not substantially changed the support- this is especially true when health care have become more acute with the ad-
ing database structures. Available prod- facilities are located in distant geographic vent of BCMA and National Drug Code
ucts do not adequately support a single areas or served by different pharmacy (NDC) billing requirements. Historically,
formulary database capable of flexing warehouses. Formulary maintenance is formularies could be built around one
prototypical NDC identifier, but current
systems demand that formularies include
The Informatics Interchange column gives readers an opportunity to share their experiences with all available NDCs so proper links be-
information technology in pharmacy. AJHP readers are invited to submit their experiences and perti- tween a product and the manufacturer’s
nent lessons-learned related to pharmacy informatics. Topics should focus on the use of information
technology in the medication-use process, informatics pearls, informatics education and research, containers can be maintained through-
and information technology management. Readers are invited to submit their ideas or articles for out the process. The NDC landscape is
the column to ajhp@ashp.org or ASHP, c/o Karl Gumpper at 7272 Wisconsin Avenue, Bethesda,
MD 20814 (301-657-3000).
Continued on page 206

204 Am J Health-Syst Pharm—Vol 68 Feb 1, 2011

 Informatics Interchange
Continued from page 204
extremely fluid, necessitating daily up-
dating of databases.
Integration of formulary databases
is complicated by formularies’ diverse
data requirements. A formulary for a
smart pump, for example, has different
data requirements than one serving a
PIS, which, in turn, differs from a for-
mulary driving an automated i.v. prep-
aration device. As a result, maintaining
synchrony among these various sys-
tems requires compiling and maintain-
ing the “superset,” or union, of all data
needs. In addition, more standards for
data exchange by foreign systems are
needed to enhance automated formu-
lary and database synchronization.3 All
medication formularies have common
elements that should flow downstream
from the PIS to other automated sys-
tems and solutions.2
Economic forces will likely compel
more hospitals to join health care net-
works to survive. Consequently, chal-
lenges related to the lack of formulary
synchronization capabilities will con-
tinue to grow. As facilities seek to become
more cost-efficient through alliances, the
need to provide accurate drug informa-
tion across disparate systems, databases,
and devices will increase. There is also
increasing pressure for pharmacy op-
erations and informatics to become more
efficient in providing safe patient care
based on valid, consistent information.4
A call for action. We challenge the
vendor community to place a high prior-
ity on the integration and standardiza-
tion of formulary databases, beginning
with the following steps:
206 Am J Health-Syst Pharm—Vol 68 Feb 1, 2011
1. Work with the pharmacist community
to identify and articulate a standard
formulary data structure for an in-
teroperable formulary. This structure
must: be well defined, both structurally
and semantically, and broad enough to
encompass the various uses of a formu-
lary; accommodate formularies com-
mon to multiple sites within an IHDN,
with allowances for standardization and
site specificity; and include methods for
synchronizing formulary information
across multiple applications and mul-
tiple instances of the same application.
2. Design and produce applications, devices,
and systems around this standard struc-
ture to facilitate interoperability.
The development of systems that allow
automation of formulary synchroniza-
tion is crucial if health systems, facili-
ties, and pharmacies are to optimize the
systems needed to provide high-quality
patient care.
1. Pedersen CA, Schneider PJ, Scheckelhoff
DJ. ASHP national survey of pharmacy
practice in hospital settings: dispensing
and administration—2008. Am J Health-
Syst Pharm. 2009; 66:926-46.
2. American Society of Health-System Phar-
macists. ASHP guidelines on the safe use
of automated dispensing devices. Am J
Health-Syst Pharm. 2010; 67:483-90.
3. McCreadie SR, Stumpf JL, Benner TD.
Building a better online formulary. Am J
Health-Syst Pharm. 2002; 59:1847-52.
4. Kleiss J. Standardizing the formulary
across a health system. Pharm Purch Prod.
www.pppmag.com/article/597 (accessed
2010 Nov 1).
Leslie Brookins, B.S.Pharm., M.S.,
Pharmacy IT Coordinator
Saint Luke’s Health System
4401 Wornall Road
Kansas City, MO 64111
lbrookins@saint-lukes.org
Ron Burnette, B.S., M.B.A., President/
Consultant
Pharmacy Consulting Group, LLC
Ponte Vedra, FL
Charles De la Torre, B.S.Pharm., M.I.S.,
Pharmacy Systems Coordinator
BayCare Health System
Clearwater, FL
Doina Dumitru, Pharm.D., M.B.A.,
Director of Pharmacy
Memorial Hermann The Woodlands
The Woodlands, TX
Rhonda B. McManus, Pharm.D., Director,
Clinical Operations
CareFusion
San Diego, CA
Christopher J. Urbanski, M.S.Pharm.,
Director, Pharmacy Informatics and
Medication Integration
Clarian Health
Indianapolis, IN
Rayburn Brian Vrabel, Pharm.D., Senior
Director, Medication Systems Strategy
Omnicell, Inc.
San Diego, CA
Robynn P. Wolfschlag, B.S.Pharm.,
M.B.A., Applications Developer
Catholic Health Initiatives—Information
Technology Services—Denver
Englewood, CO
Dennis A. Tribble, Pharm.D., Chief
Technology Officer
ForHealth Technologies, Inc.
Daytona Beach, FL
The authors have declared no potential
conflicts of interest.
DOI 10.2146/ajhp100354