1

An Overview of Pharmacy Information Systems

Trajche Masinov
University St. Cyril & Methodius - Faculty of Electrical Engineering and Information Technology, Skopje, Republic of Macedonia
In the late 1990s and into the new millennium, technology advances have again allowed departments more flexibility in choosing a pharmacy information system. The widespread use of Health Level 7 (HL7) standards for data interchange and the emergence of local area networks, client-server and Web-based applications, and wireless technologies have opened up the available options to allow for distributed computing that can be tailored to the needs of both the department and the institution

I. INTRODUCTION Pharmacy Information Systems, or shortly PIS, are complex computer systems designed to meet the needs of a pharmacy department. The use of such systems gives the power to the pharmacists to supervise and directly affect the use of medication in hospitals. Pharmacy information systems were initially designed to manage the immediate business and efficiency needs of the pharmacy, especially the rapidly growing data requirements of unit dose systems.[1,2] Some of the key features of early pharmacy information systems included pharmacy billing,[3] inventory management,[4] and report generation consisting of medication labels,[5] fill lists, and patient profiles.[5-7] More modern functionalities, such as those that support clinical pharmacy activities, would be addressed later.[8,9] Since vendors of early integrated CISs were not sufficiently agile to compete with the robust functionality of pharmacy information systems developed for inpatient pharmacy practice, many hospitals elected to purchase a "best-of-breed" mainframe-based or stand-alone pharmacy information system using conventional purchasing processes, such as the request for proposal.[9-13] During the late 1980s to mid-1990s, the computing power of mainframebased integrated CISs began to sway eager hospital administrators seeking greater integration, especially in smaller hospitals, where the lure of greater control, the potential for ease of integration, and efficiencies of scale (paying less for one all-encompassing system for all departments versus paying more for individual selection) often won out over the desires and needs of individual departments. In the late 1990s and into the new millennium, technology advances have again allowed departments more flexibility in choosing a pharmacy information system. The widespread use of Health Level 7 (HL7) standards for data interchange and the emergence of local area networks, client-server and Webbased applications, and wireless technologies have opened up the available options to allow for distributed computing that can be tailored to the needs of both the department and the institution. Modern pharmacy systems are a component of a larger entity called the clinical information system (CIS). A CIS is considered to be an inpatient information system that at a minimum provides health care professionals with computerized physician order entry (CPOE), clinical decision

support (CDS), medication administration documentation (i.e., an electronic medication administration record), and clinical views of data provided by ancillary information systems, such as pharmacy, radiology, and laboratory. These clinical data may appear in the application via a direct interface with an ancillary system or from a database source, such as an institutional clinical data repository (CDR). There are many additional features that could be included in a CIS, such as discipline-specific task lists, clinical documentation, patient scheduling, and outpatient functionality. A key milestone for the CIS project is definition of the scope of work. The scope of work determines the technology requirements for integrating the CIS with the pharmacy information system. If an organization broadens the scope of work, it can significantly increase the complexity of the interface. Consequently, the scope of work needs to be carefully considered and well defined within the project plan. A number of concepts should be considered when defining the scope of work, including the patient population served, the types of medication orders handled, the content included within the medication orders, the need for non-medicationorder messages, how allergies and diagnosis will be handled, and whether the system will be used for clinical documentation, such as medication administration documentation and billing. II. TYPICAL FEATURES OF A PHARMACY INFORMATION
SYSTEM

Some of the activities that a PIS should implement are: Clinical Screening: the system can assist in patient care by monitoring drug interactions, drug allergies and other possible medical complications. When a prescription order is entered, the system can check for any interactions between two or more drugs taken simultaneously, or with any food, known allergies to the drug, or if the correct dosage is given. The system can alert the pharmacist if any problems occur. Prescription Management: the system should manage the prescriptions for in and outpatients. When the orders are received the system can check for available pharmaceutical products and dispense them according to whether the patient is an inpatient or outpatient. The system can also print prescription labels and instructions. Inventory Management: Todays pharmacies require a continuous inventory culture to ensure that drug do not go out of stock. So, the system could maintain a internal inventory of all pharmaceutical products, notifying the pharmacist if some

2 products are bellow some quantity. The system could also implement electronic ordering system, who will recommend ordering of the affected item. Patient Drug Profiles: Here, the system would maintain patient profiles and will contain details for their current and past medications, known allergies and many other parameters. These data can be used for clinical screening. Report Generation: the system can generate reports which range from determining medication usage patterns to the cost of drugs purchased and/or dispensed. Interactivity with other systems: it is very important that the system can communicate with other system, such as CIS for receiving prescription orders or the financial information system for billing and charging. [14] Today, there are a number of solutions on the market that meet the demands of the pharmacy department. In the following text I will give a review of some of the pharmacy information systems developed by various vendors. III. REVIEW OF EXISTING PHARMACY INFORMATION SYSTEMS PharmNet - Cerner. The first solution that I will describe is from the international company Cerner. Cerner is a global supplier of healthcare solutions with over 8000 clients worldwide. Cerners solution for the pharmacy department called PharmNet is part of an entire healthcare system called Cerner Millennium. PharmNet gives pharmacists and pharmacy administrators the ability to increase safety and improve pharmacy management. PharmNet links pharmacists , nurses and physicians from the time caregivers order medication through its administration, ensuring efficiency, continuity and safety. This solution offers the following abilities to the pharmacists : access to more patient information, patient monitoring around the clock with knowledge-driven alerts, support for point-of-care medication storage, inventory and administration, production of fill lists and medication administration records automatically and on demand, clinical decision support and more.[15] HCS Medics - Health Care Systems (HCS). HCS Medics pharmacy information system is a solution created by Health Care Systems (HCS). It is used in over 400 hospitals around the United States, and its rated one of the best pharmacy information systems available. Its designed by pharmacists and nurses and ensures medication safety, combines speed and accuracy, with a superior price to performance ratio. HCS Medics meets HL7 standard and has many benefits. It ensures superior patient safety by bringing improved medication accuracy to your pharmacy system, does clinical checks including allergy checking, prior reactions, drug-to-drug interactions, drug-to-food interaction and drug-to-laboratory interaction. It also does dosage error check, user defined errors and warnings, inpatient and outpatient order entry and calculation of body surface area and creatinine clearance. HLC Medics provides printing of medication labels with barcodes, tracking of inventory and patient care. HLCs Rx Assistants solution can work with Medics or with any pharmacy information system and provides easy way to electronically manage pharmacy clinical and management tasks. The solution provides the tools to assist with the accurate dispensing and administration of medications. Combined together they present a powerful software for managing all the needs of a pharmacy department. [16] Centricity Pharmacy GE Healthcare. Centricity Pharmacy is a comprehensive pharmacy information management system, providing powerful tools and driving informed decisions across the continuum of care, from inpatient acute care to retail pharmacy and long-term care. Centricity Pharmacy supports the seamless exchange of information among caregivers, helping to prevent common medication errors. It enables caregivers to securely access patient information from a variety of mobile handheld devices, or from any PC using a Web browser, facilitates clinical documentation and reporting by streamlining dispensing and administration of medications, enables closed-loop medication management, when used in conjunction with computerized provider order entry (CPOE) and bar-code enabled medication administration record (MAR). It also tailors the pharmacy system to address organizational needs without compromise or costly customization and maximizes revenue potential with advanced inventory control and integrated purchasing capabilities. [17] MetaCare Enterprise RX - Inpatient Pharmacy Information System. While many competing application suites minimize the importance of pharmacy, MetaCare Rx provides health enterprises with an extremely powerful software solution to support patient medication safety initiatives. At the heart of MetaCare is a comprehensive set of powerful-yet-flexible clinical modules, making it a complete solution for efficiently managing all aspects of a hospital inpatient pharmacy department. A cost-effective solution, MetaCare Rx allows users to expedite daily activities, including: verification and perfection of physician entered orders, flexible pharmacy order entry supporting all order types, comprehensive functionality in support of medication product services, full integration with automated dispensing machines and other devices; unparalleled support of pharmacy clinical services. At the core of Metas success is a complete understanding of the myriad of complex and diverse roles that pharmacy fulfills and delivering seamless applications in support of those objectives. MetaCare easily integrates with all key enterprise applications and devices including ADT, Billing, Laboratory, drug wholesaler, automated medication dispensing machines and even third party CPOE and point of care medication safety systems. Combined with MetaCare CPOE, this health care solution represents a serious competition for other vendors. MetaCare CPOE provides hospitals with an innovative computerized prescriber order entry (CPOE) system with an added focus on medication safety. A highly-functional order entry solution designed to reduce the complexity of order entry; MetaCare CPOE simplifies key processes, increases efficiency and avoids too much reliance on human memory. [18] RxConnect Netsmart Technologies. RxConnect, Netsmarts pharmacy management software, supports key pharmacy functions and processes for behavioral and public health organizations that operate their own pharmacies. Designed by a pharmacist, RxConnect has a full range of features and capabilities to assure smooth and efficient pharmacy operation. RxConnect provides pharmacies with management of all pharmacy processes, patient-centric

3 approach, pharmacist-friendly interface, responsive customer and technical support. The key capabilities RxConnect offers are : creating fill lists, printing IV labels, checking of drug interactions, allergy check, review drug utilization, control formulary, management of inventory, tracking of statistics and implementation of discharge counseling. [19] SoftRx SCC Soft Computer. SCCs total hospital Pharmacy Information Systems Suite offers management and information solutions that are designed to meet the challenges of the dynamic inpatient and outpatient hospital pharmacy environment. SoftRx utilizes unique timesaving features to directly address the need to reduce medication errors, increase productivity and communication, and enhance the timeliness and quality of patient care. The SoftRx system has multisite capabilities that allow patient profiles to be viewed or orders to be entered from any of the networked sites. Full integration with clinical laboratory and microbiology systems provides a seamless flow of information throughout the enterprise - a key ingredient of improving patient outcomes. SoftRx easily integrates with existing HIS and LIS systems, as well as a variety of drug dispensing and other delivery systems. This total hospital pharmacy system for inpatient and outpatient management offers: IV and med order entry, pharmacy medication profiles, cart fills, IV batching, extensive intervention documentation, productivity monitoring, interaction reporting, controlled substance tracking, patient medication administration reports, automated device interfacing, hand helds, rules-based, user-defined interactions.
[20]

NRx Pharmacy Management System QS/1. QS/1's NRx provides a complete pharmacy management and prescription processing system that's easy-to-learn and use. Process both new prescriptions and refills quickly and simply with just a few keystrokes or mouse clicks. The cost-effective design is modular so you can build a system to meet your store-specific needs and as you grow, you can add capabilities such as workflow, accounts receivable and centralized patient profiles. NRx is also fully integrated with other QS/1 products including IVR, Point-of-Sale, WebRX and Multi-site Management (MSM). Key features of the software are : prescription processing (which includes fill or refill prescriptions with a simple, step-by-step process; handling refills and renewals in seconds; printing sales receipts, labels and patient information leaflets simultaneously; easily edit important information about the patient or prescription; easily adding patients, drugs, doctors and sigs from the prescription processing screen; checking of drug-drug and food-drug interactions, geriatric and pediatric precautions, min-max dosing, allergies and duplicate therapy), inventory management ( order electronically from wholesalers; receive electronic update prices ), data maintenance ( quick adding of new drugs; ensures security by requiring appropriate security access levels; update drug clinical and pricing information electronically as needed; implement daily back-ups to protect all system data including signature records). [21] AbacusRx - Abacus Visual Pharmacy Plus Software. Abacus is a leading provider of pharmacy management systems to independent, chain, outpatient, institutional, mail order pharmacies and dispensing physician practice. Abacus has been in business for over 20 years and has thousands of

users already trained on the system. Since 1984, Abacus has been a pioneering force in the pharmacy software industry. Its software product line has been responsible for introducing many of the standard features found in today's state-of-the-art pharmacy software systems. The Abacus Visual Pharmacy Plus Software is an integrated prescription processing environment that provides today's pharmacies with all of the industrial strength software tools necessary to handle the complexities of modern prescription processing. The system offers a high degree of functionality combined with an easyto-use interface. When you have an Abacus System, you have a full plate of business tools available to you and you can choose the options you need for your business. Next is the list of features the Abacus software has: highly centralized prescription processing; detail patient prescription profiling, document hardcopy scanning/imaging, drug/patient screening, third-party billing, accounts receivables, nursing home, signature capture, workflow management, complete set of analysis tools and reports. [22] Guardian Rx - CarePoint Systems. GuardianRx puts the full range of pharmacy management tools at your fingertips with elegantly integrated Dispensing, Medication Therapy Management, Compounding, A/R and Reconciliation, and Perpetual Inventory Management (including the ability to maintain multiple real or virtual inventories from multiple wholesalers). Integrated workflow tools and queues greatly reduce processing time while increasing quality control. Our AutoRefill scheduling and refill processing improves workflow and increases profits. Automated primary and secondary third party billing eliminates unnecessary multiple steps in claims processing. Electronic Signature Capture and scanning of hard copy Rx's and other documents reduce paper maintenance requirements and errors, and simplify recall and review of data. And the ability to operate the system fully with the keyboard, the mouse, or both allows you to further increase productivity by operating the system in the manner most comfortable to you. System alerts and safety cap flags, bar coding and scanning, drug images and imprints, and configurable Rx and Dispense Verification Screens provide maximum patient safeguards and protect from potentially critical and costly errors. [23] IV. RELIABILITY OF PHARMACY INFORMATION SYSTEMS A survey conducted by the Institute for Safe Medication Practices (ISMP) shows that many hospital pharmacy computer systems may not be detecting and correcting prescription errors or pharmacy order entry errors reliably, according to an Aug 30, 2005, news release from the ISMP. To field test when safety warnings appeared, survey participants were asked to create a test patient in their medication order entry system used by pharmacists and place a series of orders associated with actual errors or hazards reported to the ISMP. Of the 182 systems tested, only four were able to detect all of the unsafe orders, and fewer than half were able to detect orders for medications that exceeded a safe maximum dose. Only one in five computer systems was able to intercept the entry of a contraindicated medication based on the patient's diagnosis or condition (i.e., pregnancy), and only one in four was able to detect a clinically significant

4 interaction between 'medications and herbal supplements. When unsafe orders were detected, approximately nine in 10 systems allowed the user to override serious warnings, often by simply pressing a function key. Most systems were able to provide reports of medication warning overrides and permitted staff members to build alerts for serious error-prone situations. Only half of the systems tested, however, allowed the use of tail man Letters to differentiate look-alike medication names (e.g., hydrOXYzine, hydrALAzine), and only 9% allowed users to change the font and color to highlight look-alike medication name pairs. The poor field test results may be a result of failure to update technology or software. More than half (i.e., 56%) of the survey participants were using a system that was at Least five years old with no, recent upgrades, and 38% had been using the same system for eight years or more without upgrades. Certain' types of warnings may be omitted if a medication information providers software vendor deems them unimportant, and important alerts may not appear if the software content is not current or adequate. [24] Figure 1 shows the average number of unsafe orders detected by age of pharmacy computer systems, where n is the number of facilities.
[5] [6] [7] Souder DE, Gouveia WA, Sheretz D et al. A computer-assisted intravenous admixture system. Am J Hosp Pharm. 1973; 30: 1015-20. Freund RG. Evolution of a computerized drug profile. Am J Hosp Pharm. 1973; 30: 160-4. McGovern D. Print, prepare, check, and deliver a 24-hour supply of unit dose medication for 600 patients in one hour. Hosp Pharm. 1981; 16:193-4, 199-200, 203-6. Chamberlain MA. Computerized support of clinical pharmacy services. Top Hosp Pharm Manag. 1982; 1:37-45. Ryan ML, Rinke R, de Leon RF. Selecting a pharmacy computer system for the future. Pharm Pract Manag Q.1995; 15:1-14. Puckett WH. Developing a request for proposal for a pharmacy computer system. Top Hosp Pharm Manag.1982; 1:19-27. Coblio NA. The request for proposal as a tool for computer selection. Hosp Pharm. 1984; 19:79-81,85-7. Neal T. Evaluating and selecting an information system, part 1. Am J Hosp Pharm. 1993; 50:117-20. Saya FG, Shane R. A stepwise approach to the evaluation and selection of a hospital pharmacy information system. Pharm Pract Manag Q. 1995; 15:15-22. Web resource : Pharmacy Information Systems (http://www.biohealthmatics.com/technologies/his/pis.aspx) Web resource : Cerner Pharmacy (http://www.cerner.com) Web resource : Health Care Systems (http://www.hcsinc.net/HCSMEDICS/medics-overview.html) Web resource : GE Healthcare (http://www.bdm.ca/product_rxtfc.html) Web resource : Meta HealthCare IT Solutions (http://www.metapharmacy.com/index.php) Web resource : Netsmart Technologies (http://www.ntst.com/index.asp) Web resource : SCC Soft Computer (http://www.softcomputer.com/) Web resource : QS/1 (http://www.qs1.com/nrx.html) Web resource : Abacus Pharmacy Software (http://www.abacusrx.com/) Web resource : CarePoint Systems (http://www.carepoint.com/) Web resource : AORN Journal, Nov 2005 (http://findarticles.com/p/articles/mi_m0FSL/is_5_82/ai_n15866277/)

[8] [9] [10] [11] [12] [13]

[14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24]

Figure 1. Average number of unsafe orders detected by age of pharmacy computer system (n is the number of facilities) V. CONCLUSION There are so many different pharmacy information systems on the market today. More or less, every single one of them satisfies the basic needs of a pharmacy department in hospitals and clinics, as well as stand-alone pharmacies. Needs such as patient monitoring, interactions checking, allergy checking, prescription management, inventory management, and reports and so on. They differ in their unique characteristics that are specific for every vendor. REFERENCES
[1] [2] [3] Evans SJ, Howe DJ. A computerized unit dose pharmacy system. Am J Hosp Pharm. 1971; 28:500-6. Derewicz HJ, Zellers DD. The computer-based unit dose system in The Johns Hopkins Hospital. Am J Hosp Pharm. 1973; 30:206-12. Fish KH. Charging for hospital pharmaceutical services: computerized system using a markup and a dose fee.Am J Hosp Pharm. 1979; 36:3603. Winters BH, Hernandez L. A computerized drug inventory control system. Am J Hosp Pharm. 1972; 29:780-5.

[4]