Meaningful use technology and the hospital pharmacy: Three things every rural hospital exec should know


Kelly Morrison

Marketing and Product Management
Innovative Delivery Solutions
Cardinal Health

Kelly Morrison will join Richard Stomackin, RPh., director of pharmacy at Lewiston Hospital in Pennsylvania, to lead an educational session entitled "Elevating the Level of Patient Care with Remote Pharmacy Services" at the American Hospital Association's Rural Health Care Leadership Conference in Phoenix. In this post, Morrison provides a sneak peak into the issues she and Stomackin will explore during their session. She'll also follow up with us after the conference to share insight into how hospitals can select the remote pharmacy model that best meets their needs.

So, you're implementing meaningful use technology to attract your share of the nearly $40 billion in 'high tech reimbursements' that the federal government is offering to early adopters.Although the implementation deadline for Stage 2 has been pushed back to the Fall of 2014, you already know that implementing meaningful use technology will have its share of challenges. But do you also realize that in order to maximize your investment in those technologies, your hospital needs to provide 24-hour pharmacy services?

In my experience working with hundreds of rural hospital executives and pharmacy leaders across the country, very few are aware that 24-hour pharmacy services are needed to fully maximize their investment in meaningful use technologies. And often they realize this only a few months or even weeks before the technology implementation -- and that's when they begin searching for options. Based on those experiences, here are a few things every rural hospital leader needs to know before implementing meaningful use technologies:

If you don't currently offer 24x7 pharmacy coverage, you're not alone.

Most hospital executives already know that the Centers for Medicare and Medicaid Services (CMS) and accreditation organizations have regulations and standards requiring hospitals to provide a consistent continuity of care, 24x7. The goal of these standards is to ensure all non-emergent patient medication orders are prospectively reviewed by a pharmacist, prior to administering the medication to a patient. But the reality is that more than 70 percent of U.S. hospitals have limited pharmacy hours. That's usually because it can be a significant expense to hire enough pharmacists for evening and weekend shifts -- and it can be difficult to recruit pharmacists to fill those shifts, particularly in rural areas.

The time to act is now.

While it's true that many hospitals have already been managing to operate without 24x7 pharmacy coverage, adoption of new technologies increases the need and the return on investment. Meaningful use technologies like Computerized Physician Order Entry (CPOE), Electronic Medication Administration Records (eMAR) and bedside bar coding simply can't work as they were intended without 24x7 pharmacy coverage. Without real-time prospective pharmacist review, 24x7, physicians' medication orders are not entered and approved in the patient's profile and, therefore, are not approved to be dispensed and administered in automated dispensing systems. That means they also don't appear on the patient's electronic medication administration record (eMAR). And that the medication can't be made available for drug verification during bedside barcoding, when the medication is being administered.

So efforts to ensure the right patient receives the right medication at the right strength and right dose at the right time are also thwarted. All of these patient safety measures are predicated on the need for prospective pharmacist review of every medication order. So 24x7 pharmacy coverage is essential if you want to truly maximize these technologies and their capacity to protect patients.

It's not just about patient safety; it's also about volume.

Once a hospital implements a CPOE program, for example, pharmacy order volume increases by 30% or more, on average. This increase is due in large part to how certain order types (such as sliding scale insulin and range orders) are handled in CPOE systems. Another contributing factor is that once CPOE is adopted, the pharmacy often begins entering medication orders for additional areas such as the emergency and procedural departments. Pharmacy leaders typically don't anticipate this sudden increase in order volume, and assume their current staffing is sufficient; however they typically soon find that is not the case.

The good news?

If you're one of the many hospitals that finds it challenging to provide 24x7 pharmacy coverage, or if you're concerned you may not have enough pharmacists to meet the increased order volume that meaningful use technology will create, you have some options.

A common solution is to leverage remote pharmacy services to provide flexible, cost-effective and sufficient pharmacist coverage, 24x7. In doing so, remote pharmacy services enable hospitals to maximize their investment in technologies to achieve meaningful use status, while also helping them to ensure a consistent continuity of care for their patients.

Many remote pharmacy models and services exist. You can partner with another hospital, leverage larger facilities within your healthcare system or contract services through an external provider. Determining the model that best fits your needs is key.

In my next post, I'll share some questions to help you determine which option is best for your hospital - along with a basic overview of the various types of remote pharmacy services available. I'll also share a real-life example of how one rural hospital successfully implemented remote pharmacy services and reduced its pharmacy labor costs, improved pharmacy and nursing satisfaction and most importantly, elevated the level of care it offered patients.