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Hospital takes EHR heavyweight to court

Senators press for EHR interoperability

McKesson makes ambulatory move


Check out the upcoming ICHITA conference beheld at Western University in Kalamazoo, MI. This year, our conference will focus on service innovation and stakeholder engagement with a primary goal to expedite health care reform. The conference starts at noon on October 17th and finishes up at 4:45 PM on October 18th.

Welcome to the Michigan Chapter of HIMSS.

The Michigan Chapter of HIMSS (MI-HIMSS) is dedicated to improving information systems management in Michigan's health care institutions. MI-HIMSS was formed in the Spring of 2002. Chapter members come from diverse backgrounds, all involved in some aspect of health care information systems and management. Our members consist of professionals from hospitals and clinical organizations, third-party payers, administrators, information technology systems vendors, consultants, management engineers, telecommunications professionals, physicians, nurse and medical informatics professionals, and essentially anyone interested in the trends of health care information and management systems. Visit our Membership page to learn about how you can get involved.

The Key Role of Pharmacists in the Development and Validation of Electronic Order Sets
By Ken Risko, B.S. Pharm., MBA, and Bruce W. Chaffee, Pharm.D.

The development of electronic order sets is an integral part of any Computerized Prescriber Order Entry (CPOE) implementation. The goals of a well-developed order set include:
  • standardization (content, structure);
  • patient safety;
  • clarity of presented information;
  • optimized use of evidence-based care;
  • clinician efficiency;
  • and cost-effectiveness.
Order sets are often built using evidence-based guidelines and serve as a teaching tool to guide prescriber therapy. In addition, order set committees are typically formed to provide a forum for discussion of order set content and review. Medications are typically a significant part of order set content and represent one of the potential areas for the occurrence of error. To minimize this risk, pharmacists must be “at the table” to play a key role in the development, implementation and maintenance of order set content as part of a multidisciplinary team of clinicians.

            Pharmacist verification of proper medication prescribing is just one component of assuring medication safety. Pharmacists have a comprehensive view of the entire medication process, which includes assessment, prescribing, verification, dispensing and administration. In addition, pharmacists have a unique understanding of the drug products, including availability, drug product alternatives, legal issues, security, storage and dispensing methods, dose forms and concentrations of dose forms. A properly designed order set requires knowledge of much more information about a medication than just drug name, strength, rate, dosage form or frequency. 

            Pharmacists also have knowledge about the need for and content of additional information that should be included in the order set for the prescriber, pharmacist and nurse for specific medications, patient populations (e.g., adult vs. pediatric) and disease states (e.g., renal function). Such information can include alternative doses, medication administration instructions, therapeutic interchange recommendations, precautions and hyperlinks to additional drug information. Pharmacists are needed to review order sets to ensure the logical flow of orders, standardization of content, spelling, titration parameters, dose range conflicts, drug interactions, formulary adherence, proper timing of medication orders, appropriate sequencing of medication tapers, use of appropriate corollary orders (e.g., laboratory testing surrounding medication administration) and potential look alike/sound alike (LASA) issues.

            At health care facilities where barcode medication scanning at the bedside is used, pharmacists can ensure that the order set content is compatible with the scanning process and that it integrates well with other CPOE system components such as rules and alerts.

            Pharmacists can also provide content on medication orders not directly related to products. These can include pharmacy dosing consults, patch checks and relevant laboratory orders.

            Core measure initiatives also provide an opportunity for pharmacists to ensure that order set content is clear and attainable within the core measure guidelines. For example, making sure doses will be administered within the timeframe of the core metrics based on the functionality of the CPOE system.

            In the rush to implement CPOE, pharmacists are often under-utilized, substantially increasing the risk that patient safety will be compromised and that additional work will be required to ‘fix’ order sets that are improperly designed. The pharmacist’s role in order set development and maintenance is crucial in providing the best evidence-based content as well as providing medication dispensing and administration information to provide the highest level of medication safety and standard of care. Pharmacy directors should strongly advocate the involvement of pharmacists in order set development to ensure that the medication use continuum is optimized for patient safety, cost-effectiveness of medication use and clinician efficiency.

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