What a Long, Strange Trip it’s Been

HIMSS Clinical Informatics Insights

Pharmacy was an early adopter of information technology. Before computers, our practice was almost always limited to a single prescription belonging to a single patient. We had no way to connect multiple prescriptions (filed numerically in neat little books) to one patient. Early pharmacy information systems allowed us be more patient-focused. For the first time, we could see individual prescriptions as part of the patient’s entire therapy. Technology allowed us to integrate external drug databases to support our efforts to prevent inappropriate dosing and detect potentially dangerous drug interactions. Updating these references usually involved feeding floppy disks into the single computer buried under the counter. We backed up this precious data nightly onto tapes. When we needed support, it was usually equipment related. We lived in constant fear of hardware failures.

Over time, information technology allowed us to connect. First with payers, instantly adjudicating insurance claims electronically. Pagers untethered us from the phone, and we left the hospital satellites to become part of the patient care team. Pharmacy benefits managers provided us with information regarding medications a patient had received elsewhere, providing a more complete therapeutic picture. We connected our computers to various types of automation – machines to count pills, machines to compound complex IV solutions, machines to answer the phones. The references in our systems were automatically, invisibly updated. Each connection was a potential (and in some cases, frequent) failure point. In May of 1998, technical support meant re-pointing the satellite dish on the roof when the satellite failed.

We now use automated dispensing cabinets on hospital floors, robots to fill carts, machines to automatically fill and package prescriptions, and giant carousels to store and manage inventory. The adoption of barcoding throughout the medication use process provides more safety than our vigilance ever could. Our solid foundation in IT allows us to use informatics to optimize medication therapy for entire populations of patients. We write clinical decision support rules to guide the prescribing of complex therapies like total parenteral nutrition and chemotherapy. We build order entry systems to direct providers to current evidence-based therapies. We customize drug databases and smart pumps to protect even the tiniest of NICU babies from medication misadventures. Supporting informatics requires more than technical knowledge – it requires clinical experience, data analysis, an awareness of human factors, workflow design, quality improvement, interdisciplinary teamwork and patience.

What does the future hold for us? Only one thing is certain – there will be more databases, more connections and more automation than we’ve ever seen before. And no backup tapes.

About the Contributor
Jenn Suhajda is a Clinical Pharmacy Specialist in Pediatrics and Informatics at the Floating Hospital for Children at Tufts Medical Center. She earned a BSPharm from the Massachusetts College of Pharmacy and Health Sciences and an MSHS in Clinical Research Administration from George Washington University.