In this interview with ComputerTalk's Maggie Lockwood, the
American Society of Consultant Pharmacist’s Carla Sexton, R.Ph.,
CGP, assistant director, policy and advocacy, along with consultant and
ASCP board member Shelly Spiro, R.Ph., FASCP, talk about the ways
evolving technologies, from web-based interfaces to the LTC
e-prescribing pilot, are impacting the consultant pharmacist.
CT: How does the diversity of technology that exists for the consultant pharmacist impact day-to-day operations?
Sexton and Spiro: Consultant pharmacists often work with a
multitude of nursing facilities that may use different long-term care
pharmacies. It can be burdensome for the consultant pharmacist to be
knowledgeable about and prepared to use the various types of technology
implemented in each nursing facility and dispensing pharmacy. For
example, more-progressive nursing facilities may have electronic
medication administration records (eMARs), while others may not have
computers or technology systems at the nursing stations or on the units
or floors. Information necessary to a consultant pharmacist’s
medication regimen review may be found in a paper chart at some
facilities, while the consultant pharmacist might need passwords and a
basic understanding of the computer systems to access the same kind of
information in another facility that uses electronic health records
(EHRs), eMARs, or other technology solutions. Just knowing where to
find resident information and how to access it can be difficult as the
consultant pharmacist moves from one facility to the next.
Another way in which diverse technologies impact the consultant
pharmacist is access to residents’ medication lists/histories. Most
consultant pharmacy software systems typically interface with
dispensing pharmacies’ systems in order to populate the consultant
pharmacist’s software with the current medications each resident is
taking. If different companies make the dispensing and consulting
systems, the interface is not necessarily standardized and must be
manually written by software programmers. For the consultant
pharmacist, how this interface occurs and how the medication
information is populated must be considered when purchasing consulting
software. Updating the medication list may require action by the
consultant pharmacist, which means that the list/history is not always
up-to-date and may require time and effort to maintain.
Communication with the physician is a major role for the consultant
pharmacist. As the physician’s technology changes, the consultant
pharmacist’s software will have to adapt to those changes until
standards are developed, accepted, and implemented.
How do you see technology evolving to address the challenge of software compatibility in the marketplace?
Sexton and Spiro: The problem with writing situation- or
system-specific interfaces to enable communication between systems is
that they lack standardization. Standards help systems “speak the same
language” more easily while providing the end-user with enhanced
accuracy and ease of use. These benefits to the user will result in
better overall care for residents and will be the major impetus for the
adoption of standards. There are two major reasons why providers need
fully interoperable software systems:
• It will result in access to more information than is currently available
• The accessible information would be more up-to-date, which means
less discrepancies in the data and less chance for inaccurate or
inappropriate decisions based on the information
Eventually, standardized, inter-operable electronic health records
will be the “norm” in long-term care, with which consultant pharmacist
and long-term care pharmacy software systems will directly interface.
While this is closer to reality than ever before, we aren’t there yet.
What standards are ASCP work groups focusing on from the standpoint of technology?
Sexton and Spiro: ASCP staff and members have been working in a
variety of coalitions and groups to further the development of health
information technology standards in long-term care. First, a long-term
care Workgroup was formed within the National Council for Prescription
Drug Programs (NCPDP) approximately two years ago. Within the LTC
Workgroup, there are several Taskgroups that are working on topics such
as electronic prescribing and the interface between consultant
pharmacists, their software systems, and electronic health records in
the LTC setting. Thanks to work being done in some of these Taskgroups,
revisions to the NCPDP SCRIPT standard, the CMS-named standard for
e-prescribing in the community setting, are being proposed. These
changes are necessary to accommodate the nuances of e-prescribing in
In addition, ASCP has been participating in a LTC industry-wide
initiative to define the functions and characteristics needed in a
standardized EHR specific to long-term care. The EHR functional model
was developed by HL7, and it is this model from which the LTC industry
is developing a LTC-specific functional profile. The LTC functional
profile will eventually be balloted through HL7 and provided to the
Commission for Certification in Health Information Technology to aid in
defining criteria for certification of LTC EHR systems.
ASCP is also a member of the Health Information Technology Standards
Panel (HITSP). HITSP’s mission is to help the public and private
sectors define a widely accepted and useful set of standards to support
widespread interoperability among healthcare software applications, as
to how they interact in a local, regional, and national health
Do consultant pharmacists see the web as a way to work more seamlessly with the various players in the LTC arena?
Sexton and Spiro: In general, nursing facilities have limited
access to the Internet. This, in turn, makes it difficult for facility
staff and/or visiting consultant pharmacists to access online drug
information resources, third-party plan formularies and other plan
information, and additional Internet-based resources. Therefore, simple
access to the Internet, independent of software systems employing
web-based functions, would be beneficial.
In the end, web-based systems and tools are enabling more timely
and accurate communication of information between providers. They can
be particularly helpful in a LTC setting where more sophisticated
technology is not yet present.
As wireless technology becomes more available, the use of the web will
help consultant pharmacists communicate more seamlessly with
facilities, staff, and physicians.
CT: Tell us a little about the impact of the recent e-prescribing pilot from the perspective of the consultant pharmacist.
Sexton and Spiro: Although more primitive forms of
e-prescribing have been used in the LTC environment for many years, the
CMS/AHRQ study was the first pilot to test e-prescribing standards in
LTC. The purpose of the LTC pilot was to validate the e-prescribing
NCPDP SCRIPT and electronic prior authorization standards in the LTC
setting and to study the effects on cost, quality, and safety.
The greater efficiency and increased accuracy realized by the
nursing facility, dispensing pharmacy, and prescribers through the use
of e-prescribing will indirectly impact consultant pharmacists. Based
on the CMS regulations and survey guidelines, consultant pharmacists
are tasked with playing an intermediary role as consultant to the
facility regarding all aspects of pharmacy services. Therefore, part of
a consultant pharmacist’s job is to help the facility develop policies
and procedures relating to medication orders (e.g., transcribing and
recapitulation of orders), medication error reporting and prevention,
communication among providers relative to medication order
clarifications, etc. E-prescribing has the potential to change
medication-related policies and procedures within facilities. In
addition, the integration of clinical decision support tools into
e-prescribing systems could aid in proactive screening for unnecessary
or inappropriate medication use prior to the consultant pharmacist’s
medication regimen review.
For all these reasons, implementation of e-prescribing in LTC has the potential to:
• Make daily work more efficient for nursing facility staff, dispensing pharmacy staff, prescribers, and consultant pharmacists.
• Increase patient safety and quality of care for residents.
• Help facilities maintain compliance with federal and state regulations and survey guidelines.
Participation in the e-prescribing pilot helps the LTC industry keep
pace with the rest of the healthcare industry. The pilot was the first
major step to ensuring that LTC is on the national HIT agenda. Through
ASCP and its members’ involvement in the pilot, the consultant
pharmacist will have a place at the table.