by Brad Ordener

With each passing year healthcare and other industries are becoming more and more reliant on technology. Pharmacy is one industry that is particularly dependent on new innovations to keep up with increasing demand. As this reliance on technology increases some unique problems are emerging that are slowing progress and making it difficult for pharmacy owners to change pharmacy systems. The technological landscape in pharmacy could be improved significantly with the adoption of a data storage standard as a part of the foundation for developing new technologies and industry practices.

The History

Technology in pharmacy has always been a mix of various innovations and proprietary software and hardware. We have seen many important improvements that make our lives easier. We have seen the emergence of online claims billing, e-fax, digital hard copy images, digital signature logs, e-prescribing, etc. Some of tools have developed nicely while others haven't. One of the differences between technologies that have had successful deployment across pharmacy and those that haven't is the creation of standards. For example, we have NCPDP to thank for creating a universal standard so we can bill insurances for our patients regardless of the software system, location, drug etc. Now, we are seeing the emergence of universal standards for e-prescribing and even the beginning of a standard for billing MTM and other clinical services.

Despite the successful application of standards in these and other areas, one place where we don't have a standard is in the way that we store the data  accessed by pharmacy management systems, including patient, prescriber, and drug data. Wouldn't it be wonderful if every pharmacy system stored this data in the exact same way? Let's explore the implications of this for a moment. A benefit of a universal standard is the capability for multiple systems to interpret and make changes to the same data. Imagine implementing a new pharmacy system on a trial basis for a few hours or a few days and switching effortlessly back and forth until you find the system that is right for you. Consider the competition and ultimately, innovation that this type of standard could drive. Another possible application for this may be a transition period in which an owner could use his or her new pharmacy system during portions of the day that are less busy. When the going gets tough the old system can be used until things calm down. As long as the old system and hardware are available they can be used when necessary until the new system has been mastered.

A Few of the Benefits

Off-site backups could be streamlined as well. When data is stored in a standard format the off-site storage solution can know what the data will look like and how to interpret the data it receives. This allows the source to send less information. Imagine that the database is a series of bookcases filled with trays. In this analogy the book case is a data set (e.g. one patient) and the trays are individual fields (e.g. patient name). The information sent in the initial backup only needs to consist of the data and which bookcase and tray it fits in. This is significantly less information to transmit compared to making a mirror copy of the drive that is being backed up. Once the database is copied the first time it's even faster. Changes since the last back-up can be flagged and only that information would be sent to update the off-site copy of the database. This significantly reduces the amount of time required to perform a backup. And keep in mind, if you aren't backing up your data you aren't protecting your most valuable asset.

There are other benefits. With a standardized database structure we could more effectively encrypt and protect data. This is particularly critical when you consider that there has been an increasing amount of talk about, and some use of, public databases in pharmacy. Many states have started tracking and sharing information on controlled substances to help identify abuse and diversion. Many of us have heard about and supported efforts to create electronic health records by making patient charts and profiles accessible via a national database for all healthcare providers. If a data storage standard exists as these systems are created, the aggregation and sharing of this data will not only be more secure, but it will be effortless for our industry as well. The list of potential benefits goes on and on.

Encouraging Competition

And how would a standard contribute to pharmacy system innovation? Simply put, if it were easy to change from system to system within a matter of minutes or hours pharmacy owners could more easily find and buy the best system for their needs. Without standards, changing pharmacy systems is difficult. Even if there is a better system out there we can't or won't use it. Vendors are well aware of this fact and are slow to invest in their products because of it. These technical barriers can be advantageous to vendors who aren't innovating at the cost of pharmacists and patients. When a new technology emerges companies often add it to their product but rarely do it well. Too many pharmacy systems contain poorly integrated and executed pieces of technology. For example, when e-prescribing came to the forefront of new technology in pharmacy most, if not all, developers added support to their software suite. Many of these companies' products still don't offer full functionality several years later. In a world where it is easy to switch systems because of data storage standards, pharmacists could readily move to the system with the best e-prescribing tools, or whatever the newest and most important feature may be. This is true for digital record keeping and other items as well. This industry is in need of more fierce competition to drive product development and a data storage standard is a great way to make it happen.

Moving to Standards

The creation of a standard like this would present some technical challenges for the users and developers. Many pharmacies are operating outdated versions of pharmacy systems. Because of resistance from pharmacy owners, most vendors continue to support these old versions of their systems despite threats to stop. Pharmacies that operate these older systems might experience more challenges moving to standardized databases than those that upgrade regularly, but the benefits would be worth the extra effort. Vendors already create data migration tools for each new version of their software. In order for a pharmacy to move from a several-version-old system to a current system using standardized databases they would most likely need to take a step-wise upgrade approach from their outdated system to the new version.

As far as development goes, the developer would have to create a data migration tool in order to fill in the new database. On top of this developers would have to modify or create a system to use the new standard. The logical approach for vendors is to only create a data migration tool to work with their current system however it is certainly possible to create several migration tools for the vendor's various software versions. I can't neglect to mention that someone would need to create a data storage standard first. The standard I envision is essentially an all-inclusive collection of all the types of data pharmacies store that has been consolidated and formatted for use by any pharmacy system. The database itself would need cross platform support to allow use by Linux, Unix, and Windows based systems. There are competing database solutions currently available that have this capability.

What can we do? Someone in our industry must take the lead. This type of standard is not very difficult to create. Each company would have to dedicate some additional resources to convert to it's use yet that isn't necessarily a major barrier. The difficult aspect of a project like this is convincing the industry to participate. Perhaps a good first step we can take is presenting this idea to our national associations and politicians. Whatever the catalyst, data storage standards will be an important piece of future technology in pharmacy.

Brad Ordener is a student pharmacist in his final year at Midwestern University College of Pharmacy in Glendale, Ariz.  He has experience in community and hospital pharmacy as well as a background in computers. He has been involved in pharmacy system testing, troubleshooting and implementation during his short time in the field of pharmacy.  Brad can be reached at brordener@gmail.com.