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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.
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