The Next Horizon: Integrating Pharmacy across the Inpatient-Outpatient Divide

Colin Banas, M.D., CMIO at VCU Health System in Richmond, Va., is trying to make the best of a situation facing healthcare IT leaders in integrated health systems nationwide—how to manage the inpatient-outpatient continuum issues with regard to pharmacy information systems. As he notes, “VCU is full-CPOE with our Cerner system on the inpatient side, and has been live for decades, is totally automated with Cerner also on the outpatient side. We’re full Cerner for everything, but we don’t yet have the doctors inputting their orders directly. We’re 100-percent CPOE on the inpatient side, but will be on the outpatient side in the next years.” Meanwhile, he says, “We’re still struggling along with a standalone pharmacy information system on the outpatient side, while we’ve been successful with integration between the Cerner Millennium core EHR and the Cerner pharmacy product on the inpatient side.”

On the outpatient side, Banas says, “I wish it would go into Cerner, because there are a lot of benefits we could realize. When things like that haven’t happened in our institution, it’s typically related to a paucity of talent; the talent is sometimes very difficult to recruit and retain. I can count on one hand the number of people I trust to help me integrate the medication and pharmacy elements. We’ve had a shortfall in that area for years, and those people are hard to find. Now, of course, all EMR talent is hard to find, and I think the pharmacy niche is a really weak spot for a lot of institutions. That’s unfortunate, because really, the biggest bang for your buck on EMR is a tightly integrated pharmacy and ordering system.”

For now, because of the demands of meeting the meaningful use requirements and preparing for the ICD-10 transition, he says, “People are saying, gee, it would be great to move forward on the outpatient pharmacy thing; but especially when we look at some issues we haven’t completed, such as outpatient CPOE and inpatient barcoded meds administration system for meaningful use Stage 2, we have to work on those first. We have an eMAR but just don’t have barcoded meds admin yet. And I really need to see how the requirements around barcoding, if any, in Stage 2, fit into the mix, before moving forward on this.” Still, he agrees, creating seamlessness across the inpatient-outpatient divide in terms of EHR-pharmacy information systems is very important. “Competing priorities will make this really hard to do; yet it’s probably one of the most important things we could do for patient safety, to fully integrate CPOE and pharmacy IT. So the bottom line is everyone had better get busy recruiting pharmacy informaticists, because you’re going to need them.”