Pharmacists complete health IT communication loop

Because they are at the point of sale, pharmacies have traditionally been ahead of the technological curve. Their records have been computerized for years, though they've often had to communicate with doctors and patients via phone and fax. E-prescribing and electronic healthcare records (EHRs) promise to change that.

"There's a lot of potential for information to be communicated that way: diagnosis codes, benefits, formulary information, plan information, sales status-all those things can be communicated at various levels," says Harry Hagel, director of the Academy of Managed Care Pharmacy's (AMCP's) Healthcare Information Technology department. "The potential is there. E-prescribing is potentially connected to an electronic healthcare record. That's a lot of information for pharmacists to use when advising patients and resolving problems with medication use."

The benefits are obvious: fewer harmful drug interactions, a reduction in prescription errors, immediate drug regimen adherence information and access to patient medical history. But the hurdles seem just as impressive: determining what information should be shared and by whom, implementing standards and convincing every segment of the industry to adopt them.

"The biggest hurdle is time," says consultant Shelly Spiro, president-elect of the American Society of Consultant Pharmacists. Spiro has served on a number of national and local committees involved in healthcare information technology. "It's very difficult for me because I work day-to-day five years [in the future]," she says. "The things I work on, the average pharmacists won't see for five years. Standards are done first, then adoption. So we're laying groundwork for what will be happening with technology in the future."

John Klimek, senior vice president of Industry IT for the National Council for Prescription Drug Programs (NCPDP), agrees.

Adoption requires time and money. As standards and formats are set, systems need to be modified to use them, pharmacists and clinicians need to be trained, and cultures need to shift.

"Probably the main beef of pharmacists revolves around technology adoption issues and communication issues-having systems that may not communicate seamlessly," says Hagel. "There's the cost of implementing that, the impact on workflow and efficiencies, transaction fees, moving that info along the tech highway-there are fees associated with that. Currently those fees are assigned to pharmacy. Right now, prescribers don't have those fees. Our hope is that as the volume increases, the costs will decrease."

More difficult to quantify, but just as important as costs, is the effort to change mindsets that may be resistant to using new technology. Spiro says some pharmacists and physicians who don't understand what is happening are afraid technology will replace them. Even healthcare professionals who understand technology well may not want to use it because it's new and different.