Spring 2003

I n f o r m a t i o n   T e c h n o l o g y 
Patients will benefit from the Pharmacy Network

The Pharmacy Network will enhance the quality of care provided by physicians and other health care providers, facilitate accountability, assist in cost containment of prescription drugs and improve the ability to measure the outcomes of care.

    NLMA members recently received a President's Letter regarding the proposed Newfoundland and Labrador Pharmacy Network being planned by the Newfoundland and Labrador Centre for Health Information. Previous articles about the Pharmacy Network in Nexus have concentrated on what a province-wide pharmacy information system is and the planning process NLCHI is undertaking. In the most recent issue the emphasis has been placed on how the Pharmacy Network will help physicians provide better patient care because of the improved information they will have about each patient.
    Drugs that are prescribed, dispensed and consumed appropriately are one of the most cost-effective interventions available in today's health care system. They enable patients to remain active, avoid hospital stays and maintain productivity. Building the Pharmacy Network will enhance the quality of care provided by physicians and other health care providers, facilitate accountability, assist in cost containment of prescription drugs and improve the ability to measure the outcomes of care.

The Pharmacy Network 
    The Pharmacy Network is a provincial pharmacy information network which will offer on-line, real-time, province wide patient drug usage profiles, as well as a comprehensive drug information and interaction database. The network will operate 24 hours a day, 7 days a week, supporting prescribers and pharmacists through authorized access to medication histories and providing decision support tools to improve the delivery of medication therapy.
The Pharmacy Network will offer clinical, educational, administrative and financial benefits. Authorized health care providers will use the Pharmacy Network through a secure Intranet application. The system will reduce the risks of misused medications. The proposed categories of information to be maintained in the pharmacy network include:

  • Patient drug profiles including all drugs dispensed and the ability to record over the counter and natural medications
  • Allergies
  • Patient clinical conditions (diagnoses)
  • Patient demographics including Unique Personal Identifier (UPI), name, address, gender and date of birth
  • Patient Demographics include accurate MCP number and eligibility
  • Drug information resources

    The Pharmacy Network will link doctors, hospitals, pharmacists and other authorized health stakeholders together into an electronic data network. Proposed functionality includes:

  • On-line comprehensive active medication profile
  • Electronically supported prescriptive service
  • Prescription monitoring program supported on-line
  • Drug interaction checking
  • Contra-indication checking
  • Best choice drug suggestions
  • Adverse drug event recording
  • On-line drug monographs
  • On-line provider lookup and
  • On-line patient lookup

Health Benefits 
    The Pharmacy Network will be used by health care providers to deliver better care and provide increased patient safety. The Pharmacy Network will support health care providers in making better medication choices, counselling on the use of medications, reduction of medication errors and other ways.

Better Medication Choice
    Access to each patient's complete medication profile including over-the-counter and, natural medications, immunizations and sample medications will: 

  • Help prevent duplicate medications
  • Help prevent drug interactions
  • Help detect missed medications
  • Help alleviate the reliance on patients' memory and interpretation of their medications

Better Counselling on the Use of Medication 
    The Pharmacy Network will provide the tools to better counsel patients on how to use medications. 

  • Drug information, including natural medications and antidotes for poisonings, will be readily available, allowing for consistent and holistic counselling and avoidance of patient confusion
  • Complete medication profiles will allow for faster detection of potential misuse, such as unfilled prescriptions or prescriptions that are refilled too early

Reduction of Medication Errors

  • Helps health care providers avoid errors due to misunderstandings 
  • Provides universality of medication information 
  • Provides seamless movement of medication information across traditional health care boundaries, i.e. institution to community clinic 
  • Facilitates patient transfer between health care facilities throughout the province 
  • Provides medication information in situations where the patient cannot communicate, i.e. intoxication, coma, confusion, etc.
  • Helps health care providers to overcome the challenges of an unreliable system of paper-based prescriptions 
    • Medication orders will be in a clear and legible form
    • Instant drug interaction, allergy and dose checking

    In addition to the health benefits, the Pharmacy Network will enable accountability and administrative efficiencies such as:

Trial Prescription Program 
    The purpose of a Trial Prescription Program is to reduce the incidence of drug-related problems and minimize medication waste through increased patient monitoring and follow-up. The program allows the physician to order or the pharmacist to dispense a limited quantity of a prescribed medication to the patient and have it recorded in the patient's profile. The trial period of seven to ten days is used to evaluate the patient's tolerance to the medication. The limited quantity dispensed allows the patient to try the medication without the purchase of the entire prescription. If the medication agrees with the patient, the balance of the prescription is dispensed in the usual manner.
    Reasons to implement a trial prescription program include:

  • Improving the health of patients by decreasing the incidence of drug related side effects and intolerance of medications
  • Enhancing the role of health care providers through increased patient monitoring and increased communication between the prescribers and the pharmacist
  • Acting as a cost saving measure to minimize drug wastage

Decrease in Hospitalization Due to Adverse Drug Events 
    The definition of an adverse drug event (ADE) is an event or circumstance involving a patient's drug treatment that actually or potentially interferes with the achievement of an optimal outcome. It includes poor compliance, inappropriate self-medication, inappropriate prescribing and drug interactions.
    Adverse drug events account for 2% to 11% of all hospital admissions each year and this increases to 28% for people aged 65 and older. It has been estimated that 1%-4% of all visits to emergency rooms are due to inappropriate use of medications.
    The most common cause of an adverse reaction is linked to failure to disseminate drug knowledge. The Pharmacy Network will provide an efficient reduction of the incidences of ADEs by enhancing the collection, organization, retrieval and display of data.

Seamless Care 
    The most important element in the provision of seamless care is an efficient and accessible information system. Errors are made in patient care because not all members of the health-care team have access to updated, patient-specific information.
    One potential target group for a seamless care model is the elderly as they are more susceptible to ADEs because of their decreased ability to tolerate incorrect dosages. Currently, 10% of all admissions to the emergency room and 28% of all hospital admissions of the elderly are directly related to drug noncompliance and drug misadventure. In many cases making their medication profiles available can prevent this.

Benefits as an Applied Research Tool
    The Pharmacy Network has enormous potential as a complement to clinical trials. Analyses of pharmacy databases have been used to monitor medication use, to study disease prevalence or incidence and to monitor inappropriate under- or overuse of medications. Accurate information on drug costs and utilization can be analyzed to assess patterns of drug use as well as the economic health-related effect of changes in medical or drug therapy.

Professional Benefits
    The Pharmacy Network will support an environment of teamwork and enhanced scope of practice, including: 

  • Access by authorized health care providers to patient medication information from various sites of practice
  • Reduction in unnecessary interruptions for medication order clarifications
  • Future linkages with other components of the Electronic Health Record

Electronic Prescribing
    A fully implemented Pharmacy Network will enable physicians to enter and transmit medication orders on-line. This is a powerful tool for preventing medication errors due to misinterpretation of hand-written orders. It can ensure that the dose, form and timing are correct and can also check for potential drug-drug or drug-allergy interactions.
    Drug choice becomes more efficient as regimens and guidelines are available on-line and can be instantaneously updated. Evidence suggests that physicians will significantly improve their ordering practices in response to electronically delivered recommendations.

Next Steps in Building the Electronic Health Record 
    The Pharmacy and laboratory functions of the Electronic Health Record are intimately related. For example, abnormal renal or hepatic laboratory results often necessitate altering drug regimens. Many medications require laboratory monitoring, the results of which have an impact on subsequent prescribing. NLCHI's business plan includes implementing information systems for laboratory and diagnostic imaging functions as part of the Electronic Health Record.
    The Pharmacy Network, if approved by the provincial government, will be implemented in stages that will see some of the benefits early in its development and others over a longer timeframe.


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Nexus is published quarterly for Newfoundland and Labrador's physicians. It is a forum for the exchange of views, ideas and information for members.