This year, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began requiring that U.S. hospitals have a pharmacist available 24 hours a day to review all medication prescribed to patients.
Easier said than done.
However, some hospitals with limited resources (especially those in rural areas) are experimenting with IT to comply with JCAHO's new rules.
"We have one pharmacist who works 40 hours a week," said Kim Larkin, CIO of Washington County Hospital in Nashville, Ill. "Even if we could find another pharmacist, we couldn't afford to pay them."
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The 25-bed Washington County Hospital is one of Illinois' 52 "critical access" hospitals; it is the only hospital that serves the 16,000 residents of rural Washington County. Not only does the hospital lack the money to hire three more pharmacists to keep its pharmacy open 24 hours a day, but there is also a dearth of pharmacists in the area who would be willing to do the work.
"Our daily in-patient census runs around four," Larkin said. "Yesterday we may not have had a single new patient or a single new (medication) order to be reviewed. To pay a pharmacist to sit here and twiddle his thumbs, we can't afford to do that. And we're not going to find a pharmacist who is willing to do that. I have to find some way to do this that doesn't require hiring more pharmacists."
Instead of hiring more pharmacists, Larkin is working with the Illinois Health Network to create a virtual private network (VPN)-based system. The VPN will allow a small number of pharmacists to be on call to review medication orders for all of the state's 52 critical-access hospitals.
"What we're trying to do is allow one pharmacist to support maybe a dozen hospitals remotely after hours. It would allow us to reduce our costs and have a pharmacist review medication orders 24 hours a day, but it wouldn't bankrupt us."
The Illinois Health Network (IHN) is a not-for-profit affiliate of the Naperville, Ill.-based Illinois Hospital Association. It was created with a $1.5 million state grant. Powered by VPN technology from St. Louis-based Talisen Technologies, IHN provides a secure Web-based gateway that allows hospitals and other healthcare providers in Illinois to exchange information and conduct transactions.
Talisen's VPN solution combines aspects of both IPSec-based and Secure Sockets Layer-based VPN technology to create an especially secure collaboration among employees, partners, suppliers and customers of companies and organizations, Talisen president and founder George Brill said.
IHN Director Todd Hart said the network was originally envisioned as a virtual online marketplace modeled after Google Inc. or Yahoo, where Illinois healthcare providers could search for services and technologies.
But the federal Health Insurance Portability and Accountability Act (HIPAA) and other regulatory policies have placed new demands on healthcare providers. Hospitals, clinics and doctors are expected to secure the privacy of their patients while also improving patient safety by sharing patient data with other healthcare providers.
Hart said IHN's VPN gateway enables Illinois hospitals to share data more accurately, securely and swiftly. About 40 of the 200 hospitals in the Illinois Hospital Association have joined IHN, Hart said. He said 100 percent of the association's membership will eventually sign up.
"If a doctor is at home and he wants to send patient information (to another hospital), he can't send it through an open system like Yahoo Mail," Hart said. "It has to be secure."
In addition to the pharmacy coverage program, hospitals are also using IHN to share electronic health records among emergency rooms. Hart said laboratories at member hospitals will also use IHN to improve the speed and efficiency of their procedures for reporting results of infectious disease tests to the Illinois Department of Public Health.
At Washington County Hospital, Larkin is beta-testing a VPN-based solution that would allow doctors and nurses at small hospitals to scan medication orders and send them to a secure server maintained by IHN. The IHN server would then send an e-mail and a page to an on-call pharmacist. The pharmacist would log into the server and check the dosage and appropriateness of the medication. He could then approve the order, which would trigger a printer at the hospital to print a label. The nurse or doctor would then take the label and fill the medication.
Larkin said this process would create a record that would prove to JCAHO that a pharmacist had reviewed each prescription.
To pay a pharmacist to sit here and twiddle his thumbs, we can't afford to do that.
Kim Larkin, CIO, Washington County Hospital
"This is just one of those things where the payback is enormous," Larkin said. "The IHN comes in as a way of centralizing access, for all the hospitals to dump data to one repository and to have that data there, available and secure for any hospital that needs to access the data."
Larkin said IHN is a great help to hospitals like hers that don't have significant IT resources. Larkin said she has a one-person IT staff at her hospital.
Vi Shaffer, research vice president for healthcare providers at Stamford, Conn.-based Gartner Inc., said the virtualization of healthcare is a significant global trend. She said many healthcare providers with limited resources and shortages of specialized labor are turning to solutions like IHN's after-hours pharmacy program to provide patients with the care they need.
"This is a great example of how that thinking is evolving," Shaffer said. "This is a good one because obviously it's really important to get the right drug to your patient. And if your child has strep throat, there is no reason to wait until the next day (for the medication)."
There are still some wrinkles to iron out. For instance, in order for a pharmacist to review and approve medication at a hospital he must be licensed at that hospital. Larkin said this will require legislation by the Illinois legislature.
"When you have a pharmacist employed at a hospital they have to have their license hanging on the wall," Larkin said. "They can't be at more than one place."
Shaffer said the coverage pharmacy program is just the beginning of what can be done with virtualized healthcare services.
"Once you can do virtualized medicine, you can provide virtual services from anywhere to anywhere," Shaffer said. "You have to deal with licensing issues and patient privacy. If that is overcome, there's no reason why the pharmacist can't be in India, Ireland or California. This changes the dynamics of healthcare over time and nobody knows how overall it is going to change."
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