Anthony Vecchione

AlphaProteo was created to advance drug design and disease understanding by helping researchers configure high-strength proteins that bind to molecules.

With an eye on improving safety, increasing compliance and reducing waste, an increasing number of hospitals and health systems are looking to insource and automate their IV compounding processes.  

Getting pharmacists involved in patient-centric activities, including being part of clinical care teams, is a little easier thanks to telepharmacy technology. When Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, needed to optimize its pharmacy workflow with the goal of improving patient care, it turned to PowergridRx, a cloud-based HIPAA–compliant telepharmacy platform from San Francisco-based PipelineRx. Starting in February, Dartmouth-Hitchcock began deploying PowerGridRx in its hospitals across New England. PowerGridRx is a software as a service platform that aggregates, manages and optimizes virtual pharmacy management for health systems. In addition, it differentiates Dartmouth-Hitchcock's telepharmacy network and manages the order verification process for current and future facilities. The interoperable technology platform is designed to improve medication administration visibility between facilities and addresses logistical and budgetary challenges that arise from managing and staffing multiple care settings. [Also: Dartmouth-Hitchcock, Harvard Pilgrim join forces on population health] Sarah Pletcher, MD, medical director and founder, Center for Telehealth at Dartmouth-Hitchcock Medical Center, said the health system uses PowerGrid Rx as a tool in the delivery of telepharmacy services across wider landscape. "Our customers are the ultimate end user in that regard," Pletcher said. After going live in six hospitals Dartmouth-Hitchcock has processed thousands of patient orders: "We have data that suggests the benefit to the hospitals in that we are allowing them to load-level staffing and optimize their in hospital team sometimes deploying them to more patient care or clinical activities," she said. Pletcher pointed out that for many smaller rural and critical access hospitals, the volumes that they see on weekends for example, aren't enough to rationalize them having an in-house pharmacist. "But we are also finding hospitals recognizing the value of having telepharmacy support for scenarios where they want to allow their pharmacists to be out on the floors helping with patient care," she said. In a cancer infusion suite for instance, Pletcher explained that oftentimes pharmacists are part of clinical team working on projects where they might be involved in an electronic medical record implementation, or working on quality or formulary projects for the hospital. "Any time we can help extend their team to allow them to optimize their in-hospital team, we're happy to be there for them," she said. From a technology perspective, Pletcher noted that there are obstacles associated with integration and with host IT systems and EMRs. She said that with anything involving multiple hospital IT departments and multiple hospital EMRs, there's always a challenge – not just the technology integration, but cultural barriers where hospitals have different levels of comfort for how much bi-directional integration they want with outside software platforms. "Because we offer so many other telemedicine services this is something we are familiar with managing – the telepharmacy is the latest service – we have six or seven other 24/7 telemedicine services to hospitals where we've had to contend with IT or EMR integration. We kind of know to expect and support those conversations." Pletcher said Dartmouth-Hitchcock is expanding its telepharmacy program to more sites and more regions. "We're excited about the opportunity to further integrate our telepharmacy solutions with other clinical services." Industry insiders contend that the demand for PowerGrid Rx-type technology is on the rise for multi-site multi-facility organizations that are growing and want to tie their pharmacy network closer and closer together. "We want to create a platform that enables them to share pharmacy labor and pharmacy resources across their whole organization, opposed to having to staff individually each hospital within their network, this enables them to tie them to together," said Brian Roberts, CEO of PipelineRx. Roberts noted that among the challenges is to work with different and multiple types of IT systems. "Some of our customers have eight to ten different types of IT systems that they work with - we integrate back with their host IT systems and bring it into one platform." The other side, according to Roberts, is that they want a system that can capture policies and procedures for each one of their individual hospitals. So for example, if they were creating a central telepharmacy center they would want that telepharmacist to have information at their fingertips. "Our tool helps consolidate and bring policies and procedures into one software offering," said Roberts who added that because PowerGrid Rx is a cloud-based piece of software – there is no hardware on each individual site. "So we use the power of the Internet to build a private cloud that can manage all that information – manage the information and store the information for the hospitals." Roberts said CIOs like that because it’s a cloud-based piece of software that doesn't require them to have to go and do updates and update hardware; that's all taken care of from the PipelineRx side.

Patient care teams at Yale-New Haven Hospital, looking for a faster, more efficient and more secure way to communicate with each other in the emergency room, have adopted smartphone applications to speed up workflows. The changeover from stilted clinician communications and responsiveness as a result of the hospital’s emergency room reconstruction. At certain times, different areas of the department would be closed creating confusion and making it difficult to locate personnel. In addition, the way the pediatric emergency department was logistically set up, the clinicians working there had no line of sight, making it hard for them to communicate with one another. [Also: Intermountain deploys ReadyPoint for audit compliance] Eventually, the hospital bucked its traditional methods, which included a public address system and a VOIP wireless phone system, turned to MH-CURE – for Clinical Urgent Response – a smartphone application from Waltham, Massachusetts-based Mobile Heartbeat. MH-CURE offers care teams secure, single smartphone access to all clinical communications, pertinent patient information and lab data. Care team members have a choice of using their own smartphone or sharing hospital-supplied devices. It consolidates clinical communications, including alarms and notifications, pertinent patient information, lab data, texting, voice and photography. Allen Hsiao, chief medical information officer and associate professor of pediatrics and of emergency medicine at Yale-New Haven, said adoption was easy and the staff realized early the power of having everyone on one platform. [Also: OhioHealth taps Epic's MyChart Bedside] "We choose the ED because it's as a self-contained a unit as you're going to find in a hospital," said Hsiao. "We certainly have the dynamic need of trying to find the right nurse, the right physician, at the right time, they are often in different rooms out of sight." So far, he said, the impact has been positive. "We're saving a lot of time. We used to play phone tag, used to get interrupted taking care of patients, having to step out to take a call or answering an overhead page. It's giving us back time with the patient at the bedside." Hsiao said that if a doctor or nurse gets a text, they can glance at it very quickly without leaving the patient and they can decide whether or not they need to step away or if it can wait and continue to do what they were doing with the patient. In addition, their train of thought and conversation with the patient is not interrupted. "Unlike a traditional text message I can see if another physician or nurse has read my text or not – they can tell if I read it or if it’s been delivered and not read yet," he said. "That helps a great deal. Then I know if they haven't read it and it's urgent, I can escalate with a phone call." Hsiao said that with traditional text or pager you have no way of knowing if the receiving person read a text or not. For example, if a lab sends critical lab alerts, instead of playing phone tag the alert is automated – so when something is critical, needs intervention right away, as soon as the result is back the text gets triggered right to a smartphone. Hsiao said the effect on patient care has been positive. "It cuts down on the delays between awareness of information and actual treatment." Hsiao said adoption has been driven by the flexibility of the platform, such as the ability to use an Android or iPhone device, and integration with the electronic health record. "All these features add to the functionality and the importance of the technology so it becomes a secure HIPAA-compliant ecosystem for clinical tools, that is the wave of the future," he said. According to a Mobile Heartbeat, an outside consulting firm conducted a study, before and after the MH-CURE implementation, to determine how long it took for the clinicians in the emergency departments to communicate with one another. Results revealed that the amount of time required for clinicians to locate and transmit information to one another was greatly reduced, allowing staff to spend more time with patients and thus provide better patient care. In a poll of clinicians, 75 percent said they now found it easy or very easy to communicate with colleagues with MH-Cure; just 24 percent felt that way prior to using it. Nearly 75 percent, meanwhile, reported that MH-CURE has improved patient workflow and patient safety. [Like Healthcare IT News on Facebook] James Webb, vice president of strategic accounts for Mobile Heartbeat, said that the market for this smartphone technology is growing because secure texting is a major driver. "What we're seeing at MobileHeart beat is that people do not want to lock in to just a secure text solution, they want a full communications package, clinical workflows and inputs and alerts from various systems in the hospital," said Webb. "We see a lot of sites looking at their mobility strategy and really the major thing for their apps is they have to be able to play well together." Hsiao said that in addition to the adult and pediatric ED the smartphone app is now being deployed in its medical and surgical departments – and recently in intensive care units and emergency departments – at all of Yale's other hospital campuses, including the main campus in New Haven. Twitter: @HealthITNews

Carestream says Vue Motion platform also addresses Stages 2 and 3 meaningful use because it gives patients an easy way to see their images.

Health system pharmacy managers and contracting & purchasing executives got a reprieve when the Food & Drug Administration moved the deadline for compliance with the Drug Supply Chain Security Act to Nov. 1, 2015.

Hospitals are recognizing the value of interoperability between EHRs and automated dispensing cabinets. Beyond eliminating redundancies during the medication ordering process, it helps reduce errors at the point-of-care.

New York Governor Andrew Cuomo recently signed a bill that will postpone a deadline for physicians to issue only electronic prescriptions. Despite this, some hospitals are adopting IT that will enable secure e-prescribing of controlled substances.