•American Heritage Dictionary defines a system as, “A
group of interacting, interrelated, or interdependent
elements forming a complex whole; a condition of
harmonious, orderly interaction.”
•In the future, technologies that dispense medications,
manage patient information, and evaluate drug
therapies will free pharmacists to provide expanded
patient care.
•The focus is on systems approach in utilizing
technology to support a practice of pharmacy and
describe the complex interactions that occur in a
pharmacy practice between people and technologies.
•These interactions focus primarily on the welfare of
patients and are performed by pharmacists and their
associates who share a common vision because they are
involved in the pursuit of rendering appropriate
pharmaceutical care.
Health informatics -The development and assessment
of methods and systems for the acquisition, processing
and interpretation of patient data with the help of
knowledge from scientific research. -It covers all aspects
of the generation, handling, communication, storage,
retrieval, management, analysis, discovery and synthesis
of data, information and knowledge in the entire scope
of healthcare.
Alert: A patient- and context-sensitive warning
presented to the ordering provider at the time an order
is being entered. Used to inform the provider of a
clinical concern relevant to the patient and order being
placed.
Clinical Reminder: context-sensitive electronic prompt
to the provider to perform an intervention or procedure,
based on the patient’s specific clinical data as applied to
a set of logical conditions.
Notifications: It is a patient- and context-sensitive
prompt to the ordering provider, attending physician,
primary provider, or care team to alert them of new
information (ex: abnormal lab result) or tasks in need of
completion (ex: unsigned order or note).
Two Purposes of Technology 1. Replace completely the
work done by humans. 2. Enhancement of human work
(Barcoding/barcodes)
Drug Utilization Review -It is defined as an authorized,
structured, ongoing review of prescribing, dispensing
and use of medication. (American College of Medical
Physics ACMP, 2019). -The National Committee for
Quality Assurance (NCQA) currently refers to the process
as Pharmaceutical Utilization Management with defined
tenets. -Drug is appropriate, improve quality of life,
optimize medication review
Patient Laboratory values (Platelets, RBC, WBC, Urea)
RBC -M: 4.7-6.1 cells/mcL F: 4.2-5.4
WBC – bet 4k and 11k/microliters
Platelets -from 150k-450k platelets/microliter of blood
Plasma -Protein,h20,plasma,salts/minerals(55%)
rbc(45%) wbc,platelets,buffy coat(1%)
Technology -It comes from the greek word techne
meaning art, craft, skill -set of data or techniques that
have been develop over time for specific purpose
enhancing human capability and possibility.
Levels of Development
Obsolete Technology -hindi masiyado ginagamit
Current Technology
Emerging Technology -planning to use, not widely use
Point of Care -It is the place where pharmacists and
their patients and colleagues attempt to address the
identification, resolution, and prevention of drug-related
problems. -The ideal point of care device would be a
large (17–21-inch display) that would offer long life,
battery power, and high- speed wireless connectivity to
the data and information required to practice
pharmaceutical care.
Evidence Based-Pharmacy -Sackett and his colleagues
define evidence-based practice as, “the conscientious,
explicit, and judicious use of current best evidence in
making decisions about the care of individual patients.”
-The complexity of pharmacotherapy demands that
high-quality evidence be applied at the point of care to
the decisions made by pharmacists. -scientific method -
aim to optimize decision making by using evidence
based pharmacy from well designed and conducted
research.
Levels of Evidence
Meta-analysis: a meta-analysis combines the results of
similar studies by searching the literature and
systematically assesses previous research studies to
derive conclusions.
Systematic reviews: systematic reviews are similar to
meta-analyses. It is a literature review focused on a
research question that tries to identify, appraise, select,
and synthesize all high-quality research evidence
relevant to that question.Often, systematic reviews
include a meta-analysis component which involves using
statistical techniques to synthesize the data from several
studies into a single quantitative estimate or summary
effect size.
Randomized controlled clinical trials: a randomized con-
trolled trial is a type of scientific experiment, where the
people being studied are randomly allocated one or two
different treatments (or placebo) under study. Subjects
are randomly allocated to a control group (no interven-
tion) or to an experimental group (those receiving treat-
ment or having a diagnostic test performed). Blinding is
conducted to prevent bias; ie, the patients do not know
whether they are receiving the active treatment or a
placebo. If there is double-blinding, neither the
researcher nor the study participants know who is
receiving the treatment or the placebo.
Cohort studies: a cohort study is a form of observational
study. It analyzes the risk factors and follows a group of
people who do not have the disease, and uses
correlations to determine the absolute risk of subject
contraction, or some populations are observed over
time to determine whether exposure to something will
result in a certain effect. Cohort studies are not
randomized, and there may be other confounding
conditions affecting the results. For these reasons,
cohort studies are less reliable than randomized
controlled clinical trials. Cohort studies may be
prospective and retrospective. A prospective study
follows the population from present to the future, while
the retrospective study collects data from the past by
evaluating hospital records.
Case–control studies: the case–control is a type of
epidemiological observational study. An observational
study is a study in which subjects are not randomized to
the exposed or unexposed groups, rather the subjects
are observed in order to determine both their exposure
and their outcome status and the exposure status is thus
not determined by the researcher.
Case series/case reports: a case series is simply a report
describing many case reports on the same subject. A
case report is important to initiate a signal about an
effect.
Editorials and expert opinions: editorials and expert
opinions have a weaker role in EBM, since they are not
studies. However, they are based on knowledge and
experience of the experts in the field.
In vivo (animal) research: basic science studies using
animals also build some evidence up to some extent. On
the other hand, the controlled conditions in the
laboratory setting may not always reflect the effects on
humans.
In vitro research: in vitro studies are performed with
cells or biological molecules done outside their normal
biological context; ie, in a solution or culture medium.
Diagnostic Tools
PATH AI: It has the mission to improve patient outcome
to artificial intelligence-powered pathology and increase
the accuracy of diagnosis and therapeutic efficacy for
diseases. It is also partnered with biopharma and clinical
stakeholders alike their technology drives biopharma
initiatives from translational research through in vitro-
diagnostic device development.
ENLITIC: It is a medical intelligence company committed
to transform the future of healthcare with evolving care
collaboration adaptability relevance and enlightenment
of system for all patients. It has the mission to
comprehensively impact the future of healthcare by
blending information with insights to improve
outcomes. •One of their products and services is the
Career Intelligence which is empowered by Enlitic
Intelligence.
FREENOME: It uses molecular biology and machine
learning to detect cancer this is through training
thousands of cancer positive blood samples its platform
learns which biomarker patterns signify a cancerous
type and effective treatment pathways its detection can
help clinician optimize treatments and the next
generation precision therapist.
NANOX AI: It is on AI medical imaging technology to
screen early signs of chronic and acute diseases with
mission to scan globally to protect one’s health while
reducing cause and race. The Nanox AI solution helped
physicians identify the early signs.
Therapeutic Tools (Cloud Med X, Twim Health, Kaia
Health, Babylon)
Telepharmacy refers to the use of electronic
information and communications technologies to
provide and support healthcare when distance
separates the participants.
Telemedicine OXFORD’S TELEMEDICINE DEFINITION IS
“THE REMOTE DIAGNOSIS AND TREATMENT OF
PATIENTS BY MEANS OF TELECOMMUNICATIONS
TECHNOLOGY.” •IT REFERS TO THE PRACTICE OF CARING
FOR PATIENTS REMOTELY WHEN THE PROVIDER AND
PATIENT ARE NOT PHYSICALLY PRESENT WITH EACH
OTHER. •IT MUST BE COMPLIANT BASED ON Data
Privacy Act (DPA)
Telehealth exchanging information for diagnosing and
etc.
History of Telemedicine
Ancient Times -Uses fire, smoke signals, drums, horns,
etc.
Early Telemedicine - It was kicked off by the inventions
of the electrical telegraph and the telephone. -The
telegraph and telephone brought long distance
communication into the mainstream, where almost
anyone could send a telegraph message or make a
phone call.
Antonio Meucci– 1846 first basic phone
Telephone – 1876 patented Alexander Graham Bell
Samuel Morse – telegraph 1844 (Morse system) The
American Recording Electromagnetic Telegraph
Major city hospitals and doctor offices installed
telephones. Within a few years, many city residents also
had telephones in their homes.
Late 1800’s -Capital Avenue Drugstore was connected to
21 different local physicians via the early version of
telephone.
January 1 1886 -First long distance transmitter was
created
April 1924 -The first idea of telemedicine was
introduced.
1925 -The concept "Teledactyl" was introduced by Hugo
Gernsback. -Teledactyl – it can mimic what the doctor is
doing on the other machine. A future instrument by
which it will be possible for us to “feel at a distance”
1940s -Pennsylvania, radiology images were sent 24
miles between two townships via telephone line in the
world’s first example of an electronic medical record
transfer.
•The “Centennial model” of Bell’s telephone, shown at
the Centennial exhibition in Philadelpha in June 1876.
This was an improvement on his original “gallows model.
•Replica of Bell’s ‘gallows frame’ telephone, on display
in the Communicate gallery. It was on this type of device
that Alexander Graham Bell first transmitted sounds,
though still not recognisable speech. In the summer of
1875. Replica, GPO Engineer’s Department, Britain,
1937.
•The phrase “telegraphic speech” references the
telegraph, a popular device of the late 19th and early
20th centuries.
1959 -at the University of Nebraska •Used interactive
telemedicine to transmit neurological examinations,
which is widely considered the first case of a real- time
video telemedicine consultation.
1990 The rise of the Internet in the 1990s also brought
with it the information explosion. The Internet protocols
allowed support for practically all information and traffic
needed for telemedicine.
1968 Invented the 911
Memorandum 2021-0095
Telemedicine as enabler for patient referral systems
•The DOH partnered with Quezon City's local
government to deploy the country's first end-to-end
telemedicine project, which will strengthen the LGU's
ability to provide patients access to medicalconsultation.
Quezon City is the first LGU in NCR and CALABARZON to
roll out telemedicine that connects to the national
COVID-19 surveillance system.
•The Department of Health (DOH) and the National
Privacy Commission (NPC) has developed a framework
for telemedicine services in a bid to improve access to
health services during the Enhanced Community
Quarantine.
Konsulta MD, Cloud px, MedCheck -2018 with their
electronic medical record system
Automation Any technology, machine or device linked
or controlled by a computer and used to do work.
Carousel Automation A medication storage cabinet with
rotating shelves used to automate dispensing.
Centralized Robotic Dispensing System design to
operate the entire process of Medication Dispensing
Supply Chain Management The management of the
pharmaceutical order-to-pay process including
management of inventory and distribution of supplies
throughout medication use process.
Supplier->Manufacturer->Wholesale Distributor-
>Hospital/Pharmacy->Patient
Pharmacy automation (Websites, Dispensing Robots,
Digital Displays, PMR Systems, Prescription Reordering
Apps, Electronic CD Registers, Prescription Collection
Points, Pharmacy Management Systems)
Purposes of knowing Pharmacy Automation System
•To provide background on the use of automation in
inpatient pharmacy practice. •To describe several
pharmacy automated dispensing technologies. •To
identify best practices for maximizing the safe and
efficient use of automation. •To provide a predictive
model for the impact of automation will have on the
future of pharmacy practice.
Features shown desirable for reducing errors in
automated pharmacy systems:
1. Controls are comprehensive—Controls extend all the
way from the point of order- entry to the point of
dispensing or administration and are integrated with the
pharmacy or facility information system.
2. Electronic identification (eg, bar coding)—All
components including the drug, patient, and person
dispensing are identified.
3. Access to medications is limited and controlled—
Medications are accessible only when needed, and only
by authorized personnel.
4. Dispensing/administration is captured—
Documentation is automatic and complete.
5. Drug use information is provided—Access must be
immediate.
6. Labeling machine prints and affixes a label
7. Controls are not easily compromised—System
overrides are signaled visibly and/or audibly at the time
of the event, and electronically documented.
The Medication Use Process
1. Prescribing (evaluate patient, establish need for
medicine, select right medicine, determine interactions
and allergies, prescribe medicine)
2. Transcribing/Documenting (transcribe
prescription/order, transmit to pharmacy)
3. Dispensing (review prescription order, confirm
transcription, contact prescriber for discrepancies,
prepare medicine, distribute medicine)
4. Administering (review prescription order, confirm
transcription, review transcription, review warnings
interactions and allergies, evaluate patient, administer
medicine)
5. Monitoring (assess patient’s response to medicine,
report and document results)
Technologies applied in Prescribing (CDSS SOFTWARE,
CPOE, E-PRESCRIBING)
Clinical Decision Support System -program that analyses
data to assist health care provider in making decision
and providing better health care. E.g. First Electronic
Mycin 1970s at Stanford University Al -applying 600rules
for identifying infectious diseases and recoomend a case
of treatment
Technologies applied in Dispensing (Carousel
technology, Centralized robotic dispensing tech.,
Centralized narcotic dispensing and inventory tracking
device, Decentralized ADC, IV and TPN compounding
devices, Pneumatic tube delivery systems, Unit dose
repacking systems)
IV and TPN compounding devices
IV Fluids- for fluid replacement, electrolyte balance
restoration and supplementary nutrition or as a vehicle
for other drug substances (NSS).
IV admixture- when one or more sterile products are
added to an IV fluid for administration (dextrose,Mino
acid, lipid, use to patient who are unable to eat)
TPN- Total Parenteral Nutrition IV administration of
calories, nitrogen and other nutrients in sufficient
quantities to achieve tissue synthesis and anabolism.
These are indicated for patients who are unable to
ingest food and who refuse to eat.
Exactamix -validated compounder (AOECS)
Unit dose Repacking Systems (unit dose- a dose of
medicine in an individual packet)
Technologies applied in Monitoring (Electronic clinical,
Web-based compliance documentation systems and
disease management tracking systems)
Automation of Inventory Management inside the
Pharmacy
Drug Purchasing and Supply Chain Management
Systems
Pharmacy Asset Management -AKA :order to pay
process -Process of drug purchasing and management of
supplies inside the pharmacy.
Supply Chain Management -the distribution of
medication supplies throughout the medication use
process. Equipment use to effectively manage supplies:
• A Point-of-sales(cashier, location where customer
exchange or pay) • An inventory management
system(track good or entire chain) • A handheld
terminal (it gets the code or bar code of a product)
• Automated dispensing software (automated d cabinet)
Automating the Dispensing and Drug Distribution
Process
Drug distribution and Dispensing System
Devices used in dispensing and drug distribution:
• Decentralized automated dispensing device
• Centralized robotic for dispensing medications
Decentralized Automated Dispensing Devices -AKA:
unit-based dispensing cabinets -A secure storage
cabinets capable of handling most unit-dose and some
bulk medications due to storage limitations. -1980s reduction in the number of full-time pharmacy
introduced E.g. Unit base D. Cabinet technician positions -The pharmacist’s traditional of
Benefits of using this device: preparing and distributing of medications will most
-Eliminate manual medical cart fill and delivery process certainly be challenged -Pharmacists will be more
-Improve charge capture -Improve controlled substance involved with direct patient care.
accountability -Reduce the time of pharmacists on Impact of Automation on Pharmacy Manpower
purely distributive tasks. Future work of pharmacists will depend primarily on
Disadvantages of using this device: four issues: -Breadth of tasks that a pharmacy technician
-Nurses can dispense any drug they choose -Downtimes is legally allowed to perform a task -The extent to which
may impact patient care -Inspection and removal of pharmacists is reimbursed for medication therapy
expired medications must be performed manually management services -The level of productivity which
-Potential for medication errors and suboptimal therapy can be achieved by automation systems -The extent to
Centralized Robotics for Dispensing of medications which pharmacists are able to demonstrate improve
This device is designed to automate the entire process quality and overall lower cost of patient care
of medication dispensing including: Medication storage,
Dispensing, Restocking, Crediting of unit dose
medications
Benefits of using this technology:
-Reduce pharmacy labor cost -Restructuring
pharmacist’s tasks from technical to more clinical
activities -Improve medication dispensing accuracy
-All doses dispensed by the robot are bar coded thus
facilitating the implementation of BCMA systems
Carousel Technology -The pharmacy fosters an
environment of accuracy having evolved from a more
reactive operation into a calmer, predictable operation
with decreased potential for ditraction.
With the carousel implementation, we have minimized
the opportunity for errors in several ways: -Personnel
involved in the pick and fill process are much less
distracted and experience far fewer interruptions -The
medication package is bar-code verified during
dispensing upon removal from the carousel -Pharmacists
are more actively involved in the checking process, as
they must physically place each medication in a bag
rather than simply inspect medications gathered by the
technicians -All dispensed medications are first scanned
in the pharmacy and any labels that cannot be scanned
are fixed prior to delivery to the nursing units, thus
increasing nursing’s scanning compliance
Centralized Narcotic Dispensing and Record Keeping
Systems -System that can record all doses dispensed
from a central pharmacy narcotic room or decentralized
automated dispensing devices as well as identifying
individuals performing every transaction.
Other capabilities of this system:
-This system can generate “proof of use” forms for
patient care areas -Can suggest reorder quantity based
on past usage -Provide useful compliance reports for
DEA -Facilitate documentation of controlled substance
waste
Cost Justification of Automated Systems -A ROI analysis
(Return on investment) should be established to
demonstrate the positive financial effects of technology
is essential to gain administrative approval for financing
the piece of technology.
Drivers for automation to be highlighted in ROI:
IMPROVEMENT IN PATIENT SAFETY, IMPROVE
CUSTOMER SERVICES, OPERATIONAL EFFICIENCY,
REVENUES, REGULATORY COMPLIANCE, OVERALL
QUALITY OF CARE, REDUCED COSTS
Impact of Automation on Pharmacy Manpower -Cost-
justification of new technologies will likely require a