Information Technology in Pharmacy An Integrated Approach

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Stephen Goundrey-Smith

Information Technology
in Pharmacy
An Integrated Approach
Stephen Goundrey-Smith, MSc.
Cert Clin Pharm, MRPharmS
SGS Pharma Solutions
Chedworth, Gloucestershire
UK

ISBN 978-1-4471-2779-6 ISBN 978-1-4471-2780-2 (eBook)

DOI 10.1007/978-1-4471-2780-2
Springer London Heidelberg New York Dordrecht

Library of Congress Control Number: 2012949460

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Preface

The purpose of this book is to provide a general introduction to pharmacy informa-

tion technology at the current time, to discuss issues surrounding the adoption of
technology and to discuss how technologies may be utilised by the pharmacy pro-
fession to exercise new professional roles and achieve new professional
aspirations.
This has been a major project for me as a pharmacist, a health informatician and
as a writer, and I would like to thank those whose assistance and support has been
invaluable in the production of this book.
I am grateful to those who were of assistance with certain sections of the
book.

• Hillary Judd and colleagues from First Databank Europe Ltd., for their input in
the area of data support for electronic prescribing
• Joan Povey from JAC Computer Services Ltd., for providing screen views of the
JAC electronic prescribing medicines administration module
• Garry McCrea, from the pharmacy department, Gloucestershire Hospitals NHS
Trust, for photos of the Gloucester Royal Hospital pharmacy robot
• Dan Mandeman from the pharmacy department, Guys and St Thomas’s NHS
Trust, for photos of electronic ward cabinets at St Thomas’s Hospital
• Donald MacIver, Manager of Cox and Robinson Pharmacy Ltd., Horsefair,
Banbury, for photos and information on automated methadone dispensing

I am especially indebted, however, to those people with whom I have worked

most closely on the electronic prescribing and pharmacy IT agendas over the past
10 years. In a sense, my expertise reflects theirs. They are (in no particular
order):
• Former colleagues and associates from iSOFT – George Brown, Tom Bolitho,
Clive Spindley, Tim Botten, Sue Braithwaite, Julie Randall and Raghu
Kumar
• Heidi Wright from the Royal Pharmaceutical Society and Lindsay McClure from
the Pharmaceutical Services Negotiating Committee
• Fellow members for the Guild of Healthcare Pharmacists/United Kingdom
Clinical Pharmacy Association (UKCPA) IT Interest Group Committee

v
vi Preface

I would also like to thank:

• Alix Sibbald for his work on illustrations and diagrams
• Grant Weston and colleagues at Springer Verlag for their editorial support
Above all, I am grateful to my family – Sally, Edward, Archie, Sam and Emily
– and friends in Chedworth for their support.

Chedworth, Gloucestershire, UK Stephen Goundrey-Smith

Contents

1 IT Enabling Pharmacy Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
IT in Pharmacy – Purpose and Scope. . . . . . . . . . . . . . . . . . . . . . . . . . 2
The Profession of Pharmacy – Past, Present and Future . . . . . . . . . . 4
The Development of Clinical Pharmacy . . . . . . . . . . . . . . . . . . . . . . . 6
The Development of Information Technology in Healthcare . . . . . . 7
The Benefits of IT in Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
The Quest for Intraoperability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Coding of Medicines Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Medicine Item Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Electronic Information Sources for Pharmacy and Therapeutics . . . 15
Electronic Drug Databases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Information Technology to Support the Medicines Use Process . . . 20
Information Technology to Support Clinical Pharmacy . . . . . . . . . . 21
IT and the Interface Between Pharmacy and the
Pharmaceutical Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Clinical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Pharmacy IT as a Sociotechnical Innovation . . . . . . . . . . . . . . . . . . . 24
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

2 Electronic Patient Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Development of Electronic Patient Records . . . . . . . . . . . . . . . . . . . 28
Legal and Professional Framework for EHRs . . . . . . . . . . . . . . . . . . 29
Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Information Governance and Data Sharing . . . . . . . . . . . . . . . . . . . . 31
UK Health Records Standards Initiatives . . . . . . . . . . . . . . . . . 32
EHRs – Principles of Design and Use . . . . . . . . . . . . . . . . . . . . . . . . . 34
What Is an EHR? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Systems Used for EPRs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

vii
viii Contents

Creation of EPRs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Access to EHR Systems by Pharmacy Professionals . . . . . . . . 36
Liability for Record Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Subject Access to EHRs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Viewing the EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Sharing of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Use of Data for Purposes Other Than That for Which It Was
Collected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Business Continuity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Archiving and Destruction of Records . . . . . . . . . . . . . . . . . . . . 41
Electronic Health Record Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Benefits of EHRs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Clinical Pathways and Content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Optimisation of EPRs for Pharmaceutical Care. . . . . . . . . . . . . . . . . 48
Applications of EPRs for Pharmacists . . . . . . . . . . . . . . . . . . . . . . . . . 49
The Content of a Pharmaceutical Care Record . . . . . . . . . . . . . . . . . 50
Medicines Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Medicines Reconciliation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Shared Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Long Term Condition Management . . . . . . . . . . . . . . . . . . . . . . 53
Homecare Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Appliances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Patient Group Direction (PGD) Supply . . . . . . . . . . . . . . . . . . 55
Public Health and Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Home Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

3 Electronic Prescribing and Medicines

Administration in Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Benefits of Electronic Prescribing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Reduction in Medication Error Rates with EP Systems . . . . . . . . . . 61
Effect of EP Systems on Medication Error Rates in Paediatrics . . . 66
Role of Barcodes in EP Systems . . . . . . . . . . . . . . . . . . . . . . . . . 67
Increases in Medication Errors due to the Introduction
of EP Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Reduction of Medication Errors due to the Availability
of Electronic Decision Support Tools at the Point
of Prescribing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Problems with Evaluating Risk Reduction
Aspects of EP Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Workflow Management for Clinical Users of EP Systems . . . . . . . . 78
Discharge Process Efficiency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Facilitation of a Seamless Pharmaceutical Supply Chain . . . . . . . . . 83
Contents ix

Reduced Use of Paper and Consumables . . . . . . . . . . . . . . . . . . . . . . 85

Clinical System Intraoperability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Improvement in Hospital Business Processes due to Electronic
Dissemination of Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Security of Prescriptions and Prescribing Information . . . . . . . . . . . 88
Quality of Care Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

4 Pharmacy Automation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
History and Development of Dispensary Technology . . . . . . . . . . . . 96
Pharmacy Robot Design and Operation . . . . . . . . . . . . . . . . . . . . . . . 97
Adoption of Pharmacy Automation in the UK. . . . . . . . . . . . . . . . . . 98
Drivers for Use of Automation in Pharmacy . . . . . . . . . . . . . . . . . . . 100
Benefits of Pharmacy Robots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Evaluating the Benefits of Pharmacy Robots . . . . . . . . . . . . . . . . . . . 105
Electronic Ward Cabinets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Benefits of Electronic Ward Cabinets . . . . . . . . . . . . . . . . . . . . . . . . . 109
Implementation Issues with Electronic Ward Cabinets . . . . . . . . . . . 110
Remote Dispensing Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Specialist Dispensing Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

5 Electronic Medicines Management in Primary Care . . . . . . . . . . . . . 121

The Development of Systems for Medicines Management
in Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Clinical Coding for GP Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Data Quality in GP Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
GP System Functionality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Identifying Patients and Registration . . . . . . . . . . . . . . . . . . . . . 127
Problem and Episode Recording. . . . . . . . . . . . . . . . . . . . . . . . . 127
Recording of Allergies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Prescribing, Medication Records and Prescribing
Decision Support Systems (DSS) . . . . . . . . . . . . . . . . . . . . . . . . 129
Items of Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Pathology Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Document Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
GP to GP Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Data Migration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
GP System Safety and Usability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Electronic Transfer of Prescriptions (ETP) . . . . . . . . . . . . . . . . . . . . . 135
Benefits of eTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
eTP Functionality Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Problems with eTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
x Contents

Supplementary Clinical Information . . . . . . . . . . . . . . . . . . . . . 142

Professional Checking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Substitution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Labelling of Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Accuracy Checking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Owings and Out of Stock Items . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Dispense Notification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Submission of Reimbursement Endorsement Messages . . . . . 145
Cancellation of Electronic Prescriptions . . . . . . . . . . . . . . . . . . 145
Electronic Repeat Dispensing . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Data Structure and Product Selection . . . . . . . . . . . . . . . . . . . . 146
Business Continuity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Adoption of ETP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Prescribing Management Software. . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

6 Pharmacy Management Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
History and Development of Pharmacy Systems . . . . . . . . . . . . . . . . 151
Pharmacy System Requirements and Use . . . . . . . . . . . . . . . . . . . . . . 152
Pharmacy System Architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Community Pharmacy System Functions . . . . . . . . . . . . . . . . . . . . . . 155
Hospital Pharmacy System Functions . . . . . . . . . . . . . . . . . . . . . . . . . 157
Stock Control Methodologies in Hospitals . . . . . . . . . . . . . . . . . . . . . 158
Pharmacy System Interfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Availability of Clinical and Medicines Information Through
Pharmacy Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
System Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Benefits of Pharmacy Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Other Pharmacy Departmental IT Applications . . . . . . . . . . . . . . . . 166
Extension of EP Functions from Pharmacy Systems . . . . . . . . . . . . . 168
Fridge Temperature Monitoring Software . . . . . . . . . . . . . . . . . . . . . . 169
Integrated Community Pharmacy Systems . . . . . . . . . . . . . . . . . . . . . 170
Systems to Support Clinical and Enhanced Services
in Community Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

7 Barcodes and Logistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Current Pharmaceutical Distribution Processes . . . . . . . . . . . . . . . . . 176
Development of Barcodes and Optical Technology . . . . . . . . . . . . . . 178
Radio Frequency Identification (RFID) . . . . . . . . . . . . . . . . . . . . . . . 179
Contents xi

The Regulatory Framework for Supply Chain Harmonisation . . . . 179

Rationale for Barcode Symbology Harmonisation . . . . . . . . . . . . . . 181
Benefits of Barcode and Optical Technology in Pharmacy
and Medicines Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Security of the Supply Chain . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Tracking of Supply Chain Efficiency . . . . . . . . . . . . . . . . . . . . . . 184
Intraoperability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
E-Commerce in Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Reduction of Dispensing Errors . . . . . . . . . . . . . . . . . . . . . . . . . 186
Electronic Medicines Administration . . . . . . . . . . . . . . . . . . . . . 187
Pharmacy Workflow Tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

8 Future Prospects in Pharmacy IT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

Towards Integrated IT Systems in Pharmacy Practice . . . . . . . . . . . . 193
Smart Pumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Oncology Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Challenges of Device Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Smart Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Telecare and Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Clinical Homecare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Methodology and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Development of Professional Standards . . . . . . . . . . . . . . . . . . . . . . . 208
Pharmacy Professional Engagement in IT Adoption . . . . . . . . . . . . . 210
IT Education and Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Chapter 1
IT Enabling Pharmacy Practice

Introduction

Over the last 30–40 years, information technology (IT) has revolutionised profes-
sional life for millions of people around the world. IT has reduced the need for bulk
storage of paper records by organizations due to its capacity to store large amounts
of digital data on hardware which is relatively small in size. Also, because IT sys-
tems can copy, process and disseminate data, and present data in different ways,
computers have been able to automate tasks that were previously repetitive and
labour-intensive, and carry them out in a fast and accurate way. For these reasons, the
expansion of IT into the workplace – and indeed, the home – has completely changed
working practices in many industries. IT has enabled economies of scale, improved
efficiencies and enabled new ways of working that were hitherto impossible. The use
of IT means that services can be provided to large populations, yet customised to
each individual. Computers have had a major impact on many industry sectors
including banking and finance, retail, the service industries – and healthcare.
In parallel with the rise of IT during the last 40 years, the role of the pharmacist –
and the society in which pharmacists work – has changed considerably. Pharmacists
are no longer principally compounders of medicines, as most medicines now are
available in a suitably packaged form from manufacturers. However, pharmacists are
still responsible for ensuring that the patient receives the correct medicine, ensuring
that the patient understands why they should take their medicine, and helping the
patient with taking the medicine and being concordant with therapy.
Modern medicines are becoming increasingly sophisticated in terms of their
modes of action, so the information available about them is correspondingly more
complex. Furthermore, the amount of medicines information available has
increased exponentially, with information now available through a range of differ-
ent providers. Traditionally, information on medicines was available in reference
sources – pharmacopoeias and compendia – produced by specialist publishers and
professional bodies, and also from the pharmaceutical industry. Today, however,
medicines information is available from a plethora of sources on the internet.

S. Goundrey-Smith, Information Technology in Pharmacy, 1

DOI 10.1007/978-1-4471-2780-2_1, © Springer-Verlag London 2013
2 1 IT Enabling Pharmacy Practice

However, information provided over the internet will not be subject to the same
quality processes and review mechanisms as information in the traditional medi-
cine reference sources so, in some cases, this information may be biased or of
questionable quality. A key issue is how the most appropriate information on med-
icines can be made available in the most readable form to the patient or healthcare
professional at the point of care.
The increasing availability of medicines information direct to the patient, as with
internet sources, means that information on medicines is no longer the sole preserve
of the healthcare professional. There has also been an increase in the growth of
consumerism in healthcare, with a corresponding reduction in paternalism on the
part of the healthcare professional. People therefore see themselves as consumers of
healthcare rather than patients. While, in fomer days, the doctor’s advice was the
final authority and was not questioned, now the patient will simply find a different
clinician if they don’t like the advice they receive. The concepts of the “empowered
patient” and the healthcare professional as “a partner” with the patient in the health-
care process are now in common use among healthcare policy makers.
A combination of new medical technology and new information technology
means that public health needs can now be identified and addressed in a way they
could not in previous generations. And with the full understanding of public health
issues, and the ability to address them, comes the ethical imperative to do so, with
the corresponding pressures on health professional activity and healthcare provider
budgets. Pressing public health issues, and their budgetary impact, especially in the
deprived sections of the population, are huge drivers for the development of new
professional roles in healthcare and the use of IT to enable these roles in both the
United Kingdom and the United States. At the time of writing, the NHS in the UK
is undergoing a far-reaching programme of reforms, which will have considerable
impact on the efficiency of healthcare provision but, more subtly, on the relationship
of different professional groups and how they might work together to optimise
healthcare provision in the NHS. The UK NHS needs to realise huge cost savings in
healthcare delivery – to the tune of approximately £20 bn – and many managers and
clinicians recognise that these cost savings will only be realised through the use of
IT systems in healthcare delivery, with the reduction of risk, increase in efficiencies,
and the new ways of working that they enable.

IT in Pharmacy – Purpose and Scope

The book will describe some of the benefits and risks associated with the use of IT
to support the provision of a pharmacy service, and some of the issues that phar-
macy managers implementing these technologies face. The book will also explore
the way in which current and emerging technologies might support new ways of
working in pharmacy, to make the most of the pharmacist’s skill set. IT applications
that support the work of pharmacists in hospital and community pharmacy practice
will be described and discussed, drawing on the author’s experience and available
IT in Pharmacy – Purpose and Scope 3

research literature in the field. The emphasis will be on the holistic use of technolo-
gies to streamline and influence the prescribing and medicines use process, and so
the book will look at IT systems that are not, or not solely, used by pharmacists,
such as hospital electronic prescribing systems and the systems used in doctors’
surgeries (GP systems).
Chapter 2 will look at the development of electronic health records, and the
design, security and legal issues associated with them, and how the electronic health
record can enable and optimise high quality pharmaceutical care. Chapter 3 will
examine the benefits of hospital electronic prescribing (EP), the experiences of
implementation and how it affects pharmacists. Chapter 4 discusses the various
forms of automated dispensing that have been developed, including dispensary
robots, ward cabinets, remote dispensing kiosks, and other forms of dispensing
device. Chapter 5 will review the use of IT systems in the wider primary care arena,
including general medical practitioner’s systems, electronic transfer of prescrip-
tions (eTP), and prescribing management systems and will describe the functions of
these systems from a pharmacy perspective. Chapter 6 will examine the role of
patient medication records in community pharmacy, and departmental pharmacy
systems in hospital pharmacy, looking at their functions and their contribution to
pharmacy management. Chapter 7 reviews the development of pharmacy logistics
and how IT has impacted on this, particularly in the area of product and batch
identification. Finally, Chap. 8 assesses potential future developments in IT to sup-
port pharmacy practice, together with the standards in education and professional
development that will be required to capitalise on these.
The book will discuss the use of IT in pharmacy practice from an international
perspective, looking at literature describing innovation and practice from different
countries – most notably, the United States, UK, Europe and Australia.
The scope of the book does not extend to a full discussion of:
• The editorial and distribution processes for distributing reference sources on
pharmacy and clinical medicine (eg formularies and monographs)
• The medicines information systems used purely to support the activities of the
pharmaceutical industry
• Databases and systems used for the capture and storage of clinical trial data.
However, the discussion will touch on these areas to the extent to which they
relate to the practice of pharmacy. The book describes pharmacy IT in general terms
and is not intended to be a substitute for professional advice or consultancy in a
specific practice setting.
As well as a discussion of the impact of technologies on pharmacy practice, this
book will also discuss the issues surrounding the adoption and use of technology,
the engagement of the pharmacy profession with technology, and the policy and
standards that should underpin the use of technology by pharmacists. An exhaustive
literature review of IT applications in pharmacy is beyond the scope of this book,
although the book will refer to key research papers. Also, many of the IT applica-
tions and systems discussed are interrelated and there is an extent to which the divi-
sion of the subject matter between the chapters is arbitrary.
4 1 IT Enabling Pharmacy Practice

In order to discuss the information requirements of the pharmacy profession

and the role of IT in the working life of the pharmacist, it is necessary to review
the history of the pharmacy profession [1], and the environments in which the
profession operates.

The Profession of Pharmacy – Past, Present and Future

The profession of pharmacy emerged in the UK during the early nineteenth century,
with a gradual distinction developing between apothecaries on the one hand, who
were essentially medical practitioners, and chemists and druggists on the other,
whose prime occupation was the preparation and supply of medicines. Some of
these chemists and druggists were also apothecaries, others members of the pep-
perer’s section of the Guild of Grocers and still others with no trade affiliation.
However, following the Apothecaries Act of 1815, the activities of apothecaries
were increasingly regulated, and there was a concern that, in emerging legislation,
chemists and druggists who did not wish to become apothecaries would become
subservient to the apothecaries. Consequently, a number of chemists and druggists
decided to form a professional association to ensure that their interests were best
served, and that they remained an independent group. The Pharmaceutical Society
of Great Britain (Royal Pharmaceutical Society) was formed in 1841 for this pur-
pose and soon established the legal basis for a register of pharmacists and a designa-
tion of pharmacist as a restricted title.
In Victorian times, in both the US and UK, pharmacists largely sold medicines
rather than dispensed doctors’ prescriptions (at that time pharmacists dispensed
less than 10 % of prescriptions written by doctors in England and Wales).
Furthermore, at this time, medicines were made of crude plant or animal extracts,
and were of limited efficacy and often dubious quality. Many were produced in
individual pharmacies according to a proprietary formula (secret recipe) of the
pharmacist’s choice. Consequently, during the early years of pharmacy, there was
a large number of medicines available of variable formulae and quality and there
was very little information available on these medicines, other than that compiled
for advertising purposes.
In the UK, the 1911 National Insurance Bill signalled a change in how health
services were provided, with a significant impact on the pharmacy profession. The
National Insurance legislation established a national insurance scheme for those in
employment, which provided free medical care – and medicines – for those con-
tributing to the scheme. Previously, anyone consulting a medical practitioner would
have paid a fee for the consultation, and a fee for any medicine prescribed at the
consultation from the doctor’s own dispensary. Under the national health insurance
scheme, doctors would write prescriptions, which pharmacists would have the right
to dispense. Because of the need for national health scheme reimbursement, the
role of the doctor as prescriber and of the pharmacist as dispenser were separated.
This had two effects. Firstly, it established a need for doctors and pharmacists to
The Profession of Pharmacy – Past, Present and Future 5

communicate about the dispensing of prescriptions. Secondly, there was a sharp

increase in the percentage of doctors’ prescriptions dispensed by pharmacists from
around 10 % (as previously mentioned) to around 40 %. Income from prescription
remuneration therefore became a major source of income for a pharmacy business.
Local committees were established to process national health insurance scheme
remuneration and a national Drug Tariff was introduced to standardise medicine
prices and prescription payment processes.
These far-reaching changes in healthcare were further extended by the establish-
ment of the National Health Service (NHS) in 1948, which aimed to provide free
medical care (and medicines on prescription) to every citizen, not just those in
employment.
The development of the welfare state in the UK, through the national insurance
legislation of 1911 and the NHS Act of 1946, was the impetus for national stan-
dardisation of formulated medicines, and the availability of standard information on
these medicines. As mentioned previously, in Victorian times, there had been a
plethora of chemist’s remedies of variable formula and quality available from phar-
macies. However, following the introduction of the national insurance scheme in
1914, local reimbursement committees were urged not to pay for medicines with a
“secret formula”. This led to the development of a national formulary in 1929,
which provided standard formulations for commonly-used unbranded medicines.
This was the forerunner to the British National Formulary, one of the standard medi-
cines reference sources in use today.
While the activities of the Pharmaceutical Society of Great Britain ensured that
pharmacy began to emerge as a profession in the mid nineteenth century, pharma-
cists were still businessmen and a number of issues faced by pharmacists in the UK
at that time related to their trade interests as much as to their professional standing.
In 1880, a court action established a precedent that it was permissible for a corpo-
rate body to own multiple pharmacy premises. This was regularised in law in the
1908 Poisons and Pharmacy Act. This enabled the growth of multiple pharmacies in
the UK, such as Boots, which had been established in 1877. There was therefore an
increasing need for pharmacies to communicate with other branches of the same
company, as well as with doctors and with their customers and patients.
Following the establishment of the NHS in 1948, the percentage of doctors
prescriptions processed by the NHS rose to around 70 %, which is the figure at the
current time. The formation of the NHS also therefore led to a reduction in the
sales of proprietary medicines from pharmacies. However, while these trends
might have been negative ones for pharmaceutical manufacturers, the industry
was in a strong position with many new medicines being developed in the twenti-
eth century “therapeutic revolution”, and there was increased advertising activity
for all medicines. A reaction to this was increased regulation of the medicine
development and marketing process and the development of the Association of
the British Pharmaceutical Industry Code of Practice on the advertising of medi-
cines, introduced in 1958 [2] . These developments increased the amount of infor-
mation on medicines available in the public domain, although many professionals
have been concerned about how unbiased some of the information was. More