HEALTH-SYSTEM EDITION
BUSINESS/MANAGEMENT

Cardinal Health offers off-site resource for hospitals

A drug wholesaler has launched a remote order entry system in Texas to provide additional pharmacy coverage for hospitals through an Internet-based connection. The service will be offered to other states as their boards of pharmacy approve the concept.

After a successful pilot program at two hospitals in Texas, Cardinal Health launched Rxe-source, a service providing additional pharmacy coverage to hospitals, easing staffing pressures, reducing the risks of adverse medication events, and providing for continuity of patient care. The service uses a high-speed Internet connection to link hospital staff to a remote order entry system staffed by pharmacists at Cardinal Health's support center.

Rxe-source [pron., re-source] has been in use at Mission (Texas) Hospital since November 2002, said Imelda Ochoa, R.Ph., the hospital's director of pharmacy. This South Texas community hospital has 138 beds and is in the process of expanding.

The pharmacy department at Mission closes overnight at 10 pm, Ochoa said. "But a lot of physicians make rounds late, at 9 or 10 pm." Each morning, as a result, the pharmacy staff comes in to a two- to three-hour backlog of medication orders. Now, nurses fax overnight prescription orders to Rxe-source, where the pharmacist enters the order into Mission's system. A decentralized automated dispensing machine then dispenses the medication. When the hospital's pharmacy department reopens in the morning, Rxe-source faxes a report of overnight activity, including information on any interventions or communications with the hospital staff.

The majority of hospital pharmacy departments in the United States—70% to 77%—do not have 24-hour staffing, said Ron Graham, R.Ph., VP for operations at Cardinal Health. As most states require medication orders to be reviewed by a pharmacist, there is a lot of pressure to evaluate prescriptions and dispense them quickly. If a hospital wanted to keep a pharmacy department open all night, he said, it would have to hire more help. It is more efficient for one pharmacist to cover two or more hospitals remotely than for each hospital to have a pharmacist on site at night.

Cardinal Health decided to develop a program to solve the gaps in pharmacy coverage. The company approached the Texas Board of Pharmacy and, with the board's participation, started the pilot program at Mission Hospital and at Polly Ryon Memorial Hospital in Richmond, Texas. No other company offers a remote order entry system as extensive as Rxe-source, which can do all that an in-house pharmacist would do, Graham claimed.

According to Greg Butler, Cardinal's Senior VP for marketing and business development, most state boards of pharmacy have realized that the technology governing order entry systems has outstripped regulations. The company is now working with other state boards of pharmacy to get approval for Rxe-source, he said.

A hospital would need high-speed Internet access for Rxe-source, but most already have that, Butler continued. "The hardware aspect is negligible, and we take care of the rest." The primary market for Rxe-source, he noted, is acute care hospitals.

A third acute care hospital in Texas has already signed on.

Butler explained that tertiary care hospitals could use Rxe-source as a backup or to take some of a pharmacy department's load all day, and Rxe-source's coverage can be tailored to fit a hospital's needs. The costs of Rxe-source varies with the volume and extent of coverage chosen, he added.

Cardinal Health will be recruiting more employees as Rxe-source is launched in other states, Graham noted.

The pharmacy staff from Rxe-source went to Mission to learn the hospital's pharmacy system, Ochoa said. "I was impressed by the commitment to make it work." She said that she had mixed feelings about the system when it was proposed but is very pleased with how well it has worked out. Initially, there had been some worries about confidentiality and technical problems during the setup period for Rxe-source, but the problems caused by Internet outages in December were solved by the addition of a backup dial-up Internet service.

Nurses at Mission are happy with the system, too, Ochoa observed. One nursing floor has been asking for a second automated dispensing machine because of a backup in nurses waiting to process overnight medication orders each morning.

Mission still has a pharmacist on call each night. That pharmacist is now contacted about once a week for information and may need to come into the hospital only once a month. This is a great reduction in the number of calls and night trips, Ochoa said.

Valerie DeBenedette

The author is a New York-base healthcare journalist.

Valerie DeBenedette. Cardinal Health offers off-site resource for hospitals.

Drug Topics

Apr. 21, 2003;147:HSE35.