Three technology innovations for your health system to explore

What do Vanderbilt University Medical Center, Indiana University Health, and MedStar Health System have in common?

These health systems have leaders who were willing to leverage their resources and evaluate cost-saving measures with the help of technology. The results are paying off, according to pharmacists from these institutions who presented their technology innovations during the 2015 ASHP Midyear Meeting in New Orleans, La.

A purchasing app

Matt Marshall, PharmD, an analytics pharmacist, and Seth Strawbridge, PharmD, an informatics pharmacist, both at Vanderbilt University Medical Center, Nashville, Tenn., used pricing and purchasing data to build an app to help guide the purchasing of drugs for the health-system.

They developed an algorithm to normalize items to the smallest unit of measure and then were able to calculate the cost per the smallest unit of measure.

"Our previous solution was a spreadsheet that was used to compare three items. This was a great solution for one drug, but not for a health system that purchases approximately 40,000 drugs," Marshall said.

With this new algorithm, over a two-month timeframe they were able to save almost $30,000. "Our net 12-month savings is more than $200,000," which is a proactive approach to purchasing, he said.

CPOE for oncology

Has your institution implemented computerized physician order entry (CPOE) for oncology drugs? asked Lisa Starost, PharmD, the informatics pharmacist at Indiana University Health (IUH), in Indianapolis.

In November 2013, IUH tried to implement a CPOE for chemotherapy drugs and experienced some growing pains. By February 2014, the institution went back to the paper method because of issues with safety checks and sign-offs, multiple steps, and clicks for dosing evaluation, and a high level treatment view.

A multidisciplinary team of stakeholders, which included a project manager, a system expert, a nurse, an implementation analyst, and a pharmacist (herself), met to work out the kinks. By August 2014, the CPOE for oncology drugs was up and running again, Starost noted.

"We learned to listen to our customers. The success, or failure, of the system is correlated to the buy-in and comfort of the customers-in this case, they were the physicians and nurses who were the most frequent users," she noted.

Also, the team evaluated the system to see if it would allow for modifications that customers wanted. And they identified key stakeholders quickly and kept them engaged.

Centralized batch cabinet refill

MedStar Health System had 6 hospitals that used a pharmaceutical distributor to refill its automated dispensing cabinets (ADCs). They were considering a change in distributor and wanted to determine if they could handle a loss of this outsourced service. Could they do it themselves? asked Eula Beasley, PharmD, clinical pharmacy director at MedStar.

"Our initial goals were to insource the batch cabinet fill at 6 hospitals that were currently outsourced and expand that to include all 10 hospitals in the health system," she said. "We also wanted to fill more than 65% of the oral solids, injectables, and other non-refrigerated/non-IV dosage forms and reduce the non-drug shortage stock-outs."

By mapping out the workflow and analyzing the implementation requirements, they were able to change from 6 hospitals utilizing the outsourced model to 7 hospitals that were insourced. With a reduction from an average stock-out of 99 lines per day in 6 hospitals to an average stock-out of 18 lines daily in 7 hospitals, MedStar had an average cost avoidance of more than $150,000, Beasley noted.

In the second phase of the insourced model, MedStar expanded its space for its centralized fulfillment center and installed carousel technology and virtual storage location software. In October 2015, they expanded the batch cabinet refill to 9 hospitals for an annual cost avoidance of $185,000.

"You can achieve cabinet batch refill through insourcing," Beasley said. "Mapping workflow and data evaluation are critical in successful planning and implementation."