ADVANCING TECHNOLOGY INNOVATION AND VENDOR ACCOUNTABILITY IN HEALTH-SYSTEM PHARMACY

To urge hospitals and health systems to actively engage pharmacy departments in prospective assessment, governance, competitive procurement, ongoing performance monitoring, and evaluation of technologies impacting patient care, inclusive of pharmacy informatics leadership; further,

To encourage pharmacy leaders to take ownership of pharmacy’s role in implementing, maintaining, and optimizing medication-related technologies, including associated processes and governance; further,

To support collaboration between pharmacy leaders and technology vendors in the design, implementation, maintenance, and ongoing optimization of technologies that improve patient-care outcomes and the user experience, consistent with appropriate procurement and contracting requirements; further,

To encourage technology vendors to provide transparent estimates of the resources required for implementation, integration, training, maintenance, and long-term support; further,

To advocate for federal laws and regulations that establish appropriate oversight mechanisms and define technology vendors’ responsibilities for safety, performance transparency, and timely remediation of identified risks.  

Rationale

The adoption of medication-related technology [e.g., health information technology (HIT)] in hospitals has been steadily increasing. The 2024 ASHP National Survey of Pharmacy Practice in Hospital Settings reports basic analytics (e.g., data from smart pumps, clinical decision support, compounding technology) are used in nearly 80% of hospitals and advanced analytics (e.g., artificial intelligence, machine learning, predictive analytics) are used in about 7% of hospitals, an increase from 4% in 2021 and 2.6% in 2020. Investing in technology and properly integrating it within healthcare can prevent errors, improve quality, and prevent waste. Emerging or novel technologies offer opportunities to transform the medication use process. These technologies offer significant opportunities to increase direct patient care time, close care gaps, reduce administrative burden, and minimize repetitive tasks. However, without a coordinated approach, adoption can be fragmented, underused, or misaligned with hospital goals.

Before selecting or upgrading medication-related technology, organizations must determine their needs and goals. For instance, the Office of the National Coordinator for HIT maintains the Health IT Playbook to help clinicians, administrators, and clinician-practice staff. The Health IT Playbook provides tools to help healthcare organizations choose and implement the right HIT systems for their needs. As hospitals and providers implement HIT within their institutions and practices, however, they often encounter new types of errors and problems. The medical literature is replete with many reports of the unintended consequences of HIT, so continuous monitoring of these systems is required. It has become increasingly important to properly assess the interface between HIT and users to identify whether any new risk has been introduced to the system and implement HIT appropriately, considering medication-use processes and human factors. Critical questions hospitals and health systems face include (1) when do HIT advances exceed the capacity for integration into workflow, (2) when does HIT begin to introduce risk into the medication-use process rather than improve patient safety, and (3) what are the accountabilities of HIT providers, regulators, and providers to ensure the necessary product development and assessments are made before implementation of new HIT.

ASHP advocates that the pharmacy department be part of the implementation team for any medication-related technology within an institution. Pharmacy technology solutions are capital investments with major budget implications costing millions of dollars annually. Given the rising cost of healthcare and internal competition for finite capital dollars, it is important to identify solutions that will improve quality and safety while being fiscally responsible. Pharmacy leaders must assume responsibility for guiding the design, selection,  assessment, and implementation of new and existing medication-related technologies within the department of pharmacy, including their governance and continuous evaluation. Technology assessment tools should be applied by the pharmacy workforce to proactively determine gaps in function prior to implementation, during upgrades, and as part of the continuous evaluation of technology performance. Assessments should include but are not limited to, risk, cybersecurity, clinical and operational. The use of failure modes effects analysis (FMEA) and other resources should be considered. Organizations selecting or upgrading medication-related technology should work closely with implementation partners or vendors to ensure the following: (1) products are suited to the organization’s needs; (2) Technology will be usable by clinicians and staff; and (3) accurate estimates of resources needed are identified to implement and support new or upgraded technology. It is imperative that technology vendors provide comprehensive estimates that clearly specify all required human, technical, financial, and operational resources and time commitments necessary for the implementation, integration, training, and long-term support of new or upgraded technology solutions. These processes also provide opportunities to examine and optimize care delivery processes. Tailoring both technology and processes around care pathways takes advantage of the technology’s potential to support safer care, inclusive of patient goals, while reducing burdens on healthcare professionals. Risk assessment should also be considered when implementing any new technology to ensure that unintended consequences are minimized. Regulatory and accreditation organizations include components of risk assessment and quality improvement within their criteria, but hospitals need to incorporate these into their overall plans. Such risk assessments may lead to reduced scrutiny of certain medication-related technology implementations as purchasers are often not required to research each product’s capabilities and limitations. Finally, federal law should recognize vendors’ accountability for the safety of their products as implemented.

Pharmacy workforce involvement in the development of technologies is critical. ASHP supports collaboration between pharmacy leaders and technology vendors to share pharmacy input for the development or enhancement of innovative technologies that improve patient outcomes and optimize usability. The medication-use process is inherently a multi-disciplinary process requiring involvement from numerous health-system departments. Pharmacy leadership is necessary and core principles of system-wide strategic alignment, collaboration, and change management are also fundamental. ASHP encourages members of the pharmacy workforce to actively pursue and engage in opportunities to influence technology construction.