August 28, 2017

HealthPRO Pharmacy Services Member CAMH Earns Prestigious HIMSS Stage 7 Designation

The Centre for Addiction and Mental Health (CAMH), a HealthPRO Pharmacy Services member, has become the first academic research and teaching hospital and only the second hospital in Canada to earn a Stage 7 designation from the Healthcare Information and Management Systems Society (HIMSS). The Society is a non-profit organization with the vision of better health through information technology.

A Stage 7 designation is the highest possible rating and represents a near paperless environment that uses technology to support optimal patient care.

Thomas Chan, Director, Pharmaceutical Services at CAMH, provides his perspective about achieving HIMSS Stage 7.

Q: In your own words, please describe the significance of this achievement.

The electronic medical record (EMR) system, I-CARE, helps us access patient information faster and allows us to make the best decisions for our patients and to provide standardized, evidence-based care.

From a pharmacy perspective, HIMSS focused on how healthcare information technology can help improve medication safety in the hospital.  We have demonstrated how technology is utilized to improve inventory management, the packaging process to unit dose, barcode utilization, medication dispensing and distribution activities. 

HIMSS also paid attention to other various pharmacy processes including medication reconciliation, afterhours medication order management, and barcode scanning at bedside administration, all of which contribute to improved medication safety. 

Also, because I-CARE has so much data, HIMSS wanted to see how we utilize and translate data to support better patient outcomes.  For example, if a patient is on a medication and lab work shows early signs that suggest a potential adverse effect for a patient, the system will provide an alert. Clinical decision support tools like this allows clinicians to address medication related issues before they become more challenging to manage.

Q: What were the challenges with achieving this milestone and how were they overcome in Pharmacy and within CAMH?

In Pharmacy, the biggest challenges pertained to the adoption of barcode scanning during medication administration; incorporating information technology into all aspects of pharmacy processes, and managing associated changes. 

Nurses scanning patient identification and medications prior to administration ensures the right medication is given to the right patient.  However, currently not all pharmaceutical products have barcodes.  Lack of a barcode increases the workload for the pharmacy team as we must affix a barcode internally before we can dispense the products to the nurses on the inpatient units.  HealthPRO is working very closely with pharmaceutical manufacturers so that when contracts are awarded, there is a requirement for a barcode. This ensures member hospitals have as many products with a barcode as possible.

In the CAMH environment, we faced an additional challenge as a result of many patients bringing in their own medications, such as herbal supplements. How will nurses scan these herbal medications prior to administration? What is the process for safely administering such medications? Should a barcode label be created for these medications?  At CAMH, we addressed this challenge by developing a new process to affix barcodes to patients’ own medications.

Another challenge faced in our environment pertained to the need to ensure that all processes were supported by the use of information technology.  In particular, like most hospital pharmacies, we are not open 24/7, so we needed to determine how to review electronic medication orders and distribute the appropriate medications to nurses after hours, while ensuring that barcode scanning could still occur for medications safety.  CAMH implemented a process change supported by a policy update that addressed after hours medication orders, to ensure the safest outcome for the patient.

Lastly, an organizational culture change was required for successful adoption of the clinical information system.  Articulating the value of such a system and its benefits to patient care helped promote positive reception and adoption by staff.

Q: How does this achievement contribute to safe medication management?

Our Closed-Loop Medication Administration (CLMA) system is designed to facilitate medication management from prescribing to administration of medications. CAMH has developed Integrated Care Pathways, which clinicians can use to provide standardized, evidence-based care to patient.  Our pharmacists can view medication histories, identify drug interactions or allergy information, monitor patient lab works, view inter-professional notes, while verifying medication orders.   Medications are dispensed with barcodes, for nurses to scan prior to administration to patients, to eliminate dosing error. I-CARE enhanced our collaboration and communication with other health care providers, in an effort to produce better patient outcomes, together.

Q: How will this help support patient outcomes?

As part of the Stage 7 validation, the HIMSS team visited many CAMH inpatient units and departments to view how our clinicians use I-CARE to support patient care. With improvements in clinical decision support systems, and computerized access to all clinical documents, clinicians can make better informed decisions.  As well, CAMH can now generate high-quality data to evaluate practice and care pathways, allowing for continuous improvements in patient care.

Q: What advice would you give to others aiming to achieve this milestone?

Achieving HIMSS Stage 7 is a complex undertaking. It involves all aspects of the organization, from leadership to front line clinicians and requires buy-in from all departments.  Having clinicians champion the effort in the planning stages is important. Working together and acknowledging that everyone has a role to play is crucial to success.  

Lastly, having clinicians engaged in modifying processes, practices and systems, and providing regular communication about the status and benefits of change were key to transforming the culture of CAMH.