I have offered a previous commentary regarding medication safety as it relates to patients migrating across various care environments. In fact, I have suggested that hospital pharmacists should assume formal responsibility for taking admission histories, writing admission medication orders, writing discharge prescriptions, and offering discharge counseling. Regardless of whether pharmacists routinely assume these responsibilities "officially"within their hospitals, the relevant (and reliable) data are needed at our fingertips.
So why can't a "National Patient Registry"be created that could enable the capture, storage, and retrieval of data reflecting drugs prescribed and purchased? I understand we will need to overcome issues related to the Health Insurance Portability and Accountability Act and technological challenges. I am put off by pharmacists who refuse to "give copies"to others, or those who might resist submitting all the relevant informationthis too can be resolved. What troubles me most of all is that this information is in cyberspace floating around, but cannot be aggregated and used easily by those who are relied on to help patients make the best use of their medicine. The Asheville Project exemplifies pharmacists in hospitals and the community collaborating with physicians, other providers, employers, and patients to more effectively care for their patients through the use of a comprehensive medication database.
The National Council for Prescription Drug Programs will soon be issuing national provider identifiers for claim submission. The secretary of Health and Human Services recently announced plans for the development of the National Health Information Network and the creation of a federal advisory commission on standards for health care information technology. Electronic prescribing is being encouraged in both private and public sectors as a safer and more efficient procedure. It seems to me that the writing is on the wall. The infrastructure is coming into place that should enable the creation and maintenance of a drug use database for all patients.
I strongly believe that our national associations need to collaborate and propose essential data elements which should be part of the database. Given the huge numbers of patients seen in hospital ambulatory clinics and as inpatients, hospital pharmacists must be a part of deliberations so that we can use data from the patient's pharmacy on admission and pass along discharge medication information. Similar arguments can be made for pharmacists practicing in home care, long-term care, and a variety of other settings. We need to be sensitive to the data that are needed in all practice settings, and even consider other essential information (laboratory findings, weight, etc) that is needed as we contemplate the evolution of our role.
Let's get proactive on this issue and chart our own destiny, rather than wait for the federal government to tell us what this database should contain. It's ours for the taking.
Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.
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