I have offered a previouscommentary regardingmedication safety as itrelates to patients migratingacross various care environments.In fact, I have suggestedthat hospital pharmacistsshould assume formalresponsibility for takingadmission histories, writingadmission medication orders,writing discharge prescriptions,and offering dischargecounseling. Regardlessof whether pharmacists routinelyassume these responsibilities"officially"withintheir hospitals, the relevant(and reliable) data are neededat our fingertips.
So why can't a "NationalPatient Registry"be createdthat could enable the capture,storage, and retrieval ofdata reflecting drugs prescribedand purchased? Iunderstand we will need toovercome issues related tothe Health Insurance Portabilityand Accountability Actand technological challenges.I am put off by pharmacistswho refuse to "givecopies"to others, or thosewho might resist submittingall the relevant information—this too can beresolved. What troubles memost of all is that this informationis in cyberspace floatingaround, but cannot beaggregated and used easily bythose who are relied on tohelp patients make the bestuse of their medicine. TheAsheville Project exemplifiespharmacists in hospitals andthe community collaboratingwith physicians, otherproviders, employers, andpatients to more effectivelycare for their patientsthrough the use of a comprehensivemedication database.
The National Council forPrescription Drug Programswill soon be issuing nationalprovider identifiers for claimsubmission. The secretary ofHealth and Human Servicesrecently announced plansfor the development of theNational Health InformationNetwork and the creation ofa federal advisory commissionon standards for healthcare information technology.Electronic prescribing isbeing encouraged in bothprivate and public sectors asa safer and more efficientprocedure. It seems to methat the writing is on thewall. The infrastructure iscoming into place thatshould enable the creationand maintenance of a druguse database for all patients.
I strongly believe that ournational associations need tocollaborate and propose essentialdata elements whichshould be part of the database.Given the huge numbersof patients seen in hospitalambulatory clinics andas inpatients, hospital pharmacistsmust be a part ofdeliberations so that we canuse data from the patient'spharmacy on admission andpass along discharge medicationinformation. Similararguments can be made forpharmacists practicing inhome care, long-term care,and a variety of other settings.We need to be sensitiveto the data that are needed inall practice settings, and evenconsider other essentialinformation (laboratory findings,weight, etc) that isneeded as we contemplatethe evolution of our role.
Let's get proactive on thisissue and chart our own destiny,rather than wait forthe federal government totell us what this databaseshould contain. It's ours forthe taking.
Mr. McAllister is director ofpharmacy at University ofNorth Carolina (UNC)Hospitals and Clinics and associatedean for clinical affairs atUNC School of Pharmacy,Chapel Hill.