Improving the efficiency of distributive and clinical services in hospital pharmacy.

Three problems impede the assessment of hospital pharmacy efficiency. First, although multiple efficiency indicators are utilized to measure a large variety of activities, it has not been possible to validly measure overall efficiency. Second, there have been no widely-used clinical activity indicators, so key outputs often have not been accounted for. Third, there has been no effective methodology for identifying when declines in efficiency are normal random variations and when they represent true decreases in performance. This paper presents a procedure that simultaneously addresses these three problems. It analyzes data from a group of U.S. hospital pharmacies that collect an inclusive set of clinical and distributional indicators. It employs Data Envelopment Analysis to develop comprehensive efficiency measures from the numerous outputs and inputs. It applies statistical Panel Data Analysis to estimate confidence intervals within which each pharmacy's true efficiency resides, and to develop control charts for signaling when a pharmacy's efficiency has declined by more than can be attributed to random variation. This integrated efficiency evaluation system is transferable to other hospital pharmacy systems, thereby offering decision makers a better way of measuring, controlling and improving hospital pharmacy efficiency.

Electronic prescribing: a review of costs and benefits.

Electronic prescribing tools are currently available but most medical practices are not using them. The literature was reviewed for data on adverse drug events and the expected dollar savings that could occur if these events were prevented. In addition to cost savings from improved patient safety, the effect of these systems on formulary compliance and drug cost savings was examined. Improved physician, nurse, and staff efficiencies were calculated using time trial comparisons between a paper system of handling prescription refills and a representative electronic prescribing system. The conclusion is made that electronic prescribing software is cost-effective for all size practices with a more rapid return on investment in larger practices.

The business case for medication safety.

The decision to invest in a medication-safety system should take into account not only implementation costs but also reduced hospital costs for treating complications resulting from medication errors and potential liability. Medication-safety programs should be analyzed and planned the same as any other investment. Providers should base their projected return from a medication-safety system on intangible benefits to the organization as well as an ROI calculation. Investment in medication-safety systems can be justified in terms of risk management and legal liability.

Will decision support in medications order entry save money? A return on investment analysis of the case of the Hong Kong hospital authority.

The computerized medications order entry system currently used in the public hospitals of Hong Kong does not have decision support features. Plans are underway to add decision support to this system to alert physicians on drug-allergy conflicts, drug-lab result conflicts, drug-drug interactions and atypical dosages. A return on investment analysis is done on this enhancement, both as an examination of whether there is a positive return on the investment and as a contribution to the ongoing discussion of the use of return on investment models in health care information technology investments. It is estimated that the addition of decision support will reduce adverse drug events by 4.2 - 8.4%. Based on this estimate, a total net saving of $44,000 - $586,000 is expected over five years. The breakeven period is estimated to be between two to four years.

Evaluating the capability of information technology to prevent adverse drug events: a computer simulation approach.

BACKGROUND: The annual cost of morbidity and mortality due to medication errors in the U.S. has been estimated at $76.6 billion. Information technology implemented systematically has the potential to significantly reduce medication errors that result in adverse drug events (ADEs). OBJECTIVE: To develop a computer simulation model that can be used to evaluate the effectiveness of information technology applications designed to detect and prevent medication errors that result in adverse drug effects. METHODS: A computer simulation model was constructed representing the medication delivery system in a hospital. STELLA, a continuous simulation software package, was used to construct the model. Parameters of the model were estimated from a study of prescription errors on two hospital medical/surgical units and used in the baseline simulation. Five prevention strategies were simulated based on information obtained from the literature. RESULTS: The model simulates the four stages of the medication delivery system: prescribing, transcribing, dispensing, and administering drugs. We simulated interventions that have been demonstrated in prior studies to decrease error rates. The results suggest that an integrated medication delivery system can save up to 1,226 days of excess hospitalization and $1.4 million in associated costs annually in a large hospital. The results of the analyses regarding the effects of the interventions on the additional hospital costs associated with ADEs are somewhat sensitive to the distribution of errors in the hospital, more sensitive to the costs of an ADE, and most sensitive to the proportion of medication errors resulting in ADEs. CONCLUSIONS: The results suggest that clinical information systems are potentially a cost-effective means of preventing ADEs in hospitals and demonstrate the importance of viewing medication errors from a systems perspective. Prevention efforts that focus on a single stage of the process had limited impact on the overall error rate. This study suggests that system-wide changes to the medication delivery system are required to drastically reduce mediation errors that may result in ADEs in a hospital setting.

Quantifying value for physician order-entry systems: a balance of cost and quality.

Healthcare CFOs commonly demand hard data to prove that an investment in computerized physician order entry (CPOE) will be worthwhile. However, a balanced analysis of cost and quality of the CPOE system has advantages over traditional return-on-investment appraisals. Montefiore Medical Center (MMC), Bronx, New York, assessed the value of its CPOE system by quantifying cost and quality measures rather than relying solely on dollar returns. MMC collected process times for medication ordering before and after the CPOE system was introduced and demonstrated that the use of CPOE increased medication ordering efficiency by 92 percent. MMC calculated additional process times for ward clerks, nurses, and pharmacists before and after CPOE implementation and determined the time saved per employee. From that number, the dollars potentially saved per employee and total potential dollar value of time savings per year were calculated.

CPOE (computerized physician order entry). An executive's guide.

Computerized physician order entry is controversial. Backers say it helps reduce medication errors significantly. Critics note that it's expensive, as well as complex to design and implement. This guide considers the advantages and costs of CPOE.