Measuring Cognitive Services

Gary Baldwin, Editorial Director
Health Data Management Magazine, March 1, 2009

The Valley Hospital is a busy place - just ask Carlo Lupano. Pharmacy manager at the 451-bed hospital, Lupano works with 40 full-time pharmacists. Together, they process more than one million medication orders annually at the Ridgewood, N.J.-based hospital. "It works out to over four million doses," the registered pharmacist says.

Despite the heavy load, the work of pharmacists has not always been appreciated, Lupano adds. In addition to dispensing and fulfilling medication orders, pharmacists often provide what he calls the "clinical-pharmacy" aspect of the job. These interventions come at the request of physicians and nurses who often need help in understanding proper dosing, likely side effects, or medication alternatives. Historically, when clinicians approached pharmacists on such issues - often before medication orders were even placed - the subsequent intervention advice went undocumented.

For several years, Valley Hospital pharmacists attempted to measure their interventions, by using a spreadsheet and entering data on a PDA. But the device was cumbersome and the data capture time-consuming. In 2004, Lupano found commercial software to do the job, beginning a deployment that is in full swing today. The software, called Quantifi, from Pharmacy OneSource, Bellevue, Wash., enables pharmacists to track their interventions on a Web-based application hosted by the vendor. "The software gives high visibility to the cognitive services we provide," Lupano says. "It is a way to keep track of the high performers, the people providing exemplary service to the patients."

Here's how the system works: After a pharmacist intervenes on an order, he logs onto the system, identifying himself and the patient. The pharmacist uses pull-down menus to describe the type of intervention, such as a request from a physician on the proper dosing for a patient with impaired renal function. The pharmacist then logs the action taken, identifying, for example, the recommended change in medication. "It takes about a minute to document the entire intervention," Lupano says. "We document one patient at a time." Many interventions document pharmacists' work supporting medication reconciliation, he adds.

The Quantifi system is stand-alone. Thus, pharmacists must complete medication orders through the hospital's pharmacy system, then use the Web tool to document any interventions they may have made. The first version of the Quantifi system ran on a handheld, and took longer to use.

Once the technology gravitated to the Web, it became more user-friendly, Lupano recalls, and the number of pharmacists using it increased dramatically. Valley Health has more than quadrupled the number of documented pharmacy interventions it makes on an annual basis since it began using the system (see bar graph). In 2008, the hospital hit some 88,000 interventions. "When doctors get exposed to the service pharmacists provide, they want more of it," Lupano observes.

The system provides aggregate data on the number and types of interventions made. In addition, it provides an estimate of associated cost reductions attributed to the intervention.

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