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A Pharmaceutical information system consists of a server along with various clients or users at the end-points of the system. The Clients are connected to the server through a system. In the client all the information is stored. Besides another back-up system is also existent in case of any emergency. The major components of the server include an integrated gateway, a document manager, a drug database, the patient information, administration of the system, etc. The relevant user can retrieve the patient information from the server and accordingly make relevant changes in the medical records, prescriptions, order, etc (Yeh, 2004).
In the system, the patient's information is organized in a systematic manner so that information can be accessed, modifications can be made and details can be recorded in a user-friendly manner. In a system, there may be four categories of the electronic medical record including:-
- the patient details including history and symptoms
- the exact timings of the initial and followup visit
- the diagnosis and the evaluations conducted
- the treatment details including surgical and drug interventions (Yeh, 2004)
The electronic medical record gives great amount of importance to the drugs prescribed and administered to the patient. Once the user logs in, he could very easily see the drugs that the patient has been administered, the duration of the drugs, the manner in which the drug has to be administered, etc. Besides, importance is also given to any potential for drug interactions, previous drug history, previous drug allergies, etc. In this way potential complications and harms to the patient can be prevented using a pharmaceutical information system. The pharmaceutical information system can also be utilized to educate the patient and to inform them about potential issues and precautions to be taken. One way of demonstrating the drug would be in the form of a picture in JPEG format. Information of the drug would usually mention in a PDF or Acrobat format (Yeh, 2004).
The information present in the electronic record includes:-
- The name of the drug, along with alternative names and brand names
- The primary and supplemental classification of the drug
- The category of the drug
- Physio-chemical data
- Mechanism of action and effects of the drug
- Absorption of the drug - oral, injections, IV, etc
- Distribution of the drug - in the CSF, skin, saliva, lungs, muscle
- Protein-binding capacity
- The half-life of the drug - including in adults, neonatal, children, elders, compromised patients, etc
- The dosage of the drug including those for children, neonatal, adults, elders, medical patients, etc
- Serum concentrations at regular intervals of time
- The time at which the peak serum concentration is reached
- The manners in which the drug is excreted from the body
- Precautions to be taken while administering the drug
- Precautions to be taken during pregnancy, lactation, childhood, elders, medically-compromised patients (various conditions), etc
- Drug interactions
- Laboratory alteration values
- Contraindications for the use of this drug
- Situations in which risk and benefits need to be considered
- Monitoring of the patient required
- Adverse-effects/side-effects of the drug
- Situations in which medical attention is required - frequency, severity, etc
- Interventions to be taken in case of overdose
- Identification, treatment and prevention of overdose
- Various situations the patient may encounter whilst consuming the drug and the measures that the patient has to take
- The dosage chart
- Dosage order forms
- Strengths of the drug usually available
- Manner in which the drug has to be stored and packaged
- References and further information links (Harrison's, 2004).
The system can be set in such a way that details are provided for all the patients or a group of patients. In one study conducted by Yeh et al (2004), the manner in which the pharmaceutical information system could help improve the patient knowledge was determined. In this study more than 150 patients who utilized the pharmaceutical information system were given questionnaires. The answers of these questions were recorded and tabulated and analyzed using the SPSS software. The Pharmaceutical information system collects patient information along with the diagnosis, order forms, drugs administered and combines with the latest evidence-based information regarding any drug. This informat on can be utilized to help the pharmacist dispense the drug to particular patient and at the same time educate the patient. The electronic medical record can be modified in such a way that the individual needs of the patients are met. Information provided in the pharmaceutical system is credible and reliable. The information presented in such a system is simple, precise, easy to understand, explaining several aspects including the dosage of the drug, adverse effects, method of administration, precautions to be taken, reporting of any event, etc. The compliance and the adherence levels were seemingly higher following use of an automated pharmaceutical information system. The information presented in the pharmaceutical information system is in a multimedia format, thus making it a better audio-visual aid. As the compliance and adherence levels are better, the treatment outcomes are usually better (Yeh, 2004).
In Canada, a national pharmaceutical database being developed and implemented should help meet the crucial needs of several Canadians. Patients and service providers would be able to access comprehensive and reliable information about patent and drug details. The Canadian Institute for Health Information (CIHI) and the National Prescription Drug Utilization Information System (NPDUIS) are playing a very important role in developing and implementing such a system. In Canada, the use of drugs plays a very important role in medical management. In 1985, about 10 % of the healthcare spending was on drugs, whereas in the year 2004, these figures have touched about 16 %. A majority of the spending is on prescription drugs. The Canadian healthcare authorities have given significant importance to drug information system, and only through implementation of such a system would the quality of healthcare improve in Canada. At present there exist very few databases that actually present information regarding drug formularies, drug description, drug utilization, etc, as standarized data is not available. The CIHI and the NPDUIS are playing an important role in the decision-making process for policy-framing in Canada. The CIHI laid down that it was important to have a drug information system in Canada. Several of the public health programs would be using this drug information system, which would be based on evidenced pharmaceutical practices. Some of the added advantages of the pharmaceutical information system included:-
- cost control
- better evidence-based practices
- analysis of the drug utilization
- can up-to-date the drug information and the plans
- better interpretation of the results (CIHI, 2005)
Only in the last 10 to 15 years have advances in the pharmaceutical field have been really significant. Newer drugs not only have to meet the expectations of the patient but also have to be within the specified spendings. Several criteria including evidence-based practices have to be met. The interests of the patients, service providers, government, etc, need to be met. A newer drug should be one that has additional benefits from the present ones. This should be clearly demonstrated from clinical trials. In the interests of the society, the pharmaceutical industry would have to come out with safe and effective drugs. However, several of the pharmaceutical companies are not releasing the data obtained from clinical trials and most of the information that is already existent in the public domain is outdated data. One mean to ensure that the data accumulated in the pharmaceutical information system is updated, reliable and credible is to selective use certain information that may be available on the internet. The internet is not only a easy to access, quick and searchable alternative for data mining, but also could be connected very easily to a pharmaceutical information system. Information that is available on a particular drug would be filtered across and be available in the pharmaceutical information system. Hence, the quality of care would improve in the hospital improve as it would be safer and more effective (Sykes, 1998).
For a drug to be administered to the patient, certain circumstances need to be present, and only if criteria are present, a drug can be administered. This permits hospitals to administer drugs only in appropriate situations. This is one of the means by which quality of care could be improved. In a study conducted by Gregoire et al (2006), the criteria under which cisapride could be administered was determined. In a few hospitals cisapride was administered under particular criteria, whereas in another hospital, no criteria system was followed. Several statistical methods were utilized to study the effect of the drug utilization of cisapride. In the study it was found that the use of the criteria and the appropriateness of the drug treatment helped to improve the quality of care. Hence, in the future, drug administration needs to follow an evidence-based criteria system. For each drug, the conditions in which it could be utilized and has to be utilized should be listed. The dosage of the drug and the duration of administration should also be mentioned. Other information such as drug interactions, side-effects, adverse-effects, etc, needs to also be mentioned (Gregoire, 2006).
Besides, a pharmaceutical information system would also help maintain patient drug information kept safe and confidential in a hospital. A study conducted in the Taipei Medical University Hospital in 2002 demonstrated these benefits. The patients found it very easy and efficient to extract drug information. The user was able to better understand several aspects of the drug including category, classification, side-effects, adverse-effects, drug dosage, method of consumption, etc. Besides the patient outcome improved once the pharmaceutical information system was installed (Sykes, 1998 & Liua, 2003).
In one study conducted by the WHO, it was found that patients consuming medications for chronic illnesses on an average stopped the drug after one year of initiating treatment. The adherence levels were low because of a very poor patient information system in which all relevant information of the drug can be presented to the patient, and the patient itself could get educated. Having such a system in place can significantly help improve the compliance and adherence levels. Once the patient does not comply with the drugs administration there would be increased chances of morbidity, mortality, extra interventions, loss of productivity of work, etc. Hence, the patient should be able to access relevant, credible, updated, comprehensive and evidenced-based information regarding the particular drug. The patient should get an idea of the dosage and the expected outcome of the drug administration. Several studies have demonstrated that the more the patient has information of the drug, the better would be the adherence and the compliance levels and the better would be the treatment outcomes. The physician and the pharmacist should also have relevant information that is updated, current and credible. The presence of such information would help the decision-making processes. Any adverse-effects and problems during drug treatment could be better monitored. Using such a pharmaceutical information system, the patient could be motivated. Several companies are now coming up to develop such a system that could be utilized for several patients (BMJ, 2003).
Thus it can be said that having a pharmaceutical information system in place would have several benefits for the organization. Such a system forms a very critical link in the hospital, for several purposes including confidentiality, safety, educational, relevant, evidence-based, current, etc. The pharmacist and the physicians should be trained to use such a system to collect and process patient data. Only the relevant staff members should be able to access and make changes to the patient record.
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