Managing Change - pharmacy computer systems - Industry Trend or Event

Health Management Technology, June, 2001 by Salvatore M. Barcia

Preparing staff for a new pharmacy computer system is one of the most important aspects of implementation.

One of the stars of the television series "Frasier" is inanimate. Prominent in nearly every scene in Frasier Crane's posh apartment is a battered, patched-up easy chair belonging to Frasier's dad. The elder Crane clings protectively to this remnant of his former life and favors it over the highbrow furniture that surrounds it.

The parallel of this example to new pharmacy computer systems is striking. Many new pharmacy computer systems are highly functional, possessing superior clinical features, more complete order functions and better user interfaces. Windows-based systems are mostly object oriented, allowing multiple windows to be opened simultaneously, and allowing software to multi-task the way pharmacists do in their daily routines. Yet during new product selection, implementation and go-live, many users prefer their old clunker systems the same way Frasier's father prefers his eyesore chair.

Comfort Factor

Why? Legacy pharmacy computer systems are character-based, requiring many screen flips to enter an order. They offer few clinical screenings and little overall functionality. Monochrome character-based screens are as attractive and contemporary as a black and white television. Clearly, their value lies in the comfort factor.

Users of older systems are so familiar with them that they often process orders at breakneck speed. Hunt-and-peck pharmacists barely refer to the screens as they fly through order entry. Clinical warnings scarcely appear on the screen before the pharmacist has overridden them. Because the systems are less functional, there are often fewer clinical warnings, and therefore fewer decision-making opportunities for the pharmacist.

Newer systems are more complex, better organized and with better screen designs, but more features make for a higher learning curve, making initial use more difficult. The existence of more comprehensive clinical screenings and rules-based engine warnings require more pharmacist intervention. This results in more clinical intervention documentation, another step that was absent from the prior workflow.

Users may see that the newer systems have slower response times than their former systems--for several reasons. First, the Windows operating systems require an enormous amount of computer resources and are naturally slower than text-based operating systems. Secondly, newer systems have more screenings and calculations, further slowing processing. Finally, the amount of data being written and stored can be several times as much as the older, simpler systems, slowing things down even more.

Prepare for Change

Pharmacy practice is experiencing a crisis in staff resources. First came the staff reductions in the early and mid-1990s. More recently, a nationwide shortage of pharmacists has resulted in many hospital pharmacy vacancies. As a result, new implementations tend to be poorly staffed.

New systems are tested minimally. Errors are not detected until after the system goes live, making the lives of client and vendor miserable. Pharmacy managers must be fully prepared for change and to budget staff resources appropriately.

The most important facet of staff satisfaction in accepting a new system is attitude. Positive attitudes are contagious, just as negative ones are infectious. Difficulties will exist in installing new systems and staff will become frustrated adapting to newer products. But if pharmacy management continues to reinforce all of the positives of the new system, a healthy attitude will prevail as pharmacists adjust to the newer, better systems. Managers must staff appropriately during this phase, budgeting more staff hours than usual to accommodate for a possible reduction in productivity.

Newer systems are unquestionably superior to the systems they replace. But to make them work requires diligence, patience and a positive attitude--criteria for success in any new endeavor.

Salvatore M. Barcia is president of Meta Pharmacy Systems, Floral Park, NY. Contact him at sbarcia@ metapharmacy.com.