Meaningful Use Stage II Quick Hits and how they got a pharmacy principle wrong

Stage II of Meaningful Use hit yesterday, in a flurry of Tweets from HIMSS12.  It was very interesting to watch all of the tweets.  Here are some good quick hit analysis of what is in Stage II and how they got a fundamental pharmacy issue wrong.

I started this site for a series of talks on the pharmacist and meaningful use.  I will continue to maintain and send focused material on pharmacy practice and meaningful use to this site.  http://mu4pharm.posterous.com/  

Here are some good summaries

• John Halamka, MD CIO from Beth Israel Deaconess Medical Center and Harvard Medical School 1st Look
• Moving Up the Escalator by  Margalit Gur-Ari (thanks to Jerry Farhni @JFahrni to turning us on to this post)
• Brian Ahier's summary on Health, Technology and Goverment 2.0
• Project Direct summary by Fred Trotter that is important for pharmaicsts to get rid of the fricking fax machines and share clinical documents.

The Office of the National Coordinator also got at least one thing wrong.  It looks like they fell for the bar code medication administration (BCMA) dogma.  I have been a critic of this practice because, oh idunno, I believe in evidence based and cost effective pharmacy practice.  Neither applies to BCMA.  While they emphasis electronic medication administration records, which are terrific, they mix up BCMA with bar codes in the pharmacy dispensing process. The will require "Automatically track medication orders using an electronic medication administration record (eMAR)" for hospitals".  God is in the details, of course.

They cite Eric Poon's terrific NEJM article as justification.  While I will post a more detailed critique of this,fully half of the benefit shown in this study is due to eMAR documentation and not the wonders of bar codes or BCMA.

Here is what they get completely mixed up.  They cite Savario Maviglia's study as evidence of "A study done to evaluate cost-benefit of eMAR".  Yet this study is not even about eMAR!  It is about tracking medication through the dispensing process in the pharmacy, not for electronic medication administration. I put together a panel on technology and pharmacy practice at the ASHP Midyear meeting with Dr. Maviglia in explaining this practice.  This practice of tracking medications through the dispensing process in the pharmacy has more evidence to decrease errors than BCMA does.  Eric Poon tells me that a paper on the cost effectiveness of BCMA is in the works.  I will look forward to that.

Formal comments to the ONC will follow.  What say you.

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