Hohmeier Kenneth C, Spivey Christina A, Boldin Samantha, Moore Tara B, Chisholm-Burns Marie
J Am Pharm Assoc (2003). 2017 Sep-Oct;57(5):608-615. doi: 10.1016/j.japh.2017.05.009. Epub 2017 Jul 18.
To explore the feasibility and report preliminary outcomes of the integration of a health information exchange (HIE) into community pharmacy workflow clinical service delivery.
Independent pharmacy in eastern Tennessee.
The pharmacy offers medication reconciliation services via HIE access, as well as other clinical pharmacy services. The average number of prescriptions filled weekly is 1900, and staffing included 3.5 full-time-equivalent (FTE) pharmacists, and 7 FTE technicians.
HIE integration within the workflow of the pharmacy was used to enhance existing patient care services, such as medication distribution, drug use review, medication therapy management, and immunizations, as well as to implement a novel transitional care service.
A mixed-methods design was used to explore HIE workflow. Data collection included a pharmacist and pharmacy technician perceptions survey, mapping steps involved in HIE use in workflow via a think-aloud protocol, and quantitatively reporting the number and type of discordant medications found on medication reconciliation.
In total, 25 patients qualified for the medication reconciliation intervention and data collection. All 25 patients (100%) had at least 1 discordant medication. HIE access was used for 60% of patients. Community pharmacists were confident in their abilities to perform medication reconciliation and were able to perform the medication reconciliation with the use of the HIE within their workflow, albeit with some reported barriers. The average time spent per patient for HIE-facilitated transitional care was 21 minutes.
Integration and utilization of an HIE within the workflow for the purposes of patient care service delivery in the community pharmacy is feasible, but not without limitations. Such HIE utilization and extended access to the patient's clinical picture may represent a scalable method to enhance currently delivered pharmacist services.
探讨将健康信息交换（HIE）整合到社区药房工作流程临床服务提供中的可行性，并报告初步结果。
田纳西州东部的独立药房。
该药房通过HIE访问提供用药核对服务以及其他临床药学服务。每周平均处方调配量为1900张，工作人员包括3.5名全职等效（FTE）药剂师和7名FTE技术员。
在药房工作流程中整合HIE，以加强现有的患者护理服务，如药物分发、用药审查、药物治疗管理和免疫接种，以及实施一项新型的过渡性护理服务。
采用混合方法设计来探索HIE工作流程。数据收集包括药剂师和药房技术员认知调查、通过出声思考协议绘制工作流程中使用HIE所涉及的步骤，以及定量报告用药核对中发现的不一致药物的数量和类型。
共有25名患者符合用药核对干预和数据收集的条件。所有25名患者（100%）至少有一种不一致药物。60%的患者使用了HIE访问。社区药剂师对其进行用药核对的能力有信心，并且能够在工作流程中使用HIE进行用药核对，尽管报告存在一些障碍。通过HIE促进的过渡性护理，每位患者平均花费的时间为21分钟。
在社区药房工作流程中为提供患者护理服务而整合和利用HIE是可行的，但并非没有局限性。这种HIE的利用以及对患者临床情况的扩展访问可能是一种可扩展的方法，以增强目前由药剂师提供的服务。
