PIMS By Mark H.

Siska, BS, RPh

Functional Requirements for

Pharmacy Information
Management Systems
SELECTING OR WRITING REQUIREMENTS FOR A PHARMACY INFORMATION
management system (PIMS) presents significant challenges and requires con-
siderable insight, particularly for those in the midst of the initial confusion
caused by a newly automated medication-use process. To address the major-
ity of operational transformations driven by supporting medication manage-

Photo courtesy of Meta Pharmacy Systems

ment systems, the PIMS must be able to communicate and exchange data
accurately, effectively, consistently, and multi-directionally with other medica-
tion systems, as well as non-medication systems, and, more importantly, be
able to use the information that has been exchanged.
Traditional pharmacy systems that have focused on and isolated the tran-
scription, preparation,
and distribution phases
of the medication-use
process are now being
looked upon as the Although the focus of this article is on functional require-
hub for communicating ments, it is important for pharmacy leaders to articulate and
meaningful informa- develop use cases for non-functional requirements, particularly
tion outside the phar- when direct patient care becomes more dependent on these sys-
macy domain. The tems. Some important non-functional requirements to consider
next-generation phar- when evaluating a pharmacy information management system
macy information man- include:
agement systems must I System availability
Photo courtesy of Softwriters

distance themselves I Allowance for maintainability and enhancements

from previous require- I Recovery from failure

ments for integration I Reliability

and interfacing and I Response time

move towards system I Throughput

interoperability, allow-
ing for real-time sharing of information across the medication-use cycle. They To maintain the integrity of the medication-use cycle, the PIMS must effec-
must move beyond system analysts and or pharmacists maintaining and man- tively use and communicate information in real time from and to supporting
aging dictionary tables and medication information, and require the real-time medication- and patient care-related systems. This will facilitate the following
transmission of drug knowledge from expert resources directly into the appli- core medication-use functions:
cation with little or no manipulation. I Order management and communication
Capturing the services, tasks, or functions a pharmacy information manage- I Order verification, confirmation, and fulfillment
ment system is required to perform within the framework of today’s complex I Preparation, distribution, and inventory control, storage, and security
medication-use process calls for broader insight into how information may be I Administration
shared outside the pharmacy realm. The sequence and extent of interactions I Intervention and monitoring
between systems and providers necessary to deliver these services or functions
have greater implications than previously performed with PIMS. This will require Order Management and Communication
the pharmacy analyst to develop use cases that go beyond the traditional acute Pharmacy information management systems must provide greater functional-
care and hospital pharmacy settings to adequately represent the pharmacy man- ity than the standalone medication order management systems used today.
agement system functional requirements necessary in today’s environment. PIMS must permit multidirectional real-time sharing of order processing infor-

2 I NOVEMBER 2006
 PIMS

PIMS must tightly integrate medication order management with

enterprise-wide process tracking systems, allowing upstream or downstream
providers to access information regarding the status of their order.

mation across the continuum of care. PIMS must tightly integrate medication time, patient-specific distribution and avoiding functionality that promotes
order management with enterprise-wide process tracking systems, allowing unordered drugs on the patient care units.
upstream or downstream providers to access information regarding the status The PIMS must support systems such as automated dispensing cabinets
of their order. The system must provide customizable order views, triaging and storage and retrieval systems that automate and manage inventory
capabilities, and the ability to communicate delivery or availability time of a throughout the receiving, storage, retrieval, and distribution process.
particular order to others involved in the medication-use process. The PIMS Requirements should include:
must provide a variety of mechanisms for notifying performing departments
of pending orders, including text and verbal paging. I Real-time, on-hand inventory information at the time of patient-specific
medication ordering and/or verification and fulfillment
Order Verification, Confirmation, and Fulfillment I Inventory control across multiple facilities

The PIMS should support multiple verifications of an order(s) by more than I The ability to automate wholesale medication-ordering processes

one type of user or multiple users of the same type. Order verification and con- I Automated workflow in the distribution process with sequenced orders

firmation would include the process by which the pharmacist confirms the that guide staff through emergency, high-priority, routine, and batch
appropriateness of an ordered medication, including any alerts or patient-spe- order fulfillment
cific information such as tests, procedures, and labs. Although the alerting sys-
tems in future PIMS may play a secondary role, customers must be attentive
to how the system manages these alerts to minimize needless communication.
The system must effectively use upstream alerts to avoid redundant warnings
and must be able to communicate necessary information regarding alert rec-
onciliations to the provider and nurse. The system must allow the user to
defer verification or modification and facilitate communication with the physi-
cian or nurse regarding the verification status. These communications must be
reconcilable in the PIMS.
The system should allow the pharmacist the ability to fulfill an order with
the necessary components to deliver an “administrate-able” dose without alter-
ing the integrity of the order or requiring additional communication with the
ordering provider. The fulfillment process should be transparent to the order-
ing process and avoid any additional transcription. The pharmacist must have

Photo courtesy of Mediware Information Systems

the ability to edit the provider’s medication order during verification and ful-
fillment, with or without requiring the provider’s signature. Customers should
require considerable flexibility within the verification process to address state
board of pharmacy or specific institutional policies pertaining to changing
components of a medication order and required signing1.

Preparation, Distribution, and Inventory Control, Storage,

and Security
Once an order has been verified, confirmed, and fulfilled with the appropri-
ate components for preparation, the PIMS must communicate requirements
to the supporting medication preparation and dispensing systems that will pre-
serve medication integrity and security. Such systems include automated dis- Administration
pensing cabinets, robotic IV automation devices, and automated packaging Pharmacy information management systems play a significant role in the drug
systems. These systems must work collectively, prioritizing the daily drug- administration and documentation processes. These systems need to act as an inter-
preparation and fulfillment processes and can utilize bar code technology at mediary between ordering and medication administration systems by translating
each step to enhance efficiency and dispensing accuracy. They must provide what has been ordered into a bar code-enabled, “administrate-able” dose on an elec-
the flexibility to support a number of delivery approaches, focusing on just-in- tronic “to do” list. Proper documentation of and/or scanning these doses should

4 I NOVEMBER 2006
fulfill the electronic medication administration Conclusion
record (EMAR). The EMAR needs to be a continu- Requirements for the development or purchase
ous document that includes medications adminis- of pharmacy information management systems
tered across all levels and episodes of care within all should focus on their capability of sharing and
areas of the organization. It must also be capable of using information across the medication use
linking with the organization’s billing and financial- cycle and the patient’s continuum of care. These
services systems to improve compliance with billing systems must support interoperability and stan-
regulations. The PIMS must provide a means to rec- dardization, and enable multidirectional commu-
oncile doses from medication administration systems nication amongst all professionals involved in the
and the order fulfillment and preparation processes medication-use process. I
with the pharmacy’s inventory management systems.
Customers seeking a PIMS must be assured the sys- Mark H. Siska, BS, RPh, is the medication clini-
tem is able to connect ordering and administration cal systems manager at the Mayo Clinic in
systems, including smart pump systems, allowing for Rochester, Minnesota. He also serves as a mem-
real-time communication between systems in multi- ber of ASHP’s Advisory Group on CPOE and
ple directions. Imagine the pharmacy system being Pharmacy Informatics and is involved in health
able to recognize when to prepare and send another care technology groups, including AMIA and
continuous medication infusion without a nurse or HIMSS. He received a BS from the University of
member of the pharmacy intervening. The PIMS Illinois, College of Pharmacy.
must be able to send specific medication administra-
tion instructions directly to an infusion device to
deliver a particular medicine over a specified period Reference
of time. These types of requirements reemphasize the
1. Dotson T. (2003). Are Your Medication
need for future PIMS to not only communicate infor-
Systems Integrated? Retrieved September 20,
mation, but to also use information from other
2006
administration-related systems.
www.abbeyassociates.com/Medication%
Intervention and Monitoring 20System%20Integration.htm
Pharmacy information management systems must
incorporate functionality to support the documen-
tation and monitoring of pharmacists’ clinical inter- WHERE TO FIND
ventions as well as adverse drug reaction or event Pharmacy Information
Management Systems:
reporting. Although most customers expect these
systems to allow for data mining and extraction, Vendor Reader Service
Number
many fail to recognize the importance of allowing
users or managers to develop and run queries spon- Cerner Corporation 80
taneously without dramatically effecting system Crown Software, Inc. 82
performance. The ability for pharmacy managers GE Healthcare 83
and users to run ad hoc or planned detailed reports
Hann’s On Software, Inc. 84
helps identify trends in intervention acceptance,
time spent on clinical activities, and drug costs LifeCare Technologies 85
avoided. The PIMS must provide pharmacy man- McKesson 86
agers with key financial data to quantify and to MEDITECH 87
improve their clinical programs and staff. Other
Mediware Information Systems, Inc. 76
features customers should require include:
I Electronic notification or alerting to appro- Meta Pharmacy Systems Inc. 75
priate care giver(s) of interventions, adverse Misys Healthcare Systems 74
drug reactions, and/or medication errors Omnicell, Inc. 73
I Ability to electronically reconcile or share
Paperless Pharmacy 72
follow-up information of ongoing monitor-
QuadraMed Corp. 71
ing of patients’ clinical events
I Real-time management reporting and trend- SCC Soft Computer 70
ing capabilities that can be exported and Siemens Medical Solutions 68
graphed Softwriters, Inc. 67
I The ability to support mobile solutions For more information, circle #45
Talyst 6
I Integrated in-depth drug information on the Reader Service Card