System and software of enhanced pharmacy services and related methods

• US 7,706,915 B2
• Filed: 07/01/2005
• Issued: 04/27/2010
• Est. Priority Date: 12/03/2004
• Status: Expired due to Fees

• Current Assignee: Johns Hopkins Aramco Healthcare Company (Government of Saudi Arabia)
• Original Assignee: Saudi Arabian Oil Company (Government of Saudi Arabia)
• Inventors: Arimilli, Rao, Mohapatra, Om, Farooki, Masood U.
• Primary Examiner(s): SHAPIRO, JEFFREY ALAN
• Application Number:
  US11/173,354
• Publication Number:
  US 20060149416A1
• Time in Patent Office: 1,761 Days
• Field of Search: 705 2- 4, 700231-244
• US Class Current: 700/231
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A system, software, and methods related to enhanced pharmaceutical order entry and administration by medical personnel, and enhanced pharmaceutical inventory control within a medical institution are provided. An embodiment of the system includes a pharmaceutical information management server having memory and a medication administration program product including a set of instructions stored in the memory of the pharmaceutical information management server to enhance provision of pharmacy services. The system also includes medical institution physician computers to provide for computerized physician medication order entry, pharmacy computers to provide for review and verification by a pharmacist of electronic medication orders placed through the physician computers, and medical institution nursing unit computers, to provide for review of and input to electronic medication administration records.

Claims

1. A system positioned within a hospital to enhance pharmaceutical order entry and administration by medical personnel and enhanced pharmaceutical inventory control within a hospital, the system comprising:

a hospital information processing and management computer including memory to store data therein to thereby define a hospital information management server;

a database in communication with the hospital information management server and including a plurality of hospital patient medication profile records and a plurality of electronic medication administration records corresponding to the hospital patient medication profile records for each of a respective plurality of hospital patients, and including patient master data, a hospital drug formulary and a plurality of medication inventory records, each of the plurality of electronic medication administration records providing a single consolidated patient medication administration profile for a corresponding one of the plurality of hospital patients, the single medication profile including both hospital inpatient and outpatient prescribed medications, the electronic medication administration records also indicating unit dose-level dispensing and actual patient consumption verification of individual doses of a prescribed medication for hospital inpatient patients provided to perform clinical checks and non-clinical checks responsive to the hospital drug formulary;

a hospital communications network associated with the hospital in communication with the hospital information management server;

a plurality of hospital physician computers associated with at least one of a plurality of physicians and positioned in the hospital and remote from the hospital information management server, each in communication with the hospital information management server through the hospital communication network and each including memory and software stored in the memory adapted to provide access to the hospital information management server;

a plurality of hospital pharmacy computers associated with at least one of a plurality of pharmacists and positioned in the hospital and remote from the hospital information management server and remote from the plurality of physicians computers, each of the plurality of hospital pharmacy computers in communication with the hospital information management server through the hospital communication network and each of the hospital pharmacy computers including memory and software stored in the memory adapted to provide access to the hospital information management server;

a plurality of hospital nursing unit computers associated with at least one nursing unit member and positioned in the hospital and remote from the hospital information management server and remote from the plurality of hospital pharmacy computers and from the plurality of hospital physicians computers, each of the plurality of hospital nursing unit computers in communication with the hospital information management server through the hospital communication network, and each of the plurality of hospital nursing computers including memory and software stored in the memory and adapted to provide access to the hospital information management server;

at least one hospital nursing unit video display in communication with at least one of the plurality of hospital nursing unit computers positioned at a nursing unit, remote from the hospital information management server, and in communication with the hospital information management server through the hospital communication network;

a plurality of automated drug dispensing devices, each of the plurality of drug dispensing devices positioned in the hospital and in communication with the hospital information management server through the hospital communication network to store pharmaceuticals therein and to dispense the pharmaceuticals to one of the plurality of nursing unit members, pharmacists or physicians, each automated drug dispensing device including memory and software stored in the memory to provide access to the hospital information management server, to receive electronic medication administration records, and to provide an interface to modify electronic medication administration records, to thereby provide hospital personnel a tool for recording medication administered to patients, each of the plurality of automated drug dispensing devices also including an override function responsive to entry of hospital patient identification data to enable unscheduled or emergency withdrawal of medication from each of the plurality of automated drug dispensing device and positioned to provide medication removal event data and hospital patient identification data to the hospital information management server, the medication removal event data including medication identification, amount removed, and time of removal; and

hospital information management software stored in the memory of the hospital information management server and including medication administration program product comprising a set of instructions that when executed by the hospital information management server cause the hospital information management server to perform a process of integrating medication order, verification and delivery within a hospital and a process of monitoring drug dispensing in the hospital, consisting of;

formatting at least one of the plurality of hospital patient medication profiles stored in the database, responsive to a medical records request from one of the plurality of physicians through one of the plurality of physician computers connected to the hospital information management server through the hospital communications network, to thereby enable a display of a selected hospital patient medication profile record on one of the plurality of physician computers;

formatting the hospital drug formulary stored in the database, responsive to a drug formulary request from one of the plurality of physicians through one of the plurality of physician computers connected to the hospital information management server through the hospital communications network, to thereby enable a display of the hospital drug formulary on one of the plurality of physician computers and allow a one of the plurality of physicians to search an available selection of medication;

creating a medication order entry form, responsive to a medication entry request, for the selected hospital patient medication profile record, the medication order entry form accessible by the one of the plurality of physicians through one of the plurality of physician computers connected through the hospital communications network to the hospital information management server, the medication order entry form allowing one of the plurality of physicians to use one of the plurality of physician computers to perform computerized order entry within the hospital, the medication order entry form having database record input fields that when supplied with input from by one of the plurality of physician computers, communicate the input through the hospital communications network to the hospital information management server;

writing the input supplied from the record input fields to the database to create an electronic medication order accessible by a one of the plurality of pharmacists using one of the plurality of pharmacist computers located within the hospital;

inspecting the electronic medication order, responsive to the receipt of the electronic medication order, with non-clinical checks and clinical checks using at least the hospital patient medication profile records and the single consolidated patient medication administration profile, the non-clinical checks determining at least whether the patient is post-op or pre-op and the clinical checks determining at least whether proper drug dosages for the one of the plurality of patients associated with the single consolidated patient medication administration profile are contained in the electronic medication order;

suspending the electronic medication order, automatically, responsive to at least a determination that the patient associated with the electronic medication order is pre-op or post-op;

notifying, responsive to suspending the electronic medication order, one of the plurality of physicians at one of the plurality of physician computers of the suspension of the medication order to thereby allow one of the plurality of physicians to override the medication order suspension;

creating an electronic medication verification form, responsive to the receipt of the electronic medication order, the electronic medication verification form accessible by one of the plurality of pharmacists through one of the plurality of pharmacist computers within the hospital, the electronic medication verification form allowing computerized input from the one of the plurality of pharmacists at one of the plurality of pharmacist computers to electronically document the verification of electronic medication orders, the electronic medication verification form having database input fields that when supplied with verification input from the plurality of pharmacist computers, communicate the verification input through the hospital communication network to the hospital information management;

writing the verification input into the database to store the electronic medication order with the verification input as a hospital inpatient verified medication order;

formatting the electronic medication administration records and hospital inpatient verified medication order, responsive to a nursing unit member request for access to the database, so that the electronic medication administration records and hospital inpatient verified medication order can be graphically displayed on the nursing unit video display connected to at least one of the plurality of nursing unit computers, the electronic medication administration records being displayed with database input fields so that the nursing unit member can enter medication administration input, and the hospital inpatient verified medication order being provided so that the nursing unit member can review one of the plurality of pharmacists and one of the plurality of physicians notes and special instructions and authenticate the hospital inpatient verified medication order;

updating the electronic medication administration records with the medication administration input, responsive to administration input from the nursing unit member computer or the drug dispensing device, the medication administration input indicating completed administration of the inpatient verified medication order and including the time of medication removal;

creating, automatically, a patient medication order responsive to the override function indicating an unscheduled or emergency medication removal event to thereby reduce incidence of medication dispensing without an electronic medication order; and

checking the electronic medication administration records for the plurality of hospital patients to maintain proper medication inventory for the hospital.

2. A system as defined in claim 1, wherein the clinical checks include performing a comparison of the electronic medication order against the hospital patient medication profile both at individual ingredient level and at therapeutic level to verify medication is not being duplicated.

3. A system as defined in claim 1, wherein each automated drug dispensing device maintains an accounting of inventory of medication stored therein to periodically update the medication inventory in the database by connecting to the hospital management server over the hospital communications network.

4. A system as defined in claim 1, wherein each of the plurality of automated drug dispensing devices are positioned to access the medication administration program product to perform an automated posting of a time-of-removal of medication from the respective automated drug dispensing device to a patient associated electronic medication administration record, and wherein each of the plurality of automated drug dispensing devices further comprise a user input device positioned to allow the nursing unit member to post an actual medication administration time to the patient associated electronic medication administration record when so displayed.

5. A system as defined in claim 1, wherein the medication administration program product further includes instructions to perform the operation of:

creating, automatically, the electronic medication order responsive to input of medication administration event data describing an unscheduled medication withdrawal.

6. A system as defined in claim 1, wherein the medication administration program product further includes instructions to perform the operation of:

alerting at least one of the hospital nursing unit computers of a modified medication order responsive to entry of the modified medication order; and

updating electronic medication administration records and hospital inpatient verified medication orders, provided to one of the plurality of nursing unit computers for display on the nursing unit video display, along a medication administration timeline.

7. A system as defined in claim 1, further comprising:

a plurality of claim card printers, each connected to a respective one of the plurality of physicians computers to print a claim card indicating a medication corresponding to the electronic medication order; and

a plurality of nursing unit printers positioned remote from the hospital information management server, each in communication with the hospital information management server through the hospital communication network to print a modified medication order responsive to completion of an entry of the modified medication order.

8. A medication administration program product comprising a set of instructions stored in a memory of a computer defining a hospital information management server that when executed by the hospital information management server cause the hospital information management server to perform a process of integrating medication ordering, verification and delivery within a hospital and a process of monitoring drug dispensing in the hospital, the set of instructions consisting of:

formatting at least one of a plurality of hospital patient medication profiles stored in a database, responsive to a medical records request from one of a plurality of physicians through one of a plurality of physician computers connected to the hospital information management server through a hospital communications network, to thereby enable a display of selected hospital patient medication profile record on one of the plurality of physician computers;

formatting a hospital drug formulary stored in the database, responsive to a drug formulary request from one of the plurality of physicians through one of the plurality of physician computers connected to the hospital information management server through the hospital communications network, to thereby enable a display of the hospital drug formulary on one of the plurality of physician computers and allow a one of the plurality of physicians to search an available selection of medication;

creating a medication order entry form, responsive to a medication entry request, for the selected hospital patient medication profile record, the medication order entry form accessible by the one of the plurality of physicians through one of the plurality of physician computers connected through the hospital communications network to the hospital information management server, the medication order entry form allowing one of the plurality of physicians to use one of the plurality of physician computers to perform computerized order entry within the hospital, the medication order entry form having database record input fields that when supplied with input from by one of the plurality of physician computers, communicate the input through the hospital communications network to the hospital information management server;

writing the input supplied from the record input fields to the database to create an electronic medication order accessible by a one of a plurality of pharmacists using one of a plurality of pharmacist computers located within the hospital and connected to the hospital information management server via the hospital communications network;

inspecting the electronic medication order, responsive to the receipt of the electronic medication order, with non-clinical checks and clinical checks using at least the hospital patient medication profile records and a single consolidated patient medication administration profile, the non-clinical checks determining at least whether a patient associated with the single consolidated patient medication administration profile is post-op or pre-op and the clinical checks determining at least whether proper drug dosages for the patient associated with the single consolidated patient medication administration profile are contained in the electronic medication order;

suspending the electronic medication order, automatically, responsive to at least a determination that the patient associated with the electronic medication order is pre-op or post-op;

notifying, responsive to suspending the electronic medication order, one of the plurality of physicians at one of the plurality of physician computers of the suspension of the medication order to thereby allow one of the plurality of physicians to override the medication order suspension;

creating an electronic medication verification form, responsive to the receipt of the electronic medication order, the electronic medication verification form accessible by one of a plurality of pharmacists through one of a plurality of pharmacist computers within the hospital, the electronic medication verification form allowing computerized input from the one of the plurality of pharmacists at one of the plurality of pharmacist computers to electronically document the verification or electronic medication orders, the electronic medication verification form having database input fields that when supplied with verification input from the plurality of pharmacist computers, communicate the verification input through the hospital communication network to the hospital information management;

writing the verification input into the database to store the electronic medication order with the verification input as a hospital inpatient verified medication order;

formatting the electronic medication administration records and hospital inpatient verified medication order, responsive to a nursing unit member request for access to the database, so that the electronic medication administration records and hospital inpatient verified medication order can be displayed on a nursing unit video display connected to at least one of a plurality of nursing unit computers, the electronic medication administration records being displayed with database input fields so that the nursing unit member can enter medication administration input, and the hospital inpatient verified medication order being provided so that the nursing unit member can review one of the plurality of pharmacists and one of the plurality of physicians notes and special instructions and authenticate the hospital inpatient verified medication order; and

updating the electronic medication administration records with the medication administration input, responsive to administration input from the nursing unit member computer or a drug dispensing device, the medication administration input indicating completed administration of the inpatient verified medication order and including the time of medication removal.

9. A medication administration program product as defined in claim 8, the set of instructions further consisting of:

accessing one of the hospital patient medication profile records stored in the database to display the single consolidated patient medication profile including both hospital inpatient and outpatient prescribed medications.

10. A medication administration program product as defined in claim 8, the set of instructions further consisting of:

creating, automatically, a patient medication order responsive to an override function indicating an unscheduled or emergency medication removal event to thereby reduce incidence of medication dispensing without an electronic medication order.

11. A medication administration program product as defined in claim 10,

wherein the medication administration input includes medication identification and amount removed;

and

wherein the drug dispensing device further comprises a user input device positioned to allow the nursing unit member to post the time of medication removal to the electronic medication administration record.

12. A medication administration program product as in claim 8, the set of instructions further consisting of:

generating an automated alert indicating a modified medication order responsive to the modified medication order, the automated alert being formatted to enable display on the nursing unit computer.

13. A medication administration program product as defined in claim 8, the set of instructions further consisting of:

formatting the plurality of single consolidated patient medication administration profiles to display on the nursing unit video display as a multi-patient unit dose-level inpatient medication administration schedule auto-refreshed at a preselected time intervals to allow automated screen shifting along a medication administration timeline to thereby provide an automated real-time medication administration schedule.

14. A medication administration program product as defined in claim 8, the set of instructions further consisting of:

formatting at least one of the verified medication orders, responsive to the verified medication order being modified, so that the hospital nursing unit computer and a hospital nursing unit printer cause the hospital nursing unit printer to perform an automated print of the verified medication order report responsive to the modification.

15. A medication administration program product as defined in claim 8, the set of instructions further consisting of:

storing a plurality of medication inventory records in the database associated with the hospital information management server;

initiating automated inventory management transactions including issuing materials from stock and automated depletion of medication inventory from the medication inventory records responsive to the verified medication order; and

initiating, automatically, replenishment of pharmaceuticals from external suppliers responsive to the automated depletion of an individual medication below a preselected level of inventory.

16. A computer-implemented method for causing a computer, defining a hospital information management server, to perform a process of electronically integrating medication ordering, verification and delivery within a hospital and a process of monitoring drug dispensing in the hospital the computer-implemented method comprising the steps of:

formatting at least one of a plurality of hospital patient medication profiles stored in a database, responsive to a medical records request from one of a plurality of physicians through one of a plurality of physician computers connected to the hospital information management server through a hospital communications network, to thereby enable a display of selected hospital patient medication profile record on one of the plurality of physician computers;

formatting a hospital drug formulary stored in the database, responsive to a drug formulary request from one of the plurality of physicians through one of the plurality of physician computers connected to the hospital information management server through the hospital communications network, to thereby enable a display of the hospital drug formulary on one of the plurality of physician computers and allow one of the plurality of physicians to search an available selection of medication;

creating a medication order entry form, responsive to a medication entry request, for the selected hospital patient medication profile record, the medication order entry form accessible by the one of the plurality of physicians through one of the plurality of physician computers connected through the hospital communications network to the hospital information management server, the medication order entry form allowing one of the plurality of physicians to use one of the plurality of physician computers to perform computerized order entry within the hospital, the medication order entry form having database record input fields that when supplied with input from by one of the plurality of physician computers, communicate the input through the hospital communications network to the hospital information management server;

writing the input supplied from the record input fields to the database to create an electronic medication order accessible by a one of a plurality of pharmacists using one of a plurality of pharmacist computers located within the hospital and connected to the hospital information management server via the hospital communications network;

inspecting the electronic medication order, responsive to the receipt of the electronic medication order, with non-clinical checks and clinical checks using at least the hospital patient medication profile records and a single consolidated patient medication administration profile, the non-clinical checks determining at least whether a patient associated with the single consolidated patient medication administration profile is post-op or pre-op and the clinical checks determining at least whether proper drug dosages for the patient associated with the single consolidated patient medication administration profile are contained in the electronic medication order;

suspending the electronic medication order, automatically, responsive to at least a determination that the patient associated with the electronic medication order is pre-op or post-op;

notifying, responsive to suspending the electronic medication order, one of the plurality of physicians at one of the plurality of physician computers of the suspension of the medication order to thereby allow one of the plurality of physicians to override the medication order suspension;

creating an electronic medication verification form, responsive to the receipt of the electronic medication order, the electronic medication verification form accessible by one of a plurality of pharmacists through one of a plurality of pharmacist computers within the hospital, the electronic medication verification form allowing computerized input from the one of the plurality of pharmacists at one of the plurality of pharmacist computers to electronically document the verification or electronic medication orders, the electronic medication verification form having database input fields that when supplied with verification input from the plurality of pharmacist computers, communicate the verification input through the hospital communication network to the hospital information management;

writing the verification input into the database to store the electronic medication order with the verification input as a hospital inpatient verified medication order;

formatting the electronic medication administration records and hospital inpatient verified medication order, responsive to a nursing unit member request for access to the database, so that the electronic medication administration records and hospital inpatient verified medication order can be displayed on a nursing unit video display connected to at least one of a plurality of nursing unit computers, the electronic medication administration records being displayed with database input fields so that the nursing unit member can enter medication administration input, and the hospital inpatient verified medication order being provided so that the nursing unit member can review one of the plurality of pharmacists and one of the plurality of physicians notes and special instructions and authenticate the hospital inpatient verified medication order; and

updating the electronic medication administration records with the medication administration input, responsive to administration input from the nursing unit member computer or a drug dispensing device, the medication administration input indicating completed administration of the inpatient verified medication order and including the time of medication removal.

17. A computer implemented method as defined in claim 16, wherein the clinical checks verify one of the plurality of physicians is authorized to prescribe each of the items listed in the medication order to the hospital patient associated with the single consolidated patient medication profile;

and the medication order does not include items having a quantity or duration exceeding preselected institutional limits.

18. A computer implemented method as defined in claim 16, further including the steps of:

allowing one of the plurality of pharmacists to modify the electronic medication order, responsive to the receipt of the electronic medication verification form, through the database input fields as verification input; and

substituting a drug in the single consolidated patient medication profile, responsive to the receipt of a command from the pharmacist computer authorizing the substitution, the command from the pharmacist computer being contingent upon consultation with one of the plurality of physicians.

19. A computer-implemented method as defined in claim 16, further comprising the steps of:

integrating pre-medication administration patient laboratory results with the medication order prior to the performance of the clinical and non-clinical checks; and

delaying, responsive to the clinical and non-clinical checks, creating at least a portion of the medication order verification form sent to the pharmacist when a predetermined pre-medication administration patient laboratory result criteria is met.

20. A computer-implemented method as defined in claim 16, further comprising a step of:

logging the overrides of the automatic suspensions ordered by one of the plurality of physicians and a hospital nursing unit member.

21. A computer-implemented method as defined in claim 16,

wherein the medication order form includes database input fields that have default values for at least one of a medication route, dose, frequency, and duration;

wherein the medication order form includes database input fields that allow a physician to access to dosing recommendations including at least one of the following;

minimum and maximum dose, lifetime cumulative dosing, pediatric dosing, neonatal dosing, and geriatric dosing; and

wherein the medication order form includes database input fields that allow the physician to access at least standard medication order sets, IV templates, and chemotherapy templates.

22. A computer-implemented method as defined in claim 16, wherein the medication order form includes database input fields that include a tool to select and copy a prior active or inactive medication order to function as a template for a current medication order.

23. A computer-implemented method as defined in claim 16, further comprising the step of:

integrating inpatient and outpatient medication orders to provide the single consolidated patient medication profile for each patient of the plurality of hospital patients.

24. A computer-implemented method as defined in claim 16, further comprising the step of:

integrating patient laboratory results with the order template to provide the one of the plurality of physicians with data required to determine proper medication order ingredients.

25. A computer-implemented method as defined in claim 16, wherein the medication order form includes database input fields providing access to a master list of intervention codes grouped by code type;

the computer-implement method further comprising the steps of;

logging override by one of the plurality of physicians during computerized medication order entry, overrides by one of the plurality of pharmacists during computerized medication order verification, and interventions by a hospital nursing unit member during at least one of computerized medication order entry and medication administration, to thereby enhance non-compliance tracking.

26. A computer-implemented method as defined in claim 16, wherein the database includes drug restriction data containing restrictions for each medication based on one of the plurality of physicians, specialty, patient, or a combination thereof, doctor-patient familial relationship restriction alerts and patient medication abuse propensity alerts.

27. A computer-implemented method as defined in claim 16, further comprising the steps of:

generating a patient medication stop notification to the hospital nursing unit member, a order by one of the plurality of physicians responsible for a medication order being stopped when within the preselected time; and

alerting one of the plurality of physicians of the medication order being stopped, so that the one of the plurality of physicians can opt to either extend the medication order identified by the patient medication stop notification or confirm the medication order stop time.

28. A computer-implemented method as defined in claim 27, further comprising the steps of:

reporting medication orders for inpatient residents at the hospital that are about to expire within a preselected time period, the report organized by at least one of hospital nursing unit or prescribing one of the plurality of physicians; and

wherein the non-clinical checking includes verifying that at least one day'"'"'s supply of the ordered unit dose medication is available in inventory for hospital inpatient patients responsive to the medication order entry.

29. A computer-implemented method as defined in claim 16, further comprising the step of:

generating an automated alert indicating a modified medication order responsive to the modified medication order, the automated alert being formatted for display on the nursing unit computer.

30. A computer-implemented method as defined in claim 29, further comprising the step of:

formatting a plurality of the patient medication administration profiles to display on the nursing unit video display a multi-patient unit dose-level inpatient medication administration schedule auto-refreshed at a preselected time interval to allow automated screen shifting along a medication administration timeline to thereby provide an automated real-time medication administration schedule.

31. A computer-implemented method as defined in claim 30, wherein the step of generating the automated alert further comprises the step of:

formatting modified medication orders to display on the nursing unit video display with the modified medication orders highlighted on the administration schedule, responsive to entry of the modified medication order.

32. A computer-implemented method as defined in claim 30, further comprising the step of:

formatting modified medication orders to print on a nursing unit printer responsive to entry of the modified medication order.

33. A computer-implemented method as defined in claim 16, further comprising the steps of:

posting medication administration event data for an emergency medical services, using a nursing unit computer, the medication order being posted using a graphical user interface; and

creating, automatically, a hospital patient electronic emergency medical services medication order responsive to the posting of the medication administration event data for the emergency medication administration when the emergency medication administration is performed without a pre-existing electronic medication order.

34. A computer-implemented method as defined in claim 33,

wherein the step of posting the medication administration for an emergency medication order is performed responsive to a medication removal event data generated responsive to medication removal from the automated drug dispensing device and responsive to hospital nursing unit member input of hospital patient identification data;

wherein the medication removal event data includes medication identification, amount removed, and time of removal.

35. A computer-implemented method as defined in claim 33, further comprising the steps of:

posting medication administration event data for an immunization medication order in the graphical user interface responsive to an immunization medication administration; and

creating a patient electronic immunization medication order including an optional one of the plurality of physicians with a confirmation requirement within a preselected time interval, responsive to posting of the medication administration event data when the immunization medication administration is performed without a pre-existing immunization medical order.

36. A computer-implemented method as defined in claim 16, further comprising the steps of:

integrating inpatient hospital patient medication and outpatient medication records stored in memory of a computer to provide the single patient medication profile for each patient of a plurality of patients.

37. A computer-implemented method as defined in claim 16, further comprising the step of:

logging, automatically, any incidence of one of the plurality of physicians overriding an alert.

38. A computer-implemented method as defined in claim 16, further comprising the steps of:

storing a plurality of medication inventory records stored in the memory of the hospital information management server;

initiating automated inventory management transactions including issuing materials from stock and automated depletion of medication inventory from the medication inventory records responsive to the verified medication order and

initiating, automatically, replenishment of pharmaceuticals from external suppliers responsive to the automated depletion of an individual medication below a preselected level of inventory.