Closed loop medication use system and method

• US 8,478,604 B2
• Filed: 06/19/2003
• Issued: 07/02/2013
• Est. Priority Date: 06/21/2002
• Status: Active Grant

• Current Assignee: Harris Dawn Holdings Incorporated
• Original Assignee: McKesson Automation Incorporated (Omnicell Inc), Mckesson Technologies Incorporated (UnitedHealth Group Incorporated)
• Inventors: Henderson, Dwight, Lunak, Richard, Markiewicz, Eugene, Tobin, Caren C
• Primary Examiner(s): Lubin, Valerie
• Assistant Examiner(s): Reyes, Reginald R
• Application Number:
  US10/465,197
• Publication Number:
  US 20030236683A1
• Time in Patent Office: 3,666 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G16H 10/65 stored on portable record carriers, e.g. on smartcards, RFID tags or CD
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 30/20 for handling medical images, e.g. DICOM, HL7 or PACS
• 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 40/67 for remote operation

Abstract

A closed loop medication use system and method includes selecting a medication to prescribe to a patient based on patient information, such as laboratory results, radiology results, and patient allergies, healthcare industry practices, patient-care site specific guidelines, and medication information. The selected medication is prescribed on an unverified prescription order that is then transcribed. Transcribing includes performing multiple crosschecks of the prescription order to real-time patient information, healthcare industry practices, and medication information to generate a verified prescription order. After transcribing, the appropriate dispensing method is determined for the prescription order and dispensed. The dispensed medication is administered after confirmation by the administering clinician of the right patient, right medication, right dosage, right route, and right time. The whole process of medication use described above is monitored continuously in real-time. The monitored information is communicated to the prescribing, transcribing, dispensing and administering parts of the system.

Claims

1. A method comprising:

receiving a prescription order for prescribing medication to a patient from a prescribing computing apparatus at a first computing apparatus;

placing, by the first computing apparatus, the prescription order in a queue including one or more other prescription orders using a scheduling technique, wherein placing the prescription order in a queue comprises (1) prioritizing the queue based on one or more scheduled follow-up medication interventions, (2) receiving selection of a prescription order from the queue, (3) receiving input at the first computing apparatus to indicate verification of an appropriateness of the selected prescription order, and (4) generating a verified prescription order by the first computing apparatus in response thereto;

sending the verified prescription order to one or more other computing apparatuses to facilitate (1) dispensing the medication, (2) providing a medication administration task to direct administering the medication to the patient, and (3) monitoring status reports submitted, electronically by medical personnel, regarding the patient after administering the medication, wherein sending the verified prescription comprises sending the verified prescription to a dispensing location selected based on an availability of a medication inventory of a medication identified by the verified prescription at one or more dispensing locations associated with the one or more other computer apparatuses, wherein information related to the dispensing, administering and monitoring is recorded and made available for a subsequent verification of the appropriateness of a prescription order for a subsequent prescribing of medication to the patient, and

receiving and presenting by the first computing apparatus clinical information related to one or more of the dispensing, administering or monitoring for a previous prescribing of medication to the patient before receiving input to indicate verification to thereby facilitate the verification, said clinical information including real-time patient information, medication information that includes possible adverse medication interactions, or administering guidelines, the clinical information being presented to thereby facilitate a comparison of the prescription order and the clinical information;

receiving in at least one instance an indication of an error based upon the comparison of the prescription order and the clinical information; and

in response thereto,

receiving input at the computing apparatus modifying the prescription order; and

sending a message including the modified prescription order to the prescribing computing apparatus.

2. The method of claim 1, wherein receiving a prescription order, sending the verified prescription order and receiving information related to the dispensing, administering and monitoring include communicating information over an electronic medium, wherein the electronic medium is a network, World Wide Web, or intranet.

3. The method of claim 2, wherein receiving a prescription order comprises receiving an electronic prescription order, the electronic prescription order having been converted from a non-electronic prescription order into the electronic prescription order by scanning or faxing the non-electronic prescription.

4. The method of claim 2, wherein communicating information comprises communicating information using a communications protocol.

5. The method of claim 4, wherein the communications protocol is a health level seven messaging protocol.

6. The method of claim 1, further comprising prescribing the medication on the prescription order before receiving the prescription order at the computing apparatus, wherein prescribing comprises:

receiving information generated from monitoring the patient;

comparing the generated information to medication selection criteria; and

determining at least one recommended medication based on the comparing.

7. The method of claim 6, wherein the medication selection criteria is from the group consisting of patient specific information, medication information, laboratory and radiology information, standard of care information, healthcare industry recommended treatment information, verified prescription orders, and alerts.

8. The method of claim 7, wherein the operation of comparing comprises:

suggesting a plurality of recommended medications; and

calculating an individual cost for each of the plurality of recommended medications.

9. The method of claim 1, wherein the message is an alert.

10. The method of claim 1, further comprising:

determining at the computing apparatus the dispensing location based on a plurality of dispensing requirements, the dispensing location being determined from one or more dispensing locations available for dispensing the medication.

11. The method of claim 10, wherein the dispensing requirement includes patient location, type of medication, medication location, or quantity of medication needed.

12. The method of claim 10, wherein the one or more dispensing locations available for dispensing the medication include one or more of a robotic dispensing system, an automated storage and retrieval system, or medication dispensing cabinets.

13. The method of claim 1, further comprising receiving the verified prescription order and dispensing the medication from the verified prescription order, wherein the step of dispensing the medication comprises electronically verifying the dispensed medication is the correct medication for the patient.

14. The method of claim 1, further comprising receiving the verified prescription order and dispensing the medication from the verified prescription order, wherein the dispensing of the medication generates one or more alerts.

15. The method of claim 1, further comprising receiving the verified prescription order and dispensing the medication from the verified prescription order, wherein dispensing the medication comprises electronically updating a location'"'"'s on-hand quantity of the dispensed medication.

16. The method of claim 15, wherein electronically updating a location'"'"'s on-hand quantity of the dispensed medication generates alerts.

17. The method of claim 1, further comprising receiving the verified prescription order and administering the medication dispensed from the verified prescription order to the patient, wherein administering the medication comprises:

identifying the medication to be administered; and

identifying the receiving patient.

18. The method of claim 17, wherein the medication is identified by scanning a medication bar code.

19. The method of claim 17, wherein the medication is identified by selecting medication from a list.

20. The method of claim 17, wherein the patient is identified by scanning a patient bar code.

21. The method of claim 17, wherein the patient is identified by an electronic chip.

22. The method of claim 17, wherein administering the medication further comprises:

performing checks to determine if this is the right patient, right medication, right dosage, right route and right time of administration; and

wherein recording of the administration includes recording observations about the patient, wherein the observations include blood pressure, pain scale, or sugar level.

23. The method of claim 1, further comprising monitoring the patient, wherein monitoring the patient includes continuously analyzing information generated from one or more of the prescription order, verification of the prescription order, dispensing the medication or administering the medication.

24. The method of claim 23, wherein continuously analyzing information comprises continuously analyzing one or more of laboratory results, radiology results, unverified prescription order, verified prescription orders, scheduled tests, administered medication, adverse medication reactions, allergies, intravenous infusion rates, patient vital signs, patient observations, or cost of patient'"'"'s treatment.

25. The method of claim 1, wherein monitoring the patient generates information that is communicated to prescribing.

26. The method of claim 25, wherein the information generated is in graph form, chart form, tabular data, or text.

27. The method of claim 1, wherein placing the prescription order in a queue by the computing apparatus using the scheduling technique includes prioritizing the prescription orders based on the medications'"'"' scheduled administration time.

28. The method of claim 27, wherein the scheduling technique includes prioritizing the prescription orders based on the location of the medication.

72. The method of claim 1, wherein sending the prescription based on an availability of a medication inventory of a medication identified by the prescription comprises receiving an input of the availability of the medication inventory of the various dispensing locations.

73. The method of claim 1, further comprising providing access to medication stored in one or more unit-based medication-dispensing cabinets in response to successful authentication of a user requesting access to the one or more unit-based medication-dispensing cabinets to at least retrieve a medication identified by the prescription.

29. A medication use apparatus comprising:

a processor configured to receive a prescription order for prescribing medication to a patient from a prescribing computing apparatus,

the processor being further configured to place the prescription order in a queue including one or more other prescription orders using a scheduling technique, wherein the processor being configured to place the prescription order in a queue comprises the processor being configured to prioritize the queue based on one or more scheduled follow-up medication interventions,

wherein the processor is configured to receive selection of a prescription order from the queue, receive input to indicate verification of an appropriateness of the selected prescription order, and generate a verified prescription order in response thereto,

wherein the processor is configured to send the verified prescription order to one or more other apparatuses to facilitate dispensing the medication, providing a medication administration task to direct administering the medication to the patient, and monitoring status reports submitted, electronically by medical personnel, regarding the patient after administering the medication, wherein information related to the dispensing, administering and monitoring is recorded and made available for a subsequent verification of the appropriateness of a prescription order for a subsequent prescribing of medication to the patient, wherein the processor is configured to send the verified prescription order by sending the verified prescription order to a dispensing location selected based on an availability of a medication inventory of a medication identified by the verified prescription order at one or more dispensing locations associated with the one or more other apparatuses, and

wherein the processor is further configured to receive and present information related to one or more of the dispensing, administering or monitoring for a previous prescribing of medication to the patient before receiving input to indicate verification to thereby facilitate the verification,

wherein the processor being configured to receive and present information includes being configured to receive and present clinical information including real-time patient information, medication information that includes possible adverse medication interactions, or administering guidelines, the clinical information being presented to thereby facilitate a comparison of the prescription order and the clinical information, and

wherein the processor is configured to receive in at least one instance an indication of an error based upon the comparison of the prescription order and the clinical information; and

in response thereto,

the processor is configured to receive input modifying the prescription order; and

the processor is configured to send a message including the modified prescription order to the prescribing computing apparatus.

30. The medication use apparatus of claim 29 embodied as a personal digital assistant or computer system, the personal digital assistant or computer system including the processor.

31. The medication use apparatus of claim 29, wherein the processor being configured to receive a prescription order, send the verified prescription order and receive information related to the dispensing, administering and monitoring include being configured to communicate over an electronic medium, wherein the electronic medium is a network, World Wide Web, or Intranet.

32. The medication use apparatus of claim 31, wherein the processor is configured to communicate using a health level seven messaging protocol.

33. The medication use apparatus of claim 29, wherein the message is an alert.

34. The medication use apparatus of claim 29, wherein the processor is further configured to determine the dispensing location based on a plurality of dispensing requirements, the dispensing location being determined from one or more dispensing locations available for dispensing the medication.

35. The medication use apparatus of claim 34, wherein the dispensing requirement is patient location, type of medication, or quantity of medication needed.

36. The medication use apparatus of claim 34, wherein the one or more dispensing locations available for dispensing the medication include one or more of a robotic dispensing system, an automated storage and retrieval system, or medication dispensing cabinets.

37. A closed loop medication use system for patient care, comprising:

one or more centralized servers coupled to a plurality of databases, the databases stored on one or more storage devices;

a prescribing module coupled to the centralized servers, wherein the prescribing module is configured to generate a prescription order for prescribing medication to a patient;

a transcribing module coupled to the centralized servers, wherein the prescribing module is configured to place the prescription order in a queue including one or more other prescription orders using a scheduling technique, receive selection of a prescription order from the queue, receive input to indicate verification of an appropriateness of the selected prescription order, and generate a verified prescription order in response thereto, wherein the transcribing module is configured to prioritize the queue based on one or more scheduled follow-up medication interventions;

a dispensing module coupled to the centralized servers, wherein the dispensing module is configured to dispense or facilitate dispensing of one or more medications prescribed on the prescription order;

an administering module coupled to the centralized servers; and

a monitoring module coupled to the centralized servers, wherein the monitoring module is configured to monitor information generated by the closed loop medication use system,

wherein the transcribing module is configured to send the verified prescription order to the dispensing module, administering module and monitoring module to facilitate dispensing the medication, providing a medication administration task to direct administering the medication to the patient, and monitoring status reports submitted, electronically by medical personnel, regarding the patient after administering the medication, wherein the transcribing module is configured to send the verified prescription order to a dispensing location selected based on a determination as to a quantity of a medication identified by the verified prescription order in inventory at one or more dispensing locations associated with the dispensing module, the selected dispensing location comprising a selected type of dispenser from among a plurality of different types of dispensers, and wherein information related to the dispensing, administering and monitoring is recorded and made available for a subsequent verification of the appropriateness of a prescription order for a subsequent prescribing of medication to the patient

wherein making the information available for the subsequent verification includes receiving and presenting clinical information including real-time patient information, medication information that includes possible adverse medication interactions, or administering guidelines, the clinical information being presented to thereby facilitate a comparison of the prescription order and the clinical information, and

wherein receiving a prescription order includes receiving the prescription order from the prescribing module, and wherein the transcribing module is further configured for;

receiving in at least one instance an indication of an error based upon the comparison of the prescription order and the clinical information; and

in response thereto,

receiving input at the transcribing module modifying the prescription order; and

sending a message including the modified prescription order to the prescribing module.

38. The closed loop medication use system of claim 37, wherein the prescribing module sends the prescription order to the centralized servers, wherein the prescription order prescribes the medication for a patient.

39. The closed loop medication use system of claim 38, wherein the centralized server sends the prescription order to the transcribing module to verify appropriateness.

40. The closed loop medication use system of claim 39, wherein the transcribing module sends the verified prescription order to the centralized server, wherein the centralized server informs the dispensing module of the medication to dispense.

41. The closed loop medication use system of claim 40, wherein an administering clinician receives the dispensed medication from the dispensing module, wherein the administering module receives information from the centralized server for administering the medication to a patient.

42. The closed loop medication use system of claim 41, wherein the administering clinician uses the information received by the administering module to check if this is the right patient, right medication, right dosage, right route and right time of administration.

43. The closed loop medication use system of claim 42, wherein after the administering clinician administers the medication, the administering module informs the application server of the medication administration, wherein the administration is recorded.

44. The closed loop medication use system of claim 43, wherein information on the medication administration is communicated from the server to the monitoring module.

45. The closed loop medication use system of claim 44, wherein the prescribing module, transcribing module, dispensing module, administering module and monitoring module communicate using a health level seven messaging protocol.

46. The closed loop medication use system of claim 37, wherein the storage device is an redundant array of inexpensive disks, hard disk drive, compact disc jukebox, or tape drive.

47. The closed loop medication use system of claim 37, wherein the database is a medication information database, radiology database, prescription order database, patient-care site financial database, laboratory database, clinical recommended healthcare industry practices database, standard of care database, patient information database, physician'"'"'s database, or recommended prescribing healthcare industry practices database.

48. The closed loop medication use system of claim 47, wherein one or more database is coupled to the prescribing module through one or more database servers.

49. The closed loop medication use system of claim 47, wherein one or more database is coupled to the transcribing module through one or more database servers.

50. The closed loop medication use system of claim 47, wherein one or more database is coupled to the dispensing module through one or more database servers.

51. The closed loop medication use system of claim 47, wherein one or more database is coupled to the administering module through one or more database servers.

52. The closed loop medication use system of claim 47, wherein one or more database is coupled to the monitoring module through one or more database servers.

53. A system for use of medication, the system comprising:

means for generating a prescription order for prescribing medication to a patient;

means for transcribing the prescription order including placing in a queue including one or more other prescription orders using a scheduling technique, receiving selection of a prescription order from the queue, receiving input to indicate verification of an appropriateness of the selected prescription order, and generating a verified prescription order in response thereto, wherein placing in a queue comprises prioritizing the queue based on one or more scheduled follow-up medication interventions;

means for dispensing the medication from the verified prescription order, wherein dispensing the medication comprises sending the verified prescription order to a dispensing location associated with a selected one of one or more computer apparatuses based on an availability of a medication inventory of a medication identified by the verified prescription order at one or more dispensing locations associated with the one or more computer apparatuses;

means for providing a medication administration task to direct administering the medication to the patient, wherein the administration of the medication is recorded; and

means for monitoring status reports submitted, electronically by medical personnel, regarding the patient,

wherein verification of the prescription order in the means for transcribing comprises;

means for comparing the prescription order to clinical information, wherein clinical information is real-time patient information, medication information that includes possible adverse medication interactions, or administering guidelines,

wherein comparison of the prescription order in at least one instance produces an error, the system further comprising;

means for modifying the prescription order when comparison of the prescription order produces error; and

means for sending a message including the modified prescription order to the means for prescribing.

54. The system of claim 53, wherein the means for prescribing, transcribing, dispensing, administering, and monitoring communicate information over a medium.

55. The method of claim 54, wherein information is communicated between the prescribing means, transcribing means, dispensing means, administering means and monitoring means using a health level seven messaging protocol.

56. The system of claim 53, wherein the means for prescribing comprises:

means for receiving information generated from monitoring the patient;

means for comparing the generated information to medication selection criteria; and

means for determining at least one recommended medication based on the comparison.

57. The system of claim 56, wherein the medication selection criteria is from the group consisting of patient specific information, medication information, laboratory and radiology information, standard of care information, healthcare industry recommended treatment information, verified prescription orders, and alerts.

58. The system of claim 56, wherein the means for comparing comprises:

means for suggesting a plurality of recommended medications; and

means for calculating an individual cost for each of the plurality of recommended medications.

59. The system of claim 53, wherein the message is an alert.

60. The system of claim 53, wherein the means for dispensing comprises:

means for determining the optimal dispensing approach based on a plurality of dispensing requirements.

61. The system of claim 60, wherein the dispensing requirement is patient location, type of medication, or quantity of medication needed.

62. The system of claim 53, wherein means for administering the medication comprises:

means for selecting a patient;

means for identifying the medication to be administered; and

means for identifying the receiving patient.

63. The system of claim 62, wherein the medication is identified by scanning a medication bar code.

64. The system of claim 62, wherein the medication is identified by selecting the medication from a list.

65. The system of claim 62, wherein the patient is identified by scanning a patient bar code.

66. The system of claim 62, wherein the patient is identified by an electronic chip.

67. The system of claim 62, wherein means for administering the medication further comprises:

means for performing checks to determine if this is the right patient, right medication, right dosage, right route and right time of administration; and

wherein recording of the administration includes recording observations about the patient, wherein the observation is blood pressure, pain scale, or sugar level.

68. The system of claim 53, wherein means for monitoring the patient includes continuously analyzing information generated from the means for prescribing, transcribing, dispensing and administering.

69. The system of claim 68, wherein the information generated is laboratory results, radiology results, unverified prescription order, verified prescription orders, scheduled tests, administered medication, adverse medication reactions, allergies, intravenous infusion rates, patient vital signs, patient observations, or cost of patient'"'"'s treatment.

70. The system of claim 53, wherein the means for monitoring the patient generates information that is communicated to the means for prescribing.

71. The method of claim 70, wherein the information generated is in graph form, chart form, tabular data, or text.