I’VE BEEN THINKING ABOUT BALLPOINT PENS, FAXmachines, moms, and MOMS, as in medicationorder management systems. It is interesting toobserve how technology can both aid and inhibitthe process of medication orders making theirway—intact—from the physician to the pharmacy.

For their first 200 years, physicians inAmerica’s hospitals wrote orders with stylusesand fountain ink. Back then, penmanship was acore subject in our schools and a doctor’s orderswere easy to read. The doctor my mom workedfor when I was a kid used a Schaeffer fountainpen, while upstarts wrote orders with Parker T-Ball Jotters. Over the years, technology hasadvanced, and somewhere along the line, pen-manship took a hike. Now, it seems that pos-sessing indecipherable handwriting is a prereq-uisite for becoming a physician.

I imagine some people figured the typewritercould bring an end to illegibility, but under-standably, doctors continued to prefer theportability of pen and paper. And even whenward clerks transcribed doctors’ orders via anUnderwood or IBM Selectric, for an order tobe filled, a piece of paper still had to be physi-cally transported from the ward on the thirdfloor to the pharmacy in the basement. Not allof them made it.

Along the way, the telephone offered hope: Justcall the order in! However, Michael Cohen sum-marizes the professional wisdom on the matter inMedication Errors (the bible on the subject). He

begins the section entitled Verbal Orders with,“Verbal (spoken) orders should be avoided when-ever possible.” Suppose a doctor or nurse says“every four to eight hours” when calling in anorder, but the person on the other end of the linehears and writes “every 48 hours.”

When the pneumatic tube system came along,handwritten orders were delivered to the phar-macy after flying through a labyrinth of pipe. Asuseful as these systems are, they have a way ofdoing with medication orders what dryers do withsocks: Too many orders get lost or take detours.

Then came the fax machine. Faxes were soeffectively sent from the ward to the pharmacythat, today, there is hardly a hospital in thecountry that does not utilize this technology.However, this approach has not been withoutits problems. As Michael Cohen writes,“Ideally, no faxed order to the pharmacyshould be filled until the original copy has beenreceived.” Why? Because noise on the transmis-sion line and dust in the machines have a wayof making those all-important decimals myste-riously disappear or, in other instances, appearin inappropriate places.

Another highly touted solution is the tabletPC, a device that uses handwriting, whichmakes doctors feel comfortable. Yet, for all of atablet PC’s initial appeal, a doctor can get frus-trated when the computer is unsure which hand-written word was meant, and subsequentlyoffers several possibilities to choose from. Afterall, paper never argued with doctors’ pens.

There may be a bit of poetic justice in all this,however. When using a tablet PC, doctors

would have to learn to write clearly enough thata human could read it. Hmm…

Today, many say the ultimate solution is com-puterized physician order entry (CPOE).However, CPOE has its own issues, not the leastof which are the expense of implementing thesystems and the difficulty of motivating doctorsto use them. Doctors insist that the computerizedentry process take no more time than it takes toscratch an order on a paper chart. “When I canspeak my orders into a handheld,” my neighbor(a doctor) tells me, “I’ll be willing to make theswitch.” That would be nice, but what aboutsafety experts’ warnings against verbal orders?Will the computer do any better than humans indistinguishing “48” from “four to eight”?

Eventually, the barriers to CPOE will be over-come and the day will arrive when most physi-cians will enter orders directly into computers.However, for most hospitals, that day is proba-bly five or more years away.

In the meantime, while paper rules, I encour-age my clients to adopt another technology:medication order management systems, orMOMS. These systems solve a number of prob-lems associated with getting handwritten ordersfrom the physician’s hands to the pharmacy,intact, and I might add, they deliver a relativelyquick ROI (18 months on average). In oneexample of the cost savings MOMS can provide,consider that scanners require only single sheetsof paper. With MOMS, those expensive, four-page NCR forms become a thing of the past.

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from the Automation ExpertMARK NEUENSCHWANDER

THE VALUE OF MOMS: MEDICATION ORDER MANAGEMENT SYSTEMS

All in all, MOMS promotegreater and more efficientcommunication between clinicians and caregivers.

McKesson's MedDirect is a web-based order management system.

Pyxis Connect can also be used from a remote location.

(Continues on page 4)

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The benefits are significant and immediate. Ihave yet to meet a MOMS user on the ward orin the basement who didn’t feel this type of sys-tem was a winner. Suppose I were a director ofpharmacy, and the only piece of medication-useautomation my hospital had was a pharmacyinformation system. What would be the nextcomponent I would add? A MOMS. Thiseven makes sense to my long-retired, tech-nology-averse mother.

Mark Neuenschwander is president of theNeuenschwander Company and a recognizedexpert in medication-use automation. He can bereached at mark@hospitalrx.com.

How do MOMS work?Each patient ward is outfitted with a scanner.

Handwritten orders are fed into the scanningdevice, are converted into electronic images,such as PDFs, and are sent electronically by theMOMS to a system “inbox.” Pharmacists canaccess the system from any computer in thehospital, open and read the orders, and arrangethem in a queue for filling, with STAT ordersfirst. At any time, nurses can go online and seethe status of an order to determine if it has beenreceived and opened, where it is in the queue,and if it has been approved and filled.

High-resolution scanners eliminate most of thenoise and dust problems plaguing fax machines,and pharmacists can enlarge PDFs for clarificationand apply time-stamped notes to the documents.In addition to the ability to send illegible ordersback to the prescribing source for clarification,pharmacy can archive and easily retrieve thoseorders for quality improvement purposes. All inall, MOMS promote greater and more efficientcommunication between clinicians and caregivers.

MOMS save everyone time and limit thenumber of phone calls, voice mails, and pagesbetween pharmacists and nurses. Pharmacies arequieter and wards are calmer. Because eachtransaction is time-stamped and progress can beviewed by anyone at any point, the system helpsresolve discrepancies over “lost” orders and“foot-dragging.” Everyone is held accountable,while argument and blame are reduced.

Pharmacists also no longer have to make thetrek to the fax machine and rummage through astack of papers. They can access order informa-tion and review orders from any computer inthe hospital. If the system is browser-based, theycan even do this from home or from a hospitalacross town, and because the system archivesthe order, papers don’t have to be filed.

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Not all MOMS are created equal…Some MOMS are server-based, and others are browser-enabled. The latter have the advan-tage of providing user-access from any computer connected to the Internet, not just from com-puters on the hospital’s local area network.

Some scanners provide higher-resolution images than others. The image on the screen canbe no better than the resolution capability of the scanner. Some hospitals use their old faxmachines to send orders to a MOMS, running into the same dust and noise problems they didwhen sending documents to another fax.

Who provides the hardware? Some companies will only sell their MOMS software along withthe system hardware. By buying just the software, hospitals can take advantage of the scannersand computers already in place, leading to cost savings. However, this may result in a hospital set-tling for low-resolution documents.

Two screens or one? While not essential, there are advantages to having two screens at the phar-macy workstations—one for viewing the pharmacy information system and the other for display-ing the PDF of the written order.The ease of use and time saved may be worth the cost of the sec-ond screen. However, some prefer to have the PDF share the screen with the order entry windowof the pharmacy information system.

Where to find it:

PRODUCT/COMPANY READER SERVICE # WEBSITE

InterChange/AmerisourceBergen #22 www.medselect.com

MedDirect/McKesson #34 www.mckesson.com

OmniLinkRx/OmniCell #51 www.omnicell.com

Pyxis Connect/Cardinal #70 www.pyxis.com

The Neuenschwander Company #91 www.hospitalrx.com

from the Automation ExpertMARK NEUENSCHWANDER

MedSelect InterChange, from the Amerisource-Bergen Technology Group, can utilize existing equipment.

Omnicell's OmniLinkRx is a software-only solution.

MOMS (Continued from page 2) I have yet to meet a MOMS user on the ward or in thebasement who didn’t feel this type of system was a winner.

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