Weighing the Costs

Are hospitals spending enough for pharmacy computer systems?

By Salvatore M. Barcia, president of Meta Pharmacy Systems, Floral Park, NY.

We loved your system,” the pharmacy director began, with a tone that implied the pharmacy computer system vendor was not chosen, “but your system was more expensive than the product we have selected.”

The salesperson persisted. After several minutes of delineating the advantages of his product, which were numerous, the pharmacy director could only agree. There were more clinical features, more ways to reduce risk, better order entry, and great references. The competing product just cost less. The pharmacy director was unable to convince his hospital to spend more for the additional quality.

A dangerous situation is emerging in hospital information systems today. Many hospitals are unable or unwilling to spend enough money on pharmacy computer systems to purchase the best systems available. Pharmacy directors often are pressured to select products, either from HIS vendors or standalone vendors, that they rate as merely acceptable.

There are reasonable limits as to what a hospital can and should spend on computer software. In the midst of one of the most prolonged periods of continued economic growth and prosperity in the history of the United States, hospitals struggle to remain viable.

Staff cutbacks, reduction in beds and services, forced mergers, and even closure of hospitals are occurring in every area of the country.

Registered nurses are being replaced by paraprofessionals, who are trained to perform basic tasks like taking vital signs. They lack the assessment skills of a clinical nurse practitioner who can identify the signs of a life-threatening crisis. Pharmacy departments are doing more with less.

As positions are eliminated, staff pharmacists are asked to be more productive and more clinical. Highly skilled, experienced pharmacy directors are being pushed out like relics from a bygone era. Their replacements are often not the most qualified, educated or experienced; in fact they are often lower salaried—hired because they won’t rock the corporate ship to defend a department’s mission to provide excellence in patient care.

However, manpower shortages underscore the need for computer systems that offer higher levels of functionality. In pharmacy, the demand for product services remains constant. The perfunctory aspects of pharmacy practice, moving medications from pharmacy to nursing station to patient, must be performed. Clinical services usually suffer in the wake of cutbacks. Shouldn’t hospitals be looking to spend a little more for the best systems available to help make up for staffing deficits?

What price can be placed on just a single clinical feature that could have averted a catastrophic medication error? In the aftermath of multimillion dollar lawsuits, of loss of reputation, and perhaps even the loss of life, will someone ask, “Would a decision to spend thousands more on a better pharmacy system have averted this situation?”

The Philadelphia Inquirer recently reported that hospitals spend much less than other business sectors on computer systems. On average, other business sectors spend an estimated 12 percent to 15 percent of total revenue on information technology. Hospitals spend an estimated 2.5 percent of revenues on information technology, much of it for billing systems! Some hospitals even use low-end pharmacy computer systems priced little more than retail pharmacy systems. Some actually use retail systems for institutional practice—systems that offer only a small piece of the functionality that the higher end products offer.

One is reminded of a scene from the movie Moonstruck, where a plumber explains the need for copper piping—justifying his higher pricing—to a yuppie couple. “It costs money. But it costs money because it saves money,” actor Vincent Gardenia cooed. The couple, enlightened, nodded in unison at this revelation. If only it were so simple with pharmacy systems.

© 2000 Nelson Publishing, Inc

July 2000