"Closing the loop" on medication management has long been discussed as a worthy health IT goal, but just 5 percent of U.S. hospitals have been able to get there, Health Data Management reports. That figure comes from a recent HIMSS Analytics report on EMR adoption.

There are many reasons why closed-loop medication management is so elusive. "When you look at medication management across the continuum of care and all the processes involved, they're complex and have multiple points of failure," Mark Siska, assistant director of informatics and technology for pharmacy services at the Mayo Clinic, tells HDM. "There are a number of opportunities for distraction and miscommunication, so automating medication management and connecting everything is very challenging."

Why is it so complex? For one, the inpatient "medication loop" involves multiple steps. There's the initial ordering, and the order entry process should include automated checking for contraindications, drug-drug interactions, allergies and duplication. The order needs to get sent to the pharmacy, where the pharmacist should "translate" the order to a specific form and dosage, then pull the right medication from inventory and send the drug to the appropriate hospital unit.

On the unit, administering nurses need to perform checks of the "five rights" of medication management, assuring that the right patient is getting the right drug in the right dosage on the right route at the right time. Then, the nurse or other health professional administers the medication and should record the event in the patient's record. Breakdowns or headaches can happen at any step in the loop.

Hospitals haven't been rushing to close the loop in part because Stage 1 "meaningful use" standards don't require them to. One-third of the core measures for earning Medicare and Medicaid bonus payments for EMR usage do address medication safety, but there is no requirement to close the medication loop.

And though many hospitals have been moving away from standalone pharmacy information systems in favor of housewide EMRs that include pharmacy modules, health IT installations tend to lack bar-coded medication administration, and EMRs often don't have the kind of connectivity with "smart" infusion pumps that would automate IV administration. "Many hospitals have been sold a vision of closed loop medication administration, but when they sit down with their vendors to see what they can buy, most of them end up falling short," Erin Sparnon, senior project engineer at ECRI Institute, says.

For greater discussion of closed-loop medication administration:
- check out this Health Data Management story

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