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Information security and confidentiality

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While implementing information technology increases the efficiency and accuracy of the medication use process, measures must be taken to ensure information security and confidentiality. In the modern society, the development and information exchange are massive and rapid, Personal data protection becomes a significant issue. And when it comes to personal health related information, he privacy and confidentiality should be valued even more, and dealt with great caution. Information Security may be defined as reasonable protection from risk of loss, risk of inappropriate access, or doubt regarding authenticity of information. These data security can be referred as confidentiality, Authentication and Nonrepudiation. Confidentiality, which is to ensure that the data is readable only by the intended recipients.
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For example, a patient’s diagnosis, lab results or current medication profile should only be available to health professionals who need these information in order to exercise their work, rather than anyone within the hospital. To ensure and respect patients’ privacy. As for Authentication, it is to provide protection against unauthorized access or forgeries. Medication Prescriptions should only be prescribed by authorized physicians to ensure patient safety. In the case of controlled substances such as narcotic medications, ensuring system authentication not only protects patients but also prevents potential issues regarding substance abuse. As for Non-repudiation, it is to ensure that someone cannot deny having conducted a transaction.
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System should always log the identity and time of a performed transaction, for the purpose of clearing the responsibility or liability of an occurred error, and prevent the potential abuse of medications use as well. Methods such as passwords, smartcards or biometric identification can help assure that only authorized individual access the data and allows the system to log the action. Apart from ensuring confidentiality, authentication and non-repudiation, another key component of information security is the ability to back up data. So that the medication process won’t be severely affected in the case of software or hardware failures.
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In order to develop a efficient and successful information system, The system design should always meet clinical needs. And fits the workflow and process within the facility. Customized systems have the advantage of being more flexible and better fitting to each facility’s needs, but it also requires a lot of resources to set up. Resources such as the support of the organization, financial resources, the participation of IT engineers and proper staff training are all essential for the development of a successful and efficient information system. A survey conducted in 2007 showed that in Taiwan, over 90% of medical centers use self-designed information systems, where as district hospitals, which may have fewer resources and smaller service volume, mostly adopt commercialized systems.
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And Now, I would like to share some of the experience of developing pharmacy information systems and automation in Taipei Veterans General Hospital. Before I get on to the subject, First, I would like to briefly introduce the TVGH. We are a medical center located in Taipei, Taiwan. The service volume is 3000 in-patient beds, and we have around 10,000 outpatient visits per day. And, Currently, we are staffed with around 197 full-time employed pharmacists and 13 assistants. The department of pharmacy in TVGH is dedicated in improving the safety of medication use and efficiency of pharmacists’ work. And, How exactly do we incorporate information systems into our daily work, I will further discuss in 2 parts, Automation and Information systems.
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As the hospital service volume grows, automation assistance of the dispensing process became more and more important. Automation technology was first applied on medication inventory management in TVGH in 1987. Since then, automated dispensing machine, automated compounding machine, and bare-code systems are introduced into the dispensing and administration process one after another. These automation technology not only spared a lot of pharmacists’ time for routine mechanical work, and allowing them to be available for clinical patient-centered care, they also increased safety and reduced potential human errors. And as for clinical service area, electronic systems were developed for medication error reporting, medication consulting, ADR reporting and clinical pharmacist service systems.
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Which made documentation of these clinical work a lot more convenient and thus increased the overall reporting rate, and more importantly, makes it easier to perform data analysis. Now I would like to briefly introduce our inventory management system. The purchase and re-ordering of medication is a routine but yet important work of pharmacy inventory control. A hospital or a facility depends heavily on the stability and consistency of medication inventory. In TVGH, to simplify this process, we developed automatic replenishment system. For each individual medication, a safety stock quantity was set based on their daily demands. Once the medication stock ran below the pre-decided safety stock quantity or the re-order point, the system automatically places replenishment orders to suppliers.
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Saving the time and effort of pharmacists to do the routine and time-consuming paper work. We also incorporated bar-code system into inventory management. We require the manufacturers to add bar-codes on each layers of the medication package, containing information such as batch number and expiration dates. Upon receiving, the inventory managing pharmacist would scan the bar-code and the system files the information automatically. Saving the time and labor required for manual logging and improves the accuracy of inventory control. The bar-code also assists the medication distribution within the hospital. By scanning the barcode, the system auto-checks for the correctness of the medication by cross referencing the medication distribution requests and logs the quantity delivered.
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Making it easy and clear to track the stock status of each pharmacies within our hospital. The environment of pharmacy have serious impact on the quality of medication products. Especially the refrigerated medications. The pharmacy department set up the 24hr temperature monitoring system, which connects every refrigerator within the pharmacy to computer systems. When temperature exceeds the designated range, the refrigerator makes warning buzz and sends alarm signal and phone alerts to Emergency department pharmacy, which is staffed 24hrs, for immediate handling. Furthermore, the environment temperature, humidity and room pressure of hazardous medication and sterile product preparation area is also strictly monitored, to ensure the medication quality as well as the safety of working personnel.

With digitalization, comes the concern for patient confidentiality.

Patient information is stored within a system used by many healthcare workers. Thus it is important that only authorized individuals have access to these data, and their actions on the system are logged. To illustrate the concepts mentioned up till this point, Ms Chen will use TVGH’s pharmacy information system as an example. Depicting the benefits of automation and how the system should be managed to ensure both efficiency and security.

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Good Pharmacy Practice: Introduction to Medication Delivery Systems

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