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Vol 1 | Issue 3 | Oct – Dec 2022                                                                                      Indian J Pharm Drug Studies | 84  

Review Article 

Barriers to Hospital Pharmacy Information System – An emerging concern  

Janice Jacson Mandumpala, Stephy Sebastian 

From, Pharm D intern, Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India. 

Correspondence to: Janice Jacson Mandumpala, Pharm D intern, Department of Pharmacy Practice, Nirmala College of Pharmacy, 

Muvattupuzha, Kerala, India – 686661 Email: janice.jacson@gmail.com  

ABSTRACT 

Pharmacy plays an important role in keeping up with the clinical care of patients. In a hospital setting the pharmacies revol ve around 

medication demands and catering to their everincreasing prices. Such factors cause inefficiencies in the availability of information 

systems. PubMed and Google scholar databases were studied and extracted for getting information on the technology used in 

pharmacies. Ongoing vendor involvement, acknowledgement of technology limitations, and attempts to address them were crucial in 

overcoming technology barriers. This review aims to provide the importance of information systems and implement them across various 

hospitals. 

Key words: Hospital Pharmacy, Pharmacy, Information system, Healthcare.

he concept of pharmacy travels back to the ancient times 

of the Greeks and the Egyptians. The pharmacy was 

once a part of medicine but later it separated as a 

different functional unit with a unique service. One of 

the major drawbacks in the antique era is the absence or 

underdeveloped stage of computerized sophistication and 

systematic handling of data. With the fast pacing health 

technology, it is high time that the health sector also progresses 

at the same speed [1]. There is an unsatisfactory performance in 

the health sector technology in both cost and quality. Healthcare 

informatics is constantly working on improving itself along with 

a specific focus on technologies. In this review, we are focusing 

on healthcare informatics which is defined by HIMSS as “The 

scientific field that focuses on medication-related data and 

knowledge within the continuum of healthcare systems—

including its acquisition, storage, analysis, use, and 

dissemination—in the delivery of optimal medication-related 

patient care and health outcomes.” [2].   

Pharmacy plays a major role in hospitals. The review 

particularly focuses on acute hospital pharmacy in central care. 

In acute hospitals, every admitted person receives at least one 

dose of medication while a majority of the patients are 

prescribed from five to nine dosage forms some patients receive 

up to thirty dosage forms. Frank et al performed a cross-

sectional study on pharmacy, this study proved how 

polypharmacy has increased from the year 1997 to 2021 [3].  

As the number of prescriptions increased in the year the 

concern of improper diagnosis and improper treatment has also 

increased. By the year 2007, the number of excessive 

prescriptions decreased in comparison to the year 1997 after 

controlling the prescriptions through informatics. A recent Irish 

study performed by O’Sullivan et al revealed that around 84.5 

% of the patients had polypharmacy while the rest 43% had a 

prescription of more than 10 medications that are super-

polypharmacy [4].   

This showed the number of complex medications 

administered by patients. The budget of a hospital is more than 

300 million per annum. In a 2014 study, 1.8 billion Irish 

healthcare was spent on medications. These high costs of 

healthcare prove the need for information systems in healthcare. 

Powsey et al conducted a study that demonstrated that 

information systems can play a major role in simplifying patient 

data [5]. Patient safety has become an emerging concern in 

media during recent years. Patient injuries are most commonly 

due to adverse drug events.  

Many of these are caused by medication errors which are 

preventable. They can occur at any stage of the medication use 

process including ordering, transcribing, dispensing, 

administering, and monitoring. Most of the solutions to 

medication errors, such as computerized physician order entry 

systems, have focused on reducing errors at the medication 

ordering stage [6]. This reduces the stress on clinical 

pharmacists for processing paper and gives a satisfactory 

performance by the information system.  

Therefore we are taking a closer look at information 

systems that aid in improving the effectiveness across all the 

sectors along with the healthcare sector. Before we 

implement information systems in healthcare let us look at 

T 



Mandumpala & Sebastian                                                               Barriers to Hospital Pharmacy Information System 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                      Indian J Pharm Drug Studies | 85  

the barriers present in healthcare. This review article focuses 

on various barriers in hospital pharmacy information systems.  

Case Studies  

We present three case studies given by Noel Carroll et al [7] 

in their research paper. Two case studies were presented in 

public hospitals one case study was presented in a private 

hospital  

 Fig 1- Overview of the case studies 1, 2 and 3  

Case Study 1  

This case study was managed by the Irish Government health 

service executive (HSE). This hospital included various 

healthcare branches like urology, oncology, cardiology, etc. 

The pharmacist provided direct care to all the branches. The 

Doctors went on various rounds for all the patients to provide 

care and improvement in the medications. The hospital 

system did not have an epharmacy. Despite lacking e-

Pharmacy services in the hospital the hospital recognized 

how e-Pharmacy could improve patient health care. As there 

were various patients included in this case student the use of 

e-Pharmacy could give accurate information and medications 

for each patient.  

Case Study 2  

This study was also managed by the Irish Government HSE. 

This case study is presented in an acute care hospital along with 

a 24-hour emergency department. Similar to case study 1, the 

pharmacy provided medications for all patients and doctors 

went for rounds to check on patients and improve their 

medications. This hospital recognized the importance of e-

Pharmacy and implemented a business plan to run the e-

Pharmacy. Later this plan remained unexecuted.  

Case Study 3  

This case study was presented in a private hospital. The private 

hospital had medical and surgical care for various specialities. 

The doctors provided advanced surgical and radiotherapy 

safekeeping for patients. The doctors were also supported with 

modernized technology. The Pharmacy department purchased, 

stored, formulated, and compounded all the required 

medications. The clinical pharmacists regularly monitored and 

reviewed the prescriptions of patients. They also provided 

medical counselling for community pharmacists to ensure the 

safety and efficacy of the pharmacy. The private hospital 

discussed how they were interested in the information system 

for pharmacy. Figure 1 represents the overview of these case 

studies.   

Nelson et al outlined various techniques such as using the 

writing locations, key themes, and verification of stakeholders 

in the pharmacy and larger hospital staff. A total of four visits 

were observed which were followed by interviews of the staff 

members. A total walkthrough of the hospital pharmacy was 

done which led to an interaction with the key staff which 

included pharmacists, nurses, and clinical pharmacists 

delivering services. The Pharmacy is comprised of six to eight 

members. A snapshot of the pharmacist was taken regularly. 

Questions about various Pharmacy processes and sub-process 

were also asked. The observation of staff interaction was done 

and how patients were administered medications.  

Data analysis was performed with coding techniques. Initial 

first open coding determined themes of transcripts. Open coding 

was followed by axial coding which determined the categories 

or subcategories. The relationship between the two codings was 

determined. The approval of ethics was performed for these 

studies through HSE.  

Alissa et al conducted one study to determine challenges in 

the Pharmacy electronic information system. The interview was 

done from October 2007 to March 2008. Semi-structured 

interviews were conducted in this process to illustrate how the 

positive and negative impacts of information technology affect 

the work of pharmacy on healthcare workers. The employee 

interviews were taken at the United States Veterans Affairs 

Medical Center (VAMC). Both men and women were recruited 

for the study.  

Table 1- It gives an overview of software packages, which are used in coordination with the Electronic information system 

Abbreviation  Software  Function  Reference  

CP Hemo  Clinical  Procedures  

Hemodialysis  

For patients on hemodialysis; intended to transfer patient 

measurements (e.g. blood pressure) into a computerized patient record 

system (CPRS) in real-time. Clinical procedures integrate CPRS with 

the clinical instrument used for dialysis; at the time of this study, CP 

Hemo was not widely implemented across  

[8] 

 



Mandumpala & Sebastian                                                               Barriers to Hospital Pharmacy Information System 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                      Indian J Pharm Drug Studies | 86  

VAMCs  

CPOE  Computerized  Provider  

Order Entry  

Incorporated into CPRS; prescribers can order most medications and 

some labs  

[9] 

CPRS  Computerized  Patient 

Record System  

A component of VistA; graphical user interface for some aspects of 

DHCP/VistA framework; contains patient records, CPOE 

functionality, lab results, alerts, progress notes, reports and reminders, 

etc.  

[9] 

 

DHCP  Decentralized  Hospital 

Computer Program  

DOS information framework implemented in VA in 1982, later 

renamed to VistA; currently used by VA outpatient pharmacists to fill 

medication orders  

[9] 

MRMS  Microsoft’s  Rights 

Management Services  

Provides secure e-mail messaging; can set restrictions on document 

use: printing, forwarding, editing, etc.; often referred to as ‘RMS’ but 

different from than RMS system described below  

[10] 

 

PISCES  Python Implementation of the 

SPKI (Simple Public Key 

Infrastructure)  

Certificate Standard  

Provides a secure system for VA Software  [10] 

RMS  Resource  Management  

System  

Used for scheduling patient appointments and is integrated with VistA  [9] 

VistA  Veterans Health Information 

Systems and Technology  

Architecture  

Information technology framework for ~1300 care sites  [11] 

VistAWeb  (see VistA)  Used by VAMCs to view remote patient data from other VAs; separate 

package from CPRS  

[11] 

VPN  One-VA  Virtual 

 Private Network  

Allows remote veterans service organizations (i.e. clinics that have 

partnerships with VA to care for veterans) to access VA systems 

securely  

[11] 

These interviews aided in the analysis of the challenging aspects 

of electronic information systems. During the interviews, the 

employees highlighted the use of paper for maintaining records 

and the deficiency in maintaining an electronic information 

system. Table 1 elaborates the software packages available for 

use in clinical setting.  

DISCUSSION  

Our review gives a generalized perspective on Pharmacy. It 

shows how pharmacy can be improvised and benefit from 

technology. We have learned that various hospital sites give a 

better understanding of how healthcare services can work 

collectively with Pharmacies. The innovation of healthcare 

information systems gives better access to the hospital and 

pharmaceutical environment. A hospital pharmacist plays a 

huge role in a patient’s journey in the hospital. Pharmacists deal 

with a variety of pharmaceutical services. They run different 

hospital units and deal with prescription drugs, they also give 

detailed information about the drugs and provide advice to 

patients, doctors, nurses, or other healthcare providers. 

Pharmacists prevent errors that can take place in the prescribed 

medications. Therefore pharmaceutical service is the core of 

patient care. Our review has shown the improvement of 

pharmacy through information systems. An information system 

is fundamental in upgrading healthcare services. The pharmacy 

providers view their healthcare in an oriented manner. Focusing 

on the pharmacy service also included laboratory staff, analysts, 

schedulers, etc. The optimization of information systems in 

pharmacy alone is not enough the overall optimization of the 

services is required. They have their greatest impact in 

organising and making available information, in identifying 

links between pieces of information, and in doing boring 

repetitive tasks, including checks for problems. The best 

medication processes will thus not replace people but will 

harness the strengths of information technology and allow 

people to do the things best done by people, such as making 

complex decisions and communicating with each other [12].   

Holler et al explained a study on the role of information 

systems in Pharmacy improvement [13]. The study explained 

that information systems interest pharmacists. Computerisation 

of ordering improves safety in several ways: firstly, all orders 

are structured, so that they must include a dose, route, and 

frequency; secondly, they are legible and the orderer can be 

identified in all instances; thirdly, information can be provided 

to the orderer during the process; and fourthly, all orders can be 

checked for a number of problems including allergies, drug 

interactions, overly high doses, drug-laboratory problems 

(giving a patient a drug when they have a known biochemical 

factor that predisposes them to risk), and whether the dose is 

appropriate for the patient's liver and kidney function [14]. 

Health information technology poses a potential impact on 

the safety of the patient. This study conducted by Holler et al., 

encouraged the use of information technology for improving 



Mandumpala & Sebastian                                                               Barriers to Hospital Pharmacy Information System 

Vol 1 | Issue 3 | Oct – Dec 2022                                                                                      Indian J Pharm Drug Studies | 87  

patient safety without any errors. In the upcoming future 

pharmacists will adopt the wider use of technology for drug 

administration and prescriptions. A study performed by Pinder 

et al discovered an understanding that even though the clinical 

pathways have a structured approach for clinical practice the 

normal human nature to deliver healthcare often leads to errors 

and undocumented processes differing from organization to 

organization. Pinder et al also evaluated the variation in patients 

in clinical care suffering from cataracts [15]. 

Despite the variations in patients, there were also underlying 

similarities. This gives an understanding that clinical, patient, 

and management provide vital clues to the execution of the 

clinical care pathway. The tools that are now available should 

eventually be used in all hospitals. Given the potential impact of 

these technologies, their diffusion has been surprisingly slow. 

One reason may be the lack of research showing how much of a 

difference the technologies make. Funding for such research has 

been relatively limited, and relatively little support has come 

from the developers of the technologies. Another, more 

important reason is lack of demand from the healthcare industry. 

Safety has not been a high priority in medicine, in part because 

the problem of safety is generally undervalued. One reason for 

this lack of appreciation is that medical accidents occur in ones 

and twos rather than in large groups; moreover, many of those 

involved are ill and elderly. Fortunately, public concern about 

the issue is substantial, and increasing, and the healthcare 

industry is beginning to take a more active interest. Therefore 

the benefit of clinical care helps in examining clinical care 

pathways and identifying inefficiencies in pharmacy including 

patient safety and reduction in costs of medicines.   

CONCLUSION  

In this review article, we gave an overview of the barriers to 

pharmacy service. We show how pharmacy information 

systems innovate the pharmacy service. Technology has great 

potential to reduce medication errors in hospitals. We have re-

examined the clinical care pathways along with the 

inefficiencies present in the pathway. Staff resistance should be 

addressed through clear communication, identifying 

champions, emphasizing new information provided by the 

system, and facilitating collaboration among health 

professionals. Pharmacy still has to go a long way to establish 

an information system in its management.  

REFERENCES  

1. Mettler T, Raptis DA. What constitutes the field of health 

information systems? Fostering a systematic framework and 

research agenda. In: Health Informatics Journal. 2012. 

10.1177/1460458212452496  

 

 

2. Sandra V. B. Jardim. The Electronic Health Record and its 

Contribution to Healthcare Information Systems Interoperability. 

Procedia Technol. 2013, 9.   

3. Moriarty F, Hardy C, Bennett K, et al. Trends and interaction of 

polypharmacy and potentially inappropriate prescribing in primary 

care over 15 years in Ireland: A repeated cross-sectional study. 

BMJ Open. 2015, 5: 10.1136/bmjopen-2015-008656  

4. O’Sullivan D, O’Mahony D, O’Connor MN, et al. The impact of a 

structured pharmacist intervention on the appropriateness of 

prescribing in older hospitalized patients. Drugs and Aging. 2014, 

31: 10.1007/s40266014-0172-6  

5. Powsner SM, Wyatt JC, Wright P. Opportunities for and challenges 

of computerisation. Lancet. 1998, 352: 10.1016/S0140-

6736(98)08309-3  

6. Nanji KC, Cina J, Patel N, et al. Overcoming Barriers to the 

Implementation of a Pharmacy Bar Code Scanning System for 

Medication Dispensing: A Case Study. J Am Med Informatics 

Assoc. 2009, 16: 10.1197/jamia.M3107  

7. Carroll N, Richardson I. Enablers and barriers for hospital 

pharmacy information systems. Health Informatics J. 2020, 26: 

10.1177/1460458219832056  

8. Carroll JM, Chin G, Rosson MB, et al. Development of 

cooperation: Five years of participatory design in the virtual school. 

Proc Conf Des Interact Syst Process Pract Methods, Tech DIS. 

2000.   

9. Nemeth C, Nunnally M, O’Connor M, et al. Getting to the point: 

Developing IT for the sharp end of healthcare. J Biomed Inform. 

2005, 38: 10.1016/j.jbi.2004.11.002 

10. Saleem JJ, Russ AL, Justice CF, et al. Exploring the persistence of 

paper with the electronic health record. Int J Med Inform. 2009, 78: 

10.1016/j.ijmedinf.2009.04.001  

11. Sellen A, Harper R. Paper as an analytic resource for the design of 

new technologies. In: Conference on Human Factors in Computing 

Systems - Proceedings. 1997. 10.1145/258549.258780  

12. Bates DW. Using information technology to reduce rates of 

medication errors in hospitals. Br. Med. J. 2000, 320: 

10.1136/bmj.320.7237.788  

13. Holler J. The Role of Information Technology in Advancing 

Pharmacy Practice Models to Improve Patient Safety. Pharm. 

Times. (2013).   

14. Bates DW, Teich JM, Lee J, et al. The impact of computerized 

physician order entry on medication error prevention. J Am Med 

Informatics Assoc. 1999, 6: 10.1136/jamia.1999.00660313  

15. Pinder R, Petchey R, Shaw S, et al. What’s in a care pathway? 

Towards a cultural cartography of the new NHS. Sociol. Heal. Illn. 

2005, 27: 10.1111/j.1467-9566.2005.00473.x  
 

How to cite this article: Janice Jacson Mandumpala, 

Stephy Sebastian. Barriers to Hospital Pharmacy 

Information System – An emerging concern. Indian J Pharm 

Drug Studies. 2022: 1(3) 84-87. 

Funding: None                      Conflict of Interest: None Stated 

  


