INTEGRATING PHARMACOKINETICS INTO POINT-OF-CARE INFORMATION-SYSTEMS

Computer-based patient care information systems (PCIS) have emerged as an integral component of healthcare organisations. Currently 4 models of PCIS exist: the centralised model, the hub-and-spoke model, the ne twork model, and the distributed model. The centralised model has the advantage of a central patient database; however, a major disadvantage of this model is the inability to easily interface with other softwar e packages. The hub-and-spoke model links satellite or feeder systems into a mainframe computer; thus, each satellite has the ability to wor k independently This system is limited by the ability to interface sat ellite systems with the mainframe computer. The network model works vi a a local area network (LAN) using client server technology which allo ws for high speed data access and transfer. The network model does not provide an integrated view of patient information and can access only 1 host system at a time. The distributed model is similar to the netw ork model in design but provides for data and system integration via r elational databases. This allows for the creation of a central data re pository and support for decision-support tools. Computer-assisted dec ision-support has the potential to significantly improve clinical deci sion-making. Six types of computer-assisted decision-support have been defined: alerting, interpreting, assisting, critiquing, diagnosing an d managing. Software representing each type of decision-support softwa re has been incorporated into clinical practice; however, with the exc eption of drug interaction programs, widespread incorporation of decis ion-support software into PCIS is uncommon. Clinical pharmacokinetic p rograms are a category of pharmacy-related decision-support software, and current clinical pharmacokinetic software systems can be categoris ed as interpreting, assisting or critiquing decision-support. Despite the potential for significant clinical contributions, the integration of clinical pharmacokinetic software into PCIS is uncommon. Most packa ges are available only as stand alone programs or as a module of a pha rmacy information system. These packages usually maintain their ow a c entralised database and require special file transfer protocols for in tegration. Although PCIS are becoming more commonplace, the integratio n of commercial clinical pharmacokinetic packages into PCIS is limited . New technology using standardised and relational databases should al low for easier integration in the future.