Medication Management: Integrate vs. Interface: Peering Under the Hood


March / April 2009
Medication Management

Integrate vs. Interface: Peering Under the Hood

Eliminating medication errors has been a priority for hospitals since the Institute of Medicine (IOM) released To Err Is Human. In that 1999 landmark report, the IOM determined that up to 98,000 Americans die annually from medical errors, including many from preventable, medication-related errors. The report cited 1995 research that found those errors to occur throughout the medication order life cycle: 39 to 49% from physician ordering, 11 to 12% from transcription, 11 to 14% from pharmacy dispensing, and 26 to 38% from nursing administration. In 2006, the IOM estimated conservatively that approximately 400,000 preventable, drug-related injuries occur annually at hospitals in the United States, resulting in at least $3.5 billion in extra medical costs.

These findings have spurred regulatory agencies to push hospitals to “close the loop” on the medication management life cycle by deploying technology to protect patients from prescription, transcription, dispensing, and administration errors. To accomplish this, facilities can deploy an “interfaced” approach, lashing together best-of-breed information systems, or an “integrated” single-database solution. Understanding the differences between these two solutions sometimes isn’t as easy as it sounds. Primarily, that is because some skilled vendors are making internally interfaced solutions look and feel like integrated solutions. Because of this, some in the industry mistakenly believe the terms “interfaced” and “integrated” have essentially the same meaning. This is more easily understood when the hospital itself implements an interface to an existing standalone system, but can be far more challenging when an organization is replacing the entire system with a single vendor.

Both types of solutions help organizations improve medication management and patient safety, but facilities should know exactly which one they are buying, as each solution will have significantly different implications for their strategic business plan and annual budget.

Key Differences
An interfaced medication management solution, whether internally interfaced in the same vendor suite or externally interfaced across multiple products, typically links best-of-breed or standalone systems designed to meet the individual workflow needs of three different user groups: physicians, pharmacists, and nurses. The challenge is that the systems forming the core of a medication administration solution — computerized physician order entry (CPOE), nursing documentation, and pharmacist review — typically have different computing architectures.

In comparison, an integrated medication management solution is designed to address the overall medication order life-cycle workflow as a whole, on the same platform and database, so additional translation layers are not necessary.

Which solution makes sense for an organization will depend on its current IT environment. To help differentiate between the solutions, organizations should ask the following questions when evaluating systems:

Displays: Does the proposed solution have the same look and feel, regardless of where the user is within the application (e.g., physician, pharmacy, or nursing)? Although this element doesn’t necessarily guarantee that the applications are integrated, it is a good starting point.

Translation/mapping: Does the solution require translation tables and mapping to normalize data across multiple disciplines/departments? This may not be obvious, as some solutions are pre-configured with the base translations. While this is often presented as flexibility, it is a strong indicator that the solution is interfaced, not integrated. Flexibility should be built into the workflow configuration and setup to allow an organization room to grow or change as regulations change. Integrated systems run on a single database, which, when designed with integration in mind, do not need translation mapping. However, be advised that a single database alone doesn’t mean the solution is integrated. There are vendors that have merged disparate or best-of-breed systems from acquisitions into a single database that still require extensive mapping for an internally interfaced solution.

Lag-time: Does the solution provide real-time support of all actions throughout the medication order life cycle across all departments and uses? Any lag-time or missing information from medication-related views can be a good indicator that the solution is interfaced, not integrated. While views should be tailored to the audience reviewing the data, integrated solutions should provide all information throughout the medication order life cycle in a consistent, real-time manner.

Terminology: Does the solution change the wording for similar actions across the different modules and functions (i.e. CPOE, pharmacy, and nursing)? An integrated solution is designed as such and, therefore, this terminology is programmed for the overall medication order life cycle, not for a particular departmental view. Any differences or variations in terminology are clues that you are likely evaluating an interfaced system instead of an integrated system.

Audit trails: Does the solution provide a comprehensive audit trail across multiple disciplines throughout the medication order life cycle? This functional, real-time audit capability is another way to help validate an integrated solution.

Other Considerations
To choose the appropriate medication management solution, it is critical that organizations also:

  • Evaluate the impact of ongoing industry developments or trends. For example, provider interest in using mobile, barcoded medication management systems is accelerating. Under these systems, nurses use portable personal digital assistants (PDAs) or tablet PCs rather than a stationary PC at a nursing station.
  • Consider whether a system complies with regulations from state, federal, and accreditation bodies. Each year, new regulations are issued, amended or both. As such, organizations should thoroughly investigate the flexibility and scalability of medication management systems to accommodate both current and future needs.
  • Identify their own organizational challenges and timelines. For example, a facility that recently purchased an internal pharmacy system may want to look at an interfaced solution to finish closing the loop without having to retrain the pharmacy. However, a facility that doesn’t have a 24/7 IT support staff may wish to implement an integrated solution to mitigate downtime due to interface or multiple system support concerns.
  • Review current budgetary considerations along with annual costs. For example, facilities that don’t have as much up-front capital, but can plan for a greater annual/maintenance cost, may choose an interfaced solution while facilities looking for a single purchase with full flexibility may choose an integrated solution.

Ultimately, it’s up to each organization to determine whether the interfaced or integrated approach to medication management solution is right for them. The key is to make a fully informed decision and to be sure that the solution they purchase is indeed what they believe it to be because the chasm between an integrated versus an interfaced solution is enormous. In today’s fiercely competitive healthcare environment, healthcare organizations cannot afford to base strategic plans and budgets on flawed assumptions. More importantly, it is critical that they implement the solution that puts them in the best position to improve patient safety by ensuring the “Six Rights” of medication administration: right patient, right medication, right dose, right time, right route, and right documentation solution.


Valerio Carpi is a product manager at QuadraMed. He may be contacted at