STATEMENT AMERICAN SOCIETY OF HOSPITAL PHARMACISTS Before Subcommittee on Health Senate Committee on Labor and Public Welfare on S.3096, S.3297, S. 3652, S.3651 April 28 & 29, 1970 Mr. Chairman and Members of the Committee: The American Society of Hospital Pharmacists appreciates the opportunity to present this written statement, for inclusion into the hearing record, on the above referenced legislative proposals. We regret not being able to present this material personally to the Committee. Unfortunately, due to circumstances beyond our control, it was impossible. Nevertheless, we are prepared to meet with members of the Committee, individually or collectively, to further discuss the information contained in this statement or to supply additional written information, if necessary. As you may know, the American Society of Hospital Pharmacists is the nonprofit national specialty Society representing pharmacists who practice in the over 7,000 hospitals and related institutions in the United States. These pharmacists represent those persons in the health community who, day in and day out, year in and year out, try to achieve the highest quality health care possible in the use of drugs at the lowest practical cost. DRUG CODING We would like to turn our attention first to S.3096 and S.3297, both of which deal with an identification system for prescription drugs for human use. The American Society of Hospital Pharmacists recognizes the need for a uniform national code for drug products and supports the intent of these Senate bills. In fact, hospital pharmacists have been at the head of the charge attacking this problem antedating 1966. As early as 1965, hospital pharmacists were assigning codes to pharmacy inventory items. These codes were necessary because electronic data processing was being used in the hospital for patient billing and for inventory control. Individually, hospital pharmacists developed numerical codes for drug products to serve as the address location for some description of the drug product which was to be stored in the computer. The codes would also be used as a short way of referring to the drug on printouts of inventory lists and on the patient's bill. Some hospital pharmacists used "idiot" codes they assigned numbers that had no relation to each other and served only to identify a specific product in a list of products. Others designated "meaningful" codes, attempting alphabetical succession of nonproprietary names, indications of manufacturers or, commonly, indications of pharmacologic-therapeutic classification according to the American Hospital Formulary Service, the drug information compendium of the American Society of Hospital Pharmacists. See Appendix A for complete listing of classification system. These computer processable codes were designed primarily for the single function of facilitating inventory control or patient billing and were, of course, limited to the drug products used in the individual hospital. As more and more hospital pharmacists were faced with this task of building a data bank and coding their drug products a tedious job at best it became obvious that one data bank with standard codes, including all pharmaceutical products and applicable in any hospital, would be more desirable than a large number of different, non-related data banks and codes. Our members approached the American Society of Hospital Pharmacists as the logical source of such a uniform data bank and code, and the Society's Board of Directors, at its December 1966 meeting, approved a crash program to develop a code. Thus, since December 1966, the American Society of Hospital Pharmacists has been exerting a comprehensive effort in this area. Early in 1967, the ASHP formed a special code committee, consisting of selected hospital pharmacists who had themselves done drug coding, hospital computer specialists and systems analysts. This committee met to design a code content and format for a drug data bank for inventory control. Originally it was thought that a meaningful code number could be designed, but by the time each drug product was described in code, the number suggested was seventeen digits in length. Our consultant committee told us this was an unrealistic number of digits with which to work and, although a meaningful number was the more desirable, advised that this approach be abandoned and an "idiot" code, not to exceed six digits, be used. Another project, which involves a computer-based drug listing or formulary service, was begun in mid-1967. Through this listing service, the ASHP would prepare for an individual hospital a listing of the drugs which had Pharmacy and Therapeutics Committee approval for use within that hospital. Since the Society was already working on one listing of drugs with code numbers for computer processing the one and now had an additional computer project to it was decided to combine the two projects and to build one comprehensive data file. Also in mid-1967, the Task Force on Prescription Drugs of the Department of Health, Education and Welfare bacame involved with the same idea of drug coding. Something was needed to assist in the processing of 250 million individual Medicare drug bills per year and the HEW Task Force investigated a uniform nomenclature and coding system which could be effectively utilized by all hospitals, pharmacists, manufacturers, insurance companies and other third-party institutions, and government agencies in accounting procedures, adverse drug reaction reporting and drug utilization reviews. A representative of the ASHP served on the Task Force Subcommittee on Coding and, as the Task Force discussions proceeded, the ASHP incorporated all the criteria of the code envisioned by the Task Force into the ASHP code. The ASHP's drug coding service has received the endorsement of the American Hospital Association. In addition, the American Pharmaceuti cal Association's House of Delegates at its 1970 Annual Meeting commended the ASHP for its efforts in developing a coding system usable in professional practice. At the present time there are more than thirty subscribers to our Drug Coding and Listing Services representing more than 23,000 hospital beds. A complete list of subscribers is contained in Appendix B. Here in the United States, our coding service is being used for the processing of drug information by the Latter-day Saints complex of 10 hospitals, and other hospitals of varying types and sizes ranging from 210-bed Clinic Hospital of Bluffton, Indiana to 1470-bed Baptist Memorial Hospital of Memphis, Tennessee. Maimonides Hospital in New York City, the University of Minnesota and University of Wisconsin subscribe to the ASHP coding service and they have used it to prepare their hospital formularies. The Medical Center of Vermont has built price files with the ASHP coding service. The Drug Information Center of the University of Michigan, under a grant from the Regional Medical Program, uses the ASHP code in the entry and retrieval procedures for therapeutic information. Looking outside the United States, the Notre Dame Hospital of Montreal, Canada, which is a computerized national clearing center for drug reactions and a poison control center, is using the ASHP code as the basis of a Therapeutic Information System. (This is described more fully in Appendix C.) The Drug Committee of the Ministry of Health of Israel has chosen the Society's code to be used in about fifteen hospitals throughout the state for uniform drug nomenclature, drug information and consultative services, and medical research in clinical areas related to drug usage. It is because of this background that the Committee may benefit from the years of experience by the American Society of Hospital Pharmacists in the drug information field, including drug listing and coding. Turning now to the legislation before the Committee, we must measure the effect of the proposed bills against the total needs of the medication portion of our national health care system. Some of these needs are outlined in the legislation itself which mentions consumer protection measures such as "identification of drugs in cases of accidental poisoning, facilitation of drug recalls and prevention of drug mixups." These are admirable and necessary objectives and hospital pharmacists support them; however, these few objectives do not fulfill all the needs of the health professions. 1 |