Pharmacy Informatics

• Pharmacy Informatics is a unique subset of medical informatics focusing on the use of information technology and drug information to optimize medication use.
• Pharmacy Informatics is the application of technology and information systems to improve medication use, outcomes, safety, and efficiency.
• Informatics pharmacists design, implement, customize and support health information systems and technologies.
• Informatics Pharmacists act as a bridge between IT staff, clinicians, and experts in health information systems and technology.

Informatics Pharmacist Role

• A dual specialist and must have knowledge about both pharmacy practice and informatics
• Able to analyze pharmacy practice from an analytical design perspective.
• Able to analyze health informatics technologies from a clinical or operational perspective.
• Must have the ability to look at both the "big picture" and individual details and processes.
• Expected to ensure patient safety.
• Expected to provide guidance and leadership for all technology initiatives supporting medication use.
• Expected to customize and tailor health information systems and technology to the needs of practice.
• Serve as a liaison between pharmacy and other departments like Information Technology, Nursing, Physicians, and Vendors
• Provide education to healthcare professionals and managers.
• Must serve as a resource for hospital staff.
• Provides recommendations regarding vendor selection

Competencies of Pharmacists in Informatics

• Must have a basic understanding of database design and function.
• Needs to stay current with relevant standards, regulations, and initiatives.
• Should have the ability to anticipate future needs and challenges.
• Must have the ability to think about the "end user"
• Possess the ability to teach and guide others.
• Expected to possess communication and project management skills.
• Must be technology-oriented, innovative, and analytical.

Medication Information

• Can also be called drug information.
• Medication Information involves the management and use of information on medication therapy.
• Signifies the broader role all pharmacists take in information provision.

Drug Informatics

• Emphasizes technology as an integral tool in effectively organizing, analyzing, and managing information on medication use in patients.

Informatics

• Informatics is the field of information science, concerned with analysis, use, and dissemination of medical data and information through the application of computers to healthcare and medicine.
• One of three core components, along with People and Technology

Biomedical and Health Informatics

• The optimal use of information and technology to improve individual health, health care, public health, and biomedical research.

Bioinformatics

• Bioinformatics is the application of informatics to cellular and molecular biology.

Public Health Informatics

• Public Health Informatics is the application of information. It focuses on surveillance, reporting, and health promotion in public health areas.

Consumer Health Informatics

• Consumer Health Informatics works to support the patients health activities

Technology in Pharmacy Practice

• This field is rapidly evolving, as the pharmacy model changes with the introduction of information technology and automation.
• Technology is continuously developed to increase safety, reduce costs, and increase efficiency.

Current Technologies for Medication Use

• Health Information Systems.
• Electronic Medication Administration Records.
• Computerized Provider Order Entry.
• Clinical Decision Support.
• Electronic Prescribing.
• Automated Dispensing Cabinets.
• Inventory Management Systems.
• Bar Coding.
• Radio-frequency identification.
• Smart Pumps.
• Robotics.

Becoming a Pharmacy Informatics Specialist

• Must have real-world pharmacy practice experience.
• Must possess a thorough understanding of the medication use process.
• Must have extensive knowledge about health information systems and all medication-related technologies.

Applications of Pharmacy Informatics

• Pharmacy Informatics aims to support for clinical services.
• Supports pharmacy and therapeutics activities.
• Used in publications.

Drug Information Center

• It's a dedicated area within the pharmacy for providing drug information.
• Provides selected, comprehensive drug information for healthcare professionals to evaluate and compare drugs.
• Involves storing, retrieving, evaluating, and disseminating information.

Activities of a Drug Information Center

• Education
• Drug Usage Evaluations
• Investigational Drug Research
• Coordination of Reporting Programs
• Poison Information

Evolution of Pharmacist's Role in Medication Information Practice

• Includes a focus on Evidence-Based Medicine and Drug Policy Development.
• Addresses Adverse Drug Events.
• Integrates New Technologies.
• Supports the Self-Care Movement.
• Adds Sophistication to Medication Therapy.

Where to find more information

• Visit the Pharmacy Informatics and Technology section of the American Society of Health-System Pharmacists website
• The Pharmacy Informatics Primer provides practical information regarding the most relevant topics in pharmacy informatics for pharmacy managers, information technology project managers and pharmacy students.

Core Informatics Terms and Definitions

• Information Technology (IT): activities and tools used to locate, manipulate, store, and disseminate information.
• Information and communication technology: Term often used to indicate IT with a focus on communication and networking.
• Health information technology (HIT) is the use of information and communication technology in healthcare settings.
• Health information management (HIM): Discipline historically focusing on medical record management; as medical records transition to digital, HIM has begun to overlap with informatics.
• Imaging informatics: Broad term indicating the application of informatics to the management of images in health care.
• Research informatics: Broad term indicating the application of informatics to health and biomedical research.
• Informatician (informaticists): practitioners of informatics; focus more in information than technology.
• Clinical information: clinically trained individuals whose expertise is applied at the intersection of IT and healthcare; focus is on successful adoption and use of IT.

Medication Safety and Pharmacy Informatics

• Involves the minimization of medication errors and adverse drug events (ADEs), is enhanced through the integration of pharmacy informatics.

Key Term Definitions

• Medication Error: Any preventable event that could lead to inappropriate medication use or patient harm. Occurs at any point in the medication-use process.
• Near Miss: Medication error that is detected before it reaches the patient.
• Adverse Drug Event (ADE): Harm to a patient caused by a drug, which may be preventable or not.
• Potential Adverse Drug Event: An error occurred, but did not cause harm
• Side Effect: A known reaction to a medication
• Error of Commission: Occurs from an action taken involving an incorrect drug, dose, or timing.
• Error of Omission: Occurs from not taking an action i.e. failure to administer a missed dose or adjust doses based on lab results

Medication Use Process

• Involves five stages: prescribing, transcribing, dispensing, administering, and monitoring.

Prescribing

• Computerized provider order entry (CPOE) is one important part.
• CPOE allows the use of standardized ordering processes that require the prescriber to provide information on the five basic patient rights: right patient, right drug, right dose, right route, and right time.
• Must include clinical pathways to help the clinician follow evidence-based guidelines and promote safe medication ordering
• E-prescribing: goal is to have information presented to the healthcare provider to ensure all of the essential information is available and transmitted to the pharmacy
• Clinical decision support system (CDSS): Provide various levels of support to ensure that the medication is appropriate and dosed appropriately for the patient

Limitations of Technology in Prescribing

• The computer system must be accurately maintained.
• Healthcare providers must be diligent in ensuring all information on it is up to date and is accurate
• There may be incorrect patient or medication selection.
• There may be mismatches in the signature section.

Transcribing

• Health information technology used includes computerized provider order entry (CPOE) and e-prescribing.
• This process involves the need to re-enter orders into other fully integrated systems.

Dispensing Technologies

• Bar code verification (during the picking process)
• Automated dispensing cabinet (ADC) scanning during the filling and/or removal process.
• Syringe filler has added bar code verification.
• Total parenteral nutrition compounders, includes bar code verification for ingredients.
• Robotics also involve bar code verification with automated process.

Monitoring

• It uses electronic data and pre-determined rules to identify when an adverse drug event may have occurred or is about to occur.
• Many tools function by comparing electronic data to known indicators of potential medication-related problems
• More sophisticated ones needs many years to develop and maintain.
• Involves Rules engines

Limitations for Use of Health Information Technology

• Its difficult to design a system for all scenarios that produces a seamless user experience

Other Medication-Related Systems

• Medication reconciliation compares a patient's historical and current medications to determine accuracy.
• Medication incident reporting helps find weak spots in the medication system.
• Both require proper documentation of medication errors and adverse events to help improve workflow and minimize the chance of recurrence

Consumer Health Informatics (CHI)

• CHI is a branch of health informatics that analyzes consumers' needs for information studies, implements methods of making information accessible, and integrates consumers' preferences into medical information systems.

Background of CHI

• Focus is around prevention, self-management, and providing individual consumers with technologies and information to better manage their health and wellness.
• It also allows chronic disease patients to self manage their conditions and align with value-based models that reduce complications and overall healthcare costs.

Consumer Health Informatics Tools

• Includes health apps and wearable devices, to help patients monitor their condition, track progress, and improve health outcomes.

Consumer Health Informatics Milestones

• Telehealth decreases geographic distances and enables access to high quality care.
• Incorporation of Results from Randomized Clinical Trials incorporation of data and results from randomized clinical trials
• Home Monitoring has two methods; Active and Passive
• EHRs, PHRs, and Portals Provides a quality health care to patients and longitudinal record of all healthcare

Factors needed to Facilitate Consumer Health Informatics

• Political existence of a good administration, effective strategies, and a strong political good will
• Financial factors promoting and facilitating consumer health informatics, existence of a technology that is cost-effective, business model and continuous investment
• Mobile phone services and availability of office spaces

Barriers to Consumer Health Informatics Applications

• Privacy and data being subject to cybercrimes.
• Not everyone can access the internet and use a computer.
• Consumers claiming the process is complicated and difficult to use
• Level of health Literacy

Drug Information Resources

• Resource something that can be used for support or help, especially in your work or study.
• General stepwise approach; (Query -> Tertiary -> Secondary -> Primary)

Internet and Connecting

• To connect to the interent, a Computer, Monitor,Modem and Internet browser -Netscape, Navigator, Internet Explorer, Firefox, Opera, Google Chrome,is needed

Internet Sites and Domain Name Modifiers

• ".edu" is educational
• ".gov" is governmental
• ".com" is commercial
• ".org" is organizational
• ".mil" is military
• ".biz" is business

Pointers for Evaluating Digital Resources

• Appropriate experience/expertise.
• Timely information.
• Supports with info based on publication data also contains relevant information and is free of bias.

The Internet

• A network of computer networks, was made in 1969 by the Department of Defense
• Known then as ARPANET, purpose was to connect its key research facilities
• Transitioned in the 1980's with the creation of multimedia messages
• NSF have created private corporation named (Advance Network Services) and created HTML

Internet Advantages

• Breakting, current information is provided as well as keyword and interactive searching

Types of Study Designs

• Bioequivalence Study, Case Report, Case Series, Case-Control Study, Clinical Study, Cohort Study, Cross-Sectional Study, Meta-Analysis , Post Marketing Surveillance, Qualitative Systematic Review, Stability Study, Randomized Controlled Trial, Quasi-Experimental Study, Systematic Review

Bioequivalence study

• It uses pharmacokinetic parameters (AUC, Cmax, Tmax) and is analyzed.
• It usually employs a crossover design

Case report

• It is a detailed description of the single patient's condition.
• It is highly detailed and describes clinical description.

Case series

• It reports on a collection of similar, multiple cases to provide valuable insights on diseases

Clinical study

• It is a broad term and umbrella term that can cover the study designs listed

Cohort study

• Starts with an exposure and has a prospective or retrospective analysis on the specific outcome

Cross-sectional study

• Provides a "snapshot" of prevalence but no follow up of analysis

Meta-analysis

• Higher level of synthesis and the outcome provides a measure of effect size

Qualitative systematic review

• Provides frameworks for Population, Intervention , Comparison and then the Outcome