Pharmacy Informatics and Its Cross-Functional Role in Healthcare

Pharmacy informatics 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.”

The American Society of Health-System Pharmacists issued a practice document called the Statement on the Pharmacist’s Role in Informatics. The statement reaffirmed the responsibilities of the pharmacist and the pharmacy informaticist in healthcare informatics. The society outlines five broad areas of responsibility for this role:

1. Information management
2. Knowledge delivery
3. Data analytics
4. Clinical informatics
5. Change management

Let’s examine several tasks associated with pharmacy informatics that fall within these five categories. Keep in mind that these examples provide a broad overview of the specialty. Individual pharmacist informaticists may be involved in many other aspects of healthcare informatics and may work with informaticians from other specialty areas, such as medical, nursing and radiology, as well as system analysts, statisticians, database administrators and others.

1. Information Management

In their key role of overseeing medication-related information available within health IT tools, pharmacy informaticists must generate and share this information with various healthcare professionals to ensure patient safety while also measuring the usage and effectiveness of this information throughout the clinical process.

Bar Code Medication Administration

A properly trained pharmacist informaticist can apply knowledge of medications during the planning and implementation of electronic bar code medication administration. Bar code medication administration, also known by the acronym BCMA, is the hardware and software used to provide electronic verification that the “five rights” (right patient, right drug, right dose, right route, and right time) are achieved for the administration of medications.

BCMA can protect the patient through the use of clinical decision support. The pharmacist informaticist designs and implements safeguards that check the barcode of the patient to ensure any medication ordered is appropriate for the condition being treated, that the dose is appropriate for the patient and that the new drug does not interact negatively with any medications the patient is already taking.

Computerized Provider Order Entry

Pharmacy informatics professionals may be involved with the design and implementation of computerized provider order entry, or CPOE, in a hospital. CPOE is an application that enables providers to enter medical orders into a computer system, rather than placing orders using paper and impacts many areas including nursing, pharmacy, laboratory, admissions and radiology—to name a few. One way that a pharmacist informaticist may be involved in the implementation of CPOE is ensuring that clinical decision support is in place to help guide the provider to evidence-based treatment options at the time of ordering.

Interoperability

For a patient’s health records to follow them regardless of the healthcare setting, the languages of each institutions’ EHR must share a set of common languages or vocabularies. Pharmacy informatics professionals contribute significantly to these efforts by applying clinically accurate verification checks in the data flowing from system to system, ensuring that the dosing information, medication strength, frequency of administration and duration of therapy remain consistent for the millions of medication orders occurring daily in the healthcare environment.

2. Knowledge Delivery

In a health IT environment, pharmacy informaticists drive the delivery of medication-related information and knowledge throughout the clinical knowledge lifecycle.

Clinical Decision Support

Clinical decision support provides clinicians and patients with knowledge and person-specific information—intelligently filtered or presented at appropriate times—to enhance health and healthcare. Clinical decision support makes use of many tools to assist with the delivery of evidence-based care. Some include computerized alerts and reminders, clinical guidelines available during CPOE, condition-specific order sets, and patient data reports and summaries. Pharmacist informaticists may participate in, lead or help coordinate these efforts.

EHR Optimization

EHR optimization is another project that may include a pharmacy informatics professional during planning, design and/or implementation. A best practice of EHR users, EHR optimization is the concept of using the EHR to its fullest capacity in the most efficient way possible. For a pharmacy informaticist, this may include:

• Adding mandatory indications with medication orders
• Creating a computerized antibiotic stewardship program
• Developing computerized antibiotic orders with appropriate treatment plans for that medication
• Identifying clinically appropriate medication adjustments
• Preventing therapeutic duplication in patients’ active medications

3. Data Analytics

In order to improve healthcare, data must be reviewed and the insights gained from this data must be applied.

Healthcare Analytics

Healthcare analytics is the application of statistical, reporting and presentation tools and techniques to healthcare-related data in order to study past situations to improve the quality and efficiency of clinical and business processes and performance. Analytics may be applied to a week’s worth of data from a unit in a hospital or a health system’s performance measures over many years. The pharmacist informaticist’s expertise in drug information is crucial to accurate querying and reporting of health data.

4. Clinical Informatics

Clinical Informatics, also called health Informatics, promotes the understanding, integration and application of information technology in healthcare settings.

An example I often use to help illustrate applied clinical informatics (which is the title I carry on my white lab coat) is a project I worked on with my teammate we’ll call Bob. Bob is a database expert. He literally wrote a best seller on the topic. But while Bob knows how the database works from the inside out, he is not able to accurately isolate ACE inhibitors (a class of drug used to treat hypertension) from a list of thousands of medications used in a hospital during the last 12 months. The clinical informaticist is able to navigate the data in the database and help Bob query clinical data accurately.

Computerized Medication Reconciliation

Computerized medication reconciliation, also known as med rec, is the process of comparing a patient’s medication orders to all medications the patient takes via the EHR. Research has shown that almost half of medication errors occur in the handoff phase with many of these errors being avoidable through proper medication reconciliation.

Computerized handling of med rec standardizes the process and ensures that the handoff occurs at each transition of care in an efficient manner. The pharmacist informaticist’s knowledge of medications, the med rec process and the computer system being employed at the facility are important to the success of projects involving med rec. One way that the pharmacist informaticist may be involved in the successful implementation of computerized med rec is in creating computerized processes to suggest acceptable inpatient medications on formulary that would substitute for the patient’s home medications that are non-formulary in that institution.

Smart Pump Optimization

Infusion pumps are commonly used in healthcare settings to deliver medications, fluids and nutrients to patients at precisely controlled rates. “Smart" infusion pumps have become increasingly sophisticated and include such features as dose error reduction software, commonly referred to as drug libraries. These drug libraries are often implemented and maintained by pharmacy informaticists. The drug library technology allows infusion pumps to perform functions that assist healthcare providers with programming and calculating dose and delivery rates. When used properly, these features help prevent intravenous medication errors and reduce patient harm.

5. Change Management

When dealing with knowledge to guide healthcare delivery, the only constant is change. Treatments come and go, diagnostic tools evolve, clinical practice changes; healthcare regulations, best practices and laws shift—all these things change and all impact your clinical decision support initiatives.

Because successful clinical decision support requires attention to the five rights mentioned earlier, clinical decision support interventions must be actively managed. To effectively manage the process of selecting, applying and maintaining these clinical decision support assets, a governance structure and process must be assembled. A team of clinical informaticists, including the pharmacy informaticist, can help accelerate the change management process.

Before pursuing pharmacy and informatics as a profession, I was a programmer for a large insurance company. As a programmer, you are taught that without documentation your product cannot be maintained and is therefore not acceptable in a production environment. Desired components of a successful change management process include the following.

• Governance: Grants decision-making authority, may assist with selection and maintenance of clinical decision support interventions
• Structure: People involved include analysts, clinical Informaticists and management to oversee and execute knowledge management processes
• Clinical decision support change management process: Get it, vet it, implement it, watch it, fix it, replace it and retire it

Business Intelligence

Business intelligence is a term that encompasses the applications, infrastructure, tools and best practices that enable access to and analysis of information to improve and optimize decisions and performance. The clinical informaticist is able to assist in reporting out the information in a meaningful way, filtering and navigating the subtleties of clinical data.

As most healthcare workflows involve medication management, healthcare informatics teams are discovering that incorporating clinical informaticians with pharmacy expertise into their processes can lead to improved processes and increased patient safety.

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.