Introduction to pharmacy informatics

Hello everyone, my name is Mei-Yu, I’m currently a clinical pharmacist of Taipei Veterans General Hospital. And today I would like to talk a bit about pharmacy informatics and automation.

In this following session, I will introduce the definition and concept of pharmacy informatics, and then briefly introduce the information systems that is currently used in Taipei Veterans General Hospital. And after completing this session, you should be able to describe the operational, clinical and administrative applications of informatics in pharmacy practice. And, to describe the role of pharmacists in utilizing informatics to ensure the safety of medication use. So first, what is informatics? It is the science concerned with the gathering, manipulation, classification, storage and retrieval of recorded knowledge.

And when informatics is used in the area of pharmacy, it is the use and integration of data, information, knowledge, technology, and automation in the medication-use process, for the purpose of improving the efficiency and safety of medication use. And the system design should always be patient-centered and knowledge-based, in order to facilitate personalized clinical care and improve patient health outcome.

To date, pharmacy informatics is a broad and rapidly growing field. And has impacted on the change and evolving of the pharmacy practice model. Information technology can be integrated into the entire medication management cycle, from inventory control to prescribing, dispensing and administration. Here are some examples for how information systems is applied in each of these process. On the very first step, the prescribing. Electronic prescribing should be a priority for implementation in health care systems. It eliminates manual handwriting of prescriptions, saving health care professionals a lot of time and reduces errors.

Prescribing and order entry not only refers to the ordering of medications, but also diagnostic tests and referrals, which are all important elements of patient treatment. And computerized physician order entry, or the CPOE, which is the direct entry of these orders into a computer by a physician or other authorized prescriber. Compared to traditional paper-based, hand-written prescribing, the CPOE has the advantages of decreased transcription, increased accuracy and integrity of an order, and the ability to enter orders in multiple locations, and easily transmitted to other stations or departments for further handling. It is one of the first and the most commonly applied information system.

And most importantly, the use of CPOE makes it possible to deliver decision support to physicians at the point of care. Clinical decision support represents the features of functions of an information system that passively or actively convey clinical knowledge content to health care professionals, so that the choices can be made that are in the best interest of patient care. When embedded with CPOE system, it is more likely to prevent errors that result from bad judgment, insufficient knowledge, or incomplete clinical information when choosing a therapeutic plan.

There are several kinds of clinical decision supports, or the CDS, that can be incorporated into the CPOE. An example of passive method of providing CDS is the use of structured data elements for medication prescribing. By limiting the choices a prescriber can make, or provide default selections, the system can help prevent errors that occur from ordering inappropriate or unsafe dosage, frequency, or non-standard or inconsistent with medication use policy. For instance, setting default dose, frequency or administration route, or setting a maximum total daily dose of each individual medication can help reduce potential medication errors. And which may result from typos or insufficient knowledge of the prescriber.

Decision support can also actively promote clinically appropriate and cost-effective choices through synchronous or asynchronous alerts. Synchronous alerts represent pop-up warning screens that interrupt user workflow. They are generally triggered or invoked based upon specific actions taken by user of the system. A notification or warning screen pops up when a user attempts to enter an pre-decided inappropriate order, and requires the user to act on the alert before proceeding. This could be used for several different safety checks, for example, auto check for drug-drug interaction, drug allergies, or the drug dose recommendations based on patients renal or hepatic function.

The physician would have to stop and make further adjustment of the order, whether is to change the medication or to adjust the dose before moving forward to the prescribing process. Asynchronous CDS alerts generally occur as a result of an imbedded rule and typically do not interrupt the workflow unless the user chooses to do so. An example could be having a flag placed on a worklist or patient list when an abnormal lab data is entered or transmitted to the system. The physician could easily click on the alerting symbol for further information. CPOE also makes it possible to incorporate information, such as reference databases, guidelines, medication substitution recommendations for prescriber to consult upon prescribing.

Providing decision support requires the necessary data to be available in the computer system and the building of consensus within the institution on the knowledge base and rules applied.