Last week I found myself in Florida for work. I had a little extra time on my hands so I stopped by NOVA Southeastern University to visit with a friend and colleague, Kevin Clausen (@kevinclausen). Kevin is not only a pharmacist, but professor and researcher at the Center for Consumer Health Informatics Research at NOVA Southeastern. He’s one of a select few pharmacists that are dedicated to pharmacy informatics in academia.
Kevin and I talked about a lot of topics, but one topic that was of particular interest was getting information published in journals. As an active researcher Kevin has a laundry list of published articles to his credit, giving him keen knowledge of the process for publishing research in peer-reviewed journals. One thing that struck a chord with me was the effort and time required to get an article published. Apparently it can take multiple article revisions and upwards of a year to get an article accepted by a certain journals.
No one that’s been involved in the process would be shocked by this; not even me. I’ve heard this before from other people in my profession. The problem is that the model doesn’t work for informatics, automation and technology (IAT). The speed at which the field is evolving means that information is often obsolete by the time it hits the peer-reviewed journals.
The basic question is whether or not information about pharmacy IAT requires the same rigors as research aimed at the clinical side of pharmacy. Does a study of turnaround time during pharmacy distribution with carousel technology vs. robotics require the same intense scrutiny that a study looking at the use of an ACEI vs. an ARB in PWD and HTN would? Not likely. While one could argue that the method of distribution may impact patient care it is unlikely that the impact would be worth little more than a friendly debatable among colleagues.
I browse the table of contents of many journals every week. In addition I subscribe to the MedInfoNow service, which alerts me to new literature articles based on my personalized search criteria. And what I see week after week is a lack of information in a field that is arguably the fastest growing pharmacy specialty in the profession. Can you name a pharmacy specialty that is growing faster than informatics? I can’t. Informatics residencies are springing up all over the country, I’m seeing more and more IAT related information in social media, the content for pharmacy informatics at the ASHP Midyear is increasing each year, and so on. Pharmacy informatics is no longer a topic that pharmacist don’t know about. It’s mainstream.
As pharmacy informatics gains in popularity, new ideas, experimentation, and tinkering will ultimately take place on a larger scale. Unfortunately most of us will never hear about it, or if we do the information will be so out of date that it won’t apply to current practice. We need a way to disseminate IAT information to the masses.
Two journals that provide IAT information in a timely manner are ComputerTalk for the Pharmacist and Pharmacy Purchasing & Products (PP&P). I read both. They both offer information regularly and provide worthwhile content for IAT. PP&P has become the de facto IAT journal by default. They pump out volumes of new, relevant content each month. Unfortunately both ComputerTalk for the Pharmacist and PP&P are considered ‘throw-aways’ and are clearly supported by industry advertising. I have no idea if that creates a conflict of interest or not. It would for journals publishing clinically relevant drug information, but I would argue that it’s probably not the case for IAT.
You might argue that JAMIA is what we’re looking for, but that journal is only published 6-7 times a year, is insanely expensive, is not pharmacy specific and contains some articles that are so granular that they rarely apply to current practice. While JAMIA is clearly worth reading if you have a subscription – which I don’t – it’s not quite what I think we need.
There are other journals similar to JAMIA, but you get the point.
During the conversation Kevin mentioned the possibility of using a post-publication review process similar to what the physics community is doing. Apparently this group has decided that getting the information in the hands of their colleagues is more important than the review process. Articles are published first, and then reviewed for content, appropriateness, rigor, etc. While one could point to potential problems with a system like this, I think it holds promise for something like Pharmacy IAT.
How about a wiki, you say? I’ve been harsh on things like Wikipedia because content is easily added, but not necessarily accurate. We all assume it is, but I wouldn’t want to use Wikipedia for drug information or patient care. With that said it’s still a viable option. While not as rigorous as a peer-reviewed journal, it’s still a great way to compile information. Sounds like a winner, but then reality sets in. Who would curate such an effort? Who should have access? Limiting access for the purpose of control might be a solution, but this could potentially create a barrier to building content. What type of information should be included and/or excluded, if any? Where would the information reside and who would own it? These are all good questions that should be answered, eventually.
My initial thought was that an organization like ASHP should support a Wiki for Automation and Pharmacy Information Technology (WAPIT – dot com already taken just in case you were wondering), but I quickly came to the realization that that would be a bad idea. ASHP is governed by rules that would eventually cause more harm than good. No, I think the effort would be best served by an individual or small group interested in advancing the field. It would have to be open source, and the content would have to be reviewed for gross oversight and inaccuracies. But who has the time? It would likely be a labor of love, full of late night frustration and long weekends. And even if someone decided to labor over something like this, finding people to add content would be difficult. Pharmacists as a whole are introverted and don’t like to put things out there for people to read. If you don’t believe me, just take a look at the number of pharmacists that blog or play in the social media arena compared to nurses or physicians. There’s quite a discrepancy.
What about all those academics? This should appeal to them, right? Wrong. When I asked Kevin about contributing to something like a WAPIT, he simply said “peer-reviewed journals are the currency of academia”, meaning he gets to keep his job for getting his research published in a peer-reviewed journal. Pushing content to a free wiki where the focus would be on providing information over recognition and career advancement doesn’t help them keep their jobs. It’s hard to compete with that.
Creating a repository for Pharmacy IAT information is sorely needed, but getting it done would give new meaning to the phrase “beating my head against the wall“.