Jerry Fahrni

Using technology to advance pharmacy practice through education

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Jerry Fahrni

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funny_tech_cartoonI found an interesting article in the October issue of the American Journal of Health-System Pharmacy. The article, titled Informatics in clinical instruction (Am J Health Syst Pharm. 2009 Oct 1;66(19):1694, 1699), gives a description of a software system designed by the authors that “allows students at one site to receive online and teleconference instruction from preceptors at multiple sites through remote, interactive discussion. It also allows “blogging” based on assigned videotapes, simulation modules, live patient cases, discussion questions, and primary literature review. In addition, the system facilitates clinical encounter documentation, including interviewing patients, taking physical assessments (e.g., blood pressure), taking medication histories, assessing for adverse effects (e.g., abnormal involuntary movements), and addressing potential or actual medication-related problems(MRPs).”

The system presented in the article is, by itself, very interesting, but it’s the underlying message from the article that’s more important. In the article the authors elude to the fact that pharmacy schools need to embrace technology and utilize it to enhance the student experience as well as advance the practice of pharmacy. This isn’t a new thought as technology has not only revolutionized healthcare practice, but the delivery of education as well. In an article in The International Journal of Pharmacy Education in 2004 the authors call for the integration of technology “into pharmacy education and the curricula of schools and colleges of pharmacy that students would never think of practicing their profession without the support of technology.” The statement is perhaps a bit extreme, but accurate nonetheless. As far back as 2001, nearly a decade ago, the American Association of Colleges of Pharmacy (AACP) recognized the need for the use of technology in a pharmacist’s education (PDF); a view that continues today.

Unfortunately, schools of pharmacy are not holding up their end of the deal. In an article by Fox, et al. (Am J Pharm Educ. 2008 August 15; 72(4): 89)  89 pharmacy programs with recognized informatics courses were surveyed to determine the state of informatics education in the pharmacy curriculum. Of the 89 programs surveyed, only 32 responded, and of those 32 only 25 programs included syllabi information. In a nutshell the article concluded that “many professional programs are not providing instruction in pharmacy informatics. There may be confusion within the academy/profession between pharmacy informatics and drug information practice. Much work is required for programs to become compliant with the ACPE 2007 pharmacy informatics competencies.” Ouch.

The increased push for inclusion of informatics education in pharmacy schools has not generated additional interest in technology, per se. I’ve attempted to offer an informatics rotation for pharmacy students at our facility, but have yet to receive any interest. Similar stories of disinterest can be found in other Valley hospitals where pharmacy school rotations are available. I don’t blame the student. Even with my deep rooted interest in all things related to technology, my focus during pharmacy school was therapeutics. Everything else was secondary.

Regardless of the level of technology being taught in pharmacy schools, the practice of pharmacy has become one of the most technologically advanced disciplines in healthcare. Pharmacists now utilize a host of technologies to perform even the simplest tasks. Some of these technologies include:

– word processing, spreadsheet, and database software
– mobile computing technologies (mobile phones, PDAs, and tablet computers)
– carousel technologies
– automated packaging
– bar code labeling systems
– bar code medication administration (BCMA)
– pharmacy information systems (PhIS)
– automated dispensing cabinets (ADC)
– automated iv compounding systems
– clinical decision-support systems (CDSS)
– robotic technologies (examples: McKesson and ScriptPro)
– electronic medication administration records (eMAR)
– computerized provider order entry (CPOE) systems
– electronic document management (EDM) systems
– data mining
– telemedicine

In addition, advancing technologies that need to be addressed through education include:

– auto-verification of medication orders
– biometric scanning (fingerprint recognition, facial recognition, voice recognition)
– “touch” technologies (multi-touch, Surface, holographic projection)
– radio frequency identification (RFID)
– and so on

It will be interesting to see where pharmacy informatics goes from here. We’re at a point in the profession where technology is playing an unprecedented role in day to day operations as well as clinical activities. While the “typical” PharmD curriculum includes many courses to advance pharmacology and therapeutics, the future education of young pharmacists must include informatics and technology. This is the only path that makes sense if we want pharmacists designing systems for pharmacists. Do you want a “non-clinician” designing your clinical workflow and technology? I know I don’t.

Comments

11 responses to “Using technology to advance pharmacy practice through education”

  1. carlac

    Hi Jerry,

    Interesting article. I am going to share wtih the School of Pharmacy at Saint John’s University when I am there next week to dedicate their new pharmacy informatics lab where Talyst has supplied a carousel, packager, and autopharm so they can educate their students on automation and how it changes some work practices, etc. I can see that some of your subject areas will be well covered off by our lab – others might require that we help them reach beyond the traditonal pharmacy walls to understand ADU restock, etc. This gets my mind whirring about how we can expand their lab to create a best practice industry model for pharmacy students. But what really makes me wonder is this: “Do you want a “non-clinician” designing your clinical workflow and technology?”

    What can clinicians teach Talyst about how our products are “recommended use” versus “actual use”? Would this be a good topic for Las Vegas User Conference?

  2. K. Bumb

    Hi Jerry,

    It’s interesting how your article on Pharmacy schools parallels that of Engineering schools. The reluctance in Engineering curricula to introduce highly evolved software / methods stems from a fear of dependence and disconnect or lack of understanding the underlying fundamentals. A loophole was ultimately developed whereby one could take “specialized” graduate-level courses within undergraduate or graduate curricula (of which I did both) – sometimes with credit going towards graduation, but oftentimes not. Could it be a case of reluctance on the part of university accrediting boards to certify classes out of fear of their obsolescence; i.e. the technology will continue to evolve (i.e. classes on topics of keen interest today will cease to be relevant 5+ years from now due to the underlying technology becoming extinct), but the fundamentals will always be relevant?

  3. Vernard M

    Great article. What I think is: It’s very important that the maker of the technology is in sync with the professional who uses the technology. It is a good idea that the engineer work side by side with a pharmacist/clinician/nurse, from the beginning to the end of the development life cycle.

  4. Jerry Fahrni

    Hi Carla,

    Taking from Vernard, I think the best way to design any system is for the engineer to “work side by side with [someone in the profession] from the beginning to the end of the development life cycle.” I think that about sums it up.

    If you want to make the most efficient use of something, it is imperative to get an engineer involved. The problem arises when the engineer cannot visualize a unique need required by a profession that he/she is not familiar with. I’ve found several instances of this during my limited time as an “IT Pharmacist”. Nothing I do is unique, but I do provide unique perspective and direction to projects that may have gone in another direction otherwise. The same thing happened when my brother and I were working on RxCalc. Robert has a brilliant mind and can code anything. He understood the math, the design concept and the concepts behind pharmacokinetics. What he couldn’t understand was the flow of information and how it needed to be presented. Why? Simple, he’s not a pharmacist.

    I believe any vendor building technology for pharmacy could learn from practitioners in the field. You would be amazed at what comes to mind when you use something on a routine basis. I think it would be a great topic for discussion at the Midyear User Group meeting, but then again I don’t always think along the same lines as everyone else. ;-)

  5. Jerry Fahrni

    I couldn’t agree more, Vernard!

  6. Jerry Fahrni

    Hi Kameron,

    The same loophole existed when I was a chemistry major, which was good for me because many of the classes I thought were interesting didn’t exist in the undergraduate curriculum. I think you make an excellent point about technology evolving faster than courses at the university level. There’s no way to keep up with the blur of advancing technology, but you can create a firm foundation of concepts, which you elude to above. Thanks for stopping by.

  7. pillguy

    I work at a national level to help further key Informatics issues such as this. Adding Informatics to an already packed curriculum has been a major challenge for academic institutions. Although there are pioneers, many lack the knowledge about Informatics much like management. There are no good courses to prepare pharmacy students for what they will really face in the workplace. In a vision statement by ASHP on the technology enabled practice, we discussed the fact that most pharmacists would have to become very familiar with information systems, and even be able to setup monitoring parameters if methods were provided on the fly. The challenge is getting the colleges to recognize Informatics as required material, and helping them understand exactly what needs to be taught. Many still think Informatics is part of the Drug Information Center. This is certainly a great discussion.

  8. Jerry Fahrni

    Hi Chad – I understand what you’re saying and would tend to agree that the PharmD curriculum is already packed. With that said, informatics simply plays too big a role in the pharmacists job to be ignored. I think the younger pharmacists already have a head start on the rest of us secondary to the explosion of social media, including blogging. The vision statement by ASHP is spot-on and I look forward to the practice model presented. Do you think it’s time for a separate pharmacy informatics pathway similar to what UCSF has done with pharmaceutical care, pharmaceutical health policy and management, or pharmaceutical sciences (http://pharmacy.ucsf.edu/pharmd/curr/paths/)? Just a thought.

  9. pillguy

    That looks like a great example.

  10. G.Eastman

    Perhaps a useful approach would be similar to what occurs in Technical Communication programs; teaching how to learn to use new technologies. In the Technical Communications field this is a vital skill as the job often requires documenting new products. In the current environment of rapidly changing technologies, it seems that this approach would be valuable to any education program; it teaches how to adapt to changing technologies as opposed to teaching a specific technology.

  11. Jerry Fahrni

    I’m not familiar with any Technical Communication programs, but that sounds exactly like what is needed to educate a new pharmacist about technology. I realize that it is virtually impossible to keep up with changing technologies. However, I agree that providing a technology foundation and the skills necessary to adapt to changes in that environment are key. Thanks.

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