Why not a computerized pharmacist?

So IBW’s Watson recently competed and won ‘Jeopardy!”. Well, ‘Jeopardy!’ is a lot harder than verifying many medication orders routinely seen by pharmacists in the acute care setting.

According to a recent article at Network World: “Watson’s ability to analyze the meaning and context of human language, and quickly process information to find precise answers, can assist decision makers such as physicians and nurses, unlock important knowledge and facts buried within huge volumes of information, and offer answers they may not have considered to help validate their own ideas or hypotheses, IBM stated.

From IBM: “… a doctor considering a patient’s diagnosis could use Watson’s analytics technology, in conjunction with Nuance’s voice and clinical language understanding solutions, to rapidly consider all the related texts, reference materials, prior cases, and latest knowledge in journals and medical literature to gain evidence from many more potential sources than previously possible. This could help medical professionals confidently determine the most likely diagnosis and treatment options.””

Perhaps pharmacy could take advantage of the Watson technology to help pharmacists move away from nearly universal prospective order review (NUPOR), i.e pharmacists stuck at a computer terminal looking at every order written. There has been a movement in recent years to eliminate the need for NUPOR and move toward a system that allows drug orders with “imperceptible harm” to be automatically verified and activated for use on a patient. Some think it’s a crazy idea, but it makes sense to me. There are several medication orders that come to mind that would fall into an auto-verification category.

Just imagine the additional time a pharmacist would have to spend on clinical activities with the elimination of NUPOR. And we all know what additional clinical time means; yeah, saved healthcare dollars and improved patient safety. In addition, the idea of moving the pharmacist away from the pharmacy and toward the patient bedside is in line with recent goals set forth by AHSP in their PPMI. Let’s all hope that Watson lives up to expectations. I, for one, would welcome him as an honorary pharmacist.

For those of you interested in reading more about NUPOR and the idea of auto-verification of medication orders I’ve included some references below. Much of the information below can also be found at RxInformatics.com.

Poikonen, John
A new term for transcribing
Am J Health Syst Pharm 2008 65: 1801-1802

Flynn, Allen J.
Opportunity cost of pharmacists’ nearly universal prospective order review
Am J Health Syst Pharm 2009 66: 668-670

Poikonen, John
An informatics perspective on nearly universal prospective order review
Am J Health Syst Pharm 2009 66: 704-705

Tribble, Dennis A.
Automating order review is delegation, not abdication
Am J Health Syst Pharm 2009 66: 1078-1079

Pierpaoli, Paul G.
Creatively using our intellectual capital
Am J Health Syst Pharm 2009 66: 1087

Tilyou, Sarah
Should the ‘Sacred Cow’ of Near Universal Drug Order Review be Gored?
Pharmacy Practice News 2009 36:04 (requires free registration to access article)

8 thoughts on “Why not a computerized pharmacist?”

  1. I can’t take credit for this one as John Poikonen sent me a link to the original story. And John has been trying to kill off NUPOR for a while. I’m just fortunate enough to be part of John’s “Think Tank” at times.

  2. Jerry,

    I have just now read your posts starting from the mid year meeting. How true your views are with regards to the future of pharmacy and the rosy picture academia paints for students. I will go ahead and add one more…residency. I’m not talking about extreme specialty residency, I’m talking about ‘community practice’, ‘pharmacy practice’, ‘hospital’ and the like. We in the business call it the “One year waste of time” (and money). I was turned down last year from my own pharmacy school for a professorship position simply because I didn’t have a residency. Mind you–I’ve taught 4th year students for 6 years in clerkships for drug info and pharmacoeconomics!!! Anyway, I laughed at the thought and won an argument (in my opinion) with a current professor who could not name ONE advantage of having a residency over working in the same position for one year. So why do it?! $30K stipend—$100K salary… In any case, thank you for the articles and the thought provoking foresight that our profession will, at some point in the future, be replaced by automation.


  3. Hi Sean,

    Thanks for the thoughtful comments. The only time in my career that I regretted not doing a residency was when I was, as you mention, trying to get a job in academia a while back. Unfortunately the years in practice meant nothing once they discovered I was an abomination, i.e. had no post-graduate residency. I can’t be too harsh on them, after all there has to be some standard for admission to the ivory tower. Just because I can’t get in doesn’t make it wrong I suppose.

    I hope I haven’t painted too bleak a picture for the future of our practice. I do maintain some little bit of hope that we’ll turn things around and get things back on the right track, but our track record doesn’t bode well for us. Pharmacy really needs to re-invent itself, but into what I have no idea. Good luck in your practice and stop by any time.


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