By: Tiffany Dominic, PharmD Candidate c/o 2022

              As student pharmacists, there is no doubt that we have been hearing the words “pharmacy informatics” more frequently. However, a big concern remains. Many pharmacy students are not exactly sure what informatics is or only have a general understanding of the topic. Well, look no further and keep reading to explore the world of pharmacy informatics!

              Pharmacy informatics is a specialized field that pharmacists can undergo further training in. This area of study has the special ability of merging the best of two worlds together in different practice settings: clinical information and technology. The necessity and utilization of healthcare technology has been significantly increasing and pharmacy informatics involves the usage and customization of electronic health record systems to optimize access to patient data and improve treatment outcomes. ^1,2,4

According to the American Society of Health-System Pharmacists (ASHP), informatics pharmacists’ responsibilities include, “data, information, and knowledge management” and “knowledge application and delivery”.¹ ASHP also outlines that informatics pharmacists are expected to manage, “medication-related information while promoting integration, interoperability, and information exchange” and should be, “delivering medication-related information and knowledge throughout the clinical knowledge life cycle, from the point of knowledge generation through cataloging, embedding knowledge into the workflow, and measuring the usage and effectiveness of that knowledge”.¹

  Now that we know the official definitions of pharmacy informatics, you may find yourself still asking, “What exactly does an informatics pharmacist typically do?” There is certainly no one correct answer to this question as informatics pharmacists can have a variety of roles.¹ Informatics pharmacists work with numerous electronic and automated health systems such as automated dispensing cabinets, bedside bar coding, electronic medication administration records, computerized provider order entry (CPOE), and Epic.² Their roles and tasks can also greatly vary depending on their practice site. 

Dr. Brian Fung, a pharmacist who authors blogs on ASHP’s website, outlines his experiences and responsibilities as an informatics pharmacist. Dr. Fung mentions that, “we [informatics pharmacists] help design the screen that pharmacists see”. He further describes how this specialized field of pharmacy has an immense role in customizing CPOEs to help optimize patient outcomes. For example, they can choose the appropriate dosing options to be included in the drop-down menu for specific medications in the CPOE system. Some dosing options are not appropriate and therefore should not be listed as a therapeutic option. They also help maintain automatic dispensing cabinets, such as Pyxis, so only the appropriate medication is available to be taken out which greatly helps prevent medication errors.⁴ Bar Code Medication Administration maintenance is also one of their roles to ensure that the right drug and dose is given to the right patient. They also develop alert systems to notify providers of duplicate therapies, drug interactions, or inappropriate drug therapy regimens.⁶ Dr. Fung also creates technological tools to identify “bug and drug” mismatches to alert antimicrobial stewardship providers.⁴ These preventative measures can significantly reduce medication errors and adverse drug reactions.

Informatics pharmacists can also decide which medical information, such as past medications, creatinine clearance (CrCl), and allergy history, should be included in patient profiles of electronic health records (EHRs). Customization of information systems can also lead to improved monitoring for assessing the effectiveness of Drug X compared to Drug Y and better identification of at-risk patients for certain medical conditions. For example, “At Adventist Health Portland, teams use a disease registry to identify at-risk patients. This system is comprised of biometric information, claims data and pharmacy information, which helps providers to determine populations that could be at risk for certain conditions, as well as those whose clinical needs are not currently being met”. Information systems also help maintain and program dose error reduction and infusion delivery rate software in “smart” infusion pumps. Studies have ultimately proven that pharmacy informatics have beneficial impacts on the healthcare system. In 2014, a study published in the journal Health Affairs, “suggested that predictive systems could help identify patients and consequently improve outcomes in six categories: high-cost patients, readmission rates, triage, decompensation, adverse events and diseases affecting multiple organ systems. These areas alone have far-reaching benefits on both health and financial levels”.⁵  Informatics pharmacists also have the power to create tools to improve medication reconciliation which is an area that consists of high potential for errors. The Healthcare Information and Management Systems Society (HIMSS) suggests potentially “creating computerized processes to suggest acceptable inpatient medications on formulary that would substitute for the patient’s home medications”.6 Creating these tools and resources ultimately involves using a combination of technical skills and clinical knowledge.

Additionally, informatics pharmacists are similar to data scientists because they have a great role in analytics. Dr. Fung analyzes data on formulary compliance, bar code medication administration compliance, and turnaround time for time-critical medications. Informatics pharmacists often compile their analysis into reports which are then presented to administrative officials. Dr. Lukasz Przychodzien, a former clinical pharmacy manager of data analytics at New York Presbyterian, spoke about his experiences with analytics as an informatics pharmacist in his interview with Pharmacy Times. Dr. Przychodzien states, “For example, I would take a look at the data and actually see if any type of benefit has been shown for the medication or if the medication had previously been approved through F&T [usually known as Pharmacy & Therapeutics committees in hospitals] and to see if it has been giving the benefit claims and outcomes that we’re looking for in the medication”.²

Data analysis performed by informatics pharmacists can also lead to institutional-level widespread changes and is often used to increase efficiency in the workplace. Dr. Przychodzien explains, “one of the best things about being in informatics…is that you get to work on problems that affect the whole institution. I look from the perspective of I’m doing my clinician duties to try and serve as many patients as possible through this role. If I’m improving how an ICU can get its vasopressors to its patients, then I’m going to be improving how every patient that walks into the ICU that needs it gets taken care of… When I look at things from a financial aspect, I look at how the pharmacy is doing in terms of the initiatives that we have in saving us money. Are we billing things correctly? I’m even working on billing medical procedures”.² Dr. Rilwan Badamas, the chief of pharmacy informatics at the National Institute of Health (NIH) Clinical Center, had even implemented a pharmacy inventory ordering and management system and developed a Warfarin Dose Computer Algorithm for EHRs during his residency at Mayo Clinic. Through these technological initiatives, pharmacists are able to serve and impact large populations of patients.⁷

Pharmacy informatics is significantly utilized in hospitals and other healthcare institutions, but it can be applied to almost any setting where medications are involved. Pharmacy informatics is also greatly needed in the Food & Drug Administration (FDA), NIH, and other governmental agencies.²

The FDA has its own division for informatics which is called the Office of Health Informatics (OHI). Informaticists at the FDA store data from drug manufacturers, health providers, and scientists to help properly evaluate and analyze regulated products, such as drugs, biological products, and medical devices. In 2014, the OHI launched “openFDA”, which consists of data regarding drug side effects, adverse event reports, enforcement reports, registrations and listings of companies and products, premarket approvals, and recalls issued for human drugs and devices.⁹ Through the initiatives of “openFDA”, informaticists can help data become more accessible to the public while developing transparency and accountability within the agency. Similarly, the NIH also heavily utilizes informatics for, “ensuring data quality and safety, minimizing data-quality risks, and affirming medication-related data, information, and knowledge management best practice across the NIH Clinical Center”.⁷

For those reading this article that now find themselves interested in specializing in pharmacy informatics, there are numerous pathways to become an informatics pharmacist. You may consider applying to informatics residency programs during your post-graduate years. Many hospital systems and institutions, such as Johns Hopkins and Mayo Clinic, offer informatics training for pharmacy graduates. You may also consider obtaining a graduate degree in informatics.^10,11 Of course, informatics may not be for everyone and perhaps you may find yourself not as tech-savvy, however, it is definitely worth your attention as its utilization and necessity in healthcare significantly continues to increase. 

Ultimately, the old cliché holds true – “with great power comes great responsibility”. Informatics pharmacists have various roles and can customize numerous health information systems to reduce adverse events, screen for inappropriate drug regimens, and increase medication safety. These measures all work together to achieve one overarching goal: improving patient outcomes.

References:

1. American Society of Health-System Pharmacists. ASHP Statement on the Pharmacist’s Role in Clinical Informatics. ASHP Statement on the Pharmacist’s Role in Clinical Informatics. https://www.ashp.org/-/media/assets/policy-guidelines/docs/statements/pharmacists-role-clinical-informatics.ashx. Published 06/01/2015.
2. Paterini M. There Are Many Pharmacy Informatics Jobs. Pharmacy Times. https://www.pharmacytimes.com/contributor/the-nontraditional-pharmacist/2018/05/did-you-think-pharmacy-informatics-was-one-job-there-are-many. Published 05/26/2018.
3. University of Illinois Chicago. Pharmacy Informatics: What You Need to Know Now. University of Illinois Chicago. https://healthinformatics.uic.edu/blog/pharmacy-informatics-what-you-need-to-know-now/.
4. Fung B. A Day in the Life of an Informatics Pharmacist. ASHP Connect. https://connect.ashp.org/blogs/brian-fung/2017/08/08/pharmacyinformatics?ssopc=1. Published 08/08/2017.
5. University of Illinois Chicago. The power of health informatics in improving patient outcomes. University of Illinois Chicago. https://healthinformatics.uic.edu/blog/the-power-of-health-informatics-in-impro.
6. Blash A. Pharmacy Informatics and Its Cross-Functional Role in Healthcare. Healthcare Information and Management Systems Society. https://www.himss.org/resources/pharmacy-informatics-and-its-cross-functional-role-healthcare. Published 10/29/2019.
7. National Institutes of Health. Meet Our Doctors. National Institutes of Health Clinical Center. https://www.cc.nih.gov/meet-our-doctors/rbadamas.html. Published 06/18/2019.
8. Food and Drug Administration. Office of Health Informatics. U.S. Food and Drug Administration. https://www.fda.gov/about-fda/office-chief-scientist/office-health-informatics. Published 08/30/2019.
9. Food and Drug Administration. openFDA. U.S. Food and Drug Administration. https://www.fda.gov/science-research/health-informatics-fda/openfda. Published 09/11/2019.
10. Johns Hopkins. Pharmacy Residency Program: Pharmacy Informatics. Johns Hopkins Medicine.https://www.hopkinsmedicine.org/pharmacy/residents/programs/practice_residency_Informatcs.html
11. University of Illinois Chicago. Clinical Informatics. University of Illinois Chicago. https://healthinformatics.uic.edu/health-informatics-programs/clinical-informatics/.

Published by Rho Chi Post