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Pharmacy Informatics Reporting Structure:  Pharmacy or the Health Care Information Services Department?

Trinh Le

Change.  It’s inevitable in an academic medical center.   I have reported to five different managers and have seen a lot of organizational changes and restructuring.  Two years ago, we selected a new electronic medical record vendor for our health system.  This decision brought a shift from a local support model to a health care system support model.  During the contractual negotiation, resource requirements were discussed and the transition began from supporting the pharmacy department at one hospital to an integrated support model to convert the existing EMR.

I “volunteered” as one of the many resources that were requested.  After our implementation, it became official that the pharmacy support team would transition to the health care system information services department (ISD).  The official transition from pharmacy to ISD was about 9 months ago.  So taking a pulse check, I can say it has been a good transition.  Here are the unexpected good and the not so good parts of my transition.

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The Mind Tools’ Club Beware The Mid-Career Slump Bouncing Back From a Career Plateau has the following advice for us.

  • Realize that job satisfaction is U-shaped over time as you start and end your career on a high while slumping or plateauing in the middle.
  • Stop and think about how you felt at the beginning of your career as chances are your were excited about the possibilities that lay ahead and keen to develop your skills and expertise. You were also probably full of ideas and ambitious goals.
  • Towards the end of your working life there is a good chance that you will feel satisfied and rewarded by how far you have come and looking forward to your next stage in retirement.
  • So where does this leave people in the middle having established their careers but are a long way from retirement?  They can experience a drop in their level of motivation and enthusiasm and they might struggle to find their work as exciting as when they began.
  • Recognize that you have a mid-career slump if you experience some of these signs
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Having nearly completed my PGY2 in Emergency Medicine, I realize while my knowledge of topics pertinent to EM have made quantum leaps throughout the year - I had not realized how my knowledge in other areas had dwindled so rapidly.  I consider my 'system' of keeping up with the literature to be sufficient (previous blog post link) and, in general, Emergency Medicine covers a breadth of clinical topics compared to other specialties.  I have begun to realize what my preceptors had warned me about just a few years prior... New drugs keep coming onto the market.  My epiphany occurred when discussing a patient admitted for hypoglycemia who was prescribed a plethora of oral anti-hyperglycemic medications.  The EM intern asked about the drugs on the list and how they worked.  A fairly simple task that I felt adequately prepared to handle; that is until I happened upon "#@^&$gliflozin".  Took a quick peak in my mobile drug reference and glanced at the medication class "SGLT2 Inhibitor".  Perplexed look ensued.
What I love about my Emergency Medicine residency is how often this year I have said "I don't know".  This was another instance of countless episodes of the show affectionately referred to by members of the ED staff as, "Cole Doesn't Know Now, But He Will Know Soon" (followed by 
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So I actually set down tonight and started the Literature Study Module for BCPS re-certification. I was pleasantly surprised once I completed the statement of attestation and the activities were opened up to me. Instead of reading and reading to learn, the literature study modules let you analyze articles that are pertinent and new in the area. The modules provides you the article to read and assess using guided questions. While I have not made if far in the articles, I find it refreshing to have a way to re certify that is active and requires more than just sitting and reading. I have to critically analyze the articles provided and I refresh my statistics skills while learning the most update information in cardiology. I view that as a win-win situation!
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General : ASHPCerts

I haven’t gotten as much done this month as I had planned… but I had an amazingly awesome time at the ASHP Pain and Palliative Care Traineeship!!  I will refocus on the BCPS Ambassador program next month.

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Well, April is in full swing in the mid and deep south. There has been a strange, solid yellow wind over the lovely bluff city of Memphis the past few weeks. With this inspiration, and being an allergy/asthma sufferer myself, I decided to try out the COPD and Asthma review module this month. I have definitely seen an increase of cases of COPD exacerbations in our Emergency Department as of late. Time for a refresher. 

The module consisted of 4 fairly recently published articles from NEJM, Respiratory Research (a new journal to me), and, my all time favorite, the Lancet. The articles themselves were of a manageable length to review when you have an hour or so to take a look at them for a little light, in-depth, reading. The topics themselves, 2 of which pertained to IV/nebulized magnesium sulfate for acute asthma exacerbations, are quite relevant to some budding topics in clincal treatment today. I have recently overheard our residents and clinical specialists discussing these topics, so the module is spot on with choosing the most current literature for review. Practicing in an emergency department, we definitely use a combination of inpatient, ambulatory, and community knowledge to assist our teams in their every need. You must become a "jack of all trades" as it were. Having been out of the community setting for almost 2 years, and only one ambulatory care rotation as a student that focused on diabetes and anticoagulation, I greatly appreciate this mix of topics. 
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The May 1 issue AJHP features Susan Winckler’s 2014 Zellmer lecture, titled “The Intersection of Public Policy and Professional Responsibility.” I highly recommend that all pharmacists read this paper and ponder its implications as we enter a new era of health care.

Winckler describes pharmacy’s historical approach to law and regulation and compares our profession’s approach with that of medicine’s. She notes that pharmacy has chosen a detailed road map seeking detailed and specific permissions, “In defining the pharmacist’s scope of practice, our profession has chosen a very detailed, step-by-step structure that can be quite restrictive… But if a certain activity isn’t explicitly authorized, I may not engage in it on my own, even if it’s in the best interest of my patient.” Whereas other professions, notably medicine, provide wide discretion, “Other professions have taken a different approach: state medical practice acts, for example, tend to be far shorter than ours and provide physicians wide discretion in how to best care for their patients. In a nutshell, they define the practice of medicine as ‘everything you do to care for a patient.” She closes her lecture noting that “In the evolving healthcare system, the road is opening up a bit for us—requiring more individual engagement to stay within the guardrails and increase our speed, but with the opportunity to better contribute to patient care.”

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I want to thank each and every one of you for giving me the opportunity to be KCHP president this last year… because if nothing else, it gave me a captive audience for my Twilight Zone geeky obsession! Thank you to everyone who read those articles. I’m sure Jeff will have his own theme he’s ready to roll out, so get ready…

A year ago, I stood before you and gave what was probably the longest inaugural speech on record… Don’t worry, I won’t repeat that today…

But I want to remind you of one of the statements in that speech. I quoted Don Francke, who said it in 1964 when he released the findings of the study “The Mirror to Hospital Pharmacy.” The statement is:

The survival of pharmacy as a profession rests to a major degree on Health-System Pharmacists.

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What a month! Maybe it’s the warmer weather and sunshine skewing my perception of time, but I swear the days have been flying off the calendar this month.  Is it really almost May??

I was lucky enough to travel to Japan week before last and spend some time in Tokyo, at Mt. Fuji, and in Kyoto. (Do yourself and favor and make the trip one day!!—such a beautiful country, great food, and the friendliest people). But between the trip, recovering from jet lag (not that I’m complaining), work, and the anticipation of my very-soon-to-be-born nephew (‘very soon’ as in tomorrow), I have struggled to get through a single learning module! But that’s life, right? There is always something more pressing, more exciting, more important fighting for your time. I know I am preaching to the choir. A lot of you have far more responsibility than I could imagine, and you work hard to balance and stay on top of it all.

That’s one of the great things about ASHP’s recertification program. You can go at your own pace, working through the modules and completing them as you have time. And with this module, as I’m sure it will be with all of them, you are given the information you need to prepare and complete it successfully.

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It's been quite the busy April! I recently traveled to Europe for 2 weeks and took my BCPS recertification materials abroad.  When you're stuck on a plane for 8 hours, there is no better opportunity to complete BCPS recertification modules!

I decided I would read the "refresher" materials (review articles about the nested case control study design) on the way there  and read the "application" materials (pill appearance, spironolactone studies) on the way back. Having a plan for completion and not bypassing (cardiology pun alert!) preparation really helped me to get through the module by my goal date.   The articles themselves were pretty interesting and applicable to what a pharmacist may encounter in practice.  

I completed the Module 1A assessment after I returned and the post-vacation craziness settled down. A downside of the module is that you only have one attempt to complete the assessment and must score at least a 77%.  There is no feedback to see which questions you got wrong, so no way to assess what you may have learned incorrectly. It would be nice to have some additional information accompany the incorrect answers.  It doesn't necessarily have to show what the right answer is, but perhaps additional resources that can lead to why the answer was wrong.  There is unlimited time to complete the assessment, with the ability to close and return at a future time to the point at which you left off.  
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Good Evening and Happy April!

Even though it remains relatively cold here in Chicago, I know spring is here by the number of consecutive days of rain I have seen.  I took advantage of one of those many rainy days to complete my first ASHP re-certification module for BCPS: Pharmacotherapy Intensive Study A - Pharmacogenomics.

I remember learning a little about pharmacogenomics in pharmacy school, mainly in regards to the use of warfarin and a few chemotherapy agents.  However, since those few therapeutic lectures, I rarely gave this area much thought.  The re-certification module provided a good refresher on what pharmacogenomics is, the role a pharmacist can (and should) play, some specific examples of the impact genetic testing can have on pharmacotherapy selection, and some controversies surrounding the practice.

One thing that most stuck out to me was a question asked by the presenter: if a patient came to you with results of CYP2C9 genetic test (showing 2C9*3 allele) and a prescription for 10mg of warfarin, what would you do?  I, along with most of the participating audience, responded that we would recommend decreasing the dose of warfarin since the patient likely would require a lower dose in order to have a therapeutic INR.  This reminded me and the audience that despite the controversies surrounding pharmacogenetic testing, if we had the information available to us we would likely change therapy empirically.
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General : Accreditation, ASHPCerts, Continuing Education

I found some time to finish the first module of the recertification course over the past couple days. Module 1A includes an interesting article on non-persistence of medication after pill appearance changes (color or shape), a couple less interesting articles on nested case control studies (does anyone actually like statistics?), and finally an article from NEJM on spironolactone in heart failure. I thought for the most part the articles were good reads. The only exception was that I thought there was some overlap in the 2 articles on nested case control, and I probably could have gotten the same information out of just one.

I said in my first post that I was going to focus on the time it took me to finish each module. The four papers took me a little over 2.5 hours to read, with some minor distractions. The test itself took around 30 minutes to finish 18 questions. The test was not overly difficult and most of the answers were straight forward out of the text. There were maybe 2-3 I was not sure about, but I ended up with 100% so if you read the papers and understand the questions you should be fine. 

I'll post my twitter name again, feel free to add me if you want to know when I post my next blog on module 1B (more cardiology and statistics!): 
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Happy April everyone!  I hope that your weather has warmed up in the last month.  I was fortunate to be able to attend the Women’s Final Four here locally at the beginning of the month, checking that off my bucket list!  In less than 2 weeks, I’ll be taking a group of pharmacy students to Ireland and the UK to learn about health care systems, pharmacy practice, and pharmacy education in those countries.  It’ll be my first time traveling to those countries, so it’s been a true bucket list kind of months.  What’s on your personal or professional bucket list?  Does it include Board Certification?

I managed to find some time to do the Literature Review Module 1B “Cardiology and Statistics (Meta-Analysis)” this month.  As a reminder, as an Ambassador, the Recertification products were given to me for free by ASHP, but the opinions are solely my own. 

As with other Literature Review Modules, I got full text access to 4 articles: 2 clinical studies (one being a meta-analysis and one a RCT published in NEJM) and 2 statistics articles about meta-analyses, none of which I had read previously.

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Interprofessional work is one of the key aspects to expanding the role of pharmacists. It has become clear that we must establish our place on the health care team and I believe it is important to start embracing this role as students. One way for us to become more familiar with interprofessional collaboration is to participate in an interprofessional course.

I am currently enrolled in an Interprofessional Honors Colloquium offered by my school. This course is designed to provide an opportunity for health profession students to explore the implications of collaborative interprofessional practice. So far, it has been a very enriching experience. I had the opportunity to shadow a healthcare professional in a different field and learn more about various health professions including dentistry, nursing, medicine, public health and social work.

I am also working on a project with other health profession students aimed at identifying problems and suggesting solutions to improve transitions of care. It is a very interesting activity that has allowed me to better understand what every member of the healthcare team can bring to patient care and how we should go about combining our roles to improve healthcare outcomes. It is also a great opportunity to start promoting what pharmacists can do and prove to future healthcare professionals how we can help improve patient care. In my opinion, it is a great way to start building trust among future colleagues and optimize future collaborations.

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Family, friend, acquaintance, classmate, teacher, colleague, mentor, preceptor, manager. There are many names and titles to the relationships that we forge throughout our lifetime. Some are intuitive from childhood but others are learned and created in the path to professionalism.

Most of these titles are well defined. Being a mentor is often more elusive and its value can often be lost in the midst of being a preceptor, teacher, or being a manager to another. As I sit and encourage others to become a mentor I cannot help but reflect on those that have been a mentor to me.

The mentors in my career path were created long before I entered pharmacy school. I see mentors as those that were heavily involved in influencing my choice to go into pharmacy school, my involvement during pharmacy school, or those that helped identify my passion for oncology and clinical pharmacy practice. There are also mentors that did more than help me get into my current role but also ensured that I developed skills in leadership, communication, precepting, and mentoring myself.

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In Good Leaders Ask Great Questions, Your Foundation For Successful Leadership John Maxwell shares the following. Also review my blog posting on April 16 for the value of asking questions and questions leaders should ask themselves.

  • What questions do I ask my team members and really listen to the answers
    • What do you think which gets you the other person’s strength, heart and mind
    • How can I serve you which helps you not develop a positional mind-set whereby you start thinking you know best
    • What do I need to communicate as success in communication comes from the context more than the content
    • Did we exceed expectations which stimulates you to continue to improve your services
    • What did you learn which prompts people to evaluate their experience and make an assessment so they can learn
    • Did we add value and specifically how
    • How do we maximize this experience so we don't take anything for granted
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This month, I was able to complete another module in ASHP's BCPS recertification credit series literature review. The topics I completed this month involved the pulmonary system, including pulmonary embolism (PE) and pneumonia. The readings included European Guidelines for PE and 2 articles dealing with pneumonia. Both pneumonia readings were from the New England Journal of Medicine, involving the PCV7 vaccine and a review article for the treatment of pneumonia. All 3 of these articles very very interesting and added to my knowledge base. I enjoyed this module since it was able to reinforce what I already new, but give me new aspects of these topics, including European guidelines for PE treatment. The quiz was very difficult, but it proved to me that I was able to learn something on these topics which are dealt with on pretty much a daily basis in both in- and outpatient settings.
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My name is Trang Truong and I am a Post-doctoral Medication Safety Resident with Purdue University College of Pharmacy’s Center for Medication Safety Advancement. I am conducting a research survey to assess the need for medication safety education and training for physicians, pharmacists, and nurses across different healthcare settings. 

The Institute of Medicine (IOM) estimated that as many as 44,000 to 98,000 Americans die each year as a result of preventable medical error. The annual cost associated with preventable errors is approximately $17 billion. While most errors committed are system errors, safety education and training have been associated with a reduction in the number of preventable errors. Further research in medication safety education is needed to assess healthcare professionals’ understanding of medication safety terminology, knowledge about medication safety concepts, research, and best practices. The goal of the survey is to assess the current level of medication safety education provided to physicians, pharmacists, and nurses and to identify key interest areas to improve future training and education. 
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In Good Leaders Ask Great Questions, Your Foundation For Successful Leadership John Maxwell shares the following.

  • Why are questions so important for leaders
    • You only get answers to the questions you ask which makes them so powerful
    • Questions unlock and open doors that otherwise would remain closed and we would miss all kinds of possibilities leading to opportunities, experiences and people
    • Questions are the most effective means of connecting with people which is how leaders have influence through relationships
    • Questions cultivate humility, which enables us to be authentic, vulnerable, trustworthy and intimate with others. People are open to those that are open with them
    • Questions help you engage others in conversations by getting to know them and showing that you want to add value to them
    • Questions allow us to build better ideas because of the input from others so they can become great ideas
    • Questions give us a different perspective so we don't act on faulty assumptions
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Audience : Pharmacy Leadership

As provider status looms on Capitol Hill, there are a number of steps health care institutions can take to prepare for the possible recognition of pharmacists as providers among health care teams.

Regardless of provider status, one step many institutions are pursuing (or have already pursued) is credentialing and privileging of their pharmacists.  To assist with this process, ASHP has recently developed a resource center dedicated specifically to credentialing and privileging:

How has your hospital or health system addressed credentialing and privileging of pharmacists?  Many of us would greatly benefit from dialogue about the successes and failures of others.

Posted on behalf of the SAG on Clinical Leadership, Section of Clinical Specialists and Scientists

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