Earlier this week I had a spirited conversation with Greg Smith (new CIO at ASHP) and Kasey Thompson. Greg is a great addition to the ASHP senior staff; and Kasey and I have had many spirited discussions. Both were kind enough to endure this curmudgeon.
The subject of our discussion was how we get the organization moving toward the technology promise that has figured so prominently in our early PPMI discussions. My concerns arise from what I perceive as a lack of clearly articulated vision regarding how we intend to use technology to achieve our practice goals. More specifically, we spent some time exploring the edges of where leadership comes from within our professional organization and how that leadership moves us forward in a realm that is as poorly understood as technology seems to be. Proverbs 29:18 (KJV) tells us "Where there is no vision, the people perish" and nowhere is that more true that in our quest for technology.
From the vantage point of 30 years in the technology industry, I observe that our primary technology strategy appears to be to wait for the industry to give us the next wonderful thing. A colleague of mine described it as a game of "fetch a rock" ("not that rock, a different rock, I don't know what rock, but I will know it when I see it"). Understand that I believe that the technology industry should be delivering the next wonderful thing; the process would be a lot faster (and a lot less expensive) if industry and the profession were working from a common vision of what was needed.
To some degree that isn't surprising; for most of us in practice, that is not what we do every day. On the other hand, without a clear vision regarding what technology we need to achieve our professional goals, it is going to be pretty hard to recognize technology that we should adopt and support when it presents itself. If we don't understand what our brave new world should look like, how would we recognize it? So the question becomes, who paints that vision and how do we drive the marketplace to provide the technology products we need to achieve that vision? One doesn't have to look far to see other healthcare professions (surgeons come to mind; so do dentists) who spend a lot of time on the way they tool up their practice to handle the increasing pace and level of complexity with which it seems we must deal. Should we not do the same?
In 2009, the Section on Pharmacy Informatics and Technology (SOPIT) produced a vision statement on technology-enabled practice (published in AJHP). In 2010, we had the first convention around what was then called the Pharmacy Practice Model Initiative for which a technology briefing paper also painted a picture of a future practice enabled by technological advance (published the following June in AJHP). Neither was particularly technical; neither got a lot of attention.
So where do we go from there? What do we need to do next to actually get the technology we need and want? How do we ensure that we are prepared to be able to use that technology if/when it arrived? How do we even assure that we would recognize it if it appeared?
I got challenged to explore this... so here goes...
It seems to me that we need to explore what stands in our way of getting to our desired future, and see where technology solutions might help us overcome those barriers. A few things come to mind:
The first thing we need to do, IMO, is to refresh our vision statement. The two documents noted above are at least 6 years old, and would probably benefit from some editing. If these documents really do reflect our vision for the future, then they need to figure more prominently than they currently seem to in our organizational strategic planning, as well as in the research, publications, and strategic plans of our membership.
The next thing we need to do is to identify, characterize, and plan to overcome the barriers currently between us and adoption of the set of power tools that would truly enable us to achieve the practice vision we espouse.
- The first of those barriers is our reluctance to admit that our current practice model has reached the end of its useful life; that the gold standard of the pharmacist's eyeballs on every dose has turned to clay; that we need power tools to do our job. Only when we embrace our real humanity (with all its failings), as professionals in what we ordinarily perceive as high-reliability industries have done, will we get to where we can define our practice in ways that truly provide quality medication therapy to our patients. Part of that, by the way, is to recognize that the application of technology is not a project; it is an ongoing governance responsibility.
- The second of these barriers is our current regulatory environment, which has cast that failed gold standard in regulatory stone. Even if we were to have the power tools that would enable the brave new world of our envisioned practice, it would take decades to get our laws changed to actually let us leverage them. We need to start now to get public policy to the point where it would be ready to accept the changes that these power tools would create. To start with, we would need to take a long hard look at our practice as it really is (as opposed to what we imagine it to be), measure it, and report on it so we understand our baseline a lot better than we currently do. Then we would need to apply technology solutions to that baseline and measure both the improvements and the unintended consequences. Finally, we would need to get legislative/regulatory action to re-describe in law and regulation how our new reality continues to meet, and even improves our ability to maintain our public responsibility for safe and accurate medication therapy.
- The third of these barriers is that we lack some of the technology that we really need to get where we need to go; some of the power tools that would really make our distribution processes fail-safe enough that we no longer needed to touch everything that goes out the door haven't been invented yet. We need to take a long look at the tasks that law and regulation mandate for a pharmacist that could be delegated, and determine what kinds of automation would permit us to safely delegate those tasks. That gap analysis should allow us to articulate much more clearly what our technology needs are, and what those technologies need to be able to do.
Can you think of others? I probably will...
Dennis A. Tribble, Pharm. D., FASHP
Ormond Beach, FL
DATdoc@aol.com
The views in this blog are my own, and do not necessarily reflect those of my employer or of ASHP.