Pharmacy Informatics Reporting Structure: Pharmacy or the Health Care Information Services Department?
by
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.
The Unexpected Good
The EMR momentum pushed operational and clinical leaders to bridge the gap between technical personnel and clinicians. The value that I brought to the team was my broad clinical background, pharmacy business knowledge, pharmacy operations, and a vision for optimal medication therapy management to the senior information systems management group. I can confidently say that I’ve used all of my skill sets in my new home in ISD. Through the collaboration with our Chief Medical Informatics Officer and Chief Nursing Informatics Office, I have also helped promote the seamless flow of medication-related solutions through all transitions of care, not just acute care.
Being part of ISD ensures a collaborative environment for troubleshooting and looking for innovative solutions to technical or system problems. Working alongside other analysts that support different disciples from oncology to anesthesia promotes collaboration. I’ve now worked on one of many multidisciplinary teams to design workable workflows from medication reconciliation to ordering human milk.
The Not So Good
In reflecting through my current role, one of the natural negatives in the transition is the “struck in the middle” problem. It’s still unclear what some of the barriers and boundaries for support are. Ongoing monitoring of interface logs, coordinated testing of change initiatives, implementation of upgrades, and continual trouble-shooting are all activities that must be undertaken by a pharmacy clinical informatics team. Medication distribution is dynamic, and changes in practice and protocols occur almost daily. New products are added to the systems because of changes in clinical needs, drug shortages, or formulary changes. New clinical guidelines, restrictions, or treatment algorithms are implemented and must be incorporated into the medication ordering and dispensing processes.
When such changes occur, I must be available to work with the clinical or operational pharmacy staff to implement any necessary changes. It has been difficult due physical location and the processes of change control in the information services department.
Another frustration has been the value placed on the pharmacist’s knowledge. ISD created a separate clinical informatics role because we did not fall into one of the existing job categories. We are not in the same league as a nurse and are often only seen as knowledgeable in medication processes. In addition, being new to ISD comes with chartering new territory of skill sets as well as the involvement in other clinical areas of health care that may provide some discomfort. We are valued differently and may be seen as informatics technical personnel versus our clinical knowledge background.
The Verdict
After 9 months, however, it is my opinion that it’s better for pharmacy informatics positions to be based within, and report through, information services departments, given the right acceptance and human resource positions are available. This structure advocates for visible involvement of pharmacists at the levels where decisions are made about integrated clinical information solutions. Working in direct collaboration with the chief medical informatics officer and other clinical leaders, I am better positioned to help establish an infrastructure that not only supports day-to-day pharmacy operations but moves pharmacy towards a more integrated department within the health system.
So, have you recently made this change? I would love to read about your experience. Please contact me or leave a comment about the unexpected good and the not so good of your experience.