I have been long concerned that the discussions regarding pharmacy informatics from a policy perspective seem to lack a complete perspective. Nowhere does that feel more true than with the area of training pharmacists in informatics. While we have for years had a mandate that schools of pharmacy teach informatics to pharmacy students, there seems to be relatively little concrete attention to the types of roles a pharmacy informaticist might play, or that some of the proposed informatics subjects probably don't apply at all to someone who just needs to be effective in their role as a pharmacist.
Informatics is a tool. Like all good tools, it needs to be suitable to the purpose, and so must ultimately be designed by experienced tool-users to best meet the needs of those who use the tool.
Like many tools, clinical informatics is a tool that requires some training to use. Unfortunately, the plethora of consumer electronics tools have created the impression that any kind of discipline around tool use is not necessary. But the reality is that the institutional information system is not any individual's personal tool, it is a tool used by many for a very high purpose, and so must be used correctly and consistently to achieve the best results.
Like many tools, an information system needs to be maintained. In many cases, that maintenance requires adjustments to data that, if entered improperly, can harm or kill and do so in ways that will be difficult or impossible to detect given our current operating paradigms (heavy reliance on human inspection by overworked users).
So we need experienced tool-builders (experienced in both desiging and using the tools), people dedicated to maintaining the tools and keeping them running, and people who use the tools who know how to use them appropriately. This would imply that we need three levels of informatics education:
1) Basic - this is the level that needs to be delivered to every pharmacy student, regardless of area of interest, and covers such things as basic kinds of information systems, rules of etiquette and discipline regarding the use of these tools, the application of basic data analysis tools to the analysis of data, issues of data quality and when to question the output of a computer, interaction with warning and help systems, and so forth. Every pharmacy student should come out of pharmacy school knowing enough about the kinds of systems they might encounter that they can learn them quickly and use them effectively and safely.
2) Informatics Management - this is the level of pharmacist that manages systems in a hospital pharmacy or medication use system. It is, by my observation, the level of practice for which there is the most crying need (and thus the greatest opportunity) in our current practice. These people need advanced training in the RFP process, in product selection and contract management, system implementation, user training, change management, ongoing database management, the use of large scale database management tools, and issues of data and system validation.
From an education perspective, this seems like a PGY1 or PGY2 residency type of training or a Masters level program for individuals who have practice experience and want to retool.
3) Systems Development - this is the level of the tool-maker. This level requires that a pharmacist be experienced and knowledgeable in the practice of pharmacy, both clinical and distributive, and be able to use that experience not to dictate what must be, but to consider what must change. This means that this individual augments that experience with training in lean transformation, industrial engineering principles, six-sigma quality. It means that this individual studies the practice as it currently exists, dissects it into its component pieces and processes, and, for each, asks how technology might transform it into something safer, faster, and more rewarding both to practitioners and the patients they serve. This requires ongoing research into current practice and alternative models, participation in the larger global healthcare informatics standards community, and direct ties to apparently unrelated informatics disciplines. Most of all, it requires an open mind to how pharmacy practice might be changed if the right tools made some jobs change, or disappear.
The price for this education system seems high. The price for not doing it may be higher. There seems to be little doubt that our current practice of sitting around waiting for the informatics industry to provide us the next wonderful tool will not provide development at the pace required to meet our needs as described by the PPMI. Our failure to participate as leaders in the development of informatics tools, or in their managment, may result in our sitting on the sidelines as other healthcare disciplines who have undertaken the challenges pass us by.
But then, this is just one man's opinion... what do you think?
#Informaticists #Technology #PPMI