Informatics

INFORMATICS
A broad term defined as the application of computer, and information management and processing of data, information, and knowledge.

INFORMATICS
The science concerned with the gathering, manipulation, classification, storage, and retrieval of recorded knowledge The techniques and practices used to manage and operate information systems and technology.

Technologies associated with pharmacy informatics

Automated inventory and procurement systems Intelligent-fusion devices Compounding devices Automated dispensing devices and robots Web-based knowledge systems Bar-coding CDS

Electronic communication Radio-frequency identification Pharmacy information systems CPOE Electronic prescribing E-health record

Topics associated with Pharmacy Informatics

Information security and confidentiality Educational applications Operations Clinical application Systems integration Opportunities and training

Role of IT
Implementation of CPOE E-documentation of administration Integration with pharmacy systems Dispensing devices

American Recovery and Reinvestment Act of 2009

Help contain health care costs Certification Commission for Healthcare Information Technology, serve as certification bodies to ensure successful adoptation and interoperability of health information technologies

Data, Information, and Knowledge Management

DATA Simply discrete and objective facts about subject or an event Easy to capture and store in media such as databases and files EXAMPLE Patient laboratory values, drug orders, patients weight

INFORMATION Data that has relevance and purpose Has meaning because it is contextualized, categorized, calculated, corrected, or condensed EXAMPLE Knowing particular lab result was high or low from reference valur

KNOWLEDGE Broader, deeper, and richer than data and information

How information is transformed into knowledge?

Through comparison between current situation and similar one Understanding the consequences of the information gathered Knowing how the information connects to other information Understanding what people think about the information

Why is this important in the field of informatics?

Accessing Sources of Information and Knowledge Content

Advantages of Electronic Information

Availability of information from almost everywhere Reduced space requirements for storing information Greater ability to maintain up-to-date information Improved efficiency of information retrieval

The 20 Most Popular Health Websites (June 2009)

1. WebMD.com 2. NIH.gov 3. MedicineNet.com 4. MayoClinic.com 11. everydayHealth.com 12. RightHealth.com 13. wellsphere.com 14. FamilyDoctor.org

5. Drugs.com 6. Yahoo!Health
7. RxList.com 8. RealAge.com 9. MedHelp.org 10. Healthline.com

15. QualityHealth.com 16. HealthCentral.com

17. Prevention.com 18. Health.com 19. RevolutionHealth.com 20. eMedicine.com

Information Retrieval/Knowledge Sources

E-databases and search engines Medicine, Intl Pharmaceutical Abstracts E-journals E-drug information resources (Micromedex, Multum, etc.) E-textbooks The Natural Medicines Comprehensive Database

Important Quality for Health-Related Websites

Transparency and honesty Transparency of provider of site, purpose, and objective of site Target audience is clearly defined Authority Clear statement of sources for all information and date of publication Privacy and data protection policies

 Clear and regular updating of information with date clearly displayed Accountability for information Process for user feedback and appropriate oversight responsibility Editorial policy has clear statement on process used for selection of content Guidelines on accessibility, searchability, readability

Practice Application of Informatics

Operational: Computer systems manage patient drug profiles and histories Can facilitate label generation, patient billing, batch processing of work load Software interfaces allow patient information to flow directly into the pharmacy system, easy retrieval of patient laboratory results, and external devices such as IV compounders, automatic dispensing cabinets and robots

Clinical: Improving a pharmacists access to information about the patient Documentation of clinical practice Utilizes software interfaces that allow pharmacists to document their work directly int5o handheld devices

Administrative: Managers have the information tools that allow them to better assign resources Allowed managers to move pharmacists into clinical roles and increase the overall safety of the medication-use-system

Workflow and Process Improvement: Automation has permitted change in important pharmacist functions and allowed to be accomplished by robots, automated dispensing cabinets and compounding devices Pharmacists are able to participate in patient care teams and exercise clinical skills Automation increased safety e.g. BCMA- bedside barcode medication administration RFID- radiofrequency idenfication

Systems Integration and Interfacing

Pharmacist-Computer Interaction Programming infusion rates Entering orders Entering compounding volumes or extracting Extracting reports from various equipment, devices or systems e.g. PIS- pharmacy information systems CPOE- computerized prescriber order entry systems

Access to and Use of Information: THREE TIERS Client Tier- user interacts with the system Application Tier- software stored on the local machine Database Tier- contains the database tables where information is stored

Integration Information Systems with Work Activities PIS- serves as the backbone for pharmacy work activities - automates and organizes the daily workflow in addition to coordinating its many clinical function PIS-generated medication administration records (MARs)- help nurses organize activities related to the medication administration process CPOE- systems contain patient lists, profiles, demographic information, electronic medication administration documentation, order forms and other features.

Pharmacy orders can be:

Handwritten or electronic Individual or grouped Entered by physician or physician agent Delivered manually or electronically

Types of Electronic Interfaces:

Pharmacists to take printed copies of the order and reenter the orders into the PIS. Transmit orders electronically from CPOE system to the PIS via one-way interface. Orders to be transmitted back and forth between systems using bi-directional orders interface

ADVANTAGES: reduction in time spent entering orders by pharmacy staff Elimination of transcription errors, entry on the wrong patient DISADVANTAGES: Complexity-every component must work and work well in conjunction with each other

Clinical Decision Support (CDS)

Clinical Decision Support

Information system that passively or actively convey clinical knowledge content to health care professional so that choices can be made that are in the best interest of patient care

Types of CDS
Passive Conveyance
Occurs as a result of system design features and choices made during system configuration that may not necessarily be apparent to the user of the system Limits choices a prescriber can make, the institution can help prevent the errors that occur from ordering medication doses, routes of administration, or frequencies that are unsafe, subtherapeutic, excessively costly, nonstandard, or inconsistent with institutional policy

Types of CDS
Active Conveyance
Ensures that key clinical information contained in the PIS or CPOE system can be coded conveys knowledge to the user of the system Highlights abnormal laboratory values and the use of pop-up alerts performed at the time of order entry such as allergies, drug interactions, abnormal doses, therapeutic duplication, intravenous drug admixture incompatibilities, therapeutic indication problems

Clinical Data Repositories

Key prerequisite for expanding CDS to include rule-based alerts Useful for clinical or administrative reporting purposes or for use in other applications

CDS Rule
Coded program incorporated into the POE system, the PIS, or a standalone CDS system in order to identify specific clinical care or business-related situations for the purposes of alerting specified users of the ned to address a particular situation Rules can be imbedded by the vendor or as conceived by a hospitals employees Rules can take information from disparate systems, perform calculations, and/or

Alerts & Knowledge Source Links

Pharmacy Information Systems Computerized Prescriber Order Entry Standalone expert systems Requires not only the wisdom and experience of health care professional but also an understanding by these clinicians of the capabilities, limitations, and deficiencies of CDS within their environment

Types of Alerts
Synchronous CDS Alerts
Pop-up warning screens that interrupt user workflow Triggered by specific actions taken by a user of the system The user action of submitting the order invokes a check of the dose against defined criteria within the system and interrupts the user with a request to act on the alert notification before proceeding

Types of Alerts
Asynchronous CDS Alerts
Occur as a result of an imbedded rule and typically do not interrupt workflow unless the user chooses to do so Can occur based on programmed logic using either data already contained within the CPOE system database resulting from user input Can occur based from data sent to the database from ancillary systems

Information Security
Reasonable protection from risk of loss, risk of inappropriate access, or doubt regarding authenticity of information Vulnerabilities and threats to information security may consists of internal failures of hardware or software, human errors, deliberate attacks on information security, and natural catastrophes Confidentiality ensures that the data is readable only by the intended recipients

Information Security
Depends on the degree of sensitivity of the information
Ensure that the physical location where servers are stored has been secured Provide a history of access that can be examined if there are ever questions about who accessed certain data or was involved in specific transactions

Disadvantage is that they do not provide positive identification of individuals because passwords may be shared by multiple individuals

Information Security
Has the ability to back up data so that it can be restored in an event of internal hardware or software failures, these may be accomplished by replicating the data in an alternative medium and site Authenticity of the involved parties and the electronic signature

Verified Internet Pharmacy Practice Sites (VIPPS)

Developed by the National Association of Boards of Pharmacy in 1999 in response to public concern for the safety of pharmacy practices on the Internet Coalition of state and federal regulatory associations, professional associations, and consumer advocacy groups provided their expertise in developing the criteria Pharmacies displaying the VIPPS seal have demonstrated to NABP compliance with VIPPS

Criteria of VIPPS
Patient rights to privacy Authentication and security of prescription orders Maintenance of a quality assurance and improvement program Provision of meaningful consultation between patients and pharmacists

VeriSign
Encrypts prescription or other protected health information during the electronic transmission of these data Prevents interception and unintended disclosure of confidential patient information during these transactions

Health Insurance Portability & Accountability (HIPAA)

Improve efficiency in health care delivery by standardizing electronic data Interchange and to protect the confidentiality and security of health data through setting and enforcing standards Its impact on institutions has been an increased awareness of the security and confidentiality of protected health information This has resulted in updating information systems to safeguard protected health

HIPAA (continuation)
It requires the hospital to protect against any reasonably anticipated threats or hazards to the security or integrity of this information and to ensure that rules and safeguards are in place to prevent inappropriate disclosure of this information Disclosure of PHI is limited to the minimum needed for health care treatment, business operations, and quality improvement A technique that is useful when handling

Encryption
Involves replacing identifiers that are traceable to an individual with another set of letters or numbers which cannot be linked back to individual patients De-identification very useful when doing analyses of aggregate data sets, examining overall prescribing trends, and evaluating drug utilization when there is no need to identify patients specifically

Clinical Informatics Pharmacist

Positions that have evolved in response to contemporary pharmacy practice needs rather than ones which have a clear academic and training path. Either have a strong interest in informatics or have developed a specific informatics aptitude on the job ASHPs Section on Pharmacy Informatics and Technology

Led to the incorporation of informatics learning outcomes for both college of pharmacy and residency curriculums.

Devoted to enhancing networking opportunities and improving health outcomes through the use and integration of data, information, knowledge, technology, and automation in medication-use-process.

Roles and Responsibilites

Pharmacists who specialize in informatics generally are responsible for one or more of the following activities:
Inpatient pharmacy information systems Outpatient pharmacy information systems Robotic unit-dose dispensing machines Automated medication dispensing machines Point-of-care bar code medication administration Automated intravenous admixture devices Inpatient computerized prescriber order entry systems Outpatient computerized prescriber order entry systems Clinical decision support Packaging machines Programming Report writing Inventory control systems Pharmacy intranets Customized pharmacy applications Desktop and application support Staff training and education

Education and Training

Pharmacist who wish to pursue a position in pharmacy informatics can accomplish this in several ways.
Take specific courses or obtain a degree in computer science, information systems, and/or business information technology. Complete an advanced residency in pharmacy informatics. Volunteer to assume an informatics role at ones current place of employment

 Field of pharmacy informatics is constantly evolving. Many pharmacists have found applying their clinical knowledge with information technology skills for the purposes of bettering patient care to a very satisfying and rewarding career.