PHARMACOINFORMATICS
ENHANCING THE PHARMACIST-COMPUTER INTERFACE Joseph F. Dasta
that pharmacy is an information-intensive profession. To function effectively in the 21st century, pharmacists must begin to develop efficient methods to lessen the burden of information overload. I am pleased to introduce several articles that will be appearing in The Annals about pharmacy and computer applications in healthcare. These articles describe how computer technology can help with information transmission, organization, and assimilation. They discuss methods by which computers can be used to solve real-world problems in pharmacy. After reviewing these articles, it is hoped that readers will begin open dialogues with pharmacy colleagues, computer scientists, biomedical engineers, and medical infonnaticians to discuss computer-based methods of addressing information-related pharmacy problems. Woodruff and Hunt (page 1(0) provide insight into the potential technologic advances of the next century and propose a new role for the pharmacist. They suggest that the future healthcare scene will develop an integrated, easily accessible, electronic information network. They propose that many drug information functions may become relegated to "intelligent" electronic drug information centers (databases) with direct access by a wide variety of healthcare personnel. Pharmacists may therefore need to become therapeutic information managers. Regardless of whether this scenario develops during the next decade, Woodruff and Hunt challenge us to become more involved with current information system development and to consider combining our expertise on pharmacotherapeutics with computer science in order to manage complex drug-related electronic information. They advise us to keep one step ahead of technology and to take an active role in the application of technologic developments that affect our profession. My colleagues and I (page 109) attempt to cover the topic of medical informatics (medical computer application) while focusing on current and future applications of IT IS BECOMING INCREASINGLY CLEAR
JOSEPH F. DASTA, M.Sc" FCCP, FCCM, is an Associate Professor, College of Pharmacy, The Ohio State University, Columbus, OH 43210. Reprints: Joseph F. Dasta, M.Sc., FCCP, FCCM.
computers in pharmacy (pharmacoinformatics), The goal of our article is to introduce readers to a broad range of concepts related to computers in healthcare and to acquaint pharmacists with technologic advances that could have pharmaceutical applications. New developments in computer technology, hospital information systems, hospital pharmacy systems.decision support programs, and computer-based instruction are discussed. An extensive bibliography is also provided. Specific examples of implementation of pharmacoinformatic solutions will be published in forthcoming issues of The Annals. A report by Halpern et al., entitled "A Computerized Intensive Care Unit Order-Writing Protocol," will outline the problems of traditional paper-based methods of information flow and describe an automated approach to order writing in their surgical intensive care unit (ICU). Their program is not just a "pharmacy" system but is also a comprehensive approach to patient assessment and action using an organ-system approach. The pharmacy component of the program permits drugs to be ordered in a user-friendly fashion while performing routine calculations and drug-allergy screening. Basic information on drug dosing is also available, giving pharmacists the opportunity to concentrate on in-depth consultation. This type of system has the potential to decrease errors and increase the efficiency of writing orders for ICU patients. Their program is an example of how existing technology can be employed relatively inexpensively to decrease reliance on human memory and minimize paper-based methods. An article by Greer, "RXPERT: A Prototype Expert System for Formulary Decision Making," will describe a unique decision support tool being developed to help with the process of evaluating drugs for formulary inclusion in the Saskatchewan prescription drug plan. The program is an expert system that attempts to develop a computational model of the complex process humans use in formulary decision making. Expert systems require considerable development time; however, they can provide valuable information when properly implemented. RXPERT provides consistency in decision making by ensuring that all relevant variables are considered in every decision. Although
The AnnalsofPharmacotherapy • 1992 January, Volume 26 • 99
still in development, RXPERT suggests that computerbased methods can be used to solve difficult problems in pharmacy and challenges pharmacists to consider this type of approach in other pharmaceutical domains. Fish et al., in their article "Information Systems for Evaluating the Quality of Prescribing," will describe available large outpatient databases that are or could be used for drug usage review studies. They will develop a case for being able to collect prescribing information for the primary purpose of increasing the quality of drug prescribing and will suggest various changes in existing computerbased databases to effectuate improvements in drug therapeutics. This article will remind readers that, although a great deal of computer-based prescribing information exists, the data are often insufficient for clinical therapeutic
monitoring. Properly implemented, however, a computer database in the outpatient setting can provide a wealth of useful information that can augment the pharmacist's clinical role in ambulatory care. These five articles serve as an introduction to the interface between pharmacists and computers. They also highlight the increasingly important role of the computer as an integral member of the healthcare team. However, we are also reminded of the current limitations of computer technology and the need for humans to direct their development and application in a way to support the cognitive functions of pharmacists. Carbon-based (humans) and silicon-based (computer) systems must coexist in the healthcare environment. Optimal scenarios for the future will include maximizing each system's respective, unique capabilities.
INVOLVEMENT IN MEDICAL INFORMATICS MAY ENABLE PHARMACISTS TO EXPAND THEIRCONSULTATION POTENTIAL AND IMPROVE THE QUALITY OF HEALTHCARE Alise E. Woodruff' and C. Anthony Hunt
ABSTRACf: The outlook for pharmacy-related services foretells more involvement of both computers and information systems. Expert therapeutic systems and databases will enable pharmacists to expand their consultation potential through networks and improve the quality of healthcare that they provide. Therapeutic information management could be the largest pharmacy speciality of the future. As knowledgebased systems and networks become commonplace, there will be an increasing need for new components, system monitoring, and quality assurance. This is an opportunity for pharmacy to bring medical computing, as it relates to therapeutics, into the mainstream of the profession as a new discipline.
Ann Pharmacother 1992;26: 100-4.
who foresaw the impact that computer systems would have on the professional life of a pharmacist? How much more will our professional lives change in the next 15 years as a consequence of evolution in computer technology? We believe that all information generated by and needed to operate our healthcare industry will become computerized. Most everyday procedures will be software-driven. Computer-based technologies will further blur professional boundaries. Both prescription and nonprescription medication records, along with complete medical, dental, and diagnostic records will be stored in data-
FIFTEEN YEARS AGO,
ALiSE E. WOODRUFF is a Pharmacy Student; and C. ANTHONY HUNT, Ph.D., is an Associate Professor of Pharmacy and Pharmaceutical Chemistry, School ofPharmacy, University of California, San Francisco, CA 94143. Reprints: C. Anthony Hunt. Ph.D. This work was supported in part by the Department of Pharmacy, School of Pharmacy. University of California, San Francisco.
100
•
The Annals ofPharmacotherapy
•
banks under layers of security. Micro- and macroeconomic data such as costs to the individual and to the healthcare system will be recorded. Every aspect of the healthcare industry's operation, including institutional selection, acquisition, and distribution of drug products, will be governed or influenced by software. Software designed to mimic numerous professional activities (expert systems) will be in wide use. Delegation of a variety of professional activities to computer systems will be cost-effective and will promote better healthcare. A vast quantity of previously inaccessible or nonexistent data will become a gold mine for research by "knowledge navigators" (professionals skilled in getting information efficiently into and out of systems). Data can be translated into knowledge and knowledge into better healthcare. Who will manage this vast medical information and data system? Consider only the therapeutic information subset. We expect that it will affect every facet of pharmacy. What types of networks will evolve and who will be contributing members? Who will manage and accept the legal responsibility for therapeutic information management? Who will test and validate new software? Who will shoulder the responsibility for successful introduction and operation of expert systems? Who will be authorized to oversee the system's data to answer research questions? Those who become responsible for medical information management will be a new breed of professional with a position of significant stature and purpose within the healthcare field. We should start now to develop therapeutic information management into a new area of practice for tomorrow's pharmacists!
1992 January, Volume 26
ENHANCING THE PHARMACIST-COMPUTER INTERFACE Joseph F. Dasta
that pharmacy is an information-intensive profession. To function effectively in the 21st century, pharmacists must begin to develop efficient methods to lessen the burden of information overload. I am pleased to introduce several articles that will be appearing in The Annals about pharmacy and computer applications in healthcare. These articles describe how computer technology can help with information transmission, organization, and assimilation. They discuss methods by which computers can be used to solve real-world problems in pharmacy. After reviewing these articles, it is hoped that readers will begin open dialogues with pharmacy colleagues, computer scientists, biomedical engineers, and medical infonnaticians to discuss computer-based methods of addressing information-related pharmacy problems. Woodruff and Hunt (page 1(0) provide insight into the potential technologic advances of the next century and propose a new role for the pharmacist. They suggest that the future healthcare scene will develop an integrated, easily accessible, electronic information network. They propose that many drug information functions may become relegated to "intelligent" electronic drug information centers (databases) with direct access by a wide variety of healthcare personnel. Pharmacists may therefore need to become therapeutic information managers. Regardless of whether this scenario develops during the next decade, Woodruff and Hunt challenge us to become more involved with current information system development and to consider combining our expertise on pharmacotherapeutics with computer science in order to manage complex drug-related electronic information. They advise us to keep one step ahead of technology and to take an active role in the application of technologic developments that affect our profession. My colleagues and I (page 109) attempt to cover the topic of medical informatics (medical computer application) while focusing on current and future applications of IT IS BECOMING INCREASINGLY CLEAR
JOSEPH F. DASTA, M.Sc" FCCP, FCCM, is an Associate Professor, College of Pharmacy, The Ohio State University, Columbus, OH 43210. Reprints: Joseph F. Dasta, M.Sc., FCCP, FCCM.
computers in pharmacy (pharmacoinformatics), The goal of our article is to introduce readers to a broad range of concepts related to computers in healthcare and to acquaint pharmacists with technologic advances that could have pharmaceutical applications. New developments in computer technology, hospital information systems, hospital pharmacy systems.decision support programs, and computer-based instruction are discussed. An extensive bibliography is also provided. Specific examples of implementation of pharmacoinformatic solutions will be published in forthcoming issues of The Annals. A report by Halpern et al., entitled "A Computerized Intensive Care Unit Order-Writing Protocol," will outline the problems of traditional paper-based methods of information flow and describe an automated approach to order writing in their surgical intensive care unit (ICU). Their program is not just a "pharmacy" system but is also a comprehensive approach to patient assessment and action using an organ-system approach. The pharmacy component of the program permits drugs to be ordered in a user-friendly fashion while performing routine calculations and drug-allergy screening. Basic information on drug dosing is also available, giving pharmacists the opportunity to concentrate on in-depth consultation. This type of system has the potential to decrease errors and increase the efficiency of writing orders for ICU patients. Their program is an example of how existing technology can be employed relatively inexpensively to decrease reliance on human memory and minimize paper-based methods. An article by Greer, "RXPERT: A Prototype Expert System for Formulary Decision Making," will describe a unique decision support tool being developed to help with the process of evaluating drugs for formulary inclusion in the Saskatchewan prescription drug plan. The program is an expert system that attempts to develop a computational model of the complex process humans use in formulary decision making. Expert systems require considerable development time; however, they can provide valuable information when properly implemented. RXPERT provides consistency in decision making by ensuring that all relevant variables are considered in every decision. Although
The AnnalsofPharmacotherapy • 1992 January, Volume 26 • 99
still in development, RXPERT suggests that computerbased methods can be used to solve difficult problems in pharmacy and challenges pharmacists to consider this type of approach in other pharmaceutical domains. Fish et al., in their article "Information Systems for Evaluating the Quality of Prescribing," will describe available large outpatient databases that are or could be used for drug usage review studies. They will develop a case for being able to collect prescribing information for the primary purpose of increasing the quality of drug prescribing and will suggest various changes in existing computerbased databases to effectuate improvements in drug therapeutics. This article will remind readers that, although a great deal of computer-based prescribing information exists, the data are often insufficient for clinical therapeutic
monitoring. Properly implemented, however, a computer database in the outpatient setting can provide a wealth of useful information that can augment the pharmacist's clinical role in ambulatory care. These five articles serve as an introduction to the interface between pharmacists and computers. They also highlight the increasingly important role of the computer as an integral member of the healthcare team. However, we are also reminded of the current limitations of computer technology and the need for humans to direct their development and application in a way to support the cognitive functions of pharmacists. Carbon-based (humans) and silicon-based (computer) systems must coexist in the healthcare environment. Optimal scenarios for the future will include maximizing each system's respective, unique capabilities.
INVOLVEMENT IN MEDICAL INFORMATICS MAY ENABLE PHARMACISTS TO EXPAND THEIRCONSULTATION POTENTIAL AND IMPROVE THE QUALITY OF HEALTHCARE Alise E. Woodruff' and C. Anthony Hunt
ABSTRACf: The outlook for pharmacy-related services foretells more involvement of both computers and information systems. Expert therapeutic systems and databases will enable pharmacists to expand their consultation potential through networks and improve the quality of healthcare that they provide. Therapeutic information management could be the largest pharmacy speciality of the future. As knowledgebased systems and networks become commonplace, there will be an increasing need for new components, system monitoring, and quality assurance. This is an opportunity for pharmacy to bring medical computing, as it relates to therapeutics, into the mainstream of the profession as a new discipline.
Ann Pharmacother 1992;26: 100-4.
who foresaw the impact that computer systems would have on the professional life of a pharmacist? How much more will our professional lives change in the next 15 years as a consequence of evolution in computer technology? We believe that all information generated by and needed to operate our healthcare industry will become computerized. Most everyday procedures will be software-driven. Computer-based technologies will further blur professional boundaries. Both prescription and nonprescription medication records, along with complete medical, dental, and diagnostic records will be stored in data-
FIFTEEN YEARS AGO,
ALiSE E. WOODRUFF is a Pharmacy Student; and C. ANTHONY HUNT, Ph.D., is an Associate Professor of Pharmacy and Pharmaceutical Chemistry, School ofPharmacy, University of California, San Francisco, CA 94143. Reprints: C. Anthony Hunt. Ph.D. This work was supported in part by the Department of Pharmacy, School of Pharmacy. University of California, San Francisco.
100
•
The Annals ofPharmacotherapy
•
banks under layers of security. Micro- and macroeconomic data such as costs to the individual and to the healthcare system will be recorded. Every aspect of the healthcare industry's operation, including institutional selection, acquisition, and distribution of drug products, will be governed or influenced by software. Software designed to mimic numerous professional activities (expert systems) will be in wide use. Delegation of a variety of professional activities to computer systems will be cost-effective and will promote better healthcare. A vast quantity of previously inaccessible or nonexistent data will become a gold mine for research by "knowledge navigators" (professionals skilled in getting information efficiently into and out of systems). Data can be translated into knowledge and knowledge into better healthcare. Who will manage this vast medical information and data system? Consider only the therapeutic information subset. We expect that it will affect every facet of pharmacy. What types of networks will evolve and who will be contributing members? Who will manage and accept the legal responsibility for therapeutic information management? Who will test and validate new software? Who will shoulder the responsibility for successful introduction and operation of expert systems? Who will be authorized to oversee the system's data to answer research questions? Those who become responsible for medical information management will be a new breed of professional with a position of significant stature and purpose within the healthcare field. We should start now to develop therapeutic information management into a new area of practice for tomorrow's pharmacists!
1992 January, Volume 26
