9 th Annual Pharmacy Informatics Conference Pharmacy Informaticists

9 th Annual Pharmacy Informatics Conference Pharmacy Informaticists Working Outside of Pharmacy – Why Aren’t You? Anders Westanmo Pharm. D, MBA March 2018

Objectives • 1. Describe the role of the American Medical Informatics Association (AMIA) in Clinical Informatics and Pharmacy Informatics. • 2. Describe change in PACT Pharmacy to focus on whole patient and how we can quantify that the majority of Pharm. D interventions are now “NONPHARM INTERV”. • 3. Be able to give an example of how a pharmacy informaticist can help the pharmacy department and improve patient care by working on projects outside of the pharmacy department. VETERANS HEALTH ADMINISTRATION 2

How I Became an Informaticist Changes in Anders VETERANS HEALTH ADMINISTRATION 3

Year Specific Date Animal Sign 1972 2/15/1972 - 2/2/1973 Rat 1973 2/3/1973 - 1/22/1974 Ox 1974 1/23/1974 - 2/10/1975 Tiger 1975 2/11/1975 - 1/30/1976 Rabbit

What We Will Cover Today • Part I: What Is a Clinical Informatics? • Part II: Pharmacy Informaticist = Clinical Informaticist (and if they are not they should strive to be) • Part III: Highly Trained Pharmacy Specialists Should and Do Work With Other Disciplines to Improve Care • Part IV: Pharmacy Informaticists Should Work With Other Disciplines to Improve Care VETERANS HEALTH ADMINISTRATION 8

Pharmacy Specialties – What We Know BPS Specialty Ambulatory Care Pharmacy Cardiology Pharmacy Critical Care Pharmacy Geriatric Pharmacy Infectious Disease Pharmacy Nuclear Pharmacy Nutrition Support Pharmacy Oncology Pharmacy Pediatric Pharmacy Pharmacotherapy Psychiatric Pharmacy VETERANS HEALTH ADMINISTRATION Certification BCACP BCCP (2018) BCCCP BCGP BCIDP (2018) BCNP BCNSP BCOP BCPPS BCPP 9

Pharmacy Specialties – What About Informatics? ASHP, ACCP, BPS, and other pharmacy organizations have very little information to offer regarding informatics VETERANS HEALTH ADMINISTRATION 10

American Medical Informatics Association (AMIA) AMIA (the American Medical Informatics Association) is a professional scientific association that was formed by the merger of three organizations in 1988: the American Association for Medical Systems and Informatics (AAMSI); the American College of Medical Informatics (ACMI); and the Symposium on Computer Applications in Medical Care (SCAMC). VETERANS HEALTH ADMINISTRATION 11

Part 1: AMIA Defined Areas Within Clinical Informatics Biomedical Imaging Informatics Intensive Care Informatics Mental Health Informatics Nursing Informatics Pharmacy Informatics Primary Care Informatics Many More… VETERANS HEALTH ADMINISTRATION 12

AMIA - What is Clinical Informatics is the application of informatics and information technology to deliver healthcare services. AMIA considers informatics when used for healthcare delivery to be essentially the same regardless of the health professional group involved (whether dentist, pharmacist, physician, nurse, or other health professional). Clinical Informatics is concerned with information use in health care by clinicians. VETERANS HEALTH ADMINISTRATION 13

VA - AMIA 10 X 10 • The primary objectives of the VA Health Informatics Certificate Program are to develop a cadre of VA informatics leaders who can catalyze, implement and support Health Information Technology innovations, and to provide students an opportunity to explore how informatics can be used to improve health care delivery. VETERANS HEALTH ADMINISTRATION 14

AMIA Advanced Health Informatics Certification (AHIC) • AMIA’s 2015 -2020 Strategic Plan calls for AMIA to enhance avenues for, and tangible recognition of, professional advancement for all members at all stages of their careers. • Goal is to establish advanced health informatics certification for all health informatics professionals. VETERANS HEALTH ADMINISTRATION 15

Theoretical Informatics Silos VETERANS HEALTH ADMINISTRATION 16

Clinical Informatics Involves Health Information VETERANS HEALTH ADMINISTRATION 17

Clinical Informaticist Clinician – Firsthand knowledge of clinical needs and clinic workflow VETERANS HEALTH ADMINISTRATION IT Knowledge – Firsthand knowledge of IT capabilities 18

Part 2: Pharmacy Informaticist = Clinical Informaticist VETERANS HEALTH ADMINISTRATION 19

Visually - What is Clinical Informatics VETERANS HEALTH ADMINISTRATION 20

Theoretical Informatics Silos VETERANS HEALTH ADMINISTRATION 21

Where all the Clinical Informaticists? ? VETERANS HEALTH ADMINISTRATION 22

Health Care – What is it about? VETERANS HEALTH ADMINISTRATION 23

Health Care or IT Worker? VETERANS HEALTH ADMINISTRATION 24

Health Care or IT Worker? VETERANS HEALTH ADMINISTRATION 25

Health Care or IT Workers? VETERANS HEALTH ADMINISTRATION 26

Health Care or IT Worker? VETERANS HEALTH ADMINISTRATION 27

Health Care or IT Worker? VETERANS HEALTH ADMINISTRATION 28

Personality Type? INTP or ESFJ • INTP – Introvert, Intuition, Thinking, Perceiving – Recommended professions: economists, accountants, actuaries, auditors, IT jobs, and the like. Generally enjoy system challenges…not people challenges. • ESFJ – Extravert, Sensing, Feeling, Judging – Recommended professions: special education teachers, counselors, nurses, direct sales jobs, and the like. Generally enjoy people challenges…not system challenges VETERANS HEALTH ADMINISTRATION 29

How Do Pharmacists Fit Into Informatics – Historical Reasons VETERANS HEALTH ADMINISTRATION 30

Color Generalizations/Distribution In Health. Care Gold: Administrators Green: Pharmacists VETERANS HEALTH ADMINISTRATION Blue: Nurses & Allied Health Orange: Random Artists

Clinical Informaticist Clinician – Firsthand knowledge of clinical needs and clinic workflow VETERANS HEALTH ADMINISTRATION IT Knowledge – Firsthand knowledge of IT capabilities 34

Where all the Clinical Informaticists? ? Where is this year’s VA Nursing Informatics Conference? Where is this year’s VA Dietician Informatics Conference? Where is this year’s VA Medical Informatics Conference? Where is this year’s VA Pharmacy Informatics Conference? VETERANS HEALTH ADMINISTRATION 35

Informatics Training for Clinicians Comes From Pharmacy • MUMPS – Basic and Intermediate Courses Starting 2006 • Fileman - Basic and Intermediate Courses Starting 2008 • Structured Query Language (SQL): Basic and Intermediate Starting 2012 • VBA – Basic and Intermediate Courses • PGY 2 Residencies in Informatics – Only Pharmacy VETERANS HEALTH ADMINISTRATION 36

Pharmacy Informaticist = Clinical Informaticist If they are not they should be actively developing their skill to become one VETERANS HEALTH ADMINISTRATION 37

Theoretical Informatics Silos VETERANS HEALTH ADMINISTRATION 38

Reality of Health Informatics VETERANS HEALTH ADMINISTRATION 39

Why Should Pharmacy Informaticists Work Outside of Pharmacy VETERANS HEALTH ADMINISTRATION 40

Part III: Highly Trained Pharmacy Specialists Should and Do Work With Other Disciplines to Improve Care VETERANS HEALTH ADMINISTRATION 41

From Pharmacy Informatics 2010 Conference VETERANS HEALTH ADMINISTRATION

Redefining Care – The Primary Care Medical Home (PCMH) • • • 1. Comprehensive Care 2. Patient Centered 3. Coordinated Care 4. Accessible Services 5. Quality and Safety VETERANS HEALTH ADMINISTRATION 43

Patient Aligned Care Team Model (PACT) A PACT is a partnership between you and your health care team to ensure you receive whole-person care. A PACT offers many ways to access health care. A PACT achieves coordinated care through collaboration. A PACT uses a team-based approach. VETERANS HEALTH ADMINISTRATION 44

CPPO: What was the most frequently used Pharm. D Health Factor in Jan 2018? • For Diabetes - DM Type II NONPHARM Intervention • For Tobacco - Tobacco Cessation NONPHARM Intervention • For HTN - Hypertension NONPHARM Intervention VETERANS HEALTH ADMINISTRATION 45

Who Should They Work With? • PGY 2 trained ID Pharmacist? • Fellowship trained CHF Pharmacist? • BCOP (Oncology) Certified Pharmacist? • Pharmacist who completed Informatics Residency? VETERANS HEALTH ADMINISTRATION 46

Mission of the Department of Veterans Affairs VETERANS HEALTH ADMINISTRATION 47

Joint Commission of Pharmacy Practitioners (JCPP) Vision • “Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based healthcare. ” VETERANS HEALTH ADMINISTRATION 48

Minneapolis VA Vision • Provide the highest quality patient care by: • Work to identify opportunities to expand roles and services in order to improve care. • Measure and continuously improve pharmacy processes to provide the highest quality care and accurate and efficient medication processing. • Publish, present, and network with VHA and professional organizations in order to learn from and contribute to the profession. • Have the highest quality workforce through maximizing the license and training of every employee and to develop a comprehensive training program. VETERANS HEALTH ADMINISTRATION 49

Current Paradigm Pharmacy Informatics is an ancillary support function that supports pharmacists or pharmacy services VETERANS HEALTH ADMINISTRATION 50

Proposed Paradigm Pharmacy Informatics is a primary specialty that can best support patient care by using this specialty in collaboration with other services VETERANS HEALTH ADMINISTRATION 51

Proposed Paradigm • VA Pharmacy has spent a decade training pharmacists in clinical informatics. • They should be considered similar to a CPS specializing in health care data and encouraged to use this specialized knowledge to collaborate to improve care. This should not be limited to an ancillary role to support pharmacy service. • Pharmacy service should embrace this and encourage their informaticists to work with other services to improve care as they would any other CPS with specialized training. VETERANS HEALTH ADMINISTRATION 52

Risks in Proposed Paradigm? • If Pharmacy Informaticist is already “maxed” then work outside of pharmacy will lead to lowered ability to support pharmacy. VETERANS HEALTH ADMINISTRATION 53

Benefits of Pharmacy Informaticist Working Outside of Pharmacy • Clinical Care for patients will be improved • Relationships with other services and facility leadership will be improved • Pharmacists will become more involved in more clinical areas and end up working with more aspects of overall health care • The Pharmacy Informaticist will improve and be able to support pharmacy much more effectively VETERANS HEALTH ADMINISTRATION 54

The Biggest Opportunities in Health Care Today are in Data • • Improve Care Improve Safety Improve Efficiency Collaborate with clinicians, quality improvement, and research VETERANS HEALTH ADMINISTRATION 55

SAIL – Are You Involved VETERANS HEALTH ADMINISTRATION

Research – Are You Involved? • VINCI will set up cohorts…they will not pull all the data you need for those cohorts. • Abundance of individuals skilled in statistics…lack of individuals available to pull the necessary data. VETERANS HEALTH ADMINISTRATION 57

Challenges to All of You • Use Informatics to help everybody practicing at the top of their scope and ability – facility-wide • Everybody working to take care of “whole patient” • Develop a plan to involve pharmacy informatics in new areas at your facility VETERANS HEALTH ADMINISTRATION 58

Learning non-pharmacy Data – Where Do I Start? • One project at a time. • • “Most people overestimate what they can do in one year and underestimate what they can do in ten years. ” Deliberate Practice! VETERANS HEALTH ADMINISTRATION

Summary - Clinical Informaticists Working Outside of Pharmacy – Why Aren’t You? “Within Pharmacy Informatics wethey underestimate “Most people overestimate what can do what we have achieved in the pastwhat ten years and also in one year and underestimate they can underestimate what we can do with that in the next do in ten years. ” year. ” VETERANS HEALTH ADMINISTRATION 60

Part I: What Is a Clinical Informatics? VETERANS HEALTH ADMINISTRATION 61

Part II: Pharmacy Informaticist = Clinical Informaticist • Pharmacists happen to have more than their share of practitioners who happen to like data. • Informatics training (MUMPS, Fileman, SQL, VBA) started back in 2006. Thousands of pharmacists and others have gone through the training and have been practicing these skills for over 10 years. • Don’t underestimate what pharmacy has already achieved in the past 10 years. We have some of the best trained in data throughout all of health care. This is especially the case in the VA where pharmacy informatics training and networking has been deliberately developed. VETERANS HEALTH ADMINISTRATION 62

Part III: Highly Trained Pharmacy Specialists Should and Do Work With Other Disciplines to Improve Care • PACT, CHF, ID, Critical Care, Geriatrics, Mental Health, and any other CPS. In general, the more they collaborate and work with other services to improve care the better it is for patient care and pharmacy. • The title of this presentation seems provocative since it involves an Informaticist. If it were any other specialist there would not be such a reaction and it would be a given that they should do this. We need a paradigm shift. • The goal is not improving “the medication use process” – it is taking care of the whole patient and improving patient care. VETERANS HEALTH ADMINISTRATION 63

Part IV: Pharmacy Informaticists Should Work With Other Disciplines to Improve Care You have data needs? ? VETERANS HEALTH ADMINISTRATION Pharmacy Informatics specializes in data. We can help with that!

“Out beyond ideas of wrongdoing and right doing, there is a field. I will meet you there. ” -- Rumi Questions? ? VETERANS HEALTH ADMINISTRATION