The American Society of Health-System Pharmacists (ASHP) believes that pharmacists have the unique knowledge, expertise, and responsibility to assume a significant role in medical informatics. As governments and the health care community develop strategic plans for the widespread adoption of health information technology, pharmacists must use their knowledge of information systems and the medication-use process to improve patient care by ensuring that new technologies lead to safer and more effective medication use.
ASHP has long recognized pharmacy informatics as a unique subset of medical informatics that focuses on the use of information technology and drug information to optimize medication use. The purpose of this statement is to reaffirm the responsibilities of the pharmacist and the pharmacy informaticist in medical informatics.
Medical informatics was first defined during the 1960s.1 Since then, the term informatics has been redefined several times, reflecting the dynamic nature of the health care information technology environment. The National Library of Medicine defines medical informatics as the “field of information science concerned with the analysis, use and dissemination of medical data and information through the application of computers to various aspects of health care and medicine.”2 The central purpose of medical informatics is the dissemination of two core types of information: (1) patient-specific information created in the care of patients and (2) knowledge-based information, which includes the scientific literature of health care.3 Most researchers consider medical informatics an interdisciplinary or heterogeneous field, made of individuals with diverse backgrounds and levels of training with an inconsistently defined set of skills.4 The broad definition of medical informatics and the number of disciplines potentially involved present an opportunity for the growth of subspecialties within the field. One of these subspecialties is pharmacy informatics, which can be defined as the use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of improving health outcomes.
The potential for medical informatics to improve health outcomes has prompted the health care industry, large health care purchasers, and state and federal governments to undertake sweeping health information technology initiatives that commonly include the following applications5:
- Computerized prescriber-order-entry systems integrated with electronic health records (EHRs) and pharmacy information systems,
- Clinical decision-support tools that bring best-practice information and guidelines to clinicians at the time they need them and rule-based systems for monitoring, evaluating, responding, and reconciling medication-related events and information,
- Pharmacy information systems that allow electronic validation of medication orders in real time, provide the data flow needed to update both the medication administration record and order-driven medication dispensing systems, and support such operational activities as supply-chain management and revenue compliance,
- Automated dispensing cabinets and robotics integrated or interfaced with pharmacy information systems,
- Integrated medication administration management systems that enable the administration of bar-coded medications and use of “smart” infusion pumps, and
- Integrated medication surveillance applications for the reporting of medication incidents and adverse vents.
Development of these applications requires organizations to reengineer existing medication-use processes by introducing additional technologies and applications to support the end-to-end management of medications across the continuum of care. The drive to create a seamless environment for real-time sharing of medication- and patient-related information across all levels of care has highlighted the importance of medical and pharmacy informatics in health care. Traditional pharmacy systems that focus on the transcribing, preparation, and distribution phases of the medication-use process are often considered the foundation, or hub, for communicating meaningful information outside the pharmacy domain. The creation of such systems requires a unique blend of medication management and technology-related skills and draws new attention to the need for pharmacy informaticists.
Reports issued by the Institute of Medicine6,7 and subsequent research validating the importance of technology in health care led the federal government’s launch of two important health care technology initiatives. In summer 2004, the Department of Health and Human Services released a 10-year plan entitled The Decade of Health Information Technology: Delivering Consumer-Centric and Information-Rich Health Care.8 The plan was specifically designed to transform the delivery of health care by building a new health information infrastructure that links health care records nationwide. The plan describes the pressing need to achieve “always-current, always-available electronic health records for Americans.” These EHR systems would allow physicians and other health professionals to share valuable health care information at the point of care. The report identified four major goals8:
- Inform clinical practice. Bring information tools to the point of care, especially by investing in EHR systems in physicians’ offices and hospitals.
- Interconnect clinicians. Build an interoperable health information infrastructure so that records follow the patient and clinicians have access to critical health care information when treatment decisions are being made.
- Personalize care. Use health information technology to increase consumers’ access to information and involvement in health care decisions.
- Improve population health. Expand the capacity for monitoring public health, measuring quality of care, and accelerating implementation of research advances into medical practice.