February 2020 | Denise Klinker, PharmD, MBA
ASHP’s 2019 Midyear Clinical Meeting Attendees Hit the Jackpot In Las Vegas
ASHP hosted another successful event in December for over 26,000 health-system pharmacists in Las Vegas, offering hundreds of educational activities over four days. Attendees heard from clinical experts and leaders from across the globe on a wide range of topics, including improving pharmacy operational health and finances, resident and new practitioner development, and, not to mention, the vast number of clinical sessions offered to improve clinician skills at all levels. Some of the newer, hot topics included discussions and activities on staff well-being and the use of cannabis for patient care. There were so many excellent presentations; however, I found myself especially interested in the ones focused on the role of technology in pharmacy. As a pharmacist working at McCreadie Group, where we focus on delivering innovative software solutions for pharmacy research and education, I particularly appreciated those sessions that focused on the relationship between new technology and advances in patient care. These sessions allowed me to appreciate just how far we’ve come and to imagine the impact developing technologies will have on patient care and the role of pharmacists in the future.
Technological Advances in Pharmacy Practice
My pharmacy career started back in the mid-90s when I volunteered in the pharmacy department at a hospital in South Florida. One of my duties as a volunteer, and later as a pharmacy technician, was to round the nursing units or man the pneumatic tube stations to collect the paper physician orders and distribute them to the pharmacists who entered the orders into the pharmacy information system. Pharmacists spent a large portion of their time entering medication orders into the system and checking medications; we dreamed of the day pharmacists could devote more time to direct patient care activities. Fast forward to the introduction of the fax machine! It was a significant technological advance that allowed managers to have key information that led to noteworthy decreases in medication delivery times.
And by the way, at this point, patient information was stored in silos requiring users to log in to multiple systems. Pharmacy, nursing, lab, etc., all had separate information systems that did not talk to each other. To make matters worse, not all of the patient’s information was available electronically. Each patient had a paper chart, and if you could find it, you had to thumb through pages and pages of information to find what you needed. And speaking of paper, as a pharmacy student, ALL of my white coat pockets were filled to the brim with pocket-sized versions of the many drug information references we needed. I remember how excited I was when Epocrates, Lexicomp, and other pharmacy references became available via personal digital assistants like the Palm Pilot.
As an informatics pharmacist, I have seen the use of automated dispensing cabinets, like Pyxis and Omnicell, on nursing floors transform from serving as locked medication cabinets for controlled substances to serving as the primary delivery method for patient medications via cartless medication systems. I have also experienced the introduction of automation in the central pharmacy to manage inventory from ordering to dispensing, including medication carousels and robots. And of course, the introduction of electronic health records which contain all patient information and can be accessed by any member of the healthcare team anywhere the internet is available.
Throughout all of these technological advances, efficiencies were gained, allowing pharmacy departments to implement and increase clinical services managed by pharmacists. Starting with services like TPN and Pharmacokinetic drug monitoring and growing to include pain management, anticoagulation, and much more. Pharmacy practice has continued to evolve, where most inpatient orders are now entered by prescribers using computerized physician order entry, allowing pharmacists to shift their focus from distributive responsibilities to actively working as a valued member of multidisciplinary healthcare teams on a wide variety of medical services. With all of the advancement in automation, access to patient information, and expanding clinical services – what’s next?
Preparing for Pharmacy Practice in 2030
The session titled “Generating National Impact with the Practice Advancement Initiative (PAI) 2030” presented by Eric Maroyka, Pharm.D., BCPS, Director, ASHP Center on Pharmacy Practice Advancement, and others shared the history of ASHP’s work towards the advancement of health-systems pharmacy practice and reviewed the current recommendations. PAI 2030 consists of 59 recommendations and five primary domains 1) Patient-centered care, 2) Pharmacy Technician role, education and training 3) Pharmacist role, education and training 4) Technology and data science, and 5) Leadership in medication use and safety. Several themes occur within the 59 recommendations, as shown in the image “PAI 2020 Themes for Practice Change.”
PAI 2030 Themes for Practice Change| Eric Maroyka | ashp.org
Throughout my career, I was lucky enough to serve as a preceptor to pharmacy residents, and IPPE and APPE students. I taught my students the need to understand the practice of pharmacy, the use of automation and technology, how they impact our practice, as well as the need to understand the use of data to advance patient care. Nothing pleases me more than to see the Technology and Data Science recommendations built into the PAI 2030, which include:
C1. Pharmacists should use health information technologies to advance their role in patient care and population health.
C2. Pharmacy practice leaders should foster the development and application of advanced analytics (e.g., machine learning and artificial intelligence) in activities such as risk assessment, monitoring performance metrics, identifying patients in need of pharmacist care, optimizing medication use, and business management.
C3. Pharmacy practice leaders should be engaged in assessing emerging patient care technologies (e.g., mobile applications, monitoring devices, digital wearables or ingestables, blockchain technology) to support optimal medication use outcomes.
C4. The pharmacy workforce should be competent in health information technology (including but not limited to analytics, automation, and clinical applications of technology) with ongoing education and training embedded at all stages of career development.
Please refer to ASHP’s Practice Advancement Initiative 2030 to view the comprehensive list of recommendations and find tools to assist you with advancing pharmacy practice at your institution.
One of my favorite sessions was “Capturing the Needs of the 2030 Patient Today: Artificial Intelligence and the New Pharmacy Value Proposition” presented by Aaron Sihota, B.Sc.Pharm., B.Sc., R.Ph., Primary Care Pharmacist, and Clinical Instructor, University of British Columbia, Urgent Primary Care Center. Dr. Sihota started his presentation by asking attendees to raise their hands if they were Amazon Prime members – almost every attendee raised their hand. He then went on to describe Amazon Care, “a benefit being piloted for Amazon employees and their families in the Seattle area.” According to the Amazon Care website, enrolled employees will receive such benefits as Care Chat, Video Care, Mobile Care, and Care Courier.
Care Options | amazoncare.com
Assuming the pilot goes well, it is easy to imagine this program expanding to not only the entire Amazon workforce but also Amazon customers. Dr. Sihota also introduced multiple websites offering AI-assisted healthcare advice like buoyhealth.com where users answer a series of questions describing current signs and symptoms and receive healthcare advice and/or services. He referenced an article titled “How Artificial Intelligence Is Changing Health Care Delivery” by Samantha F. Sanders, Mats Terwiesch, William J. Gordon, MD, MBI & Ariel D. Stern, PhD which describes in detail the numerous ways AI is improving patient healthcare. I encourage you to access the full article to read about the numerous ways AI is impacting healthcare.
Every day I consider how to best support pharmacy through our software solutions Vestigo® and PharmAcademic™. Yet, attending the Midyear Clinical meeting allowed me to step back and reflect on the tremendous changes I’ve witnessed and to learn about the impact further technological advances will have on patient care. I encourage you to follow these scholars and to check out the great work we are doing to support residency education and research pharmacy at www.mccreadiegroup.com.