How Informatics Will Change the Future of Pharmacy

I recently gave a presentation at the Nova Southeastern University 21st Annual Contemporary Pharmacy Issues program with the above title.  I uploaded the deck to Slideshare and it can be accessed by clicking the image or here.

 

 @kevinclauson

Health Promotion, Mofongo, and Guarana

 

It has been an interesting week.  The week started with a short flight down to Caguas, Puerto Rico to attend the International Conference on Health Promotion.  It had a pretty impressive lineup of speakers, including representatives from health promotion, public health, and policy hailing from Canada, Chile,  Colombia, Ecuador, France, and Spain.  I was only able to attend the first day as I traveled the next day to collaborate and consult on a grant cultivating new HIV researchers on the island.  However, I was able to see several accounts of what has been done and what is being planned in the area of public health via survey results from Chile, a forward-looking global accounting from PAHO, and a fascinating history of the efforts towards health promotion in Canada.

On the food front – it struck me that this conference, like many others focused on health, offered only decidedly unhealthy options.  I can’t really say that *I* would have made a great choice anyway, as later I had my traditional meal of Mofongo & Medalla. 

At the conference as well as the visit the following day, there was substantial interest and openness about possibilities with mHealth and SMS patient reminders for public health initiatives as well as among HIV clinicians.  Apparently, even though mobile phone penetration there isn’t quite what it is on the mainland, it is significant enough to merit attention.

Upon my return I found a message from a columnist at the Wall Street Journal who was interested in doing an interview about guarana based on an article on energy drinks I wrote a few years ago.  The timing was just a little off as another article I helped write on energy drinks, including newer issues like toxic jock identity and anti-energy drinks, will be published next month in The Physician and Sportsmedicine.  Anyway, at this point I have done enough interviews to have relative comfort – but it is always an adventure to see what actually shows up in print.  I have found it beneficial to speak both with media savvy people in my shoes and others whose business it is like @CreativeFusion (oh Twitterverse, is there anything you can’t help with?).  In this case, it was pretty brief and straightforward and I even learned about Perky Jerky.

All in all, an interesting week.  I have stayed pretty close to my 2010 plan of hump day posts, but intend to take a ‘no excuses’ approach in the future by planning further ahead as necessary.  I’ll close with this delicious piece of proximal irony that I saw on my way home.

@kevinclauson

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Pharmacy Informatics – The Pharmacist, Librarian, and Pharmaceutical Scientist

Pharmacy Informatics by Philip O. Anderson: Book Cover

I was first alerted to the release of the new book Pharmacy Informatics via a blog post by @poikonen.  I took advantage of Amazon’s ‘Look Inside’ to check out the chapter titles and introduction.  That was enough for me, so I ordered it. I am really, really glad I did.

This textbook was created by three faculty members at the University of California, San Diego School of Pharmacy (along with area contributors) to accompany their forward-thinking pharmacy informatics course.  The authors bring a lot of credibility to the text as Phil Anderson is a very well known pharmacist in drug information and informatics circles, Susan McGuiness is a pharmacy librarian who is quite active in AACP, and Phil Bourne is the pharmaceutical scientist who is one of the more clever and creative fellows I have come across. 

The book basically delivers enough structure to create your own pharmacy informatics course.  It begins with a concise overview and the authors’ take on the meaning of pharmacy informatics (see Figure 1.1. above).  Then it sets the stage for why this specialty has developed and where it is going, touching on areas such as telepharmacy and personalized medicine.  The next major section “Prerequisites” helps provide a crash course in the basics surrounding computing and controlled vocabularies then finishes with a really well-done chapter on literature and the web.

From there the book moves onto ‘Information Systems’, breaking them down into hospital and pharmacy along with highlighting the role of informatics in avoiding medication errors.  This is also where a lot of the usual suspects make their first appearances – EHRs, bar coding, CPOE, smart pumps, etc.  I did think that this section missed a couple of opportunities.  Like many other references (and pharmacy education in general – of which I am a guilty party), it really only gave cursory attention to the community setting…despite the vast majority of pharmacists still going to that setting.  Even when it did include outpatient-specific aspects, like automated drug-dispensing machines and automated kiosks, I felt it did a bit of a disservice by not exploring the potential surrounding or psychosocial impact of these types of services.  This section also includes a couple of practically useful chapters on tertiary information sources and PDAs.  Perhaps the most interesting chapter of this section was “Pharmacy Informatics as a Career”.  While it may have been shoehorned in there, it serves as a really nice introduction to the specialty from what type of training is necessary to a pretty in-depth look at the evolution of a pharmacist with experience in different practice settings to a project leader and manager.  I also liked their 25-item informatics specialist job description.

Next was a very robust section on “Decision Support”.  It had a nice hat-tip to evidence based medicine as well as good coverage of classic clinical decision support and pharmacokinetics.  Unfortunately, I found the chapter on data mining (which I was most looking forward to in this section) was a little lacking.  The information there was superior, but I really would have liked to see additional depth, as this is such an exciting area for growth within pharmacy informatics.  The book ends with some forecasting and a peek into the near future (some of which is here now).  It provides a scenario that highlights possibilities for several Web 2.0 tools and approaches for information management and decision support.  It also hits two of my other favorite topics in social networking and open access (more on that in a moment).  The concluding chapter is a pragmatic look at where we can go and how to navigate the obstacles to get there.

Ok, back to the really cool stuff.  If you aren’t familiar with Bourne’s work and experiments with open access, peer review 2.0, and alternate/enhanced venues to disseminate scholarly work – you are missing out.  Don’t feel bad.  I stumbled across them in a variety of ways including seeing a live presentation by JOVE co-creator Moshe Pritsker at Medicine 2.0 a couple years ago, assigning my students and residents to watch some of the PLoS 10 Simple Rules collection (e.g. getting grants, getting published, making good poster and oral presentations, etc.), and reading blog posts about interactive visual posters (i.e., postercasts, pubcasts, etc.) that are housed at www.SciVee.tv.  Seriously, skip the clip of the ice skating monkey on YouTube and use those 5 minutes to go visit the 10 Simple Rules collection and SciVee!

Overall, Pharmacy Informatics is not flawless, but I found it to be as advertised or better.  It is especially timely as we are in the midst of examining education, credentialing, board certification, etc. in the ASHP SAG for pharmacy informatics education.  This book would serve as an excellent text for a course on pharmacy informatics and/or a great resource for a college of pharmacy looking to incorporate informatics into its curriculum.

@kevinclauson

Posted via web from kevinclauson’s posterous

Informatics Masters and Certificate Programs in the US

I teach in our University’s Master of Science in Biomedical Informatics (MSBI) program.  We also have a Medical Informatics Certificate program, a Public Health Informatics Certificate program, and offer a MSBI in Portugal.  However, this isn’t a commercial or sponsored post.  This information is simply to provide some context as to why I am interested in seeing a centralized source of information for all post-bac informatics programs.  More importantly, our Section Advisory Group for Pharmacy Informatics Education in the American Society of Health-System Pharmacists (ASHP) is also looking at this topic and relevant issues for pharmacy.

It would be nice – if similar to the list of hospitals using social media maintained by @EdBennett, the Google spreadsheet of journals with a Twitter presence by @laikas or the Pharma and healthcare social media wiki by @jonmrich – that there was also a comprehensive list of informatics programs.  Ideally it would be broken down into searchable fields (e.g., online/live/mixed delivery models, thesis or non-thesis, clinical or non-clinical focus, college(s) at the university involved, participation in AMIA 10×10, AMIA Academic Forum membership, tuition, etc.) and program titles (e.g., bioinformatics, biomedical informatics, health informatics, health informatics management, medical informatics, security informatics, etc.).

There are several particularly interesting informatics programs in addition to the MSBI at Nova Southeastern University.  For instance, the University of Illinois at Chicago’s Health Informatics program appears to try to cater to individual professions.  As an example, they list Pharmacy Informatics as a specialty with dedicated pages.  Minnesota also has a promising combined MD/MHI program housed in the Institute for Health Informatics (IHI).  The IHI also has the best video overview for a program I have seen so far:

My alma mater (The University of Tennessee) has a Master of Health Informatics and Information Management program, but it is offered through their College of Allied Health Sciences rather than via their college of pharmacy or medicine.  A partial list of US institutions with post-bac informatics programs I have come across thus far include: Capella University, Drexel University Online, Eastern Michigan University, Emory University, Harvard-MIT, Indiana University, Johns Hopkins University, Medical College of Georgia, Milwaukee School of Engineering, Northeastern University, Northwestern University, Nova Southeastern University, Rochester Institute of Technology, Saint Louis University, Stanford University, University of Alabama, University of California (Davis), University of Central Florida, University of Iowa, University of Maryland, University of Minnesota, University of Missouri, University of Pittsburgh, University of Phoenix, University of Tennessee, University of Texas (El Paso), University of Utah, University of Wisconsin (Milwaukee), Vanderbilt University, and Walden University.  Programs that only offer a PhD in informatics are not included in the sample of institutions above.

Some pretty cool training programs such as the CDC’s Public Health Informatics Fellowship and several pharmacy informatics residencies are also available for those in different stages of their careers.

A few websites have collected some of the post-bac informatics programs, but they generally suffer from a combination of missing programs, incomplete information, and (in some cases) are eerily reminiscent of some of the link bait ‘top 50 blog’ sites.  Maybe a comprehensive, searchable site already exists and someone will point it out to me?  Or perhaps I’ll add it to my ‘to do’ list.

@kevinclauson

Posted via web from kevinclauson’s posterous

How easy is it to read dietary supplement patient leaflets?

One of the aspects of information quality that is still very much an imperfect science is readability.  There are a handful of established tools to evaluate it, with the Flesch Kincaid Grade Level (FKGL) being the best known.  The FKGL is simple and thus limited.

I first met Qing Zeng when I was giving a poster presentation during Mednet in Toronto in 2006 (Mednet later morphed into Medicine 2.0).  We exchanged some ideas and our business cards, and that was it for awhile.  We reconnected at AMIA and formally explored some research ideas.  One area of potential collaboration revolved around a tool her group was developing called the Health Information Readability Analyzer (HIReA).

Fast forward to today.  The paper resulting from that initial collaboration was just published in the Journal of Alternative and Complementary Therapies.  In it, we used HIReA and FKGL to evaluate the readability of patient and professional leaflets.  We focused on leaflets of dietary supplements (e.g. ginseng, fish oil, SAMe) used in a common (i.e. diabetes) and less prevalent (i.e. chronic fatigue syndrome) condition.  The patient-targeted leaflets ended up being much more difficult to read than their desired level by both measures.  Part of this may be due to the fact that the leaflets were not created specifically for consumers, they were just scaled down versions of leaflets originally tailored for clinicians and researchers.  Hopefully our results will help provide some guidance as more patient-targeted health information is created, as well as serve as an introduction of HIReA in a broader forum.

@kevinclauson

Note:  If anyone happens to get a glimmer of recognition from the name HIReA, this was also the tool later used to assess the readability of the top 50 prescribed drugs in Wikipedia presented at Medicine 2.0 in 2009 and later at other venues.  Our JACM article goes in-depth about the HIReA tool and will likely address many of the questions people have had about it at the various presentations in conjunction with the Wikipedia study.

 

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