ASHP InterSections ASHP InterSections

June 14, 2011

Board of Directors Meeting

Filed under: Calendar Event — jmilford @ 9:20 am

Commission on Credentialing

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Legislative Day/Board of Directors meeting

Filed under: Calendar Event — jmilford @ 9:18 am

Informatics and the Health-System Pharmacist

AMONG THE SIGNIFICANT TRANSFORMATIONS in hospital pharmacy practice that have pushed the profession toward more direct, safe, and effective patient care, the emergence of informatics ranks near the top. When they are well-designed and properly implemented, the complex technologies that constitute pharmacy informatics can reduce medication errors, streamline medication-related processes, monitor patient status, and provide pharmacists, physicians, and nurses with instant access to critical information at the point of care.

“The precision and safety we can provide to the medication system has been astounding,” said Leslie Mackowiak, R.Ph., M.S., director of clinical information systems at Vanderbilt University Medical Center in Nashville. Vanderbilt’s integrated medication system supports electronic transfer of medication information from physician ordering, through pharmacy verification, to nursing bar-coded medication administration and documentation.

The system verifies the dispensing authority of the caregiver and the patient’s identity; matches the identity with the medication profile from the pharmacy information system, which has checked against alerts or reminders; and then records the action in the electronic medication administration record.

Hospitals considering this type of new technology must weigh the equation of patient safety and quality of care, according to Karl Gumpper, R.Ph., BCNSP, BCPS, FASHP, director of ASHP’s Section of Pharmacy Informatics and Technology.

“Is this technology going to prevent a bad outcome and add a level of patient safety? Will caregivers be able to take better care of patients?” he queried. “In most cases, the answer is yes.”

ASHP Leading the Way

ASHP continues to be at the forefront of this special field, offering members a special section, continuing education and information resources, and practice documents like the Statement on the Role of Pharmacists in Informatics.

The Society also ensures that key elements of informatics and technology are rolled into every major Society initiative. For example, at ASHP’s Pharmacy Practice Model Initiative Summit in Dallas in November 2010, participants noted that key elements of pharmacy informatics are “important enablers” in developing optimal pharmacy practice models.

These elements include:

• Computerized physician order entry (CPOE)

• Automated dispensing/robotics

• Electronic medical records (EMR) systems

• Bar code technology during medication administration

• Clinical decision support systems (CDSS) integrated with CPOE

• Systems that capture and report pharmacy metrics and outcomes data, among other kinds.

According to ASHP practice surveys, 18.9 percent of hospitals used combined CPOE and CDSS, up from 10.4 percent in 2007, and 17.8 percent of hospitals reported the adoption of information technology (IT) to some degree by 2007.

Informatics creates a better safety net by removing stumbling blocks scattered throughout paper-based systems, such as prescription transcription errors and overreliance on memory, which too often result in medication errors, according to Gumpper.

“The ability to document a pharmacist’s intervention at the bedside into the medical record by laptop or tablet gives pharmacists the tools to actually do what they were trained to do in school and their residencies,” he added.

Informaticists as Liaisons

Enhanced patient safety is just one potential benefit of pharmacy informatics, according to Gumpper. He noted that technology that processes and verifies patient medication orders on the ward or in the clinic creates better work-flow efficiency and greater satisfaction among nurses and patients.

But technology cannot stand alone. Pharmacists who implement and manage pharmacy informatics systems consistently identify one factor as crucial to successful outcomes: translating clinical necessity into information technology (IT) systems and processes.

Without question, pharmacists, not IT professionals, are best suited to play that role, said Chris Urbanski, R.Ph., director of pharmacy informatics and medication integration at Indiana University Health in Indianapolis.

These pharmacy informaticists “bridge the gap and act as liaisons and interpreters between the purely IT and the clinical realm,” said Urbanski. “We have the clinical training, and I can much more easily teach information technology to a clinician than I can teach an IT person the clinical side.”

Pharmacists are obviously not computer scientists, added Mackowiak, who cultivated her expertise by working closely with IT experts. “You’ve got to know how to manage a database and envision how information will look on a computer screen. Those aren’t skills taught in pharmacy school.”

William Churchill, M.S.

Demand for pharmacists with IT credentials will only keep rising, according to William Churchill, M.S., chief of service in the department of pharmacy at Brigham and Women’s Hospital in Boston. “As the profession grows, we’ll need more individuals with strong pharmacy backgrounds who also understand information systems,” he said. “These are pharmacists who can sit at the table and talk the language of informatics with software developers, systems analysts, and informatics managers.”

Finding those unusual skill sets isn’t easy, and pharmacy schools lag well behind the curve in filling this yawning knowledge gap. “There is not an abundance of people trained appropriately in health care informatics coming out of pharmacy schools ready to fill our needs,” Churchill said, adding that the profession must find new ways to prepare pharmacists for a future in which familiarity with informatics will be mandatory.

The Future of IT and Pharmacy

That future will see more connectivity among the assorted components of medical informatics. Ideally, the right information will flow more freely to clinicians precisely when and where they most need it, but without interrupting their work flow (persistent alerts for inconsequential drug interactions, for instance, only annoy and distract users). Caregivers, said Mackowiak, should not have to look from chart to chart or wait until they visit a patient’s room to obtain the most up-do-date case information, such as lab values or pain scores.

“In the past, you would have to query a few charts, search around, or go to the floors to find the patient record,” said Christine Beuning, Pharm.D., BCPS, pharmacy informatics application analyst with MultiCare Health System, which is based in Tacoma, Wash. “Now we can generate a report within our electronic health record in 30 to 45 seconds that includes specific clinical information from a patient’s chart. Pharmacists have always been in a contest with other providers for the paper chart, and now we’re more able to share the information.”

The reach of informatics will inevitably extend beyond individual hospitals and hospital networks. For instance, a specialist in Seattle outside of the MultiCare network will, with the patient’s permission, be able to call up relevant information from the patient’s EMR, seamlessly preserving continuity of care. E-prescribing will enable pharmacy informatics systems to capture prescriptions filled at retail pharmacies, bringing clinicians a step closer to complete medication reconciliation for patients who are moving between outpatient and inpatient care.

“Right now, we’re focused on what’s going on inside the four walls of the hospital,” said Gumpper. “Informatics gives us the opportunity to move beyond that and think about the care of the overall population of patients we serve. We’re going to take a much bigger view.”

The Growing Focus on Credentialing and Specialization

IN A TIGHTENING JOB MARKET AND WITH NEW national health care quality standards on the horizon, pharmacists are increasingly turning to specialty certification. From 2005 to 2010, the number of board-certified pharmacists more than doubled, to nearly 10,500 practitioners. The jump doesn’t surprise William Ellis, R.Ph., M.S., executive director of the Board of Pharmacy Specialties (BPS) in Washington, D.C.

“Interest in board certification is growing rapidly because there is increased national emphasis to document and hold health care professionals accountable,” said Ellis. “One way to do that is through certification, which attests to a certain level of experience and knowledge among providers.”

Board Certification through the Years

BPS introduced its first specialty certification, for nuclear pharmacy, in 1978. Today, there are five additional specialty pharmacy certifications, in ambulatory care, nutrition support, oncology, psychiatric, and pharmacotherapy (by far, the most prevalent). BPS is currently evaluating three more potential specialties—in critical care, pediatrics, and pain and palliative care—to determine if each represents a knowledge base and skill set sufficiently distinct for specialty designation.

ASHP has long been at the forefront of the pharmacy specialty movement, convening a conference in 1990 with the American Association of Colleges of Pharmacy (AACP), the American Pharmacists Association (APhA), and the American College of Clinical Pharmacy (ACCP) to examine the future of certification. ASHP also works directly with BPS and other stakeholders in exploring new specialties, supporting the need for a sound process for developing new specialty credentials.

“We saw early on that specialization and credentialing were the wave of the future for pharmacy,” said ASHP Executive Vice President and CEO Henri Manasse, Jr., Ph.D., Sc.D. “Everything is moving in the direction of higher skill and knowledge bases.”

William Ellis, R.Ph., M.S., executive director of the Board of Pharmacy Specialties

ASHP championed four of the current BPS specialties and has created more specialty review and prep courses than any other organization, including its courses for the new ambulatory care specialty certification. In addition, Manasse and ASHP helped create the Council on Credentialing in Pharmacy, which provides leadership, guidance, and coordination for the profession’s credentialing programs. ASHP also pushed for the recent publication of technician and pharmacist credentialing frameworks, which guide policy development.

Growing Acceptance

In some sectors of pharmacy practice, board certification is becoming commonplace. David Witmer, vice president of member relations at ASHP, has spearheaded work on four petitions to BPS and notes that the vast majority of pharmacists who are currently board certified practice in hospitals and health systems.

“Nearly 15 percent of ASHP’s pharmacist members have obtained certification,” he said. “APhA’s recent decision to pursue accreditation of community pharmacies, the emergence of ACO’s [accountable care organizations], an increased focus on quality, and ASHP’s Pharmacy Practice Model Initiative are all likely to fuel further expansion.”

Daniel Hays, Pharm.D., BCPS, clinical pharmacist with University of Arizona’s University Medical Center

For Daniel Hays, Pharm.D., BCPS, a clinical pharmacist in the emergency department at the University of Arizona’s University Medical Center in Tucson, board certification in pharmacotherapy differentiates him from his peers.

“When you earn certification, it shows that you took one step further to demonstrate that you are a highly trained individual who has dedicated a good portion of time to training and education,” Hays said. And as program director for second-year pharmacy residents, Hays sees very practical reasons for the new generation of pharmacists to become certified.

“Just about every position my residents apply for requires board certification or expects them to get it within a certain amount of time,”he said.

Speaking Physicians’ Language

For many pharmacists in their fifties and sixties, retirement is a moving target. Gary Stoehr, Pharm.D., dean of the D’Youville College School of Pharmacy in Buffalo, thought he might have retired by now. “But given the market, I’m glad I didn’t,” he said. “These things come in cycles, and I’m glad I rode it out.”

That is the case at the University of Chicago Medical Center, where all recently hired clinical pharmacy coordinators and clinical specialists are either board certified (and residency trained) or agree to become certified within 18 months, explained Heath Jennings, Pharm.D., BCPS, director of pharmacy acute care services and graduate pharmacy education at the 600-bed hospital.

“Physicians understand residency training and board certification. It speaks their language,” Jennings said. “My focus has been to decentralize pharmacy practice and put more specialty pharmacists on the units and at the bedside. Board certification is a marker of competence that tells me they will succeed in that.”

Even pharmacists with many years of experience are seeking certification. Robert L. Talbert, Pharm.D., FCCP, BCPS, professor of pharmacy at the University of Texas College of Pharmacy in Austin, was already a full professor and past president of ACCP when he got his pharmacotherapy certification in 1994.

”When someone is board certified, I know that they know what they’re doing,” he said. “Professionals in other areas of medicine understand the importance of board certification, but many in our own profession don’t yet appreciate its true significance.”

Certainly, board certification may mean a larger paycheck, but compensation is not a primary motivation for most pharmacists who seek certification, Talbert insists.

“In surveys asking the reasons for board certification, peer respect still tops on the list,” Talbert said. “Part of it is also the personal satisfaction of proving to yourself that you can jump this fence.”

The link between residency training and certification is also maturing. Certification in the respective specialty is expected of pharmacists who serve as directors of PGY2 residency programs. Starting in 2013, only ASHP-accredited residencies or other BPS-recognized training programs will be recognized in BPS eligibility requirements.

Pharmacy Leadership Academy Opens New Horizons

Participants in the ASHP Foundation's Pharmacy Leadership Academy discuss aspects of leadership.

FOR MICHELLE CORRADO, PHARM.D.,  the creation of the ASHP Foundation’s Pharmacy Leadership Academy (PLA) in 2007 came at the perfect time. A year earlier, she became the system director of pharmacy services for Hallmark Health System in Medford, Mass., with responsibility for a staff of about 50. Always on the lookout for opportunities to hone her skills, Corrado discovered a game changer when she enrolled in the PLA in 2008.

“I was a new leader, had a new team, had managers under me, not to mention a cadre of staff,” she said. “The course opened my eyes to a whole world of resources and gave me the confidence and basic skills at an important point in my career.”

Empowering Pharmacists to be Leaders

 The PLA is a rigorous, Web-based distance learning program for aspiring pharmacy directors, newly appointed directors, and any pharmacists who want to elevate and polish their leadership skills. Developed by the ASHP Foundation’s Center for Health-System Pharmacy Leadership, the course consists of nine six-week modules stretched over 15 months. Each module covers a specific area of competency. Elements of the program include prerecorded video presentations by distinguished leaders in pharmacy, interactive live discussions in which students can speak directly to faculty and one another, small-group projects, and readings from a range of sources.

The Academy exposes pharmacists to the possibilities of what they can achieve and empowers them to grow into effective leaders, said Richard Walling, R.Ph., M.H.A., director of the Center for Health-System Pharmacy Leadership. Corrado agrees with Walling’s appraisal.

Michelle Corrado, Pharm.D., system director of pharmacy services, Hallmark Health System, Medford, Mass.

“What I learned is readily applicable to situations and challenges I deal with all the time,” she said. One of the recurring themes from the PLA is how important it is for leaders to engage with their staff. She wasted little time putting the idea into practice by initiating an annual retreat for her department’s leaders.

Over three days every February, Corrado and her managers meet off-site to gauge their progress toward department goals, refresh milestones, reassign responsibilities, and consider budgets. “It’s worked phenomenally well,” she said. “Our plans have fallen into place. Everything links to everything else, and everything has a purpose.”

Finding Effective Approaches

Lynn Eschenbacher, Pharm.D., M.B.A., began the PLA in January. Soon after beginning the course, she noticed a shift in her mind-set about her work.

“I began thinking more about how I led and what approaches were most effective,” said Eschenbacher, who oversees 70 employees as assistant director of clinical services at WakeMed Health & Hospitals in Raleigh, N.C.

From interactions with other PLA students, she also realized that every problem usually has multiple solutions. “When a question comes up in class, it’s exciting to see how many different answers come back. That’s broadened my viewpoint,” she said.

Recently, the ASHP Foundation announced a big dividend for PLA students. Graduates are eligible to put credit hours toward advanced degrees at two accredited colleges: a master of health administration at Simmons College, and a master’s degree in management, public policy, or health information management at New England College.

All of the PLA programs are distance learning. The credit waiver applies to students who complete the 2011 and subsequent PLA courses. Pre-2011 alumni (whose PLA programs were shorter) can qualify for the exemption by completing two capstone modules.

The potential savings in time and money are significant, said Walling. Simmons College, for example, will waive 28 of the 48 required credit hours toward its master of health administration track (each hour costs more than $1,000). PLA students are also eligible for course credit from the University of Florida’s master of science in pharmacy program, provided they apply before beginning the Academy curriculum.

The PLA, observed Walling, “is the only program I know of with the opportunity to delve into the leadership aspect of pharmacy and then go on to a master’s level program and come out with a comprehensive set of skills required to lead a pharmacy enterprise.”

Corrado is taking the capstone modules in preparation for a master’s degree. Janice Glascock, Pharm.D., completed the PLA in 2009 and also began the capstone courses to make her PLA certificate creditworthy toward a master’s program. Glascock is the assistant director of clinical and educational services at Emory Healthcare in Atlanta and manages a staff of 27.

The Academy “opened up options for how I behave as a leader in ways I’d never considered before,” she said. “Sometimes it’s as simple as being a better listener or being more empathetic to others’ concerns, and finding approaches that satisfy needs beyond my own.”

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