Informatics: catching the next wave in pharmacy education.

In a society dominated by smartphones and the Internet, US health care is finding itself in a position where it has to race to catch the wave of technological advances sweeping through all aspects of our daily lives. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2013 mandated the implementation of electronic health records (EHRs) and computerized prescriber order entry (CPOE) systems.1 “Meaningful use” is a buzz-phrase on the minds of many hospital administrators and pharmacy managers. Compliance with the vague and confusing requirements for meaningful use is necessary to receive incentives from the Centers for Medicare & Medicaid Services (CMS), but this leaves many pharmacy managers feeling that they have been set adrift without the knowledge or experience needed to navigate these uncharted waters. Pharmacists are extremely well trained to deal with the clinical components of health care, but when it comes to evaluating and implementing EHR and CPOE systems, pharmacists find themselves unprepared. Even in the recent past, pharmacists did not foresee a time when such skills would be an integral part of the profession. The American Society of Health-System Pharmacists (ASHP) broadly defines pharmacy informatics as the “use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of improving health outcomes.”2(p200) Today, this includes systems such as CPOE, EHR, clinical decision support, and many others. To meet such broad expectations, pharmacists need to be able to hit the ground running upon graduation; on-the-job training is not only too late, but in many cases there is a lack of resources available to provide such training. Some pharmacists may be expected to contribute to the selection and/or implementation of such systems shortly after beginning professional practice. Even those not involved in system implementation can expect to interact with these systems as part of their daily duties regardless of their chosen practice. Attempting to implement or use any of these systems without understanding the foundations for the technology, potentials for errors, or how to address problems as they arise can lead to undue stress upon the pharmacist and the potential introduction of additional patient and medication safety hazards for the health care organization. Traditionally, pharmacists did not need an education in health information technology to be successful, but that has changed. In almost every practice setting, pharmacists are required to use computers and increasingly must rely upon electronic references and automated technology such as robots to complete their duties. The Accreditation Council for Pharmacy Education (ACPE) recognized this change in the professional landscape and included informatics in their accreditation standards in 2007.3 Informatics became a hot topic, and professional organizations released statements encouraging the integration of informatics in the practice of pharmacy and pharmacy curricula.2,4 Despite the push to include informatics in professional curricula, a 2008 study identified that only 36% of pharmacy schools had enough informatics material in their curricula to meet the ACPE guidelines.5 It is reasonable to assume that percentage has increased, as many new schools of pharmacy have opened since the publication of that study and established schools have been responding to the ACPE standards to incorporate informatics in the curriculum. Are these changes fast enough to keep pace with the needs of the profession? Additionally, long-practicing pharmacists may seek to update their skillset to ride the technology wave, and they will also need informatics resources. As pharmacist’s roles in health care have changed and expanded over time, pharmacy schools have responded by adding subject matter specialists to their faculty. Soon, adding an informatics specialist to their cardiology, pediatric, and oncologic specialists will be a necessity to ensure that their students are well prepared for the profession they are about to enter. Even though most of today’s pharmacy students have grown up using technology such as cell phones, computers, and the Internet, they still need exposure to informatics during their professional training to introduce them to the technology they will use upon graduation and to give them the skills that will allow them to critically evaluate the advantages and shortcomings of the technology they use. The inclusion of pharmacists in CPOE implementation teams is common, but many of these pharmacists have no substantive exposure to these systems and are poorly equipped to evaluate them or address the needs of other users as they arise. Because pharmacists often use components of these systems that no other health care professional sees, it is vital that pharmacists understand and can critically evaluate those components and the systems as a whole. Although several professional organizations have recognized the need for informatics to be a portion of the PharmD curriculum, this area of study has not yet caught up to the technology, and pharmacists are still entering the workforce ill prepared for the technological challenges that await them. If we do not catch the technology wave now, we may find ourselves washed away by it in the future.