Informatic Notes Part 1
Informatic Notes Part 1
CHAPTER
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Informatics and
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the Medication
Use Process rib
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Brent I. Fox
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OBJECTIVES
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T his chapter introduces two topics: informatics and the medication
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use process. Informatics plays a critical, enabling role in a safe and
efficacious medication use process. “Setting the Stage: Consensus-Based
Development of Pharmacy Informatics Competencies” describes the devel-
opment of informatics competencies for Doctor of Pharmacy programs
accredited by the Accreditation Council for Pharmacy Education and how
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those competencies relate to the organization of this book. This chapter
provides a foundational introduction to informatics, information technol-
ogy (IT), other key concepts and terms, and related topics. The latter part
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of this chapter describes the organization of this book, with a focus on the
medication use process as the framework for how the book is organized.
The majority of the other chapters in this text address specific applications
of pharmacy informatics’ supporting role in the medication use process.
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Historical Foundations
and Contemporary Definitions
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The term medical informatics first appeared in the 1960s in France. The first
informatics programs appeared in the United States in the 1970s.1 Today,
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 Simply stated, informatics
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is the use of computers to manage data and information. Figure 1–1 illus-
trates that informatics exists at the intersection of people, information,
and technology.3 Throughout this chapter and book, authors will expand
on these components of informatics.
Although the foundational definition of informatics is simple, in today’s
health care environment, many are likely to encounter confusion and a lack
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FIGURE 1–1
Core components of informatics.
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People Information
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Informatics
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Technology
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ogy, to improve individual health, health care, public health, and biomedical
research.”3 The terms may be used separately (i.e., biomedical informatics and
health informatics) in place of the comprehensive term.
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The term medical informatics is also often used. In the strictest sense,
medical informatics describes the application of informatics in health
care settings (which closely matches the National Library of Medicine’s
definition) and is a subordinate component of biomedical and health
informatics. Other key definitions include the following3:
biology.
䡲 Public health informatics: Application of informatics in areas of
public health (surveillance, reporting, and health promotion).
䡲 Consumer health informatics: Application of informatics to
support the patient’s health activities.
䡲 [Other clinical field] informatics: Application of informatics to
specific health care disciplines.
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FIGURE 1–2
Biomedical and health informatics relationships.
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Pharmacy Consumer Health [Other Clinical
Nursing Informatics
Informatics Informatics Field] Informatics
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Bioinformatics Imaging Informatics Clinical Informatics Public Health Informatics
(cellular & molecular) (tissues & organs) (individual patients) (populations & society)
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Biomedical and Health
Informatics
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Informatics = People + Information + Technology (see Figure 1–1)
Figure 1–2 depicts the relationships between these terms.3,4 The figure
illustrates that people, information, and technology provide the foundation
of biomedical and health informatics. Bioinformatics and clinical, imaging,
and public health informatics are subordinate components of biomedical
and health informatics; these components exist on the same tier. Recall
that medical informatics represents the application of informatics in health
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with which readers should become familiar.3,5,6 These terms will be encoun-
tered throughout this text and in pharmacy practice.
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TABLE 1–1
Core Informatics Terms and Their Definitions
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Term Definition
Information technology (IT) Activities and tools used to locate, manipulate, store, and
disseminate information.
Information and commu- Term often used to indicate IT with a focus on communica-
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nication technology tion and networking.
Health information Use of information and communication technology in health
technology (HIT) care settings.
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Health information Discipline historically focusing on medical record manage-
management (HIM) ment (in a paper environment); as medical records transition
to digital, HIM has begun to overlap with informatics.
Imaging informatics Broad term indicating the application of informatics to the
management of images in health care.
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Research informatics Broad term indicating the application of informatics to
health and biomedical research.
Informatician (informaticist) Practitioners of informatics; they focus more on information
than technology.
Clinical informatician Clinically trained individuals whose expertise is applied at
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estimates ranging from 44,000 to 98,000. The problem, however, was not
found to originate with the people providing care; instead, the problem
resided in the systems of care that lead to the occurrence of errors.7 In an
effort to improve the safety and quality of health care, subsequent books
looked at the challenge of increasing the quality of health care delivery8 and
the role of the government (as a purchaser, provider, and regulator of health
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care) in influencing the private sector.9 The fourth book brings us to the
topic of informatics.
The IOM series of books had significant impact on health professions
education, including the field of pharmacy and the domain of informatics.
In the series, a clear progression was made: The first two books define the
patient safety and medical error problem, identify factors influencing the
problem, and identify methods to solve the problem. The third book
(which focused on health care quality) called for an interdisciplinary
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summit to determine the reform necessary to shift health professions
education to a focus on safety and quality. The fourth book reports on the
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findings of the summit.
The summit, which included 150 participants from a variety of health-
related disciplines, focused on the reality that health professions educa-
tion did not adequately address the current and desired future state of
health care delivery; health care professionals were not being educated in
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a manner that equipped them to adequately address the challenges they
would face in practice. These challenges included:
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䡲 A health care system that was significantly segmented, leading to
poor communication and continuity of care.
䡲 A focus on acute care although the largest area of need is
chronic care.
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䡲 An inability to efficiently and appropriately use the growing
scientific knowledge base.
䡲 Inadequate rate of adoption of IT.
䡲 Inadequate involvement of the patient as a decision maker in the
patient’s care.
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of health care delivery could not occur without the efforts of the health
care professionals within the delivery system. Unfortunately, the report
concluded that health care professionals were not being educated in a
manner that would equip them with the knowledge and skills to perform
the necessary redesign. This signaled a need to change the content of
health professions education.10
On the basis of the described challenges, the summit developed rec-
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1. Provide patient-centered care: Focus on patients’ needs, desires,
and values by placing them at the center of their care; emphasize
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wellness and prevention.
2. Work in interdisciplinary teams: Providers should collaborate on
patient care to ensure continuity.
3. Employ evidence-based practice: Augment clinical experience with
the best available research.
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4. Apply quality improvement: Apply safety principles to the process
of care; measure quality and improve processes and systems where
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appropriate.
5. Utilize informatics: Use IT to communicate, manage knowledge, and
support clinical decision making.
matics (Figure 1–3). The premise of the theorem is that a person working
in conjunction with an information source is able to achieve greater
results than if the person works alone. Several tenets of the theorem are
important. First, the information source must provide information beyond
what the person already possesses. Second, the person (pharmacist)
and the information source work collaboratively to achieve a desired out-
come. Although represented by a plus sign, the magnitude of the outcome
is not numerically additive; instead, it is influenced by the interaction of the
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FIGURE 1–3
A proposed theorem of informatics.
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( + )>
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Source: Adapted from C. Friedman’s description of the fundamental theorem of biomedical informatics
in Reference 12.
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person with the information source (as designated by the parentheses).
Finally, the theorem does not suggest that the information source alone is
able to achieve greater results than the pharmacist alone.12
Readers will see throughout this book that informatics tools are applied
at the point of decision making. However, informatics activities also occur
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open comment process, and a thorough review of the literature. For the cur-
rent standards, this process lasted 3 years.
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The standards are designed to equip graduates with the knowledge and
skills to enter pharmacy practice. Accordingly, the standards reflect the cur-
rent and anticipated future state of pharmacy practice. As such, current
pharmacists can also benefit from foundational informatics education. For
student pharmacists and pharmacists alike, the goal of this book is to equip
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readers with fundamental pharmacy informatics concepts, skills, and infor-
mation, as defined in the discussion of the development of the competen-
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cies and developed according to ACPE’s Standards 2007. All pharmacists
will be impacted by information systems in virtually every aspect of prac-
tice. Patient records, medication usage information, insurance information,
laboratory tests and results, and medication administration histories are
just a few of the categories of information that are managed in electronic
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environments. Pharmacists must be able to input, access, share, critically
evaluate, and use information in these systems to support their patient care
efforts, regardless of practice setting. This book was written for these patient
care efforts that every pharmacist performs.
For readers who desire a career in pharmacy informatics, the founda-
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tional information in this book will serve as a core component of the edu-
cation necessary to develop expertise in pharmacy informatics. This book,
however, is not intended to develop pharmacy informatics experts who
are ready to step into a pharmacy informatics position after closing the
book. Expertise in informatics is often developed through years of practi-
cal experience. Table 1–2 lists additional informatics resources, including
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professional associations and journals. The list is not exhaustive but does
include the majority of the most well-known informatics resources.
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