Unsung Heroes: Recognizing the Vital Role of Pharmacy Informaticists in Health Care

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I am hesitant to admit this, but when I started in health-system pharmacy we called it hospital pharmacy, and everything was done on paper. We received paper orders that were transcribed to paper “cardexes” in the pharmacy and paper medication administration records in the patient care unit, and the entire medical record was printed on paper. We thought this remarkably dangerous system was safe at the time. We had no need for an informatics pharmacist or other support staff, but we always needed more paper.

As I write this, the Change Healthcare cyberattack occurred just days ago, and we are still trying to understand the full effect as it ripples through health systems processes. This was just the most recent reminder of how complex and technology dependent the delivery of health care has become. Systems most of us have never even heard of are lurking in the background of more familiar names like Epic and Cerner, and any disruption to the complex web of intertwined and interdependent technologies can have a significant impact on the ability to continue delivering safe and timely health care. Further, the electronic medical record is just one of the many technologies that we rely upon every minute of every day to deliver care. Where would we be without our informaticists, and specifically for our profession, our pharmacy informaticists?

The pharmacy has always relied heavily on our operations staff and our clinically trained staff to provide great pharmacy care, but today we must admit that our informatics staff is fantastic. These employees build all of our operational workflows, create predictive analytical tools to direct clinical prioritization, implement and refine clinical decision support technologies to increase efficiency, develop guidelines and protocols into order sets and panels to assist providers, program sharp end technologies like smart pumps to enhance patient safety, and implement interoperability between technologies and the medical record to improve documentation of care—just to name a few important workflow issues informatics staffers address. They also develop complex databases and queries that can be used to generate hundreds of reports that are accessible through easy-to-use data visualization tools used for business and clinical decisions, quality-control reporting, and many other applications.

In pharmacy we now utilize complex inventory management technologies for perpetual inventory, interface with procurement software to streamline supply chain management, optimize secondary inventory management in automated dispensing cabinets, and even interface with financial tools to automate general ledger transactions for decentralized distribution of drugs to hundreds of clinic locations. Controlled substance monitoring and predictive analytics software can enhance our diversion detection and protection efforts while minimizing compliance risks at the state and federal levels. Behind all this functionality is a complex array of servers, network technology, and cloud-based platforms that also requires a great deal of expertise to keep functional.

Additionally, we are just starting to scratch the surface of what artificial intelligence (AI) is going to do for pharmacy, as well as health care in general. However, it is quite certain that AI is going to have a huge impact that will make us ever better at what we do, enlarging the critical role that our informaticists are going to play as well as increasing our dependency on their expertise.

How would a modern health system pharmacy even figure out how to open the doors without a pharmacy informatics team? It would not be pretty. Unfortunately, we do not always give much credit or recognition to this team until something stops working, or some bad actor successfully attacks some component of our systems. As with many of the people in our professional lives that we become dependent on, it is easy to point fingers when things fail, but we may not always celebrate the phenomenal work being performed by these individuals every day. Usually, we are just demanding more. I am admittedly a nontechnical person, but that does not prevent me from admiring and appreciating the work of my great pharmacy informatics team.

On February 23, about midafternoon, the parenteral nutrition compounding system went down at our academic medical center. There were several orders for neonatal intensive care unit (NICU) patients (the most vulnerable from a nutrition perspective) that still had not “pumped” (we used to call it compounding). This was a critical problem, and our assistant director for compounding services could not formulate a safe plan, or at least one she could live with, for manually preparing these solutions. We really are technology dependent, and the inopportune loss of this system was becoming a critical problem. It took a while, but it was eventually isolated to a network issue on our side of the firewall and was easily corrected. Baby total parenteral nutrition was pumped and sent to the NICUs by 8 PM—crisis was averted, and a lot of gratitude was given to our pharmacy informatics group and network team.

The point of this commentary is that we should all routinely pause to appreciate the critical contributions of our pharmacy informatics teams and extend heartfelt thanks for all that they do 24 hours a day (as sometimes the greatest challenges can arise at 3 PM). I know I could express my gratitude to this team at our academic medical center more often, and perhaps this is the case for others as well.