The Pharmacist Informaticist View

Johnanne Ross, PharmD, director of pharmacy IT automation at the University of Pittsburgh Medical Center (UPMC) health system, based in Pittsburgh, Pa., has spent more than 12 years participating in informatics work. She remains as busy as ever working with a multidisciplinary clinical informatics team on ongoing EHR and other clinical IS rollouts across the 20-plus-hospital integrated system.

Ross spoke recently with HCI Editor-in-Chief Mark Hagland about the latest developments in her work at UPMC and her perspectives on what CIOs, CMIOs, and other healthcare IT leaders should be doing right now around pharmacy informatics. Below are excerpts from that interview.

What have been the latest developments in your work at UPMC?

It’s really just a continuation of what we talked about a number of months ago. The ongoing lesson being learned is that these systems are really complex. For example, we have an inpatient electronic medical  record. And now, we have one of the world’s largest comprehensive cancer centers. We have an oncology electronic medical record that we’re going live with in the clinics, and we’ve built chemotherapy protocols; and we’ll be rolling out the oncology EMR soon. And we’re also developing a new retail pharmacy project.

One of the challenges in our environment—we have Cerner [inpatient], Epic [outpatient], and now Aria, the oncology EMR; and we have to make sure all that information is available when different clinicians are using the systems. So we’re on a big learning curve developing all these applications. And we’ve got to make sure the information is readily available.

As a pharmacist informaticist, what issues keep cropping up?

There’s always the balance between getting to go-live and making sure everything is set in place. We actually have a triple-check process on chemotherapy meds. IV meds and chemotherapy meds are very dangerous, and our focus has always been accuracy. Our strength has been knowing the medications. So we get the protocols and do the build, and then a second person does the check, and a third person triple-checks it. We could build the most innocuous medication build in the world, but we need double and triple checks for safety. So that’s where our thrust has been, to make sure the chemotherapy protocols are correct and that the outpatient prescriptions are correct. In addition, we’ve been getting more and more questions from some payers around use of specific drugs. Now, some payers want to know the specific drug being administered to a patient, and the precise dose being given, so things are getting very specific; and some information systems can accommodate that level of specificity, and some can’t. So more and more, we’re having to address interoperability between different systems, and are also getting more and more requests from the financial side, from payers, for specific product-level information.

What is your advice for CIOs and CMIOs on how best to use pharmacist informaticists as part of multidisciplinary clinical informatics teams?

Just having us at the table as part of the team is huge; and I know that sounds trite, but it’s almost as though people don’t know what we know. So they don’t really realize the value of what we can add to a project clinically and workflow-wise. When you’re dealing with medications, we can walk the walk and talk the talk; and the pharmacist is usually close to a lot of smart people as well, not only other clinicians, but analysts. And you need people who really understand medications, because we’re going to think of things other people won’t even think about.