Informed Health Care
Published on 19 September 2019
The growing popularity of using at-home DNA testing to learn more about ancestry, health traits and drug metabolism has made bioinformatics a buzzword, but bioinformatics is only one example of how informatics has impacted society. Across all pharmacy and medical practice settings and specialties, informatics has revolutionized the way health care is delivered. From prescriptions at a pharmacy to online electronic medical records, health care informatics plays a key role in providing personalized care and improving patient outcomes.
By developing a better understanding of how informatics has impacted health care today, with a special attention on pharmacy informatics, providers from all disciplines can better anticipate and even advocate for positive and efficient growth in health care informatics, as well as in health care education.
The System of Health Care Informatics
Throughout patients' lifetimes, their many interactions with health care providers create vast webs of information that are shared through the intricate linkages between health care systems.
"Health care informatics is essentially anything that is produced by a patient encounter, which can take many forms," explained Scott Micek, Pharm.D., FCCP, BCPS, professor of pharmacy practice and director of the Center for Health Outcomes Research and Education at St. Louis College of Pharmacy. "If we are talking about a patient at a clinic or a primary care physician, the information that is recorded is mainly administrative-claims type data."
"If a patient goes to their doctor with flulike symptoms, the doctor may create a diagnosis-related claim that will say 'this person has the flu', " Micek continued. "From there, the claim will go into a repository, and most likely create an insurance claim. Now, if the doctor were to prescribe a medication to treat the patient’s flu, the patient would then go to the pharmacy where that prescription is filled, and that would create a prescription claim. So the information, or the informatics, from this patient's initial visit to their trip to the pharmacy can be studied and reported on as it is all fed from the administrative claims."
There are, of course, barriers in making sure that the data being collected is translated across health systems when health care organizations do not share common information systems.
"In the United States, electronic health record data are treated as a separate entity," Micek continued. "There are very few repositories that blend administrative claims and the electronic health record. But if you went to the United Kingdom or Canada where they have a one-payer system, all of that patient information is linked together. It is a little trickier in the U.S."
Because of these interoperability issues between systems, siloed data plays a large roll in contributing to inefficient care built on assumptions.
"The unfortunate thing about data is that everyone stores it differently," said Brett Venker, Pharm.D. '13, BCPS, associate of commercial development at Roivant Sciences. "One health care system may call a patient's cholesterol labs one thing and another may call them something slightly different. If an informaticist were to get both of those data sets, there is no clear way of knowing whether the two labs are both results for LDL cholesterol labs just by the name, which then results in siloed data."
There are certainly gaps within health care informatics, especially within the U.S. health care system, but there are approaches and partnerships being forged between health care institutions that are working to bridge those gaps for more streamlined patient care.
"A next step is really destyling all of the medical data and having it in a format that is completely translational across the entire country," Venker said. "This is particularly important for pharmacy, in addition to the medical community as a whole. If you get all of this data together, you can see that a patient has been taking a medication for 10 years – that is 10 years' worth of data. From this data, pharmacists can evaluate how effective the medication has been when looked at alongside data that details the course of the patients' health care history. There are many retrospective studies that can be done when all of the information is housed under one system or platform."
Health care informatics has also created a shift in the level of access patients have to their own electronic medical records, which can be an empowering tool when treatment is being delivered by two different health systems that do not share information systems.
"The patient having access to their results and health record is a fairly new development," Micek said. "When patients have access to these records, they have the ability to share their information with any of their providers. The patient may not fully know what their lab results and electronic medical histories mean, but when they are sharing it with their providers, they are linking systems, albeit on a very personal level, that may not have been previously linked by a shared information system that allows different hospitals to talk to each other."
A Look at Pharmacy Informatics
A pharmacist who creates an order set for specific treatment algorithms is engaging with pharmacy informatics but the impact of informatics on pharmacy greatly depends on the role and scope of the pharmacist. However, pharmacists are certainly seeing the benefits of pharmacy informatics, and not just because prescribers can now send prescriptions electronically, typically avoiding transcribing errors.
"When a pharmacist sees a diagnosisrelated code, for example heart attack, that can inform, based on prescription records, whether the patient is on the right medication," Micek said. "But what that diagnosis-related code doesn't tell the pharmacist is why the patient is not on this medication and for what reason. However, that can trigger a deeper investigation into whether the patient would be a good candidate for other medications recommended for their condition and identify medications that may be omitted, sometimes for specific reasons.
In another instance, you may have a patient on three medications that act similarly. The informatics on this patient can help identify therapeutic duplications, which allows for a team-oriented approach to make sure the patient is on the right medication list."
An Informed Future
From research implications to educating future health care providers, health care informatics is the inevitable future in providing more streamlined and effective patient care and encouraging interdisciplinary care through linked patient information.
From a research perspective, health care and pharmacy informatics is creating new opportunities for exploration in cases where traditional experimental models are not feasible.
"When you are evaluating massive amounts of data, you can only make associations and that is very different from causation," Micek said. "If you are comparing this medication to this other medication, it is only associated with a reduction in recurrence, but if you did an experimental study, this medication versus this medication, it's a direct cause and effect. The problem is that it's just not possible to get resources and approval to do many of those experimental studies. It is cost-prohibitive to do an experimental study for every question that may appear. So researchers rely on these massive amounts of data to help answer those questions."
As health care informatics continues to grow and evolve, there are rising questions of how to better prepare future health care providers. The study of informatics has certainly become more prevalent in health care education, but not every student pursuing a health care degree will be an informaticist.
"There is no question that health care students are going to encounter the results of an informaticist's work – that is where the education needs to be," Micek said. "There needs to be an understanding of what is done, what goes into the work, the inputs and the outputs, and how to use that information. The education needs to be the application of those results."
Health care informatics is becoming an essential component of health care education, but with that knowledge and understanding, there is a second step that still needs to be realized – the understanding that patient care does not begin and end with the patient interaction.
"We are all stewards of patient data," Venker explained. "Part of being a pharmacist or any health care provider is to not just talk to patients and create treatment plans serving their needs. It's about making sure that the information is relayed to the next provider who will treat that patient – that the provider will have accurate information and in good order."
Every day, the role of health care informatics is being refined and partnerships are being forged between health systems turning disconnected care to a more seamless route to health. Investing in responsive health care education that will better prepare students for a rapidly changing health care system is investing in an informed future.
This story was featured in the spring 2019 issue of Script magazine. To read past issues of the magazine, visit the Script magazine archive.