IT和藥劑師:經驗與技術的結合-IT and pharmacist: the combination of experience and technology
ABSTRACT 摘要
Along with the development of information technology, great changes also take place in the profession of pharmacist accordingly. Generally speaking, IT provides useful communication tools and knowledge storage for pharmacist, enabling them to learn from all sources and have more excellent communication with the medicine producers, the hospitals and also the patients. Due to the appearance of CSCW (Computer Supported Cooperative work), EMR (Electronic Medical Record), CADS (Computer Assist Diagnosis System) and other kinds of IT equipments, the pharmacists are armed by more advanced skills and tools for cooperate with other partners in the medicine R&D, prescription and disease diagnosis. On the other hand, IT imposes great influence on pharmacists’ thought and behavior mode, sometimes even makes pharmacists rely on the technology but not their knowledge and experience, which proves to be harmful for the professional and also undermines the welfare of patients. IT brings the profession of pharmacists to a new stage but also provokes us to reconsider the meaning of IT for human society progress and development.
隨著信息技術的發展,藥師的專業也相應發生著巨大的變化。一般來說,它提供了藥劑師有用的交流工具和知識的存儲,使他們從各種渠道學習和與醫藥生產企業,醫院更優秀的溝通。由于CSCW (計算機支持的協同工作)的外觀, EMR (電子病歷) , CADS (電腦輔助診斷系統)等各類IT,藥師與其他合作伙伴合作,武裝醫藥研發處方和疾病診斷。在另一方面,它對藥劑師的思想和行為模式影響很大,有時藥師靠的是技術而不是他們的知識和經驗,這證明專業有害,也破壞了患者的福利。它帶給藥劑師到一個新的職業階段,但也引發我們重新考慮IT對人類社會進步和發展的意義。
KEYWORDS 關鍵詞
Information Technology; Pharmacist; Communication and cooperation; Computer and internet 信息技術;藥劑師;溝通與合作;計算機與互聯網
1. INTRODUCTION 引言
Pharmacist is actually an age-old profession, whose responsibility is to analyze medicine and help patients to choose medicine and use them. In ancient time, the profession positions of doctors and pharmacists are combined together, however, they are departed when it comes to the modern times. Perhaps we are more familiar with doctors in the hospital, but pharmacists are still indispensable positions in contemporary society. Pharmacists work mainly on two fields, drugstore and pharmaceutical factory.
藥劑師實際上是一個古老的職業,其職責是分析藥物,幫助患者選擇藥物和使用它們。在古時候,醫生和藥劑師的職業崗位結合在一起,但是,他們當談到近代離去。或許我們更熟悉醫院的醫生,藥劑師,但仍然在當代社會不可或缺的地位。藥劑師的工作主要在兩個領域,藥店和制藥廠。#p#分頁標題#e#
In drugstores, they give suggestions for patients who are purchasing the medicines and help them do options in thousands of medicines of the drugstore. Sometimes they also could give diagnosis for patients in terms of usual diseases and find apt and specific ways to cope with the diseases. As for the pharmacists in the pharmaceutical factory, they carry out more complicated tasks related with the chemical and medicine experiments and test the performance, function and side-effect of the medicine (Friedman,1997). Along with the society progress and living standard enhance, people become to pay more attention on the health care, on the other hand, medicines are getting more varied, it is necessary to cultivate more pharmacists to help consumers choose suitable medicines and make good use of that.
In the developing countries such as China, pharmacists are compared more important than that of developed countries, although it is still a new emerging profession in China. In fact, the difference of pharmacists and specialized doctor lies in that pharmacists have all-round knowledge related with diseases and health compared with specialized doctors. Due to the advantage of pharmacists, they actually bear the role of “private doctor” for the mass in developing countries, although there are still great gap between pharmacists and the real private doctor. People get used to going drugstores and ask for the suggestions of pharmacists if they suffer from some indispositions.
2. What does IT means for pharmacist: a powerful tool for better communication and knowledge storehouse IT對藥劑師意味著什么:一個強大的工具,更好的溝通和知識倉庫
Of course, in order to be more employable as “private doctor” for the mass, pharmacists should ask for the help of Information Technology (IT). As we have pointed out that, the whole-subject medical science education is still on the beginning in some developing countries, so the private doctors with professional practice certificate are so rare. Most of the students in medical school accept the specialized subject education, such as surgery, pediatrics, and orthopedics and so on. However, being a qualified private doctor or pharmacists requires more whole round medical and medicine knowledge and experience. It is necessary for pharmacists to help the patients to choose suitable medicine with overall medical knowledge in all kinds of aspects, as a result, the IT supplies the pharmacists with great amount of information resource and great knowledge storing (Ornstein,2003).
Basically, IT provides three advantages for pharmacists to improve their work; firstly, IT enforces the relationship between pharmacists and the medicines producers, which enable them to cooperate more tightly to apply the new medicine to patients. The second, IT makes the relationship between pharmacists and hospital, and provides pharmacists more assistance and useful knowledge when they give suggestions to patients. The third, IT enables the relationship between the pharmacists and customers, pharmacists could get to know the situation about the patients after they take the medicines and pay more attention to the effect and side-effect of the medicines through the network. We are discussing the topic of IT and pharmacists based on these three aspects.#p#分頁標題#e#
2.1 The role played by IT in the relationship between pharmacists and the medicine producers
Medicine producing industry always focuses on great resource on the R&D, especially the new product development. Medicine R&D consumes tremendous investment input and proves to be one of the highest cost projects(Pankoke-Babatz,1997). In the process of medicine R&D, there is not only the cost spent in the lab, but also the cost to apply the new medicine on patients, in which pharmacists play important roles. For example, the medicine giants such as Pfizer, Bayer, Roche and Merk and so on, they possess thousands of cooperators spread in the whole world which provide them with medicine application situation and the patient information. The R&D of new medicines is perhaps the most expensive R&D project in all the new product development, a new kind of medicine could be used on the patients only when the medicines are proved to be harmless through many rounds of experiment for many years. For this reason, the development of new medicines is monopolized by several medicine giant producers because small enterprises don’t have the ability to afford the huge investment on the projects.
However, the cost for communication between the pharmacists and medicine producers are so huge that it makes up a great proportion in the whole medicine R&D cost(Shortliffe, 1998). In traditional communication mode, telephone, fax and mail are the most usual tools, which brings amount of cost and time waste for both pharmacists and medicine producers. In the process of new medicine R&D, there will be a plenty of medicine service condition related with patients and the process should be divided into several stages and rounds in order to make sure that the new medicine could be used on patients without any danger(Kraut, 1990). Therefore, it is very necessary for pharmacists to keep touch with medicine producers tightly, but the communication cost impose serious constrict on their information exchange. Nowadays, IT provides new tools for both of them, kinds of on-time communication methods have been used here, such as the MSN, SKYPE, and ICQ, which enable the pharmacists and the medicine R&D staff could discuss the problems just like “face to face”. And also they transfer the pictures and complicated documents through the net and on-time communication tools.
For the past several years, computer supported cooperative work (CSCW) come to people’s life and enter many field such as education, business and government decision. Actually, pharmacists and engineers in the medicine enterprises could also cooperate to finish some works through the CSCW, which means a team cooperates to fulfill the task together in the background of computer supporting and network environment. The concept of CSCW is brought by Irene Greil and Paul Cashman in 1984 of MIT, nowadays, many software systems have been developed to support the CSCW, which are called the “Groupware”(Lucy etal, 1993).#p#分頁標題#e#
CSCW broaden the communication methods between pharmacists and engineers in the medicine enterprises, it provides them learning and working space based on the network, including electronic conference system, tutor system, cyber classroom and so on. They could adopt many kinds of measures to cooperate and solve problems together through email, video and audio conference system, or BBS. Not only pharmacists could get to know the chemical makeup of the new medicines from the medicine enterprise, but also medicine producers could be informed with the patients’ reflection towards the new medicines and also the side-effect from pharmacists. The interaction proves to be very important for whether the medicines could be promoted into the market and used in the practice.
2.2 The role played by IT in the relationship between pharmacists and hospitals
Actually hospitals have their own pharmacists who are responsible for medicine management and distribution. However, the requirements of these pharmacists are diffrent from that of pharmacists in the drugstore or the one doing business on their own, because the latter should learn a lot about the medicine and also the patients’ situation to judge and prescribe.
Although pharmacists have been trained to master many medical science subjects and they could cope with lots of usual diseases in daily life, but they are still in need of the help from hospitals and doctors. An important reason for this is that pharmacists consider patients’ problem mainly based on the perspective of medicine makeup, function and healing effect but the diseases themselves. Faced with some kinds of disease, the pharmacists could not help linking it with the question that “which medicine could heal the disease”, but not the question that “why the patient bears the disease and how to heal it”. The obviously different thought between pharmacists and doctors decides that they should complement each other and cooperate together in the process of diagnosis and treating the disease.
As for an important application of CSCW, Electronic Medical Record (EMR) proves to a new tool for the cooperation between pharmacists and the doctors in the hospital. EMR, also called CPR (Computer-Based Patient Record), actually digitalizes patient records which use electronic appliance to reserve, manage and transfer them(Becker,1993). As we know, patient records have all the information about the patient, including the disease diagnosis, inspection report and medicine usage, and even the surgery and nursing record if there is. Different with traditional patient record, the EMR embodies complete and systematic information about the patient in the whole life, which reserved in the digital database.
Based on the technology of EMR, pharmacists could easily get the information of the patients from hospital through the networks, which help the pharmacists to evaluate the patients’ disease and list suitable prescription for patients. On the other hand, they also could add some new information to the record based on the situation of the patient after they take the medicine. It decreases the cost between them because the EMR could be transferred through the net easily. In addition, some countries have developed the magnetic card which stores the patients’ information about the disease in which they could go for pharmacists to buy medicines with it, and we could also treat the information card as one kind of EMR. An obvious feature and also advantage of EMR is that it could avoid the situation that pharmacists and patients forget former diagnosis result and prescription when the traditional paper medical records are used. Stored as digital information and in the database, the EMR could be reserved for long time and keep the precision, getting rid of the trouble to keep the paper medical records, and of course, the cost to keep the medical records could also be lowered in this situation.#p#分頁標題#e#
2.3 The role played by IT in the relationship between pharmacists and customers
Once upon, medicines are forbidden in the on line transaction, however, the ban has been abandoned as for many kinds of medicines. Customers could easily buy the medicines through the internet and the B-C business mode. Medicine is very suitable to be sold on the web; there are many reasons for that. First of all, medicine is enough small and light to be transferred or mailed after being sold to the customers(Ash, 1997). Secondly, generally speaking, medicine is enough expensive to satisfy the profit requirement of on line sales. They are standardized goods of which the function and effect could be understood easily by customers through the on line introduction and explain. And thirdly, on line sales could get rid of many intermediary sections in the process and lower the cost and price of the medicines, which decides that the on line medicine sales bear many advantages compared with traditional sales mode.
However, the on line medicine sales have not developed to a great scale, because the on line cheating behaviors are so frequent that customers can’t easily judge which on line medicine shops are selling the true medicines. On the other side, customers tend to be induced to buy excessive expensive and less effective medicines by the advertisements of the on line medicine shops. Therefore, in order to promote the development of on line medicine sales, pharmacists could play more important role in this process. There are many tasks which could be fulfilled by the pharmacists, first of all, they could help the customers to distinguish and judge the on line medicine shops, and also help the clients to decide which medicines are necessary for them and which ones are unnecessary. Secondly, pharmacists could get to know how the customers reflect after they take the medicines and keep in touch with them through kinds of news communication tools.
Actually, the IT application on the relationship between the pharmacists and patients could be linked with the EMR and CSCW which have been discussed before in this paper. As we know that, pharmacists prescribe for the patients according to their experience and professional knowledge in the traditional mode. However, single pharmacist’s skills and experiences are limited after all and he or she can’t insure the prescriptions are correct absolutely. Even if the pharmacists could give out the right solutions for the patients, it will take amounts of time and energy.
The appearance of Computer Assist Diagnosis System (CADS) helps the pharmacists to solve the problems to great extents. CADS combine the wisdom of pharmacists, doctors and also the computer professionals, and sets up mathematical models on the computer according to the technology of vague mathematics, probability statistics and artificial intelligence(Eisenhardt, 1989). It deals with the systematic information (historical and contemporary) of the patients and gives out the diagnosis, healing method and also the curing anticipation. Even the patients can’t talk and communicate with the pharmacists face to face; the CADS could still provide excellent diagnosis which pharmacists could rely on. Because the CADS combine quite a lot knowledge and information related with the patients and diseases, it will save much time and energy for the pharmacists in the process of prescription.#p#分頁標題#e#
3 How does IT alter and transform traditional pharmacist working process and function IT如何改變和改造傳統藥劑師的工作過程和函數
Here we know that IT plays important role in the multilateral relationships among pharmacist, customer and also the hospitan and doctor, in the following content, we intend to explore how does IT alter and transform traditional pharmacist working process and function and make necessary comparison.
In traditional way, companies and durgstores list the following requirement when they enroll pharmacists. Here we exhibit two recruitment exercises as the example, which both come from Career Builder (http://www.careerbuilder.com/JobSeeker/Jobs/), and the first instance is Albertsons LLC.
The functions of pharmacist are divided into three parts, essential functions, essential functions under certain circumstance and other functions.
Essential functions:
Takes all steps required to fill prescriptions in compliance with all laws, regulations, and company policies and procedures regarding the sale of pharmaceuticals including: Retrieves the product(s); counts, pours or measures out the required quantity according to established company methods and procedures; affixes the label permanently to the container; and performs a final audit of the prescription.
Assists with and responds in a courteous and professional manner to questions from customers and physicians with regard to knowledge of prescription and health-related products and issues.
Offers advice and professional consultation in compliance with state and federal laws and regulations.
Responds to telephone requests from customers, physicians and vendors, which require the expertise of the pharmacist.
Communicates and cooperates with peers, subordinates, managers, physicians and customers in all pharmacy-related areas.
Maintains all state and federal record keeping for controlled substances.
Essential functions under certain circumstances:
Accepts the written prescription or refill information from customers, confirms completeness of patient record and requests missing information as appropriate, and retrieves the customer’s pharmacy record(s) for verification.
Accesses the pharmacy computer to obtain complete patient record (on both cash and third party prescriptions) and verifies third party plan parameters.
Orders product from distribution center or other appropriate source as necessary
Stocks pharmacy product orders to specific bay locations.
Trains pharmacy technicians.
Provides feedback on pharmacy technician/clerk performance, and amplifies their professional understanding of their role in the pharmacy.
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Monitors inventory levels, rotates stock, utilizes annual return process.
Builds and prints third party report and enters third party sales into the register.
In pharmacies with a cash register:
Ø Operates customer sales register by processing individual customer purchases over the scanner or utilizing a scan gun; accurately reads and records prices for items that will not scan.
Ø Totals customer order; collects cash, checks, credit cards, gift certificates and coupons from customers; enters amount and type of payment in accordance with established company policies and procedures.
Ø Accurately counts out appropriate change to customer.
Ø Bags all product and affixes the receipt to the bag and places company stickers on items that are not in bags.
Other functions:
Knows the location of general over-the-counter merchandise.
Completes an over, shorts and damaged report.
Corrects uncollectible expense reports within allotted timeframe and maintains third party manual.
Files papers and keeps pharmacy equipment and area clean and organized.
Ensures that bags and vials are replenished and that trash is removed and floor is swept.
Attends company meetings for purposes of training, coordinating plans, and communicating policies and procedures.
Performs competition price checks.
Performs other duties as assigned by the Pharmacy Manager/Head Pharmacist and General Manager.
The second example we choose comes from Hoag Memorial Hospital Presbyterian. We focus on the job description for the position of IT pharmacist.
“Hoag Memorial Hospital Presbyterian is a 511-bed, not-for-profit, acute care hospital located in Newport Beach, California in Orange County. Fully accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and designated as a Magnet hospital by the american Nurses Credentialing Center (ANCC), Hoag offers a comprehensive mix of health care services, including Centers of Excellence in cancer, heart and vascular, orthopedics and women's health services. A National Research Corporation Consumer Choice Award endorses Hoag as Orange County's most preferred hospital based on overall quality of health care services and places Hoag in the top five percent of hospitals nationwide. And in a local newspaper survey, Orange County residents have named Hoag the county's top hospital for nine consecutive years.
Our commitment to quality healthcare begins with attracting the most qualified employees and healthcare professionals who wish to work alongside leaders in clinical and allied health sciences. With support and recognition from co-workers and management, our employees have an opportunity to attain the highest level of professional achievement and personal satisfaction in a dynamic and friendly environment.#p#分頁標題#e#
Job Description: reporting to the Pharmacy IT and Systems Manager, the Informatics Pharmacist will assist with the setting up and maintenance of our Eclipsys CPOE and Pharmacy system. Responsibilities include forms and dictionary build, item catalog creation and maintenance, order sets review, building and maintenance, interfacing between CPOE system and other ancillary systems. Informatics pharmacist will also ensure that the information systems we build support a clinically safe and sound patient care environment. Our systems are clinically driven and are supported by a team of professional IT personnel.”
Obviously, there are great difference between two position enrollments and job requirements, as for the first one, it is not necessary for the pharmacist to master advanced IT skills, the only things related with IT is answering telephones from customers physicians and vendors, and “Accesses the pharmacy computer to obtain complete patient record (on both cash and third party prescriptions) and verifies third party plan parameters.” Even in the item that “Communicates and cooperates with peers, subordinates, managers, physicians and customers in all pharmacy-related areas.”, IT skills are not emphasized and brought to an important position. However, in the second instance, the position has been changed into “IT pharmacist”, all the work and function of the employees are surrounded with Information Technology, including Eclipsys CPOE and Pharmacy system. From these two examples, we could find that IT has alter the position of pharmacist to a great extent.
4 Conclusion 結論
Here it is necessary for us to summarize the main content of this report, the influence imposed by information technology on the medicine industry and the position of pharmacists could be divided into three aspects. At first, IT shortens the time needed in the communication process among pharmacists, hospital and doctors and patients through advanced appliances and equipments. Secondly, IT enhances the diagnosis accretion degree, which is based on enlarged knowledge pool and different opinions interaction among pharmacists, hospital and doctors and patients. And thirdly, to a great extent IT lowers the cost and expenditure for pharmacists to fulfill their tasks to prescribe and to be informed with new medicine research and development information(Travers, 2000).
However, what we need to point out in the last of this report lies in that information technology is a two-side sword when used in the medicine industry and the profession of being pharmacist(Whittaker etal, 1994, Davenport, 1993, Bulkeley, 1992). As we all know that, computer language is digital and linear after all, it is lack of human affection and nonlinear thought, information technology appliance could be and only could be made by human beings, and it obeys every order given by engineers and technicians absolutely and lack the capability to make the orders into further use. Information technology tools could compute and duplicate at very high speed, but they can not come to any innovation and invention. IT could be very helpful for pharmacists to decide which medicines are suitable for patients, but it is impossible for pharmacists to rely on IT to make the final decisions. Every patient has his or her characteristics and disease features different with each other which IT can not take into consideration completely, so it is the experience and knowledge application of pharmacists to make the right prescription, but not the IT machines. IT provides only useful tools for pharmacists to make decisions, but not the decisions themselves.#p#分頁標題#e#
Looking into the future, it is undoubted that IT will be used more broadly in the field of medicine research and development, and also the position of pharmacist, the welfare of patients will definitely be improved because of the advance of the IT application. However, no matter how does the technology is advanced, it just provides tools for pharmacist. It is the responsible attitude of pharmacists that promote the profession development.
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