Drug Informatics 6 weeks

• -Use of computers to manage data and information
• -At the crossroads of people, information andtechnology

Optimal Use of information, often aided by technology, to improve individual health, health care public health, and biomedical research

• 1. Bioinformatics (cellular/molecular)
• 2. Imaging Informatics (tissues/organs)
• 3. Clinical Informatics (patients)
• 4. Public Health Informatics (populations/society)

• Patient-Specific Informatics
• Knowledge Based Informatics

information created in the care of patients

Scientific literature of health care

Prescribe, transcribe, dispense, administer, monitor

• -access from a variety of sources
• -access from a a variety of types

• Data: raw facts
• Information: interpreting/giving meaning to data
• Knowledge: analyze/synthesize info
• Wisdom: using knowledge to achieve goals/clinical expertise

• 1.Utilize a systematic approach
• -access drug info
• -tailor to client
• 2. Integrate information
• -determine critical content
• -formulate relevant and appropriate response+recommendation

• Primary-studies, creates new data
• Secondary- databases and indices 
• Tertiary- Textbooks, reviews

• Adv: Easy to find info, time-effecient
• Disadv: recency of information (information currency), bias, lack of depth

• -blue cover
• -international drug database
• -links products to country
• -published by pharmacists in uk every 2-3 years
• -unique pharmaceutical data like structures and crossing barriers
• -pharmacopoiea standards

• 1. Monographs on drugs and ancilliaries
• 2. Supplementary drugs, substances
• 3. Proprietary preparations

• -red cover
• -authoritative in the USA
• - very in-depth information+opinions
• -E-AHFS provides references(most books don't)
• -ODB uses AHFS classification system (organized from 1->100 based on alphabetical order [i.e. antihistamine is first])
• -provides uses and indications
• -very limited use to patients due to detail

• -Drug Dex
• -Drug Points
• -Detailed Drug Informaion for the Consumer 
• U.S. published

• -Part of Micromedex
• -very detailed info (comparable to AHFS)
• -extensively referenced, usually from primary sources
• -includes comparison between therapies section

• Part of Micromedex
• -less detailed than DrugDex
• -suited for patient counselling
• -Specific to USA
• -Has unique features (trade/generic availability, class and regulatory status, how supplied, clinical teaching, images and imprints)

• Part of MicroMedex
• -suitable for reading through with patients
• -pronunciations
• -blackbox warning
• -proper usage
• -missed doses
• -etc.

• -Published by CPhA
• -non-prescription equivalent of TC
• -most info from DPD (monographs),some from CPhA staff
• -comparative product tables
• -for health care professionals
• -Information for patient (similar to blue CPS pages[online information for the patient pages]), as well as monographs, and directory

• -Guide for Pharmacists to guide patients when selecting OTC
• -List of illustrations
• -Patient information Pages
• -Organized by body systems, then specific ailments
• -Lots of appendices (including complimentary/ alternative medicines, home testing, meical devices)

• -For Health Care Professionals
• -Primarily MD authored
• -quick guide/overview (not as detailed as 3 american texts)
• -also contains product comparisons

• Describes properties, claims, indications and uses for drug product
• -Organized in a standard format based on health canada regulations
• -Manufacturer Authored+government approved
• -detailed, expert authorship, scholarly, variable in length, factual

• 1. Healthcare professional information
• 2. Scientific information
• 3. Consumer information

• -part 1 of drug monographs
• -similar to CPS version. 
• -pharmacology+ indications+ use+ evidence+ safety+ geriatrics/pediatrics

• Warnings are side-effects of medication
• Precautions are preventable

-standardized classification

• -Part 2 of drug monographs
• -pharmaceutical info
• -clinical trials
• -comparative bioavailability studies
• -toxicology, microbiology
• -references

• -part 3 of drug monographs
• -General disclaimers
• -warnings precautions
• -interactions
• -proper usage
• -missed doses
• -side-effects (and management of)
• -etc. etc.

-site to find most product monographs for Canadian products

• -published by CPhA
• -Annual publication (online updated in real-time)
• -consists of different sections with various colouring

Brand and Generic Name Index

Therapeutic Guide

Product Identification Guide

Directory (poison control, health centres, manufacturer numbers)

Clinical Information

Information for the patient (only available online)

Monographs

Appendices+ Glossary

• cross-reference brand + generic names
• includes products discontinued after 2000
• Italics: generic drug name, active ingredient or therapeutic category
• Boldface+underlined: prescribing info in monograph section
• Boldface: availability info in monograph section
• Regular typeface: product available in Canada, but not in CPS (usually found in DPD)

• Grouped by ATC classification (anatomical, therapeutic, chemical)
• Not very exhaustive

• Pictures of products arrangedaccording to colour
• generally life size+ colour
• voluntary participation
• nearly 60 manufacturers participating

• poison control centres
• health organizations
• pharmaceutical manufacturers

• quick, practical reference
• broad spectrum of info,
• calculation/dosing tools, clinical monitroing, drug interactions
• ingredients of concern in packaging

• useful for patient counselling
• content of info similar tomonograph, but less depth
• 6th grade language

• -listed alphabetically by tradename
• -voluntary listing by manufacturers
• -some are CPhA monographs (shaded/grey pages)

• narcotics + controlled substances + other targetted substances
• special access programs
• A.D.Event reporting
• vaccine associated adverse event reporting

• Medical Abbreviations
• Latin prescriptionterms
• microorganism abbreviations
• risk factors for drug use during pregnancy

• mainpurpose to assisst HCP prescribing and dispensing
• not suitable for patients
• no references
• full editions published every couple years, online constantly updated

• Drug or combination of drugs in a particular dosage form and strength designated as interchangeable with another form
• onus on manufacturer to provide evidence of interchangeability

• 65+
• homecare
• ltc/special care
• trillium drug program
• ontario works/disability program

• 1: introduction:policy andinformation
• 2: preamble: % of dbp that is prescribed for odb drugs is 8%
• 3: formulary listings
• 4: consolidated alphabetical indexof drugs listedin 3a+ 3b
• 5: index of pharmacological and therapeuti cclassification
• 6: facilatedaccess drug products
• 7: trillium drug program
• 8: exceptional access program
• 9: additional benefits
• 10: manufacturer's abbreviations, dosage forms, relative potencies
• 11: not in use
• 12: limited use products

Policy and information

% of DBP that is prescribed for ODB drugs is 8%

• Ontario Drug Benefit Formulary/Comparative Drug Index
• -includes list of interchangeable drug products
• -includes limited use criteria(listed with shaded background)
• Categorized using AHFS system

• Off-formulary Interchangeability
• Application of interchangeable designations to drug products where original products not listed as ODB benefits
• Became effective april 1, 2007
• categorized using AHFS system

• Goes from 0-100
• first classification is alphabetically listing therapeutic names
• then lists generic names alphabetically

• Access to legislation + ODB/CDI
• Access to 4 specific types of references
• subscription to a drug information service

• A current edition of a Canadian Compendium
• A current edition of a drug interaction publication
• A current edition of a pharmacotherapeutic text
• Patient counselling guide

• CPS
• e-cos
• e-therapeutics (satisfied drug interaction+pharmacotherapeutic requirement as well)

• Drug interactions Analysis and Management (Hansten and Horn)
• Drug Interaction facts (Tatro)
• Evaluations of Drug Interactions ( Zucchero and Hogan)
• [previous 3 all published annually]
• e-therapeutics
• lexi-interact
• pharmacy software programs of any above texts

• Applied therapeutics: clinical use of drugs (published every 5 years; Koda-Kimble and Young; uses case-based approaches)
• Pharmacotherapy: pathophysiologic approach (published every 3 years; DiPiro,Talbert et al. )
• Textbook of therapeutics(published every 6 years; Herfindal)
• Therapeutic Choices (Gray et al; CPhA; every 3 years)
• E-therapeutics

• Patient Connect Drug and Disease Information
• Detailed Drug information for the consumer
• Lexicomp Patient Education

• Drug Information and research Centre (OPA; at sick kids)
• Sunnybrook
• LONDIS
• Ottawa Valley
• Solutions in Health (windsor)

prevention of errors and adverse effects to patients associated with health care

pursuit of reduction and mitigation     of unsafe acts within the health care system,as well as the use of best practices to lead optimal patient outcomes.

• contribute  to culture of patient safety
• work in teams for patient safety
• communicate effectively for patient safety
• manage safety risks
• optimize human and environmental factors
• recognize, respond to and disclose adverse events.

• new medications, discontinued medications, altered dose medication
• may also have medications separated by times of administration

Medication reconcilliation + provincial drug profile viewer (only 1/100 pADE)

patient centred discharge and post discharge follow-up

23%; 72%

50%, 40%, 60%, 40%

Note how it's more dangerous to transfer within hospitals than to be released home

• Patient's accurate and comprehensive medical history compared to medication prescribed at admission/transfer/discharge 
• -helps to identify discrepancies between what they take and what was prescribed

Best possible medication discharge plan

BPMH taken when going from home to hospital (admittance); BPMDP taken when being discharged from hospital to home

new medications, discontinued medications, adjusted medications (may also divide medications by when you should be taking them)

• Computerized prescriber order entry
• 70,000/year
• helps reduce order entry by improving communication+co-ordination
• but also increases errors (like omission errors, duplication, lack of flexibility errors etc.)

So many alerts, you choose to ignore them, until the one time the alert could have actually helped you.

Duplicate errors, computer down-times, and interface mismatches (this is the one that contributes to the largest number of discrepancy errors)

• shift in practice patterns to reflect constraints of the system
• hybrid situations (not all medications in online database; not all units in an institution may have the system implemented)
• lack of face-to-face communication due to everything being technology based

Vendor/software limitations: consistency and safeguards need to be balanced with user flexibility

• Need to standardize [Institute for safemedication practices (ISMP)]
• TallMan lettering
• Unacceptable abbreviations
• generic names vs. brand names
• units
• standard dosing times

• training/education (needs to be succinct and thorough, and must be ongoing)
• Human Factors (alert fatigue, inattentional blindness, excessive clicking)

• Increased: medication omissions (most common error), dose discrepancies
• Decreased: illegible orders, misspelled drugs, orders for "pharmacy to clarify"

6.3 milly, 47% of popn of Ontario

• program to promote integration between GTA clinicians (ex. of E-health)
• Drivin by clinicians and clinical priorities across care continuum

• 1) single sign-on
• 2) connectingGTA providers portal
• 3)ConnectingGTA potlets in other portals
• 4) Direct integration into Point of Care applications

• Didn't decrease in median time to communication
• Did find that it increased amount of communication(better method to communicate)

History (Hx), physical exam (Px), and patient identifiers(age, sex, d.o.b.)

• CC-chief complaint (why person sought care)
• HPI-history of present illness (symptoms)
• PMH-past medical history
• FH- family history (immediate family members)
• SH- social history
• OH- occupational history
• ROS-review of symptoms

• Appearance
• vital signs
• HEENT
• Lab data
• Assessment (diagnoses)
• Plan(recommendation for care)

• Subjective (patient's discription)
• Objective (observable information)
• Assessment (progress/evaluation)
• Plan (decision to proceed/change plan)

• Hx and Px 
• Physician's orders
• Nurses/pharmacists other HCP's notes
• consultation report (by specialists)
• informed consent+ancilliary reports
• discharge summary

Present data objectively, and avoid comments irrelevant to patient care; are used for reimbursement of cognitive services

• Yes, they are being used more
• the most important aspect is their interconnectedness.

• Community pharmacy information system
• Hard copies (of prescriptions)
• Supply chain documentation (important for recalls )

patient owns their information, but the pharmacy/physician owns the record and it cant be withheld from the patient.

the Pharmacist preserves the confidentiality of patients and doesn't divulge except where authorized by a patient or required by law

• patients own their info, and it must be protected
• giving info out except when authorized by patient or their caregiver is professional miscondunct

• used to describe ability of certain health information custodians to assume an individuals implied consent when delivering care.
• It's not defined in PHIPA
• Only if there's a risk to somebody else, or a group of peoples

• People that have people's health records.
• Must have a commitment to confidentiality as well as protection from theft, loss, inappropriate disposal of data

federally funded initiative to get EMR and interconnectedness between points of care

• electronic medical record: equivalent of charts seen in doc offices
• PHR: personal health records; records of appointments/correspondence with HCP
• MMS: medication management system; drug informatics system
• Drug Profile Viewer: ontario inititive to be able to see ODB claims in community pharmacy
• EHR: electronic health record; aggregation of information from various HCP
• E-health standard: agreed upon rule or format to maximize interoperability

More work at the the bottom (individual articles), less current at the top (systematic reviews)

conscientious, explicit, and judicious use of best evidence for therapy tailored to an individual patient

• "semi-published literature"
• posters, presentations etc.
• not as useful in health care(but could be useful in generating research questions)

Relevant, novel, interesting, feasible, solution is applicable, population is your population, your results will answer the question but also ask two more

uses PICOT format

• Open-source-clinical-application-resource
• 5 applications: 

• 1) EMR
• 2) My DrugRef- drug information
• 3) CAISI (facility/bed/case management; used at IMAGINE clinic)
• 4) Resources (acessible database of bookmarks for patients/clinicians)
• 5) MyOSCAR= PHR (tracks your medical info/allows communication with HCP

• participatory Health care
• Patient-centred
• HCP as facilitators, partners, then authorities of health

Content, communication, commerce, community

Automated pharmacy robotics machine, dispenses 60 most common drugs.

• Pharmaceutical care through the use of telecommunications and information technology
• Lack of access to pharmacist
• Category 1 ($8.20/prescription)

• patients with conditions, or pharmacists as expert bloggers
• One aspect of Web 2.0

• Stress best managed by changing our thought
• Best way to fight off a bunch of diseases is 30 mins of walking a day.