Insight: Clinical Informatics Pharmacist

Achilles Katras

My journey as a pharmacist started in sunny Greece, where I studied for my pharmacy degree and completed a joint community and hospital pre-registration training programme. Frustrated by the lack of clinical pharmacy opportunities in my home country, I moved to the UK in 2013. Since then I have tried to experience different sectors of pharmacy, including community, prison and hospital (where I also completed the University of Bath postgraduate certificate in Clinical Pharmacy Practice).

It was during a short career break that I chanced upon an advert for a Clinical Pharmacist for First Databank UK Ltd (FDB), which delivers clinical decision support (CDS) and medicines optimisation software to thousands of customers

Clinical Informatics

According to the Healthcare Information and Management Systems Society, clinical informatics (also known as health informatics) “promotes the understanding, integration, and application of information in healthcare settings, in order to support clinician objectives industry best practices.” As a field, clinical informatics is interdisciplinary, bringing together healthcare professionals, information scientists and computer scientists.

The improvement of information systems is a priority for the NHS, as highlighted in the NHS Five Year Forward View (October 2014) and the NHS Long Term Plan (January 2019). Among other recommendations, the publications highlight the need for fully interoperable, paperless electronic records connecting all healthcare sectors, as well as using decision support and artificial intelligence to help clinicians in applying best practice, eliminate unwarranted variation across the whole pathway of care, and support patients in managing their health and condition.

In the pharmacy sector, information technology has also come into focus; the ever-increasing uptake of electronic prescribing, as well as the development of CDS and medicines optimisation systems will allow clinicians to utilise the wealth of electronic patient information to facilitate efficient, safe and cost-effective prescribing and dispensing of medication. Moreover, there is a drive towards a widespread uptake of electronic prescribing, dispensing and (in hospitals and care homes) administration of medicines. Finally, the EU Falsified Medicines Directive will require an integrated information system for tracking and verifying medicines through each step of the procurement and dispensing process.

The increasing uptake of advanced information technologies by the pharmacy sector (and the NHS in general) makes clinical informatics an exciting career choice for pharmacists.

Working as a Clinical Informatics Pharmacist

The work of a Clinical Informatics Pharmacist can vary widely, depending on the setting; even within FDB, pharmacist roles depend on the clinical solution we are working for, as well as the special duties and interests of each pharmacist. Pharmacists working in clinical content for Multilex (CDS) and the International solutions tend to focus on drug knowledge database management; they ensure that the drug information (indications, contra-indications, interactions, excipients etc) stored in the database is correct, complete and up-to-date; a lot of them specialise in particular clinical areas or areas of pharmacy practice (e.g. mental health, Drug Tariff & ACBS, diabetes etc).

Pharmacists can also work as Account Managers, who manage geographic clusters of CCGs and other customers, helping to train customers in the use of the software, resolve any issues, facilitate communication between the content team and customers, and generally improve the customers’ experience.

I work on the OptimiseRx solution, which utilises targeted messages to primary care prescribers at the point of prescribing, ensuring that the safest, most cost-effective drug is chosen. In order to do this, we author advanced query logic, which dictates when our messages should trigger.  For example, let’s consider a message suggesting the prescriber opts for fluoxetine instead of other antidepressants for the first-line treatment of depression in children and adolescents (as per NICE guideline CG28). We specify that the message will only trigger when an antidepressant, other than fluoxetine, is newly prescribed and the  patients is between 5 and 17 years old and they are diagnosed with depression. If the prescribed medication is a tricyclic antidepressant, the message logic will also check the patient’s record for other valid indications (e.g. neuropathic pain for tricyclic antidepressants) to ensure the message will only trigger when it really should, minimising prescriber alert fatigue. After delivering the message, the prescriber  has the option of changing the prescription to an appropriate alternative (in this case fluoxetine).

In OptimiseRx, authors research the clinical information we want to present in the message, write the trigger logic behind the message, as well as author the message text in a concise and easy to understand way. A second author will then run the quality control (QC) checks on the message, ensuring it is correct, appropriate and follows company editorial policies. These processes can be completed by both pharmacists and non-pharmacists (Clinical Researchers from different clinical and non-clinical backgrounds) employees, but only pharmacists’ author and check messages with very complex trigger criteria or pertinent to high-risk drugs (e.g. methotrexate), and all message requests are vetted by a pharmacist before authoring, to ensure clinical appropriateness.

Pharmacists in OptimiseRx also participate in vetting message requests and the scope of the request. We also take part in identifying and addressing issues, communicating with customers, and horizon scanning of newly published (or amended) national guidance to ensure it is covered by our messages. Finally, we can also take part in more specialised tasks, such as the appropriate linking of the codes used in GP systems to certain medical conditions in our database, to ensure that our messages “know” when a patient is, for example, type 1 diabetic, pregnant, or under palliative care.

My reflections on working here

When I first applied for the role, I wasn’t sure what to expect, since informatics is not a common career choice for a pharmacist. However, I’ve really enjoyed my time from day one; the training was intense but enjoyable, and I found myself learning a lot about the way GP clinical systems work, as well as principles of authoring and editing clinical content. Although the role has no patient contact, there is still an emphasis on the clinical side of pharmacy, as we need to keep up to date with national guidance and new clinical references. There is also a focus on clinical problem solving, especially when trying to ensure the messages will only trigger for the right patients.

The role combines new technology, medicines information and editorial/ publishing aspects, all of which I find really enjoyable- this wide range of duties (clinical, technical and editorial) helps ensure every day is different and there is always something new to learn. Moreover, working for a high-tech company has its perks (free coffee, fruit, and table tennis, anyone?). Finally, although project work with strict deadlines can be occasionally stressful, it is still way more relaxed than working in community or hospital pharmacy, with weekday office hours being the norm; no late hours, on-call or weekend working.

The main downside for me is the lack of patient contact; I really enjoyed talking to patients and making a positive difference in their health and wellbeing; working as an informatics pharmacist is always behind-the-scenes, and it can be harder to see the difference you are making in patients’ lives. However, it really helps keeping in mind that our work indirectly affects thousands of patients and leads to significant savings for the NHS, which can be reinvested in patient care.

Working with a computer for long periods of time can also be challenging, and I need to ensure I take all appropriate measures to prevent bodily strain; thankfully, the company is very keen on safeguarding and supporting the health and wellbeing of the workforce by optimising workspace arrangements and encouraging regular breaks. Finally, trying to explain what I do to friends and family can be frustrating (but also fun)!

Advice for aspiring informatics pharmacists

In summary, I would highly recommend clinical informatics as a career choice for pharmacists. The learning curve can be steep at times, so the role would best suit pharmacists with a curious mind and a keen interest in new technologies. Attention to detail is also paramount.

Experience in any sector of pharmacy is also a plus. Contrary to many other clinical roles, hospital experience is not necessary; my colleagues have background in hospital, community, primary care, mental health and industry pharmacy, and this diversity of experience is encouraged in FDB. Experience in medicines information, electronic prescribing (especially in primary care) or clinical writing may also be advantageous, but not necessary, as comprehensive on-the-job training is usually provided.

What is FDB?

About FDB

FDB, part of the Hearst Health network, is the leading provider of drug knowledge that helps healthcare professionals make precise decisions. With thousands of customers worldwide, FDB enables clinical system providers to deliver valuable, useful, and differentiated solutions. We offer over  three decades of experience in transforming medical knowledge into actionable, targeted, and effective solutions that help improve patient safety, operational efficiency, and healthcare outcomes.

About FDB OptimiseRx

FDB OptimiseRx ™ is now the leading medicines optimisation solution for primary care in the UK. OptimiseRx combines evidence-based best practice, safety and cost-effective prescribing messages, and delivers them in real time at the point of care during the prescribing workflow.

Used across more than 60% of NHS Clinical Commissioning Groups (CCGs) and Health Boards and thousands of GP practices, OptimiseRx is trusted and valued by prescribers. OptimiseRx is the only solution that delivers patient-specific prescribing guidance, integrated with prescribing workflows, supporting medicines optimisation at the point of care in EMIS Web, TPP SystmOne and Microtest Evolution. Tailored to the patient medical record, OptimiseRx takes into consideration current and previous medications, morbidities, observations and measurements to support prescribers to make the safest, most clinically appropriate prescribing decision.