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APhA Name Change, 2002 Election Results, and Pharmacy Technology APhA Membership Approves the “American Pharmacists Association” By an overwhelming vote, a bylaws amendment will change the name of the national professional society of pharmacists. Nearly 90% of the APhA members who cast ballots in the fall 2002 election voted in favor of the name change. The results of APhA’s 2002 ballot were certified on December 5, and transition to the new name will occur after the conclusion of the Association’s Annual Meeting & Exposition in April 2003. The change is in concert with moves over the past 25 years by APhA’s affiliated state associations. Only associations in 6 states plus the District of Columbia still use “pharmaceutical” in their names, whereas 32 state associations use “pharmacists,” and 12 use “pharmacy.” According to APhA’s Board of Trustees, which proposed the name change in January 2002, the new name accurately reflects the composition of the organization’s membership and their vital
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role in the nation’s health care system: making medications work for patients. The new name also will eliminate frequent misperceptions about who APhA represents. “People hear the word ‘pharmaceutical’ and automatically think about drug products or the pharmaceutical industry,” said APhA President Janet P. Engle, PharmD. “APhA’s leadership decided that it simply made no sense for the nation’s only association for pharmacists in all practice settings to have a name that did not clearly state who we represent. The results of the 2002 ballot show that our members clearly agree.” Added Engle, “Now we can more effectively go about our business as an advocate for America’s pharmacists.”
APhA Announces Fall 2002 Election Results Justine Cannistra
On December 5, 2002, the results of the fall 2002 election of officers and trustees of the American Pharmaceutical Association, the leadership of the APhA Academy of
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Pharmacy Practice and Management (APhA–APPM), and the leadership of the APhA Academy of Pharmaceutical Research and Science (APhA– APRS) were certified. The results follow. Daniel A. Herbert of Richmond, Herbert Va., has been elected 20032004 president-elect of APhA. Herbert is currently serving on the APhA Board of Trustees and the boards of EPIC Pharmacies, the American College of Apothecaries (ACA) Research & Education Foundation, and the Medical College of Virginia (MCV) Foundation. Herbert is a 1966 graduate of the MCV–Virginia Commonwealth University School of Pharmacy and the owner of three innovative community pharmacies in Richmond. His past experience includes hospital pharmacy and home infusion practice. Elected with Herbert to serve on the APhA Board of Trustees for 2003–2004 are Timothy L. Tucker, PharmD, Huntingdon, Tenn., Rod Shafer, Renton, Wash., and Karen L. Reed, Beckley, W. Va. Stephen E. Dibble of Mission Viejo, Calif., has been elected 2003–2004 honorary president. Tucker is a clinical community pharmacist at his familyowned and operated pharmacy in Tucker Huntingdon. Currently, he serves on the APhA Board of Trustees as 2002–2003
Speaker of the APhA House of Delegates, a position he held in 1997–1998. Tucker received his PharmD from the University of Tennessee College of Pharmacy, where he works as a part-time faculty member. Additionally, he serves as a preceptor in the Community Pharmacy Residency Program and for clinical rotations. Shafer is chief executive officer of the Washington State Pharmacy Shafer Association. Since receiving his BS in pharmacy from the University of Washington in 1977, he has worked in long-term care, hospital, and community pharmacy settings. He is an affiliated associate professor at the University of Washington School of Pharmacy. Shafer has served on the Washington Home Care Advisory Committee, Washington State Public Health Improvement Plan, Healthy Mothers/ Healthy Babies, and various local and state health task forces. Reed was member-at-large of the APhA–APPM Executive Committee (2000–2002) and served as chair of the APhA– APPM Reed Community and Ambulatory Section (1999–2000). She is a graduate of the West Virginia University (WVU) School of Pharmacy, and currently Continued on page 6
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Continued from page 4 works as a staff pharmacist for Kmart in Beckley. She is a consultant pharmacist for Beckley Surgery Center and chair of West Virginia’s Medicaid DUR Board. Reed is an APhA Fellow, serves as a preceptor for WVU PharmD candidates, and volunteers at Healthright, a free clinic in her community. Dibble joined APhA as a pharmacy student in 1953 and graduated from Washington State University with Dibble a BS in pharmacy in 1957. Dibble was first employed in San Francisco at Mary’s Help
Hospital Pharmacy, and then moved to Los Angeles. He has owned Key Rexall Drug, La Paz Pharmacy, and Mission Medical Pharmacy. He is a founding member and former chairman of the APhA–PAC Board of Governors and a member of ACA. Valerie T. Prince, Birmingham, Ala., has been elected 2003–2004 APhA–APPM president-elect. Prince graduatPrince ed from Mercer University and completed a residency at the Regional Medical Center in Memphis. She currently works as a pharmacist at Healthsouth
Hospital and is a faculty member at Samford University. Prince has served APhA–APPM in many Section offices and is currently serving as member-at-large on the APhA–APPM Executive Committee. She was the 1997 recipient of the Alabama Pharmacy Association Distinguished Young Pharmacist Award. Earlene E. Lipowski, Gainesville, Fla., has been elected 2003–2004 APhA–APRS presidentelect. Lipowski Lipowski earned her BS, MS, and PhD degrees in pharmacy at the University of
Wisconsin–Madison. She is an associate professor of pharmacy health care administration at the University of Florida. Lipowski is an APhA Fellow and has been active in both elected positions and committee service. She served as member-at-large and chair of the APhA–APRS Economic, Social and Administrative Sciences Section, chair of the APhA–APRS Education Standing Committee, and member of the JAPhA Editorial Advisory Board. Justine Cannistra, JD, LLM, is policy & regulatory reporter, Pharmacy Today.
2002 Academy Section Election Results APhA Academy of Pharmacy Practice and Management (APhA–APPM) Executive Committee
President-elect (2003–2004)—Valerie T. Prince, Birmingham, Ala. Member–at-large (2003–2005)—Marialice S. Bennett, Columbus, Ohio Member-at-large (2003–2005)—Joni I. Berry, Raleigh, N.C. Administrative Practice
Chair-elect (2003–2004)—Dennis Bryan, Chicago, Ill. Member-at-large (2003–2005)—Cynthia J. Boyle, Baltimore, Md. Clinical and Pharmacotherapeutic Practice
Chair-elect (2003–2004)—Brad P. Tice, Urbandale, Iowa Member-at-large (2003–2005)—Bella Mehta, Columbus, Ohio New practitioner (2003–2005)—Lynne M. Ciardulli, Reston, Va.
Community/Ambulatory Practice
Chair-elect (2003–2004)—Paul A. Ackerman, Palm Beach Gardens, Fla. Member-at-large (2003–2005)—Judith B. Sommers Hanson, Huntley, Ill. Hospital and Institutional Practice
Chair-elect (2003–2004)—Wendy J. Friedig, Omaha, Neb. Member-at-large (2003–2005)—Michael P. Wascovich, Cleveland, Ohio New practitioner (2003–2005)—Sara A. Burda, Baltimore, Md. Nuclear Pharmacy Practice
Chair-elect (2003–2004)—James (Jim) F. Cooper, Charleston, S.C. Member-at-large (2003–2005)—Kara L. Duncan, West Lafayette, Ind. Specialized Pharmaceutical Services
Chair-elect (2003–2004)—David H. Schwed, Mt. Laurel, N.J. Member-at-large (2003–2005)—Page Dunlap, Hartselle, Ala. New practitioner (2003–2005)—Jeffrey J. Rochon, Seattle, Wash.
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2002 Academy Section Election Results (Continued) APhA Academy of Pharmaceutical Research and Science (APhA–APRS) Clinical Sciences
Executive Committee
President-elect (2003–2004)—Earlene E. Lipowski, Gainesville, Fla.
Chair-elect (2003–2004)—William R. Garnett, Richmond, Va. Member-at-large (2003–2005)—Susan C. Fagan, N. Augusta, S.C. Postgraduate officer (2003–2004)—Michael J. Brownlee, Kansas City, Mo.
Basic Pharmaceutical Sciences
Chair-elect (2003–2004)—Robert B. Greenwood, Buies Creek, N.C. Member-at-large (2003–2005)—Mary F. McManus, Wilkes-Barre, Pa. Postgraduate officer (2003–2004)—Randall J. Voytilla, Pittsburgh, Pa.
Economic, Social and Administrative Sciences Chair-elect (2003–2004)—Ronald S. Hadsall, Minneapolis, Minn. Member-at-large (2003–2005)—David A. Mott, Madison, Wis. Postgraduate officer (2003–2004)—Erin R. Holmes, Cheswick, Pa.
APhA–APPM
and having to make the transition from typewriter to detachable keyboard and CRT. Younger pharmacists cannot even imagine life in the pharmacy without a computer. How is all of this “advancement” likely to affect the profession in the future?
Where is Technology Taking Pharmacy? (Better Yet, Where is Pharmacy Taking Technology?) Brad Tice
Technology is developing at an almost unnerving pace. Consider just the advances within the past decade or so. I remember sitting on a plane in 1994, listening to a friend describe the Internet and e-mail and thinking, “I’ll never understand this stuff.” In the mid-1980s, did you imagine that one day you would be taking and sending digital pictures through cell phones? How about in the early 1990s, when you were buying a computer? At the time, the decision was whether you needed to upgrade to 16 MB of RAM and a 125 MHz processor for a desktop computer. And, do
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not forget the 14 kB modem you could purchase. Now, standard computers have gigabytes of RAM and processors several magnitudes faster; not to mention cable, T-1, and DSL connectivity and personal digital assistants (PDAs) that fit in the palm of one’s hand that may be underpowered for providing wireless access to e-mail and the Internet if they feature only 16 MB of RAM. What does all this technologic advancement mean for pharmacy? No doubt, many pharmacists remember life before computers became the primary tool in the pharmacy
The Hedgehog Concept Taking a step back and looking at pharmacy then and now, despite all of the technology that has been introduced, the pharmacist is still the central figure in the pharmacy, not a kiosk, computer, or robot. Dave Weinberg, former chief executive officer of Fel-Pro, which before it was sold was a Fortune 500 company that specialized in manufacturing gaskets and was rated as one of the top places in the United States to work, has related the decision to implement technology to questions of quality: The decision is based on the ability of technology to improve the processes in place, not to
increase efficiency or eliminate jobs.1 In fact, the effects of technology on pharmacy practice to date have been overwhelmingly beneficial. Computers help process prescriptions, speed up billing, and check for drug interactions. Bar code scanning, interactive voice response systems, and Pyxis machines all improve the quality and efficiency of the medication delivery process. Likely future advances in pharmacy technology include robotics, touch screens and biometrics on computers, paper prescription scanning or e-prescribing, and drug information and data collection devices encapsulated in handheld devices. On a larger scale, technologic advances are likely to include highly technology-driven mail service and central fill facilities to support prescription volumes projected to increase from 2000 to 2005 by 46% while the number of pharmacists increases by only 6%, almost an eight-fold disparity.2
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In his book on what makes companies successful, Good to Great,3 Jim Collins wrote, “Technology-induced change is nothing new. The real question is not, ‘What is the role of technology?’ Rather, the real question is, ‘How do good-to-great organizations think differently about technology?’” He also stated that “technology by itself is never a primary cause of either greatness or decline.” What his group of researchers found is that the key to “great” organizations is that they are technology accelerators. So: It is not so much technology that will make or break pharmacy’s future as it is the decisions that drive or define how new technology will be used. Continuing on the themes considered in Good to Great, the determining factor for pharmacy’s future, and, subsequently, its use of technology, depends upon what the profession defines as its hedgehog concept 3: a simple, crystalline concept that guides all of the organization’s efforts. From Collins’s work, the hedgehog concept is based on the answers to three questions: What are you deeply passionate about? What can you be the best in the world at? What drives your economic engine? Pharmacy must decide, and soon, what its hedgehog concept is. Is it centered on the convenient delivery of medications, or is it centered on bringing about positive patient outcomes? Looking at each of these three questions and seeing how technology fits into each answer, here is what can be seen. What are pharmacists
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deeply passionate about? Certainly, a core group of pharmacists has always been passionate about patient care. This group has increased in numbers and influence over the past decade as the concept of pharmaceutical care has evolved and a core mass of data establishing the value pharmacists can provide has accumulated. Also, most pharmacy chains and many independently owned pharmacies have either established some sort of patient care program or are trying to do so. Concurrently, pharmacy associations have initiated and sustained a concerted push to establish pharmacists as patient care providers, and there has been a great deal of work in pharmacy practice to get pharmacists’ value recognized. All of this indicates that patient care is probably the issue of greatest importance to a critical mass of pharmacists. Yet the majority of pharmacists, including those seen most often by the public, remain focused primarily on the necessity of delivering medications safely and conveniently. Technology can be and is being developed to improve the quality of the medication delivery process. With 20% of pharmacists’ time being spent on third party-related administrative tasks, there is certainly room to make better use of pharmacists’ time and skills.4 However, if pharmacy’s hedgehog concept is centered on medication delivery, future technologic enhancements will be focused on workflow and process improvements. If, on the other hand, it is centered on drug therapy outcomes, addi-
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tional technology will be needed to facilitate patient care, monitor patient outcomes, and if technology’s full potential in pharmacy is to be realized, to incorporate genetic data and make use of artificial intelligence to provide treatment recommendations based on primary literature and patient demographics. What can pharmacists be the best in the world at? Pharmacists have the training to be the best in the world at two tasks—delivering medications safely and conveniently and achieving positive outcomes of drug therapy. If pharmacists choose the latter, they must actively pursue the development and integration of technology in this area. Already, bar coding, robotics, and large mail service facility technology have been shown to enable the delivery of medications with lower error rates than humans, even to the point that some boards of pharmacy allow these facilities to check 1 prescription per 1,000 prescriptions dispensed. This indicates that the decision is currently being made based on delivering medications conveniently. While population demographics resulting in ever-increasing drug utilization for the next 2 to 3 decades may allow pharmacists to maintain a role here, this path is not likely to help pharmacy thrive as a “profession.” Pharmacists’ training gives them the capability to be the best in the world at achieving positive drug therapy outcomes. However, pharmacists who do not use these skills in daily practice may lose them and fall behind physicians,
nurse practitioners, and other prescribers in being able to ensure positive outcomes of drug therapy. Pharmacy is further advanced in the use of technology in maintaining patient charts, providing drug information, and billing for services and can leverage this position to transition into using technology to advance the appropriate use of medications. What drives pharmacy’s economic engine? Without a doubt, pharmacy’s current economic engine is driven by payments for dispensing prescriptions. The disconnect that has impeded the adoption of pharmaceutical care as a standard of practice has been the lack of reimbursement or payment for pharmacist-provided cognitive services. Pharmacists have, for the most part, been unable to establish payment mechanisms for services provided or patient outcomes achieved. If pharmacies choose to maintain the business model of payment for prescriptions on a commodity basis, it will likely result in technology to improve the quality of the delivery of medications and will likely lead to more and larger mail service and central fill facilities. Such a decision also will likely lead to a diminished professional status for the profession. Pharmacists must adopt pharmaceutical care as their hedgehog concept and use the current economic engine of prescription volume to drive it while leveraging the opportunities to develop the cognitive services economic engine. Based on the degree of drug therapy misuse in the United States,5,6 there currently exists the capacity to do this. For
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instance, if statin compliance is currently approximately 43%,7,8 each pharmacy is missing 8 out of 12 prescriptions per year. Pharmacists can work to increase compliance and reap the financial rewards from this effort while establishing their cognitive services.
Accelerate Technology Developm ent to Im prove Patient Care As stated in the report Professionally Determined Need for Pharmacy Services in 2020,9 “The opportunity for improving the quality of drug use, and, thus, the quality of patient outcomes and quality of life in this country is staggering.” Good patient care may well make the difference that will enable pharmacies to thrive within the current economic environment. Identifying patient care as the driver for technology development should help accelerate the development of technologies that will help pharmacy establish the value and put into place additional payment systems for pharmacists’ cognitive services. No doubt, technology will continue to develop at a rapid pace. The types of technologies that get developed and used in pharmacy practice, however, will depend on the need for quality improvement and the role pharmacists determine to establish for ourselves, or let others establish for or impose on us, in the health care system. The kinds of technologies the profession needs are those that accelerate the pharmacist
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care hedgehog concept centered on positive patient outcomes and serve to overcome obstacles to the delivery of patient care, help pharmacists document their contributions to drug therapy outcomes, and help pharmacists establish payment structures for our services. Accelerating technology development in these areas will breathe life into pharmacy’s hedgehog concept and improve the quality and safety of medication use. Brad Tice, PharmD, is assistant professor and director, College of Pharmacy and Health Sciences, Drake University, president of Rx Intervention Systems, Des Moines, Iowa, and a 2002–2003 Academy of Pharmacy Practice and Management (APhA–APPM) Section on Clinical and Pharmacotherapeutic Practice member-at-large.
References 1. Weinberg D. Organizational structure and analysis. Paper presented at: Shaping Your Pharmacy Future; February 3, 2001; Des Moines, Iowa. 2. Ziegler R. Opening general session state of the industry report. Presented at: National Association of Chain Drug Stores Pharmacy and Technology Conference; August 2000; San Diego, Calif. 3. Collins J. Good to Great: Why Some Companies Make the Leap ... and Others Don’t. New York, NY: HarperCollins Publishing; 2001. 4. Arthur Andersen LLP. Pharmacy Activity Cost and Productivity Study. Alexandria, Va: National Association of Chain Drug Stores; 1999. 5. Johnson JA, Bootman JL. Drug-related morbidity and mortality and the economic impact of pharmaceutical care. Am J Health Syst Pharm. 1997;54:554-8. 6. Ernst FR, Grizzle AJ, Drugrelated morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001:192–9.
7. Avorn J, Monette J, Lacour A, et al. Poor compliance with lipid-lowering medications. JAMA. 1998;82:61–5. 8. Andrade SE, Walker AM, Gottlieb LK, et al. Discontinuation of antihyperlipidemic drugs do rates reported in clinical trials reflect rates in primary care settings? N Engl J Med. 1998;243:373–80. 9. Knapp DA. Professionally Determined Need for Pharmacy Services in 2020. Alexandria, Va: Pharmacy Manpower Project; 2002.
Brown APhA–APRS
A New Era in Pharmacy School Education Lawrence Brown
Just as the Industrial Revolution changed the landscape of American society more than any other period, one could argue that the technologic revolution is changing the face of the classroom to the extent that it is all but unrecognizable from the teaching environment of just a generation ago. Technologies, most notably the computer and the World Wide Web, have improved the efficiency and breadth of classroom instruction and continue to do so at a remarkable pace. I doubt many faculty members would wish to exchange today’s color laser printing and desktop publishing tools for yesterday’s typewriter and mimeograph machine.
Progress Yields Challenges Computers and computer technology have innervated the pharmacy classroom. Using laptops and LCD pro-
jectors, professors present their lectures in PowerPoint format, and everywhere students and faculty are pulling out their personal digital assistants (PDAs) to check their schedules and look up drug information. Not only are many schools requiring students to have a laptop, but many schools are also completely integrating the laptop into the classroom. A number of pharmacy schools even have a local area network connection at each seat in a classroom so that students can download PowerPoint lectures and follow along on their laptop. The Internet is also having a profound effect on both pharmacy instruction and student learning. Students now have immediate access to a tremendous amount of research that was previously available only in print. Also, search engines such as MEDLINE have largely made Index Medicus a thing of the past. However, the Internet has also created a greater challenge for professors as they try to prevent plagiarism. Although most term paper Web sites have been closed down, students can be incredibly resourceful when it comes to avoiding the task of writing their own papers. Also, the
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Web offers good and bad information, and many students are using Web sites as references for their papers without much regard to the sites’ credibility. The ubiquity of e-mail has made communication much easier, as well. With the click of a mouse, students can send questions and comments to their professors and submit homework assignments. Students also find e-mail useful for communication and coordination when working with their peers on class projects. Faculty members can communicate with all of their students at once through the use of a listserv. Using e-mail to disseminate class notes and assignments also cuts down on the amount of copying needed. The downside of email is that its ease of use can result in a flood of communications that require replies. And the old excuse “my dog ate my paper” has been usurped by the now convenient excuses “I never got that e-mail” or “I sent my assignment via e-mail—I don’t know why you didn’t get it.” Lastly, even with the widespread use of antivirus software, the spread of computer viruses via e-mail is still a major concern.
In the C lassroom Computer software programs such as PowerPoint have largely transformed inclass lectures. While some professors still prefer to give purely oral lectures, I believe that most have found that using presentation software engages students by making material more visually appeal-
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ing and allowing instructors to update lecture notes more easily. These programs are not as useful for classes such as medicinal chemistry, however, since it is still pretty difficult to import depictions of molecules or show drug metabolic pathways into presentation packages. And the limited amount of information that can be presented on each slide makes it difficult to use PowerPoint to present a large amount of information at one time. Two technologies that are starting to be used more often in the pharmacy classroom are digital video and Web-based streaming video. An example of the latter is RealPlayer. These technologies are changing how students learn about pharmaceutical care and patient counseling. While the concept of videotaping students as they perform various tasks is not new, having the video accessible at any time on the Web is much more convenient for the students and eliminates the need for bulky VHS tapes. Almost any class that has a demonstration component can benefit from the use of streaming video. I have seen these technologies used successfully in the pharmaceutical care lab. They can be used for at least two purposes. One is to allow students to view examples of what should be done. For instance, professors might videotape themselves or someone else doing a pharmaceutical care work-up on a patient, then upload the video to the class Web site so that students can view the process before they perform their own patient work-ups in the lab.
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Such a practice would allow students to develop a good idea of what is expected from the interaction with the patient and eliminate the need for the professor to demonstrate the work-up repeatedly. The second purpose is to allow students to view and critique their own performances. Students can view their videos at their convenience via the Internet and can assess how they performed. Many pharmacy professors have also used the Web to post syllabi, assignments, and links to Web sites. Again, these capabilities allow convenient access to this information and permit professors to disseminate large amounts of information without having to make paper copies. Technology is also being used to establish online, or virtual, classrooms. Many schools are successfully teaching courses such as medical terminology completely online. Creighton University, in addition to their traditional pharmacy program, offers a Web-based distance learning PharmD degree, where all didactic courses are taught via the Internet or CD-ROM. Whether this will prove to be the new nirvana for pharmacy schools or a road that should have been left untraveled has yet to be seen. However, some schools have had good success thus far in training post-BS PharmDs via the Internet.
Technology Should Take a Cue From Spielberg The biggest challenge posed by computer technolo-
gy in the classroom relates to students’ and instructors’ ability to use it. Contrary to popular belief, not every student enters pharmacy school as a computer expert. Not all students can create a Web site, set up a local area network, or build a computer from scratch. In fact, many students only know the basics about computers and computer software. Unfortunately, many faculty members know even less, although this is changing. Some professors are still learning how to cut and paste or how to reformat cells within Microsoft Excel, not to mention how to create PowerPoint slides, upload information to the class Web site, or stream digital video. And although the use of technology in the classroom is, overall, a positive development, moderation remains a virtue. Technology should not be used just for the sake of using technology. This caution is especially true when the technology inhibits, rather than improves, student learning. An example of the latter would be the use of a chat room for group discussions when the students may not be familiar with the intricacies of a chat room. These students might find themselves overwhelmed by the process, and they are likely to spend an inordinate amount of time trying to figure out how and when to submit a comment. The process and etiquette of chat rooms can be challenging to master. You are forced to communicate in much shorter exchanges of information. If you try to type a three-paragraph response to a comment,
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the subject will most likely have changed before you submit your response. Also, while it is relatively easy to formulate your response while still keeping track of the group conversation when it is taking place in person, it is much more difficult to keep track of the conversation in an online chat session while you are typing your response. Another difference is that you cannot use nonverbal clues to show that you want to jump in and make a comment. Hence, students may feel excluded from the chat session. In a documentary on the making of the Indiana Jones movies, Harrison Ford said that Steven Spielberg always made sure that the stunts never drew the viewers’ attention away from the actors. The stunts were meant to make viewers connect with what was happening to the actors, not to overshadow the plot. The same should be true with technology in the classroom. Technology should only be used to engage students’ attention and help them connect with the information being presented in the course. Is technology in the classroom a good thing? I believe it is. Technology has improved the efficiency of classroom instruction, but it is also presenting new challenges. The question that remains is, Has technology improved the quality of the pharmacy graduate? If the answer is no, then maybe we are just using technology for technology’s sake, and maybe these new tools are shifting faculty’s focus away from students. That is a question that each institution needs to answer.
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Lawrence Brown, PharmD, is a PhD candidate in social and administrative pharmacy, College of Pharmacy, University of Minnesota, Minneapolis. A PhA–ASP
The Latest Impact of Technology on Pharmacy Students Andrew W. Lam
Today’s pharmacy students are living in a truly exciting time in the profession’s history, as the rapid development of technology continues to revolutionize practice. At the same time, the 87 schools of pharmacy in the United States are completing the transition to the entry-level PharmD degree program. As these two movements converge, pharmacists’ roles are rapidly changing. The profession made tremendous progress in the last century, and technology was one of the key drivers of that progress. In fact, the practice of modern pharmacy is based on the advancements in technology that have enabled the steady progression of drug discovery and the improved availability of health care. The profession has been able to survive largely because of individual pharmacists’ ability to adapt to change. With each major advancement in technology, pharmacists have been able to reinvent themselves—from apothecary, manufacturer, and compounder, to dispenser and distributor, and, recently, to community clinician.
Andrew W. Lam, contributor of this issue’s APhA–ASP column, checks out pharmacist.com.
Hesitation G ives W ay to Acceptance In a profession as old as pharmacy, change rarely comes without a struggle. New technology was not always as highly anticipated and warmly welcomed as it is today. Some developments, especially those that drastically altered previous norms, have been met with initial skepticism and trepidation. Job security has been one of the major underlying reasons for hesitation in embracing new technologies. Automation caused major controversy within the profession during the late 1980s and early 1990s, as some pharmacists feared that their dispensing functions would be taken over by robots, leaving them jobless. Today, however, automation is widely seen as a principal solution to the alarming growth in prescription volume, which is expected to soar past 4 billion by 2004.1 Pharmacies are embracing technology as a viable means of maximizing productivity
without increasing payroll, as the continuing pharmacist shortage limits pharmacy managers’ ability to improve staffing. The move, especially by new graduates, toward providing pharmaceutical care also places greater pressure on pharmacies to use technology for traditional dispensing functions.
Internet and PDAs Are Agents of Change The knowledge essential for the practice of pharmacy today is being taught alongside the skills that will be necessary for tomorrow. Acknowledging the increasingly integral role that technology plays in practice, pharmacy schools are changing the way they train pharmacists. The shift to the PharmD degree is as much about expanding the scope of practice for pharmacists as it is about preparing them to take on these expanded roles. The new PharmD curriculum is providing students with a
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more intensive clinical program while training them to meet the demands of the changing workplace. Many schools are designing new classes based on emerging scientific fields, such as pharmacogenomics. Such classes are preparing students to assume positions that did not exist a few years ago. Courses in information science are one of the more significant additions to the core curriculum. Keeping up with the explosion of information in clinical research and drug development demands the use of electronic databases for information storage, sorting, and retrieval. The widespread acceptance of the Internet has made electronic archiving of information standard. Students are trained to navigate electronic and print media, gather information efficiently, and apply it in practice. This type
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of training is essential for pharmacists wanting to preserve the role of drug information expert on the interdisciplinary health care team. The newest aspect of information sciences is mobile computing, which is enabling pharmacists to provide realtime, patient-specific drug recommendations at the point of care. Handheld computers, known as personal digital assistants (PDAs), equipped with drug reference software such as that produced by Lexi-Drugs, are proving to be invaluable tools for quick retrieval of drug information, such as dosing or drug interactions. Pharmacy students see the potential of this technology in practice and have been quick to incorporate its use into pharmacy education. Yet, as with new technologies in the past, some perceive PDAs as a threat: The
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widespread adoption of PDAs by medical students and physicians is causing some to wonder whether these devices will replace pharmacists as the preferred source of drug expertise. Although PDAs make drug information more widely and readily available, they cannot take the place of pharmacists in providing patient-specific information on drug usage.
Carpe Diem The pharmacist shortage, combined with the ever-growing workload and the struggle to expand pharmacists’ scope of practice, demands the adoption of technology to satisfy the day-to-day demands of the pharmacy workplace. Many of the traditional roles of pharmacists are expected to be taken over by technology in the near future, as the focus
of the practitioner shifts from the drug to the patient. Future generations of pharmacists— all of whom will take advanced technology for granted—will benefit from this transformation, as if it had always existed in the practice of pharmacy. Andrew W. Lam is a fourthyear PharmD candidate at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, N.Y. He is a member of the Pharmacy Student Editorial Advisory Board and is a past APhA–ASP chapter president at Long Island University.
Reference 1. 2000 retail Rx sales projected to rise 18%, surpass $143 billion on volume of 3.15 billion prescriptions [news release]. Alexandria, Va: National Association of Chain Drug Stores; August 28, 2000.
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APhA Name Change, 2002 Election Results, and Pharmacy Technology APhA Membership Approves the “American Pharmacists Association” By an overwhelming vote, a bylaws amendment will change the name of the national professional society of pharmacists. Nearly 90% of the APhA members who cast ballots in the fall 2002 election voted in favor of the name change. The results of APhA’s 2002 ballot were certified on December 5, and transition to the new name will occur after the conclusion of the Association’s Annual Meeting & Exposition in April 2003. The change is in concert with moves over the past 25 years by APhA’s affiliated state associations. Only associations in 6 states plus the District of Columbia still use “pharmaceutical” in their names, whereas 32 state associations use “pharmacists,” and 12 use “pharmacy.” According to APhA’s Board of Trustees, which proposed the name change in January 2002, the new name accurately reflects the composition of the organization’s membership and their vital
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role in the nation’s health care system: making medications work for patients. The new name also will eliminate frequent misperceptions about who APhA represents. “People hear the word ‘pharmaceutical’ and automatically think about drug products or the pharmaceutical industry,” said APhA President Janet P. Engle, PharmD. “APhA’s leadership decided that it simply made no sense for the nation’s only association for pharmacists in all practice settings to have a name that did not clearly state who we represent. The results of the 2002 ballot show that our members clearly agree.” Added Engle, “Now we can more effectively go about our business as an advocate for America’s pharmacists.”
APhA Announces Fall 2002 Election Results Justine Cannistra
On December 5, 2002, the results of the fall 2002 election of officers and trustees of the American Pharmaceutical Association, the leadership of the APhA Academy of
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Pharmacy Practice and Management (APhA–APPM), and the leadership of the APhA Academy of Pharmaceutical Research and Science (APhA– APRS) were certified. The results follow. Daniel A. Herbert of Richmond, Herbert Va., has been elected 20032004 president-elect of APhA. Herbert is currently serving on the APhA Board of Trustees and the boards of EPIC Pharmacies, the American College of Apothecaries (ACA) Research & Education Foundation, and the Medical College of Virginia (MCV) Foundation. Herbert is a 1966 graduate of the MCV–Virginia Commonwealth University School of Pharmacy and the owner of three innovative community pharmacies in Richmond. His past experience includes hospital pharmacy and home infusion practice. Elected with Herbert to serve on the APhA Board of Trustees for 2003–2004 are Timothy L. Tucker, PharmD, Huntingdon, Tenn., Rod Shafer, Renton, Wash., and Karen L. Reed, Beckley, W. Va. Stephen E. Dibble of Mission Viejo, Calif., has been elected 2003–2004 honorary president. Tucker is a clinical community pharmacist at his familyowned and operated pharmacy in Tucker Huntingdon. Currently, he serves on the APhA Board of Trustees as 2002–2003
Speaker of the APhA House of Delegates, a position he held in 1997–1998. Tucker received his PharmD from the University of Tennessee College of Pharmacy, where he works as a part-time faculty member. Additionally, he serves as a preceptor in the Community Pharmacy Residency Program and for clinical rotations. Shafer is chief executive officer of the Washington State Pharmacy Shafer Association. Since receiving his BS in pharmacy from the University of Washington in 1977, he has worked in long-term care, hospital, and community pharmacy settings. He is an affiliated associate professor at the University of Washington School of Pharmacy. Shafer has served on the Washington Home Care Advisory Committee, Washington State Public Health Improvement Plan, Healthy Mothers/ Healthy Babies, and various local and state health task forces. Reed was member-at-large of the APhA–APPM Executive Committee (2000–2002) and served as chair of the APhA– APPM Reed Community and Ambulatory Section (1999–2000). She is a graduate of the West Virginia University (WVU) School of Pharmacy, and currently Continued on page 6
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Continued from page 4 works as a staff pharmacist for Kmart in Beckley. She is a consultant pharmacist for Beckley Surgery Center and chair of West Virginia’s Medicaid DUR Board. Reed is an APhA Fellow, serves as a preceptor for WVU PharmD candidates, and volunteers at Healthright, a free clinic in her community. Dibble joined APhA as a pharmacy student in 1953 and graduated from Washington State University with Dibble a BS in pharmacy in 1957. Dibble was first employed in San Francisco at Mary’s Help
Hospital Pharmacy, and then moved to Los Angeles. He has owned Key Rexall Drug, La Paz Pharmacy, and Mission Medical Pharmacy. He is a founding member and former chairman of the APhA–PAC Board of Governors and a member of ACA. Valerie T. Prince, Birmingham, Ala., has been elected 2003–2004 APhA–APPM president-elect. Prince graduatPrince ed from Mercer University and completed a residency at the Regional Medical Center in Memphis. She currently works as a pharmacist at Healthsouth
Hospital and is a faculty member at Samford University. Prince has served APhA–APPM in many Section offices and is currently serving as member-at-large on the APhA–APPM Executive Committee. She was the 1997 recipient of the Alabama Pharmacy Association Distinguished Young Pharmacist Award. Earlene E. Lipowski, Gainesville, Fla., has been elected 2003–2004 APhA–APRS presidentelect. Lipowski Lipowski earned her BS, MS, and PhD degrees in pharmacy at the University of
Wisconsin–Madison. She is an associate professor of pharmacy health care administration at the University of Florida. Lipowski is an APhA Fellow and has been active in both elected positions and committee service. She served as member-at-large and chair of the APhA–APRS Economic, Social and Administrative Sciences Section, chair of the APhA–APRS Education Standing Committee, and member of the JAPhA Editorial Advisory Board. Justine Cannistra, JD, LLM, is policy & regulatory reporter, Pharmacy Today.
2002 Academy Section Election Results APhA Academy of Pharmacy Practice and Management (APhA–APPM) Executive Committee
President-elect (2003–2004)—Valerie T. Prince, Birmingham, Ala. Member–at-large (2003–2005)—Marialice S. Bennett, Columbus, Ohio Member-at-large (2003–2005)—Joni I. Berry, Raleigh, N.C. Administrative Practice
Chair-elect (2003–2004)—Dennis Bryan, Chicago, Ill. Member-at-large (2003–2005)—Cynthia J. Boyle, Baltimore, Md. Clinical and Pharmacotherapeutic Practice
Chair-elect (2003–2004)—Brad P. Tice, Urbandale, Iowa Member-at-large (2003–2005)—Bella Mehta, Columbus, Ohio New practitioner (2003–2005)—Lynne M. Ciardulli, Reston, Va.
Community/Ambulatory Practice
Chair-elect (2003–2004)—Paul A. Ackerman, Palm Beach Gardens, Fla. Member-at-large (2003–2005)—Judith B. Sommers Hanson, Huntley, Ill. Hospital and Institutional Practice
Chair-elect (2003–2004)—Wendy J. Friedig, Omaha, Neb. Member-at-large (2003–2005)—Michael P. Wascovich, Cleveland, Ohio New practitioner (2003–2005)—Sara A. Burda, Baltimore, Md. Nuclear Pharmacy Practice
Chair-elect (2003–2004)—James (Jim) F. Cooper, Charleston, S.C. Member-at-large (2003–2005)—Kara L. Duncan, West Lafayette, Ind. Specialized Pharmaceutical Services
Chair-elect (2003–2004)—David H. Schwed, Mt. Laurel, N.J. Member-at-large (2003–2005)—Page Dunlap, Hartselle, Ala. New practitioner (2003–2005)—Jeffrey J. Rochon, Seattle, Wash.
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2002 Academy Section Election Results (Continued) APhA Academy of Pharmaceutical Research and Science (APhA–APRS) Clinical Sciences
Executive Committee
President-elect (2003–2004)—Earlene E. Lipowski, Gainesville, Fla.
Chair-elect (2003–2004)—William R. Garnett, Richmond, Va. Member-at-large (2003–2005)—Susan C. Fagan, N. Augusta, S.C. Postgraduate officer (2003–2004)—Michael J. Brownlee, Kansas City, Mo.
Basic Pharmaceutical Sciences
Chair-elect (2003–2004)—Robert B. Greenwood, Buies Creek, N.C. Member-at-large (2003–2005)—Mary F. McManus, Wilkes-Barre, Pa. Postgraduate officer (2003–2004)—Randall J. Voytilla, Pittsburgh, Pa.
Economic, Social and Administrative Sciences Chair-elect (2003–2004)—Ronald S. Hadsall, Minneapolis, Minn. Member-at-large (2003–2005)—David A. Mott, Madison, Wis. Postgraduate officer (2003–2004)—Erin R. Holmes, Cheswick, Pa.
APhA–APPM
and having to make the transition from typewriter to detachable keyboard and CRT. Younger pharmacists cannot even imagine life in the pharmacy without a computer. How is all of this “advancement” likely to affect the profession in the future?
Where is Technology Taking Pharmacy? (Better Yet, Where is Pharmacy Taking Technology?) Brad Tice
Technology is developing at an almost unnerving pace. Consider just the advances within the past decade or so. I remember sitting on a plane in 1994, listening to a friend describe the Internet and e-mail and thinking, “I’ll never understand this stuff.” In the mid-1980s, did you imagine that one day you would be taking and sending digital pictures through cell phones? How about in the early 1990s, when you were buying a computer? At the time, the decision was whether you needed to upgrade to 16 MB of RAM and a 125 MHz processor for a desktop computer. And, do
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not forget the 14 kB modem you could purchase. Now, standard computers have gigabytes of RAM and processors several magnitudes faster; not to mention cable, T-1, and DSL connectivity and personal digital assistants (PDAs) that fit in the palm of one’s hand that may be underpowered for providing wireless access to e-mail and the Internet if they feature only 16 MB of RAM. What does all this technologic advancement mean for pharmacy? No doubt, many pharmacists remember life before computers became the primary tool in the pharmacy
The Hedgehog Concept Taking a step back and looking at pharmacy then and now, despite all of the technology that has been introduced, the pharmacist is still the central figure in the pharmacy, not a kiosk, computer, or robot. Dave Weinberg, former chief executive officer of Fel-Pro, which before it was sold was a Fortune 500 company that specialized in manufacturing gaskets and was rated as one of the top places in the United States to work, has related the decision to implement technology to questions of quality: The decision is based on the ability of technology to improve the processes in place, not to
increase efficiency or eliminate jobs.1 In fact, the effects of technology on pharmacy practice to date have been overwhelmingly beneficial. Computers help process prescriptions, speed up billing, and check for drug interactions. Bar code scanning, interactive voice response systems, and Pyxis machines all improve the quality and efficiency of the medication delivery process. Likely future advances in pharmacy technology include robotics, touch screens and biometrics on computers, paper prescription scanning or e-prescribing, and drug information and data collection devices encapsulated in handheld devices. On a larger scale, technologic advances are likely to include highly technology-driven mail service and central fill facilities to support prescription volumes projected to increase from 2000 to 2005 by 46% while the number of pharmacists increases by only 6%, almost an eight-fold disparity.2
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In his book on what makes companies successful, Good to Great,3 Jim Collins wrote, “Technology-induced change is nothing new. The real question is not, ‘What is the role of technology?’ Rather, the real question is, ‘How do good-to-great organizations think differently about technology?’” He also stated that “technology by itself is never a primary cause of either greatness or decline.” What his group of researchers found is that the key to “great” organizations is that they are technology accelerators. So: It is not so much technology that will make or break pharmacy’s future as it is the decisions that drive or define how new technology will be used. Continuing on the themes considered in Good to Great, the determining factor for pharmacy’s future, and, subsequently, its use of technology, depends upon what the profession defines as its hedgehog concept 3: a simple, crystalline concept that guides all of the organization’s efforts. From Collins’s work, the hedgehog concept is based on the answers to three questions: What are you deeply passionate about? What can you be the best in the world at? What drives your economic engine? Pharmacy must decide, and soon, what its hedgehog concept is. Is it centered on the convenient delivery of medications, or is it centered on bringing about positive patient outcomes? Looking at each of these three questions and seeing how technology fits into each answer, here is what can be seen. What are pharmacists
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deeply passionate about? Certainly, a core group of pharmacists has always been passionate about patient care. This group has increased in numbers and influence over the past decade as the concept of pharmaceutical care has evolved and a core mass of data establishing the value pharmacists can provide has accumulated. Also, most pharmacy chains and many independently owned pharmacies have either established some sort of patient care program or are trying to do so. Concurrently, pharmacy associations have initiated and sustained a concerted push to establish pharmacists as patient care providers, and there has been a great deal of work in pharmacy practice to get pharmacists’ value recognized. All of this indicates that patient care is probably the issue of greatest importance to a critical mass of pharmacists. Yet the majority of pharmacists, including those seen most often by the public, remain focused primarily on the necessity of delivering medications safely and conveniently. Technology can be and is being developed to improve the quality of the medication delivery process. With 20% of pharmacists’ time being spent on third party-related administrative tasks, there is certainly room to make better use of pharmacists’ time and skills.4 However, if pharmacy’s hedgehog concept is centered on medication delivery, future technologic enhancements will be focused on workflow and process improvements. If, on the other hand, it is centered on drug therapy outcomes, addi-
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tional technology will be needed to facilitate patient care, monitor patient outcomes, and if technology’s full potential in pharmacy is to be realized, to incorporate genetic data and make use of artificial intelligence to provide treatment recommendations based on primary literature and patient demographics. What can pharmacists be the best in the world at? Pharmacists have the training to be the best in the world at two tasks—delivering medications safely and conveniently and achieving positive outcomes of drug therapy. If pharmacists choose the latter, they must actively pursue the development and integration of technology in this area. Already, bar coding, robotics, and large mail service facility technology have been shown to enable the delivery of medications with lower error rates than humans, even to the point that some boards of pharmacy allow these facilities to check 1 prescription per 1,000 prescriptions dispensed. This indicates that the decision is currently being made based on delivering medications conveniently. While population demographics resulting in ever-increasing drug utilization for the next 2 to 3 decades may allow pharmacists to maintain a role here, this path is not likely to help pharmacy thrive as a “profession.” Pharmacists’ training gives them the capability to be the best in the world at achieving positive drug therapy outcomes. However, pharmacists who do not use these skills in daily practice may lose them and fall behind physicians,
nurse practitioners, and other prescribers in being able to ensure positive outcomes of drug therapy. Pharmacy is further advanced in the use of technology in maintaining patient charts, providing drug information, and billing for services and can leverage this position to transition into using technology to advance the appropriate use of medications. What drives pharmacy’s economic engine? Without a doubt, pharmacy’s current economic engine is driven by payments for dispensing prescriptions. The disconnect that has impeded the adoption of pharmaceutical care as a standard of practice has been the lack of reimbursement or payment for pharmacist-provided cognitive services. Pharmacists have, for the most part, been unable to establish payment mechanisms for services provided or patient outcomes achieved. If pharmacies choose to maintain the business model of payment for prescriptions on a commodity basis, it will likely result in technology to improve the quality of the delivery of medications and will likely lead to more and larger mail service and central fill facilities. Such a decision also will likely lead to a diminished professional status for the profession. Pharmacists must adopt pharmaceutical care as their hedgehog concept and use the current economic engine of prescription volume to drive it while leveraging the opportunities to develop the cognitive services economic engine. Based on the degree of drug therapy misuse in the United States,5,6 there currently exists the capacity to do this. For
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instance, if statin compliance is currently approximately 43%,7,8 each pharmacy is missing 8 out of 12 prescriptions per year. Pharmacists can work to increase compliance and reap the financial rewards from this effort while establishing their cognitive services.
Accelerate Technology Developm ent to Im prove Patient Care As stated in the report Professionally Determined Need for Pharmacy Services in 2020,9 “The opportunity for improving the quality of drug use, and, thus, the quality of patient outcomes and quality of life in this country is staggering.” Good patient care may well make the difference that will enable pharmacies to thrive within the current economic environment. Identifying patient care as the driver for technology development should help accelerate the development of technologies that will help pharmacy establish the value and put into place additional payment systems for pharmacists’ cognitive services. No doubt, technology will continue to develop at a rapid pace. The types of technologies that get developed and used in pharmacy practice, however, will depend on the need for quality improvement and the role pharmacists determine to establish for ourselves, or let others establish for or impose on us, in the health care system. The kinds of technologies the profession needs are those that accelerate the pharmacist
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care hedgehog concept centered on positive patient outcomes and serve to overcome obstacles to the delivery of patient care, help pharmacists document their contributions to drug therapy outcomes, and help pharmacists establish payment structures for our services. Accelerating technology development in these areas will breathe life into pharmacy’s hedgehog concept and improve the quality and safety of medication use. Brad Tice, PharmD, is assistant professor and director, College of Pharmacy and Health Sciences, Drake University, president of Rx Intervention Systems, Des Moines, Iowa, and a 2002–2003 Academy of Pharmacy Practice and Management (APhA–APPM) Section on Clinical and Pharmacotherapeutic Practice member-at-large.
References 1. Weinberg D. Organizational structure and analysis. Paper presented at: Shaping Your Pharmacy Future; February 3, 2001; Des Moines, Iowa. 2. Ziegler R. Opening general session state of the industry report. Presented at: National Association of Chain Drug Stores Pharmacy and Technology Conference; August 2000; San Diego, Calif. 3. Collins J. Good to Great: Why Some Companies Make the Leap ... and Others Don’t. New York, NY: HarperCollins Publishing; 2001. 4. Arthur Andersen LLP. Pharmacy Activity Cost and Productivity Study. Alexandria, Va: National Association of Chain Drug Stores; 1999. 5. Johnson JA, Bootman JL. Drug-related morbidity and mortality and the economic impact of pharmaceutical care. Am J Health Syst Pharm. 1997;54:554-8. 6. Ernst FR, Grizzle AJ, Drugrelated morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001:192–9.
7. Avorn J, Monette J, Lacour A, et al. Poor compliance with lipid-lowering medications. JAMA. 1998;82:61–5. 8. Andrade SE, Walker AM, Gottlieb LK, et al. Discontinuation of antihyperlipidemic drugs do rates reported in clinical trials reflect rates in primary care settings? N Engl J Med. 1998;243:373–80. 9. Knapp DA. Professionally Determined Need for Pharmacy Services in 2020. Alexandria, Va: Pharmacy Manpower Project; 2002.
Brown APhA–APRS
A New Era in Pharmacy School Education Lawrence Brown
Just as the Industrial Revolution changed the landscape of American society more than any other period, one could argue that the technologic revolution is changing the face of the classroom to the extent that it is all but unrecognizable from the teaching environment of just a generation ago. Technologies, most notably the computer and the World Wide Web, have improved the efficiency and breadth of classroom instruction and continue to do so at a remarkable pace. I doubt many faculty members would wish to exchange today’s color laser printing and desktop publishing tools for yesterday’s typewriter and mimeograph machine.
Progress Yields Challenges Computers and computer technology have innervated the pharmacy classroom. Using laptops and LCD pro-
jectors, professors present their lectures in PowerPoint format, and everywhere students and faculty are pulling out their personal digital assistants (PDAs) to check their schedules and look up drug information. Not only are many schools requiring students to have a laptop, but many schools are also completely integrating the laptop into the classroom. A number of pharmacy schools even have a local area network connection at each seat in a classroom so that students can download PowerPoint lectures and follow along on their laptop. The Internet is also having a profound effect on both pharmacy instruction and student learning. Students now have immediate access to a tremendous amount of research that was previously available only in print. Also, search engines such as MEDLINE have largely made Index Medicus a thing of the past. However, the Internet has also created a greater challenge for professors as they try to prevent plagiarism. Although most term paper Web sites have been closed down, students can be incredibly resourceful when it comes to avoiding the task of writing their own papers. Also, the
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Web offers good and bad information, and many students are using Web sites as references for their papers without much regard to the sites’ credibility. The ubiquity of e-mail has made communication much easier, as well. With the click of a mouse, students can send questions and comments to their professors and submit homework assignments. Students also find e-mail useful for communication and coordination when working with their peers on class projects. Faculty members can communicate with all of their students at once through the use of a listserv. Using e-mail to disseminate class notes and assignments also cuts down on the amount of copying needed. The downside of email is that its ease of use can result in a flood of communications that require replies. And the old excuse “my dog ate my paper” has been usurped by the now convenient excuses “I never got that e-mail” or “I sent my assignment via e-mail—I don’t know why you didn’t get it.” Lastly, even with the widespread use of antivirus software, the spread of computer viruses via e-mail is still a major concern.
In the C lassroom Computer software programs such as PowerPoint have largely transformed inclass lectures. While some professors still prefer to give purely oral lectures, I believe that most have found that using presentation software engages students by making material more visually appeal-
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ing and allowing instructors to update lecture notes more easily. These programs are not as useful for classes such as medicinal chemistry, however, since it is still pretty difficult to import depictions of molecules or show drug metabolic pathways into presentation packages. And the limited amount of information that can be presented on each slide makes it difficult to use PowerPoint to present a large amount of information at one time. Two technologies that are starting to be used more often in the pharmacy classroom are digital video and Web-based streaming video. An example of the latter is RealPlayer. These technologies are changing how students learn about pharmaceutical care and patient counseling. While the concept of videotaping students as they perform various tasks is not new, having the video accessible at any time on the Web is much more convenient for the students and eliminates the need for bulky VHS tapes. Almost any class that has a demonstration component can benefit from the use of streaming video. I have seen these technologies used successfully in the pharmaceutical care lab. They can be used for at least two purposes. One is to allow students to view examples of what should be done. For instance, professors might videotape themselves or someone else doing a pharmaceutical care work-up on a patient, then upload the video to the class Web site so that students can view the process before they perform their own patient work-ups in the lab.
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Such a practice would allow students to develop a good idea of what is expected from the interaction with the patient and eliminate the need for the professor to demonstrate the work-up repeatedly. The second purpose is to allow students to view and critique their own performances. Students can view their videos at their convenience via the Internet and can assess how they performed. Many pharmacy professors have also used the Web to post syllabi, assignments, and links to Web sites. Again, these capabilities allow convenient access to this information and permit professors to disseminate large amounts of information without having to make paper copies. Technology is also being used to establish online, or virtual, classrooms. Many schools are successfully teaching courses such as medical terminology completely online. Creighton University, in addition to their traditional pharmacy program, offers a Web-based distance learning PharmD degree, where all didactic courses are taught via the Internet or CD-ROM. Whether this will prove to be the new nirvana for pharmacy schools or a road that should have been left untraveled has yet to be seen. However, some schools have had good success thus far in training post-BS PharmDs via the Internet.
Technology Should Take a Cue From Spielberg The biggest challenge posed by computer technolo-
gy in the classroom relates to students’ and instructors’ ability to use it. Contrary to popular belief, not every student enters pharmacy school as a computer expert. Not all students can create a Web site, set up a local area network, or build a computer from scratch. In fact, many students only know the basics about computers and computer software. Unfortunately, many faculty members know even less, although this is changing. Some professors are still learning how to cut and paste or how to reformat cells within Microsoft Excel, not to mention how to create PowerPoint slides, upload information to the class Web site, or stream digital video. And although the use of technology in the classroom is, overall, a positive development, moderation remains a virtue. Technology should not be used just for the sake of using technology. This caution is especially true when the technology inhibits, rather than improves, student learning. An example of the latter would be the use of a chat room for group discussions when the students may not be familiar with the intricacies of a chat room. These students might find themselves overwhelmed by the process, and they are likely to spend an inordinate amount of time trying to figure out how and when to submit a comment. The process and etiquette of chat rooms can be challenging to master. You are forced to communicate in much shorter exchanges of information. If you try to type a three-paragraph response to a comment,
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the subject will most likely have changed before you submit your response. Also, while it is relatively easy to formulate your response while still keeping track of the group conversation when it is taking place in person, it is much more difficult to keep track of the conversation in an online chat session while you are typing your response. Another difference is that you cannot use nonverbal clues to show that you want to jump in and make a comment. Hence, students may feel excluded from the chat session. In a documentary on the making of the Indiana Jones movies, Harrison Ford said that Steven Spielberg always made sure that the stunts never drew the viewers’ attention away from the actors. The stunts were meant to make viewers connect with what was happening to the actors, not to overshadow the plot. The same should be true with technology in the classroom. Technology should only be used to engage students’ attention and help them connect with the information being presented in the course. Is technology in the classroom a good thing? I believe it is. Technology has improved the efficiency of classroom instruction, but it is also presenting new challenges. The question that remains is, Has technology improved the quality of the pharmacy graduate? If the answer is no, then maybe we are just using technology for technology’s sake, and maybe these new tools are shifting faculty’s focus away from students. That is a question that each institution needs to answer.
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Lawrence Brown, PharmD, is a PhD candidate in social and administrative pharmacy, College of Pharmacy, University of Minnesota, Minneapolis. A PhA–ASP
The Latest Impact of Technology on Pharmacy Students Andrew W. Lam
Today’s pharmacy students are living in a truly exciting time in the profession’s history, as the rapid development of technology continues to revolutionize practice. At the same time, the 87 schools of pharmacy in the United States are completing the transition to the entry-level PharmD degree program. As these two movements converge, pharmacists’ roles are rapidly changing. The profession made tremendous progress in the last century, and technology was one of the key drivers of that progress. In fact, the practice of modern pharmacy is based on the advancements in technology that have enabled the steady progression of drug discovery and the improved availability of health care. The profession has been able to survive largely because of individual pharmacists’ ability to adapt to change. With each major advancement in technology, pharmacists have been able to reinvent themselves—from apothecary, manufacturer, and compounder, to dispenser and distributor, and, recently, to community clinician.
Andrew W. Lam, contributor of this issue’s APhA–ASP column, checks out pharmacist.com.
Hesitation G ives W ay to Acceptance In a profession as old as pharmacy, change rarely comes without a struggle. New technology was not always as highly anticipated and warmly welcomed as it is today. Some developments, especially those that drastically altered previous norms, have been met with initial skepticism and trepidation. Job security has been one of the major underlying reasons for hesitation in embracing new technologies. Automation caused major controversy within the profession during the late 1980s and early 1990s, as some pharmacists feared that their dispensing functions would be taken over by robots, leaving them jobless. Today, however, automation is widely seen as a principal solution to the alarming growth in prescription volume, which is expected to soar past 4 billion by 2004.1 Pharmacies are embracing technology as a viable means of maximizing productivity
without increasing payroll, as the continuing pharmacist shortage limits pharmacy managers’ ability to improve staffing. The move, especially by new graduates, toward providing pharmaceutical care also places greater pressure on pharmacies to use technology for traditional dispensing functions.
Internet and PDAs Are Agents of Change The knowledge essential for the practice of pharmacy today is being taught alongside the skills that will be necessary for tomorrow. Acknowledging the increasingly integral role that technology plays in practice, pharmacy schools are changing the way they train pharmacists. The shift to the PharmD degree is as much about expanding the scope of practice for pharmacists as it is about preparing them to take on these expanded roles. The new PharmD curriculum is providing students with a
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more intensive clinical program while training them to meet the demands of the changing workplace. Many schools are designing new classes based on emerging scientific fields, such as pharmacogenomics. Such classes are preparing students to assume positions that did not exist a few years ago. Courses in information science are one of the more significant additions to the core curriculum. Keeping up with the explosion of information in clinical research and drug development demands the use of electronic databases for information storage, sorting, and retrieval. The widespread acceptance of the Internet has made electronic archiving of information standard. Students are trained to navigate electronic and print media, gather information efficiently, and apply it in practice. This type
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of training is essential for pharmacists wanting to preserve the role of drug information expert on the interdisciplinary health care team. The newest aspect of information sciences is mobile computing, which is enabling pharmacists to provide realtime, patient-specific drug recommendations at the point of care. Handheld computers, known as personal digital assistants (PDAs), equipped with drug reference software such as that produced by Lexi-Drugs, are proving to be invaluable tools for quick retrieval of drug information, such as dosing or drug interactions. Pharmacy students see the potential of this technology in practice and have been quick to incorporate its use into pharmacy education. Yet, as with new technologies in the past, some perceive PDAs as a threat: The
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widespread adoption of PDAs by medical students and physicians is causing some to wonder whether these devices will replace pharmacists as the preferred source of drug expertise. Although PDAs make drug information more widely and readily available, they cannot take the place of pharmacists in providing patient-specific information on drug usage.
Carpe Diem The pharmacist shortage, combined with the ever-growing workload and the struggle to expand pharmacists’ scope of practice, demands the adoption of technology to satisfy the day-to-day demands of the pharmacy workplace. Many of the traditional roles of pharmacists are expected to be taken over by technology in the near future, as the focus
of the practitioner shifts from the drug to the patient. Future generations of pharmacists— all of whom will take advanced technology for granted—will benefit from this transformation, as if it had always existed in the practice of pharmacy. Andrew W. Lam is a fourthyear PharmD candidate at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, N.Y. He is a member of the Pharmacy Student Editorial Advisory Board and is a past APhA–ASP chapter president at Long Island University.
Reference 1. 2000 retail Rx sales projected to rise 18%, surpass $143 billion on volume of 3.15 billion prescriptions [news release]. Alexandria, Va: National Association of Chain Drug Stores; August 28, 2000.
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