As evidenced by massive data collecting initiatives, such as the National Institutes of Health All of Us research program—which seeks to create one of the largest and most diverse health databases in history1—the potential of big data in health care systems is recognized at the highest levels as a tool to optimize patient care. (More information about the All of Us initiative is available at: https://pubmed.ncbi.nlm.nih.gov/31412182/). As data infrastructure evolves and analysis tools become more broadly available, data can be used to drive clinical and operational decision-making, justify new workflows, and reduce health care spending while improving population health.2 One way health systems are utilizing available data is through the development of dashboards and reports to visualize and interpret insights; however, security, cost, and integration challenges have limited complete implementation of these tools.2
Health systems generate huge amounts of data daily; large portions of that data are medication related, originating from sources such as ADCs, medication administration records (MARs), and pharmacy inventory systems. Within pharmacy, data analytics can be used to synthesize the data and thus drive decision-making. Actions taken based on these data can in turn help to increase operational efficiency and create a safer pharmacy practice to ensure better patient care. However, the ability to understand and harness this data to produce actionable analytical tools requires the introduction of specialized positions with unique skills and expertise, positions for which pharmacy departments historically have not recruited.
Pharmacy Analytics and Outcomes Team Structure
The Pharmacy Analytics and Outcomes (PAO) Team is a service group embedded within Pharmacy Services of UNC Health, a not-for-profit, integrated health care system based in Chapel Hill, North Carolina. The PAO Team’s goal is to aid in the delivery of high quality patient care by providing actionable insight and analytics to transform pharmacy practice and fulfill its mission of collaboratively creating, evaluating, and disseminating pharmacy data-driven best practices. Since its implementation in 2014, the PAO Team has evolved in scope and size, comprising both pharmacists and non-pharmacists (non-pharmacists include analysts and a biostatistician).
Team Roles and Responsibilities
PAO Team members support the department by gathering, interpreting, analyzing, and sharing data through a variety of analytics platforms, leveraging EHR data as well as data from a variety of external data sources that have been centralized within our organization’s data warehouse. However, there are multiple competing vendors in the analytics space, and availability of a certain tool should not hinder the capacity for team productivity. Data can vary in type and originate from pharmacy-related sources ranging from the MAR to claims databases. Day-to-day responsibilities of PAO Team members encompass clinical/quality reporting that may include development of recurring reports or dashboards, as well as data analysis that provides end users with actionable insights to aid in organizational decision-making, research, or project implementation. Due to the embedded nature of the PAO Team within the department of pharmacy, activities and initiatives are closely aligned with departmental goals.
Collaboration is a critical duty of all PAO Team members, and serves to enhance the impact of the team on the department and improve the efficiency of data delivery and tool development. Collaboration with internal and external stakeholders on project development directly ties into the group’s mission of creating data-driven best practices for integration into pharmacy departments across the health system. For example, pharmacists on the PAO team collaborate with the Antimicrobial Stewardship Team to develop performance dashboards aligned with best practices and accreditation standards.
Attributes of Pharmacist and Non-Pharmacist Positions
The Role of the Pharmacist
The unique composition of the PAO Team facilitates team members working in a highly collaborative environment that benefits from each member’s particular background and area of expertise. Pharmacists on the PAO Team have both clinical knowledge as well as a firm foundation in the data framework necessary to support the successful acquisition and warehousing of data used in fulfilling information requests. Pharmacists are also engaged on longitudinal project teams throughout the department. Projects may include quality initiatives, such as development of a report and dashboard to identify pediatric patients at risk for acute kidney injury based on a variety of factors, allowing pharmacists to make targeted interventions. As members of these teams, PAO pharmacists bring complementary clinical and data-focused backgrounds to the table to assist in implementation projects to ensure reportable programs and workflows are developed, as well as the ability to complete robust program evaluations. Pharmacists can actively participate in retrospective outcomes evaluations in multiple capacities, ranging from providing insight into why an outcomes project was successful, to determining its level of clinical impact.
These outcomes analyses, which often originate from PAO pharmacist partnership with other pharmacy services groups working in population health or specialty pharmacy, help demonstrate the value of pharmacy services. Furthermore, PAO pharmacists serve the vital role of expert consultants on pharmacy and medication-related data and collaborate with non-pharmacist team members daily. Adding a clinically trained eye helps ensure quality data delivery, and review by pharmacists can assist in catching reporting errors, identifying errors in the data pull, and establishing the clinical meaningfulness of data. This unique team dynamic allows for increased efficiency in developing tools for use in a pharmacy department by allowing pharmacist input in the development and quality processes before they reach pharmacy end-users.
The skills required to become a pharmacist within an analytics team extend beyond traditional pharmacy training, yet require clinical experience as a valuable background. Successful pharmacists have clinical experience in a health system setting, as well as advanced training in informatics or data science. On the PAO Team at UNC, pharmacists have a variety of backgrounds ranging from completing residency training, PhD training, and/or a Master’s degree in Data Sciences.
The Role of the Analyst
Non-pharmacist analysts bring expertise to the table in areas where pharmacists may be lacking more rigorous training, such as visualization development or data universe/data mart building, in collaboration with IT departments. In addition to responding to data requests from pharmacy department end users, analysts also participate in project teams related to their area of expertise and claim ownership over dashboards/reports created to drive implementation or quality initiatives from those teams.
Direct pharmacy experience is not mandatory for non-pharmacist analysts but is beneficial, as it offers enhanced context to the analyst when working with pharmacy-related data. However, technical expertise in analytics, data sciences, or prior work experience are required. Advanced degrees such as a Master’s in Public Health or computer sciences, or advanced training in strategic analytics, are included in pertinent background suitable for a successful analyst. Of note, analyst job codes are professional positions, and due to the competitive job market for analytics skill sets, hiring can be challenging. One strategy taken by the PAO Team has been to recruit past pharmacy technicians who have sought out additional Master’s training and moved into advanced roles within the department. Alternatively, other members of the PAO Team have held non-pharmacy department positions within the UNC Health system, often in IT.
Challenges and Future Opportunities
A Non-Traditional Pharmacy Career
Becoming a pharmacist in the data analytics and outcomes research space is not a traditional pharmacy career path. While schools of pharmacy provide students with extensive experiential opportunities in the hospital pharmacy or retail space, most students will only be exposed to non-traditional careers on elective advanced pharmacy practice experiences (APPE) rotations during the P4 year; however, elective opportunities are frequently limited. The advent of informatics- and analytics-focused PGY2 residency programs can assist in training pharmacists for the job market, but additional education is still needed for pharmacists on opportunities in the health care analytics field.
Utilization of Services
On a local level, utilization of PAO services has increased; however, there is still room to improve buy-in on a health system-wide level. Although the PAO Team maintains over 150 recurring reports throughout the UNC Health system, some entities do not fully utilize PAO services. While the PAO team has only recently begun to respond to pharmacy data requests from the entire UNC Health system, knowledge of resources available to these entities can be improved.
As the US health care system moves toward value-based payment models with reimbursement based on performance of quality metrics, there is a significant opportunity to leverage pharmacy data to improve performance on key medication-related quality metrics. Embedding analytics support within health-system pharmacy will allow for the development and implementation of more focused and efficient tools that are better aligned with department goals. For example, at UNC Health, the PAO Team collaborates with benefits management and population health, fostering direct stakeholder engagement in how the department is identifying, measuring, and analyzing key metrics. These collaborations allow pharmacists to offer important insights into quality improvement initiatives that will lead to maximum impact on both patient care and the health care system.
Data analytics are playing an increasing role in health-system pharmacy and health care at large. To take advantage of these opportunities, UNC Health embedded a dedicated pharmacy analytics team within pharmacy services comprising both pharmacists and non-pharmacist analysts. Team members are responsible for responding to data requests, developing and maintaining pharmacy-specific reports and dashboards, warehousing data sources, and partnering to demonstrate pharmacy outcomes. (See TABLE 1.)
Uniquely, pharmacists can serve in the role of consultant to both pharmacy end users and non-pharmacist analysts, which serves to improve efficiency and clinical relevance of PAO-developed analytical tools. Additionally, this model of bringing analytics directly to shareholders and working collaboratively has the opportunity to promote development and subsequent evaluation of key quality metrics that are becoming increasingly important as the US health care landscape shifts to value-based care.
Hannah Feinman is a PharmD Candidate in the Class of 2022 at the UNC Eshelman School of Pharmacy. She received her BA in Molecular Biology from Colgate University. Hannah is currently serving as a student intern on the pharmacy analytics and outcomes team at UNC Health.
Evan W. Colmenares, PharmD, is the lead pharmacist, analytics and outcomes, at UNC Health, and a PhD candidate in the UNC Eshelman School of Pharmacy division of pharmaceutical outcomes and policy.
Mary-Haston Vest, PharmD, MS, BCPS, is the clinical manager, analytics and outcomes, at UNC Health and assistant professor of clinical education with the UNC Eshelman School of Pharmacy. She received her PharmD from the University of Mississippi School of Pharmacy, and completed her PGY1/PGY2/MS with UNC Hospitals and the UNC Eshelman School of Pharmacy.
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