How ICT can help Pharmacists in service delivery?

Introduction

Pharmacists (chemists, druggists) are healthcare providers who with specialization in medicine deal with the composition and administration of drugs. Pharmacists are expected to monitor the health and progress of patients to ensure the safe and effective use of medication. This has over the years proven to be difficult without adequate and precise use of Information Communication Technology (ICT). Pharmacists in most cases serve as a consultant to health-challenged persons. They are said to be the first point of contact for patients with health inquires. This requires pharmacists to note, analyze and prescribe medications to the affected. 

Information Communication Technology (ICT) on its own refers to the application of computers and telecommunication equipment to store, retrieve, transmit and manipulate data in various forms. According to the Smart Computing Dictionary1, I.C.T. is a general term used to describe any technology that helps to produce, manipulate, store, communicate or disseminate information. 

Information Communication Technology (ICT) is an important tool in modernizing and improving the pharmaceutical industry. According to Daniels (2002),2 ICTs have become within a very short time, one of the basic building blocks of modern society. The use of ICTamongstpharmacists can help to improve service delivery in the pharmaceutical profession. This will help reduce the time, expenditure, and manpower required for work within the profession. 

Several existing ICT operations are being carried out in present-day pharmacies. These ICTs are helping to improve patients’ safety, enable pharmacists to provide high-quality care, and help patients make the most of their medicines. Prescription Drug Monitoring Programs (PDMP), Electronic Prescriptions (EP), Electronic Prescription of Controlled Substances (EPCS) are common ICT tools used by pharmacists.

According to HealthIT.gov, electronic prescription (e-Prescribing, electronic prescribing) allows healthcare providers to enter prescription information into a computer device and securely transmit the prescription to pharmacies using a special software program and connectivity to a transmission network.3 The introduction of electronic prescription have helped reduced medication errors, improved doctor-pharmacist collaboration on patients’ healthcare, quick and detailed service delivery and also access to a comprehensive patient medication records. The American Medical Association also noted that the benefits of e-prescribing functionalities include the ability to review patient medication histories, formulary information, and safety alerts, to help reduce the risk of adverse drug events and out-of-pocket costs for patients.4

The use of e-prescription recorded to have been in existence since 1890 has not been fully embraced and interwoven into the system in many countries. There are many factors to this. For instance, some pharmacists do not have the technological knowledge to run an e-prescribing application. Similarly, experts believe that there are new types of prescribing errors using the e-prescriber system.5

Electronic prescription and other ICT systems used by pharmacists can be used to attain efficiency in healthcare if workable policies and implementation places are made available by the government and other professional bodies. With the continuous population growth around the world, it has become demanding to melt ICT with pharmaceutical practices and services. 

This paper intends to dig into the usage of ICT among pharmacists in the United States of America (USA) and uncover more preferable and user-friendly systems that can boost healthcare services amongst pharmacists, manufacturers, and customers. 

Methodology

The qualitative research method was used in carrying out this study. This research method allowed the researcher to investigate the meaning, processes, actions, and interactions of the two variables. With this, the researcher was able to identify the variables individually and explain how the connection exists. 

The research method also reveals the structure that informs the actions or outcomes of ICT in the healthcare sector. This was carried out by investigating meanings, interpretations, symbols, processes, and relations. 

Direct observation was also used in observing and understudying the use of ICT to improve the process and operations among pharmacists. This observation was able to enhance the translation of information gathered into visible actions. 

The secondary research method was also used in carrying out this study. This involved the use of existing documented data. These data were gotten from public libraries, the internet, and media publications. 

The public library was a good source of information on healthcare providers, information communication technology, the use of ICT in pharmaceutical companies, and the process of developing improved health technology. Documents accessed in the library include; textbooks, journals, and newsletters. 

The internet also provided the needed data for this study. Information was gotten from websites, blogs, and internet forums. The websites accessed were official sites of medical companies and their associates, public health establishments, and information technology firms. The blogs accessed were information sites on information technology, healthcare process, and other ICT-related information sites. To authenticate the information received from this source, contents obtained were run through a plagiarism test. Likewise, the authority of the author was checked. 

Data from media publications such as newspapers and magazines were used to shed light on the study. Information got included public opinions and experts’ perspectives on ICT, Health technologies, the use of ICT among healthcare providers, and the use of ICT by pharmacists. 

The scope of this study is limited to the United States of America. It, therefore, speaks of what has been studied to be obtainable in society and among the people cared for by the healthcare providers. It considers the development of ICT and its use among healthcare providers and specifically among pharmacists which this study chooses to focus on. 

Results

  1. Pharmacists in the United States operate in any of the following settings –community pharmacy, hospital, long-term care facilities, pharmaceutical industry, mail service, managed care, and government. 
  2. There are 112,000 pharmacists in community pharmacy (66,000 in chains; 46,000 in independents), 40,000 in hospitals, and 21,000 in consulting, government, academy, industry, and other settings. 

Figure 1: Showing the distribution of pharmacists in the health sector

  1. Information communication technology has brought change to the administration and services at healthcare facilities. Effects could be seen from scheduling appointment check-ins, offering remote visits, sharing lab results through the patient portal, and creating two-way communication between healthcare providers and patients. 
  2. Information communication technology has also improved the follow-up process of pharmacists with patients. Pharmacist-provided medication counseling at discharge doubled from 22 percent in 2012 to 45 percent in 2016. 
  3. The study revealed that 83% of patients would welcome reminders from their physicians about checking blood pressure, completing rehabilitation exercises, taking prescriptions among other medical and similar activities. 
  4. The study revealed that the use of ICT among healthcare providers has shown great improvement since 2008 as it records the decline of paper-only patient health records from 69 percent to 1 percent. Similarly, in 2016, 93 percent of hospitals in the United States of America (USA) embraced a barcode medication administration system. 
  5. Pharmacists and pharmacy technicians are experiencing an increase in the use of medication history at admission. This is placed at 54 percent in 2012 to nearly 75 percent in 2016. 
  6. Information Communication Technology (ICT) plays a significant role in reducing medical errors which have still claim lives. The use of e-prescription for instance is helping to reduce errors in drug administration and patient’s medical history. 
  7. There is an estimated death rate of over 400,000 people per year to what could be called preventable medical harm. Medical errors, the causer of this death rate is considered to be the third most common killer in the United States. 
  8. The use of ICT by pharmacists or in pharmacies won’t actualize it will if discipline and skill were missing. Improving this will requires the right technology, incorporating automation tools, managing passwords effectively, and setting clear goals for technology usage. 
  9. Patients want to be more engaged in their care and desire more options for interacting with their healthcare providers using the same communication methods they regularly use. 
  10. Clinicians who use secure text messaging to connect with patients and their family members can improve patient satisfaction, drive medication adherence, and empower patients to be more actively involved in their health and wellness. 
  11. Pharmacists’ activities and processes can be organized into six components of the medication-use system – prescribing, dispensing, administration, monitoring, and patient education.
  12. There are several ICT tools available to pharmacists such as automated dispensing, mobile technology, barcode medicine identification, pharmacy management system among others. Notably, many pharmacies do not use all of the available functionalities of these systems. 
  13. There is the concern that the use of technology has reduced focus and productivity among the workforce. Findings also revealed that the use of information technology has reduced the human workforce due to the reduction in workload. However, healthcare providers are continually and drastically shifting towards this consumerist model of care. 
  14. The use of Unstructured Supplementary Service Data (USSD) in pharmacy will have bridge the between rural and urban healthcare services and also provide room for quick consultation sessions at low cost. 

Discussions

This substantive review identified and critically appraised pharmacists as healthcare providers and their ICT usage by evaluating the use of ICT in the process and activities of the healthcare administration. Study shows that ICT is a new train of economic and technological development in the world that creates a faster and more robust economic system.6This proves that ICT can also boost the marketing services of pharmacists through the use of ICT marketing tools. These tools include video conferencing, automated re-ordering, electronic funds transfer, electronic spreadsheet, point of sales system (POS) among others.7

Physicians have through ICT discovered pharmaceutical information by any means, either by individual research from desk references or online sources. This has gradually changed the traditional method which included peer influence, direct interactions with pharmaceutical companies, and public or private insurance companies.

Size of Pharmacists

There are over 173,000 pharmacists in the United States of America. This number is divided into several sectors and areas of operations. A study identified that 112,000 pharmacists work at community pharmacies, 40,000 work in hospitals, and 21,000 in consulting, government agencies, academics, industries, and other healthcare settings. A study reviewed by Dr. Liji Thomas explained that trained pharmacists work in any of the following places bases on their expertise; clinical pharmacy, community pharmacy, compounding pharmacy, ambulatory care, and regulatory pharmacy. Other areas are; long-term care facilities, the pharmaceutical industry, mail service, and managed care. There are however various specializations in pharmacy. Some pharmacists have been found to specialize in a certain area of pharmacy. These areas include oncology, geriatric, hospice, pediatric, poison control, nutritional support, psych-pharmacotherapy.8

IMS Institute for Health Informatics noted that the global drugstore market was worth some $595 billion in 2015 and was also predicted to reach nearly $1.2 trillion in 2016.9

Services and Resources

The services provided by pharmacists are usually determined by the area of operations. This also determines the resource that is within their reach. 

A community pharmacist usually works in a store that provides the community with access to the medication they need. They also give advice that promotes the effective use of drugs and warns against abuse of drugs. A community pharmacist also helps patients with reimbursement of drug expenses, supervising pharmacy technicians, and keeping inventory of the drugs stocked. They prescribe, educate and prevent the dangerous combination of medication. 

Hospital pharmacists often work in close collaboration with other health professionals. This is because their duties are often involved with clinical trials as well as compounding medications for individualized dosing or sterile medications. Their services also include teaching, distribution, and prescription protocols of drugs, education of medical staff, administration, and proper storage of drugs. Hospital pharmacists might work as inpatient or outpatient pharmacists. 

Ambulatory care pharmacists are found in rural areas. They operate a mobile service and help in the management of patients with a higher risk of disease complications or drug-related problems. They meet with the patient at their locations and help reduce hospital visitations. 

Consulting pharmacists work in nursing homes or visiting patients in their homes to provide healthcare services. This kind of service began in 1990. This has enabled pharmacists to monitor the effective use of medications among their patients. 

A compounding pharmacist produces new forms of medicine by reformulating a powder tablet into a solution. On the other hand, clinical pharmacists help provide drug information and monitor drug safety and efficacy. 

A regulatory pharmacist is also known as a government pharmacist because they work under government authority; providing rules and regulations for the safe use of medicine to promote positive healthcare. Regulatory pharmacists can be found at the Food and Drug Administration in the United States. Similar to the regulatory pharmacist, the Managed Care pharmacist is involved with planning and management of medication in health maintenance organizations such as hospitals, extended healthcare centers, etc. 

Pharmacy from a business angle, pharmacies make use of monetary, human, and material resources. An average independent pharmacy in 2010 generated 26.8 percent gross profit. Also, with operating and other expenses reaching 23.9 percent, it leaves profit before taxes on the level of 2.9 percent of net sales. Just like in any other business, pharmacists and pharmacies compete for patients and resources. For instance, in community pharmacy, the pharmacist must fight for a share of the market. Likewise in hospitals, directors of pharmacy must compete with other organizational units for shares of the budget.10

Stakeholders in pharmacy

According to the study, there are 3 stakeholders major stakeholders in pharmacy; pharmaceutical companies, physicians, and patients. These stakeholders make up the driving force in pharmacy. Doctors, nurses, and their clinical professionals also play a big role in improving medication adherence. They work to uncover the barriers patients face in accessing their medication. Similarly, in achieving quality pharmaceutical healthcare services, ‘patients’ engagement and medication adherence hinge on the teamwork of physicians, pharmacists, and pharmaceutical companies.’11

Major process in pharmacy

A pharmacist acts as a learned intermediary between prescribers and patients and monitors the health and progress of patients to ensure the safe and effective use of medication. 

There are various processes in the pharmacy, but the major process is ‘management’. This process can help solve problems both current and intending. Bringing all the business functions of a pharmacy into a unified whole and integrating them with the clinical activities of the pharmacy is a complex process. This, therefore, calls for a deliberate managerial function. Duties such as accounting, finance, marketing, organizing, staffing, and operational management require intelligent management. The elements of this process are; planning, organizing, staffing, directing, and controlling.

Types of technologies used by healthcare providers

Becker12 identified the 10 biggest technological advancements in healthcare in the last decade as the development that has contributed to services being taken out of the confines of hospital walls and integrating them with user-friendly and accessible devices such as smartphones and tablets. The electronic health record, mobile health, telehealth, portal technology, sensors, and wearable technology, and wireless communication are common techs used by healthcare providers. 

Wireless communication systems like Vocera Messaging offer platforms for users to send secured messages like lab tests and health alerts to one another using smartphones, web-based consoles, or third-party clinical systems. Wireless techs such as walkie-talkies have equally replaced beepers and overhead paper. 

Transparency Market Research report shows that wearable medical devices are constantly growing at an annual rate of 16.4 percent yearly. This tech is programmed in a way that it gets triggered when a patient is in a compromised health situation. It sends a signal to the healthcare provider who would respond promptly. 

Portal technology has provided the opportunity for patients to take an active part in the healthcare services they are provided with. This tech provides an interactive platform for both patients and physicians to communicate and share files such as medical reports. 

Telehealth has been able to bridge the gap of healthcare services in rural areas. Telehealth has also proven to enhance the quality of healthcare service delivery. This is confirmed by a study published in CHEST journal which revealed that “patients in an Intensive Care Unit (ICU) equipped with telehealth services were discharged from the ICU 20 percent more quickly and experiences a 26 percent lower mortality rate than patients in regular ICU. 

Mobile health (mHealth) is a tool used by physicians and healthcare providers for ordering, documentation, and gathering information about and for patients. The use and acceptance of mobile health as largely been encouraged by the capacity and features made available on smartphones and tablets. In a study carried out by R&R Market Research, it estimated that the mHealth market will reach $20.7 billion by 2019. 

The Electronic Health Record System (EHRs) has made the centralization of patients’ information possible. Study shows that only 16 percent of U.S. hospitals were using an EHR in 2009. An increase has been observed in 2018 as 80 percent of hospital operates systems that incorporate an EHR.  

Types of technologies in use by pharmacists

Pharmacists like any other healthcare provider rely on some information communication device to help meet the fast-growing health needs of patients. Tasked with duties varying from drug administration, storage, compounding, and consultancy pharmacists have embraced techs that will help lessen the efforts and improve the effects of healthcare services. 

The study reviewed shows that several technologies are existing and under testing which has made the dispensation of services in pharmacies more effective.13 These ICT tools include Electronic Prescribing of Controlled Substances (EPCS), Prescription Drug Monitoring Program (PDMP), Medication Reminder Devices, and Automated Dispensing Units. 

The EPCS helps clinicians recognize substance abuse through a medication history check. This makes available both controlled and non-controlled medications that were paid for through the patients’ insurance. Notably, this system also flags potentially deadly prescription errors and drug interactions related to opioid use. This has helped prevent accidental deaths and overdoses. 

Prescription Drug Monitoring Program (PDMPs) on the other hand is effective for collecting state-specific controlled-substance prescription data which are either operational or under development in most states of America. 

Another important technology used by pharmacists is Medication Therapy Management (MTM). MTM describes in broad range the services rendered by pharmacists which are not limited to the following: drug use review, drug dosage adjustment, identification of a gap in care, ordering and reviewing of lab tests, etc. These services have been provided by pharmacists for over a decade by taking advantage of new technologies such as telehealth and mobile health to deliver personalized care and monitor outcomes and patient adherence. 

Challenges facing pharmacies

The challenges facing pharmacy range from strict regulations and price pressure, fake drugs, illegal drugstores, limited access to medication by rural dwellers, and the growing importance of telehealth. On health techs, Edlin acknowledges that technologies are important to pharmacies to enable their work safely and effectively. With technology, pharmacists will be able to make informed decisions by using data analytics to enhance reporting. But, technology is expensive. Drug shortage is yet another major challenge in pharmacy. The biggest shortages have hit older, generic, injectable medications produced by only a small number of manufacturers. The Federal Drug Agency (FDA) noted that shortages decreased to 39 in 2017 from a peak of 251 in 2011.14

Proposed ICT to improve pharmacy

Many pharmacies have embraced computer technology because of the benefits of automated information processing. These include enabling routine, repetitive and monitoring to be conducted with consistent accuracy; standardization and consistent use of terminology and nomenclature and mass customization.15

Poorer Americans are more likely to be uninsured or underinsured, go without preventative measures, or wait until an illness is severe before seeking care. Critically, many also live in areas with far fewer hospitals and primary care physicians, according to the report. Similarly, considering the cost of technologies especially applications that serves mobile health (mHealth), there are few authentic techs out there. There is a need for a more easy and accessible by all tech. this is where Unstructured Supplementary Service Data (USSD) comes in. 

Features and functions of USSD

Unstructured Supplementary Service Data (USSD) sometimes referred to as “Quick Codes” or “Feature codes”, is a communications protocol used by GSM cellular telephones to communicate with the mobile network operator’s computers. USSD can be used for WAP browsing, prepaid call-back service, mobile-money services, location-based content services, menu-based information services, and as part of configuring the phone on the network.USSD messages are up to 182 alphanumeric characters long. Unlike Short Message Service (SMS) messages, USSD messages create a real-time connection during a USSD session. The connection remains open, allowing a two-way exchange of a sequence of data. This makes USSD more responsive than services that use SMS.16

Using USSD to address challenges

USSD messaging platform requires a little budget. According to the study, the use of USSD is one of the costless ICT techs available and affordable by the majority. This will help reduce the cost of investing in huge finance technologies and also accessibility. The pharmacy can either make the service available free of charge or provide terms and conditions for the registration of patients that can access the USSD. 

This technology allows users to interact directly from their mobile phones by making a selection from a menu in real-time making it a better option than SMS in terms of customer interaction. USSD menus can be customized to suit the needs of the pharmacy and the patients making it a favorable option over SMS.17

There are other advantages the USSD will offer. The pharmacist can monitor the frequent search of its patients. This will help the pharmacist in studying the health and medical performance of its patients. Patients will also be open to home service as patient registrations will bear their addresses. 

Components for USSD

Generally, the USSD functionality is implemented in the following modes; pull mode and push mode. The pull mode handles the mobile-initiated USSD requests while the push mode handles the network-initiated USSD requests. The USSD gateway will have an interface with the MSC. This will require the use of MAP to receive and send USSD data from the home location register (HLR).18

A USSD works on all GSM handsets of phase II or the latter. USSD is also supported by wireless application protocol (WAP), SIM Application Toolkit, and CAMEL enabling scope for many applications. 

Workflow analysis of USSD

If mobile phone users want to conduct a query by using the medical information query system, they need to dial a given accessing number to connect to the USSD platform of the medical information query system and request the USSD service. This process is as follows:

1. After the user dials the given accessing number, the dialing information is passed on to the USSD platform via the GSM network.

2. The USSD platform receives the dialing information, which indicates what application is requested by the user and then returns a user interface corresponding to the requested application to the user’s mobile handset according to the dialing information. For example, in the medical information query system developed in this paper, the given accessing number is “*119#.” After dialing the accessing number, the user will be asked to input their username and password. After inputting the correct username and password, the user will see welcome information on the handset screen.

3. The user will select a menu item by inputting a digit and their selection will be sent to the USSD platform. According to the user’s selection, the USSD platform allocates a corresponding service application server to process the query request and then returns query results to the user. At the same time, the USSD platform also charges the user for their query operation.

Feasibility of the use of USSD in pharmacy

The use of USSD has proven to be feasible in many businesses and establishments. There are hardly any banking institutions that have not, despite several other tech tools at their disposal, embraced the use of USSD. USSD has also become a tool used by security and emergency centers. There is no doubt about its efficiency and practicability.

Financial reasoning

Due to the time limitation of this research, USSD firms could not be located for financial inquiry in the United State. Financial reasoning will therefore be provided per information gathered from Africa’s Talking.19Setting up a USSD cost ZAR 5000 (327.22 USD) and monthly maintenance cost ZAR 5000 (327.22 USD). The setup cost is said to be a one-off payment. Other bills that will be arising from the use of USSD will be a service charge for the sessions patients will be making use of the platform. This is been charged by the network service provider. However, an estimate of ZAR 0.50 (0.033USD) per 20 seconds was noted by Africa’s Talking.20

Technical reasoning

Most of the technicalities need in the setting up of the USSD service will be provided by an Information Technology expert. There are over 30 IT firms with an online presence, and also provide online quotations. According to the study, it will cost 321.22 USD to get an expert to set up a USSD service. The technicality is also user-friendly; it is as easy as checking airtime balance. 

Training and knowledge requirement

The use of USSD does not necessarily require training. Every mobile phone user understands the operation of USSD. USSD messages are similar to SMS and it is simple and easy to send. It does not require an application on the phone to work, so there will be no need to go to any phone menus and options which sometimes can be complicating. 

However, patients need to be oriented about the services offered on the platform. Since USSD is a session-oriented service, an advertisement illustrating the services and options available will be helpful in case of emergency. The code for the USSD service should also be digits that are easy to relate with. 

Benefits for target patients

The target patients are patients who need the support of pharmacists for drug prescription, precautions, first aids, and emergency services which include home services and ambulance services. 

The use of USSD will meet the needs listed above. Patients will be able to make a selection of what medication to use for their pain or ailment when the symptoms experienced is similar to the one available in the options. This is more useful in a situation where the patient has a first aid kit but does not know what to use. There are other situations where the pharmacists are not available at the drugstore, but with this patients already know what they want to purchase from the store. 

Patients in critical condition will only need to ask for help from the pharmacist or ambulance and will receive a call from the pharmacist or ambulance service. Depending on the hospitality of the service provider the call might be toll-free; charges might be shared by both parties or from the patient solely. 

Patients will also be able to understand some medical precautions without having to wait in the waiting room for hours to see the pharmacist for consultation. The use of USSD will make a consultation with the pharmacist easier and faster. It also increases the learning ability of patients because they can go over the precautions frequently. Patients can also check-up on other precautions as prevention is better than cure. 

Current status in the research literature

Researchers are beginning to conduct in-depth studies on how to use the USSD to improve healthcare service. This is not limited to the United States alone, there are studies been carried all around the world to attain a more affordable and accessible mobile health service. 

Nakibuuka et.al in the journal Stud Health Technology Information examined the reasons attributed for poor data quality is the use of sub-optimal modalities for collecting and transmitting data, such as paper-based and Short Message Service (SMS). The study developed and implemented an Unstructured Supplementary Service Data (USSD)-based health data reporting intervention in a district in Uganda. The impact of the developed system on report accuracy, timeliness, and completeness was evaluated against the expected 100% rates by the Ministry of Health (MoH). A total of 224 reports were submitted over the two-month study period. Of the submitted reports, 171 (76.3%) were complete (p<0.0001) compared to MoH’s required 100%). 161 (71.9%) were accurate (P<0.0001), and 158 (70.5%) of the reports were submitted on time (p<0.0001). The deficiencies were largely attributed to a few facilities, as only 17.9% of facilities had data discrepancies with a mean of – 2.11 (P=0.38), 96.4% (0.130) of the facilities had complete reports, and 87.4% (0.100) of the facilities reported on time. Poor network coverage was an outstanding challenge to reporting.21

Zhe-long et.al examined the use of a wireless medical information query system based on Unstructured Supplementary Service Data (USSD). The study developed a medical information query system based on the use of USSD. It provided a module structure of a USSD service system. The USSD application server of this medical query system adopts a standard Short Message Peer-to-peer Application Programming Interface (SMPP API) of the USSD platform.22