Amazon Alexa UseDr. Anthony Blash

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HB: Alright, so today we have a special guest on the Talk to Your Pharmacist podcast, Dr. Anthony Blash, who received his PharmD from the School of Pharmacy and Health Professions at Creighton University in Omaha, Nebraska. Dr. Blash completed the pharmacy informatics residency at Creighton University School of Pharmacy and Health Professions in Omaha, Nebraska, and holds the distinction of being the first pharmacy graduate in the nation to complete a pharmacy informatics residency. He is currently responsible for teaching in the Healthcare Informatics concentration of the PharmD curriculum at Belmont University College of Pharmacy in Nashville, Tennessee. And as a result of Dr. Blash’s courses, which meet the Health Information Management System Societies, or HIMSS, rigorous standards for quality health IT or healthcare education, the College of Pharmacy at Belmont University has been named as a HIMSS-approved education partner, or AEP. Anthony, welcome to the Talk to Your Pharmacist podcast.

AB: Thank you, Hillary, it’s great to be here.

HB: Well, thank you. And now that our listeners have heard a little bit about your background, maybe you can fill in any gaps from that intro and maybe share a little bit about your personal life?

AB: Yeah. So briefly, let me see, my first degree was computer science, and my second was pharmacy. So it was kind of easy for me to fall into this space called pharmacy informatics. And fortunately, it was just as, you know, the country was turning away from paper medical records into electronic medical records. And that first residency at Creighton appeared in the halls of my undergrad pharmacy experience and was an opportunity that I could not resist, couldn’t resist. I think the fact that I had a bachelor’s in computer science helped a lot because there were some strong candidates there for the residency. But after that, gosh, I taught out of residency at Drake University in Des Moines, Iowa, at the College of Pharmacy. And from there, went into private practice — well, you know, what we call private practice. I actually took a position at Grady Health Systems in Atlanta, which is a large safety net hospital, very well known on this side of the country. I think it’s 960 — no, 976 beds.

HB: Oh wow.

AB: Including the children’s hospital. And it’s in downtown Atlanta. It is a major provider of healthcare for underserved populations. The police and fire and all the municipal workers can get care at this institution. They serve the prison population for a couple of the counties in Georgia in that Atlanta area and have always been on the cutting edge of technology in terms of healthcare. They’re affiliated with a hospital there as well, so the institution is an academic institution. It takes a lot of students. Very, very rich experiences in terms of clinical and informatics came out of there and was actually a launchpad for, you know, continuing to move forward. I think there were a couple of positions between there where I practiced informatics and clinical on-and-off. You know, there’s a lot of institutions that can’t afford an informatician pure.

HB: Sure.

AB: So I would be a pharmacist and an informatician at those sites whenever needed. And you know, eventually I went to corporate, where I stayed on the West Coast for a number of years, responsible for 20 hospitals and about 300 clinics. And the corporate setting was Adventist Health, which is a faith-based institution and with a focus on, again, underserved populations, providing healthcare that can meet or approach the salaries and financial burden of the population and help them with compassion and care. And that’s always kind of been my draw, you know, if I can lend my expertise to something like that, then I kind of feel good at the end of the day, right? Which brought me to Belmont, another faith-based institution where the reason I actually left Adventist Health was because, Hillary, I had 22 active projects on my desk, informatics projects, and you know, West Coast is associated with most of the innovation in pharmacy, right? PharmD comes from West Coast, came across the country. Pharmacists as providers came from West Coast, came across the country. The informatics rotation students that I was able to get from those institutions, you know, I had an expectation of strength in the conversation. I feel like I could have pulled them off the street, and they would have had an equivalent level of informatics conversation. So I found myself with more and more projects and less and less help. And I started looking for someplace where I could develop the type of student that I would have liked to have seen in that environment. And Belmont was the answer for me after an exhaustive search. The informatics position here was open for two years.

HB: Oh wow.

AB: So there was space for me to occupy without a voice already established, and I could help set the direction for that conversation, which led us to HIMSS and you know, the certifications that our students are getting and, you know, a lot of the successes that they’re having.

HB: Yeah. Awesome.

AB: Yeah.

HB: So speaking of HIMSS, can you share a little bit about what HIMSS is for those of us that don’t know? And then maybe, you know, how students can get involved. I know you’re very involved, and there’s a conference spring, coming up here soon.

AB: Yes, yes, in the next couple of days, as a matter of fact. So HIMSS is the Health Information Management System Society. You know, as subspecialists in pharmacy, we each have a smaller association that we’re affiliated with, right? So I would feel comfortable in saying there’s a pediatric conference that folks are able to go to, an association that sponsors and promotes that. HIMSS is the association that sponsors and promotes healthcare informatics across the spectrum: medical informatics, radiology, nursing, pharmacy, all of those are embraced under this umbrella of HIMSS. Very powerful organization in the healthcare information technology space. And they sponsor two certifications, global certifications. The CAHIMS and the CPHIMS. CAHIMS is the Certified Associate in Healthcare Information Systems. CPHIMS is the Certified Professional in Healthcare Information Systems.

HB: OK.

AB: So for the CAHIMS, you know, that’s an entry-level certification that has requirements that can be met by general clinical practitioners who have turned the corner and are now facing an informatics conversation. The CPHIMS is — the current requirements are that, you know, you’ve been in this space for at least five years and have an understanding of what’s going on through those five years. And the tests are appropriately leveled so that they can query your knowledge base on both those. So in the Belmont University College of Pharmacy program here in Nashville, we have affiliated with HIMSS on a large level at least for the informatics conversation. And they’re responded in kind by, you know, partnering with us as an Approved Education Partner. We were actually the first.

HB: Alright.

AB: Yeah, in the nation.

HB: Very good.

AB: So we’re very proud of that. And I believe we’re kind of the only pharmacy school that’s doing that now.

HB: OK.

AB: I think the conversation when you get to informatics is still relatively new for us as a healthcare profession. But I really feel like we are having a slightly more in-depth conversation at Belmont now. You know, it shows in our students and the type of projects we’re able to tackle and accomplish. So I guess that’s a good conversation about HIMSS, you know, for more information, I can make the links available to you.

HB: Sure.

AB: You can put them in the show notes or whatever.

HB: Perfect.

AB: And folks can find out more that way. Yeah.

HB: Wonderful. So you know, you were sharing a little bit about some of the pioneering that you guys have been doing, and I’ve seen a couple of press releases about Amazon Alexa. So if you could tell us more about some of the work that you’re doing with that, that would be wonderful.

AB: Sure. Sure, sure. So again, my first degree was computer science. And so I don’t have the natural fear of going into that space that you normally find with other clinical professionals. So healthcare is a very deep body of knowledge. Pharmacy is a very deep body of knowledge. But it’s relatively narrow as you look at the grand scheme of things, right? So a healthcare professional is not expected to have a technology degree associated with them, right? So it’s very rare to find someone with feet in both of those ponds. So the fact that I kind of fell into that type of position makes our conversation a little more unique. So the students have an opportunity to become Alexa developers maybe about mid-point in our healthcare informatics conversation. And it’s pretty rigorous in terms of what you need to do to be able to do that. I mean, they’re coming from 0 to 60 where they don’t know programming, they don’t know a language, and they have to develop a workable program that’s accepted by the accrediting body at Amazon. Once that occurs, their program gets featured in the Amazon store and they, by default, become developers. Right? So once that happens, the sky is essentially the limit with what we can do with that new platform.

HB: Awesome.

AB: Right. So there’s — oh my gosh, I wish I had accurate numbers, but I feel comfortable saying there’s 20 million Alexas in homes in the country.

HB: Sure.

AB: Right? I have a bunch of them. But you know, I want to think that it’s not as uncommon as some people may be led to believe. Amazon, on the other side of this equation, is making some very directed moves into the healthcare space.

HB: Sure, yes.

AB: So you know, as you know, they’ve purchased Whole Foods. They’ve obtained a pharmacy license.

HB: PillPack.

AB: Right. They’ve moved into the pharmacy discussion with splinter companies. And they have a team that is using Alexa to help further those aims. So back to us, we have the opportunity to become Alexa developers relatively easily, right? Students are probably going to laugh when they hear that part. It’s relatively easy for me because I’m just watching. But relatively easily. I actually got my developer — I guess you would call it license or whatever from Alexa with the first team. So it’s relatively simple to get that. Understatement. But once they’re developers, then we try to think in a space where OK, we know Amazon is moving into this space. We know that we can be productive on this platform. We know that they’re using this platform to talk to patients and other providers with healthcare-related information. We own the pharmacy conversation. No one else can have the conversations that we can have. Why not put them all together? Right? So I think it’s been a year, maybe two years now, where the first teams started developing patient information for the Alexa.

HB: OK.

AB: And we’ve crossed a major threshold in the last 12 months where we have the top 100 medications available right now for patients to access through the Alexa app.

HB: OK.

AB: The skill is called My Medical Home. And you know, again, I can give you the link in the show notes. But we have surpassed that top 100 meds goal maybe about 6-7 months ago. And we’re very close to finishing the top 200 now.

HB: OK. So what’s a use case like for somebody that maybe doesn’t know exactly what that might look like? Is it — when you’re developing a skill, is it medication-focused, condition-focused? What might that look like?

AB: For us, our team struggled with that first for quite a long time. What I like to do in our conversations is, you know, I feel like as a programmer, I have an unfair advantage. So I’m going to step back and let the students struggle with the concept. And it’s super valuable, Hillary, for them to do that because, again, flashback to me with 23 active projects, 22 active projects on my desk. I don’t necessarily have the bandwidth to drag someone from letter A to letter R, where I am right now. Right? So I want someone that can spin up quickly, grasp the situation that we’re looking at and become productive. And I think everybody wants that in a rotation student.

HB: Right.

AB: You know? I think everyone wants that in a rotation student. There’s a certain amount of give-and-take that you should expect.

HB: Sure.

AB: Because the student has to grow also, but the student should be in a position where they can support you somehow as well. Right? So with this concept and with what we’re trying to do, the students decided that the conversation they wanted to have was with the patient.

HB: OK.

AB: Right? And I think they took into account all the things that they’re seeing in terms of what Amazon is doing and the moves that they’re making. They bought Whole Foods. Well, who goes to Whole Foods? The patient, right? They’ve gotten into PillPack. Why? Because they want to give medications to patients, right? The team that’s working on Alexa is looking for patient engagement activities, right? So everything they’re doing is pointed towards the patient. So I think the team made a good choice in moving towards the patient as well. So we’re looking at a very rudimentary conversation with the patient that gives them the basic outlines of the medication.

HB: OK.

AB: We say in the introduction from Alexa that this should not replace conversations with the pharmacist.

HB: Sure.

AB: Should not. But there are patients who won’t converse with us. They won’t. Either they’re intimidated, it’s the white coat syndrome, no, nothing’s wrong with me, I’m fine. But they’ll have conversations with Alexa like it’s no problem. So if we can help bridge those conversations, that is an opportunity for pharmacy and healthcare to advance patient understanding of what they need to know.

HB: OK. That’s helpful. So there is certainly a lot of opportunity with Amazon Alexa. And something else that probably a lot of listeners are starting to hear about is AI. Like what is AI? So you might have a few thoughts on that and what kind of role might that play in the pharmacy space?

AB: Wow. That’s transformative. I mean, AI stands for Artificial Intelligence, by the way. So there are — and we’ve had this for many, many decades where we have to produce metrics, either to show our worth, to put fingers on the distributive functions of our roles, to justify our budgets, to justify our drug budgets, to justify the pharmacy activities. We’ve always had to embrace data and manage data. So it comes as no surprise that this information is valuable. So the Artificial Intelligence, wrapped on top of that, is going to be able to do three things for us. So the term we’re dancing around is analytics, which is the management of large bodies of data, right? Reporting the management and reporting the large bodies of data. So there are three types of analytics, and I hope I get this right. So there’s descriptive analytics. There’s prescriptive analytics. And there’s predictive analytics. OK?

HB: I’ve heard of predictive analytics.

AB: Yes, yes. Most people have who have started this conversation.

HB: Yes.

AB: So descriptive analytics is what we’ve been doing all our professional lives. We get the data, we report the data. Oh yeah, you know, we’ve had this number of interventions as pharmacists and we are assuming we had an impact. Right? And this should justify us being here. Right? And then there’s prescriptive analytics, which is one step past descriptive. So prescriptive analytics would be OK, so we have this data, and it’s telling us to move in this direction. We’ve accumulated a body of data that’s telling us to move in this direction. So it’s still a reactive function, right? It’s still a reactive function. Predictive analytics is we have this body of data, and it’s telling us to do something but something we’ve never done before. And the Artificial Intelligence has pulled data from here, this resource, the weather, your population, what’s going on with disease states, and it’s decided based on all of this information and whatever algorithm has been programmed into it that here’s a trend that you may not have spotted that you might want to focus on moving forward to either help your population as a whole, rise up a little bit more in terms of health, or to stave off something that you see coming in the future. I mean, the possibilities are endless. So folks call the Amazon Alexa smart speaker and the other smart speakers Artificial Intelligence platforms. And they are. But it requires someone to feed that information or that understanding into the platform to help turn it around and make it an analytics engine for you. And recently, Amazon has revealed that now, you can use databases within Alexa and you can use reporting functions within Alexa, which is pretty exciting as you think about Alexa and all these other smart speakers as AI-capable because clearly, that was their plan all along for they stumbled into it like we have.

HB: Yeah. Well, we’ve really just scratched the surface on some of these new technologies that are available. Do you have any tips that you could share on if somebody’s interested in this field, how could they start to get up-to-date, maybe some of your favorite resources that you use to stay current in the informatics field?

AB: I think I want to make sure that our audience understands that informatics can be approached at any stage in your professional career. So a lot of us as pharmacists may feel like that ship has sailed. We’re in the part of the profession that we’re in, and that’s that. I would push back against that and say that that is never the case, it’s never too late to pivot, and that opportunities exist for all of us if this is a space you think is valuable for you. I would also say if you look at trends, I think both of us would be comfortable in saying that we’re not going back to paper records.

HB: No.

AB: I think both of us would be comfortable saying that more and more, we’re being asked to provide a story with the data that we’re collecting. And that trend is not going the other way. So with each passing day, the informatics conversation becomes more and more of a necessity as opposed to this exotic offshoot that that other guy does.

HB: Yeah.

AB: Yeah. So with that being said, I think if you’re at the professional level — and we’ll start there — HIMSS is an excellent resource for you. ASHP is an excellent resource for you, APhA is an excellent resource for you, NCPDP is an excellent resource for you. But HIMSS can — our conversation in HIMSS is specifically on healthcare informatics. So there are going to be other components you can get from our other associations that have supported us for hundreds of years. And they’re awesome, and I don’t want to discount anything that they’re doing in the space, but for my money, I think that the conversations should start at a place where you can also end the conversation. So there are a lot of resources available there that could probably be of help. Now, ASHP, I do believe they have a certification packet for informatics. So there’s another great resource. I’m not as familiar with the other associations, but I believe those two places would be a good place for the professional to start, the working professional who’s looking at a career change.

HB: Yeah.

AB: You know, Nashville is a healthcare-rich city. Healthcare-rich city. I mean, you can throw a stick up, and you’re likely to hit a clinician or a healthcare informatics person, right? So we have the benefit of having a very strong local HIMSS association here that has partnered with the juggernauts in the city in terms of providing support, content, opportunities to grow and all of those things. So there’s another great place to start. There’s probably a local HIMSS chapter in your town as well or close. So you can feel comfortable with that, reaching out to them and trying to find resources. I want to tell you, Belmont University College of Pharmacy gets those types of questions every day. We, I, will give them to the students to research. And again, this is just strengthening their depth of knowledge so that when they’re at my site in the past, they can hit the ground running with intelligent conversation and useful (inaudible).

HB: Sure.

AB: So they’re helping answer all of those questions. I don’t answer any of them anymore. If they’re going off the cliff, I’ll tweak a little bit. But essentially, they’re growing their knowledge bases, they help everyone else. So you know, I think — and I’m hesitant to say — but you can also reach out to us at Belmont and ask whatever questions you need to if you’re in the pharmacy space and you’re considering that type of resource or need to find training opportunities. Now, for the students, if you are fortunate enough — alright. Our accrediting bodies in academia have decided that informatics is a required conversation for a contemporary pharmacy degree. They decided that in 2016. So colleges of pharmacy have been moving towards that informatics conversation from that point to today. Some of them are further along than others. The first thing obviously is going to be to look within your school and see what resources are available for you. There are residency opportunities all across the country. I believe there’s maybe 25 informatics residencies at this point across the country, from post-graduate experiences. We don’t have one at Belmont yet, but we are moving towards that. You know, I really got to wrap my head around that because it’s a big commitment.

HB: Sure.

AB: You know, to have a student that you’re responsible for their future successes for that long period of time.

HB: Right.

AB: I’m a little afraid of it. But I’m trying to turn the corner and see if I can get to that. But your local school is going to be your best resource. If you are approaching pharmacy school and have not been accepted as a student or have reached out to anyplace, I would encourage you to visit our site, to visit my LinkedIn, to see what our teams are doing, and you know, make yourself educated as you choose your future course. And I think that covers everybody, right?

HB: Yeah. That’s helpful. We hit all the different possible listeners, I hope, but as he mentioned, you can always reach out for more questions. And you know, something that’s neat about HIMSS is that it is non-pharmacy specific. So it’s an opportunity for interprofessional type of exposure, and you know, I think that I’ve attended the Southeast HIMSS conference that’s held here in Nashville.

AB: Oh yes. Yes. That’s an awesome conference.

HB: It is. And there, all of the innovation and everything, I mean, you just heard about the cutting edge things when you’re at a HIMSS conference. And informatics has not been my field of study, but even attending, you will walk away with some great learnings.

AB: Absolutely.

HB: So definitely. Well as our final question, Anthony, can you share maybe some advice that you would tell your younger self or for other pharmacists who are just getting started in their career?

AB: Oh my gosh. In general, leave yourself open to opportunities. Don’t assume that you know your path because that will close doors to you that are wide open at this point. Say yes to opportunities more than you say no. Be willing to explore areas of pharmacy — and there are many — where you never thought you would find yourself. And I think if you consider yourself truly a lifelong learner, you’ll have a very, very awesome, awesome experience in this space. I think the part about being willing to volunteer and being willing to put yourself out there and connect with people and mind you, there have been many personality assessments taken by pharmacy students and pharmacists. And that’s not a zone that we comfortably inhabit, but it’s worth the effort. It really is. It really is worth the effort. And I think if you consistently open yourself to opportunities, you’ll find yourself in a lot of very nice places.

HB: Wonderful. Well thank you so much for being a guest on the Talk to Your Pharmacist podcast.

AB: You’re so easy to talk to. It was awesome. Very nice. Thank you.

HB: Thank you.

Host

Hillary Blackburn

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