Improving the Interoperability – Brian Fung
HB: Alright, so today, we have a special guest on the Talk to Your Pharmacist podcast. Our guest, Brian Fung, is a PharmD and board-certified pharmacotherapy specialist who is a medication management informaticist at a large, academic medical center and a clinical assistant professor at the University of Florida College of Pharmacy. At his current position, he is responsible for the implementation of the antimicrobial stewardship and control programs into the EPIC EHR or Electronic Health Record. Brian received his bachelor’s in human nutrition and his PharmD from the University of Florida and is currently pursuing his Master’s in Public Health from the Johns Hopkins School of Public Health. He completed a PGY1 in pharmacy practice at Sarasota Memorial Hospital and a PGY2 in pharmacy informatics at the University of Utah Healthcare. As I mentioned, Brian has his BCPS and has received additional training in antimicrobial stewardship through MADID. And Brian’s practice and research interests primarily lies within the intersection of informatics, infectious disease and public health. He is actively involved with ASHP and AMIA with recent contributions as co-chair of the leadership workgroup in pharmacy informatics for ASHP and as a member of several other advisory committees within the American Society of Health System Pharmacists Association. Brian, welcome to the Talk to Your Pharmacist podcast!
BF: Yeah, thanks for the introduction. And thanks for having me, I’m excited to be here.
HB: Well, thanks, Brian. 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.
BF: Sure. So a little bit about me, I think a lot of folks — well, maybe they would assume based on my current position as an informatics pharmacists, but I come from more of a technical background. I started off as a computer engineer/computer programmer. Never really practiced as one, but as I was growing up, those were kind of the things I was interested in, dabbled in computer programming, took some courses and things like that. Maybe some other things that may be interesting that is not as professional in the introduction is I used to like to game. I was very close into the pro gaming scene. So I was probably a semi-pro gamer back in the day. And I think that’s about it.
HB: Well, those are very interesting facts. So you know, I think that probably those interests in the technology space probably peaked your interest when you got into pharmacy school and, of course, learned that that was a growing field. So informatics is certainly very popular. I don’t even think it was really something much talked about when I went through pharmacy school. So how did you decide to take that path as a PGY2 resident?
BF: Yeah, that’s a great question. So it definitely had a lot to do with growing up and having that kind of technical background. And I think, you know, I didn’t know much about it in pharmacy school. As you mentioned, I don’t think it even to this day that commonly talked about in pharmacy school. But it was in — let me see — my P4 rotations, you know, I was doing rotations, and I think it was my third rotation, I met a resident. And he said he thought about doing informatics, and my mind just lit up. And I was like, whoa, this sounds techy. So you know, I asked him, what is informatics? And can you tell me a little bit more about that? And he said, you know, the basic is that pharmacy informatics is like a liaison between the clinical side of pharmacy and the technical side. And you know, I’m just very excited that something like this even exists. And so I looked more into it, and it helped a lot because in 2013, the year I was graduating, the very first publication of the Pharmacy Forecast came out. And basically, for those who don’t know, the Pharmacy Forecast is like this thing that’s published from the various leaders across pharmacy in the United States. And they kind of predict where pharmacy may be heading. And I read through it, and they basically said, you know, we think the demand of clinical pharmacy is going to be high, but we think the supply of clinical pharmacists, specifically those with residency training, is going to meet that demand. But they don’t think that there’s going to be adequate supply of informatics-trained pharmacy. But they do think that the demand is going to continually to increase. So that’s how I kind of figured out about it and really pushed me towards pursuing my PGY2 in informatics.
HB: Awesome. Yeah, and that’s something that ASHP produces. And I know that they canvass health system leaders from all over the country, and that’s great that you got your hands on that and paid attention to check some of the economics to make sure you were setting your career up for success. So we’ve talked a lot about the tech side. Maybe share how you decided to go into pharmacy.
BF: Yeah. So that’s always an interesting question too. I never thought that I was going to go into pharmacy or healthcare at all. You know, to this day, I still love computer engineering and the design aspect. But what shifted me into pharmacy was towards the end of high school, my grandma was diagnosed with ovarian cancer. And it was probably my very first time in a hospital setting. You know, just the confusion with what all this medical jargon meant, seeing a loved one suffer in front of you and not knowing what to do really bothered me. And there was no one in my immediate family that was in healthcare, so I didn’t know how to respond to that, and it made me think that maybe I should be the one to go into healthcare so I can better help my family. So that’s what got me interested in healthcare. And then in my first year in college, I actually switched into pharmacy, and pharmacy because I’d probably pass out if I see blood. I’m not good with blood, so I can’t do any of the other health disciplines. So pharmacy kind of sounded like a great fit.
HB: Yeah. And so Brian, what are some of the things that you do as an informatics pharmacist? I think people hearing this podcast would like to know a little bit more if they’re thinking, oh wow, I’m in pharmacy and I really tech. But what do you actually do once you’re finished? And since you’re at a big academic center, you’ve probably got a lot of great opportunity for that.
BF: Yeah. That’s another great question. I actually get asked that quite a bit, you know, in terms of like what do you even do? So I guess starting off at the very top, the way I like to think about it is we are liaisons between the clinical team and then the technical team. So when we’re working with the clinical team, we communicate in a way that they understand technical information and vice versa. And a lot of that role that we play manifests in the forms of different things. And one of those things is meetings. We have a lot of meetings. And because of our role as a liaison, oftentimes, we’re the ones leading the meetings. We would probably have someone from the clinical practice, someone from the technical side, and we kind of lead, OK, this is what the clinical team needs. Can we do x, y and z? And because we’re in that leading role, we’re also facilitating all of those meetings and then also demonstrating things within the system to help make those decisions. So a lot of things are meetings. And then another large portion of the work that we do is interaction with the system. So I work primarily within the software space, so our EHRs. There’s definitely a lot of informatic pharmacists that work with hardware, so like your automated dispensing cabinets, like Pyxis and Omnicell, smart pumps, carousels, all those in the hospital. So those are hardware. But there’s definitely a software component to it. But we do a lot of interactions with the system, which we build within it. So for example, in the EHR, they need new medications. We would build medication records in the system. But you also have to test it to make sure it works, you know, it can be ordered appropriately, it dispenses the correct product, it charges correctly, things like that. So a lot of our time is spent interacting with the system in that sense. And then something else we do is kind of navigating change control, a lot of politics, basically. You know, many of the things that we touch and do impact multiple teams, multiple systems, and we need to make sure that everyone is aware of the changes, everyone is OK with the changes, and so we navigate politics in that sense. You know, you want to have good relations with various parties. We want to make sure that we’re on track to get things migrated to different environments. And yeah. So it’s a great thing, in that sense, because a lot of the work that we do are project-driven. And we need to make sure we move the project from Point A to Point B, and a lot of that revolves politics, in a sense, just knowing where things should go to get approved and communicated. And with all of that said, one of the things that I do a lot, which might sound a little surprising to some is communicate. A lot of the time I spend at my desk is either on the phone, in meetings, whether in-person or virtual, and communicate. I communicate quite a bit, which might be a surprise — and I say it’s a surprise because it’s probably stereotypical to think that a lot of us in informatic pharmacy is just sitting in a cubicle and not interacting with a lot of folks. Yeah. So those are just some of the day-to-day activities that I do.
HB: Yeah. That helps to paint a little bit more of a picture, and I love that term as a liaison because you can speak either language, the clinical side from all your training in pharmacy school and then also the technical side because they’ve got to go hand-in-hand. And I did want to clarify, when you were talking about politics, you’re meaning more of the inter-office politics in chain of command and the structure of who’s approving what and just kind of helping to build those bridges between different departments and things. But certainly politics externally is an important piece as well because we’ve got all of these different regulations that may impact the state of informatics. I’m sure you could speak to probably some of those and then maybe some of the future of informatics. I know people may have heard of AI or machine learning, so maybe you could tell a little bit more about that from your perspective.
BF: Yeah. So in regards to the future of informatics, I think it’s amazing. I think the opportunities are endless. And to be completely honest and frank, I probably don’t have a lot of concrete things to say about the future, but I do have a lot of buzzwords I can offer, such as Artificial Intelligence and machine learning. But I thought that probably is a very great topic just to begin discussions on because I just got back from ASHP Midyear in Anaheim this past year, or I guess last year. But a lot of my colleagues were talking about this. And to my surprise, there were quite a few folks that were dabbling in Artificial Intelligence and machine learning. I didn’t see a lot of practice, like actually using it to provide care; I saw a lot of it used in the research sense. And I think this is where a lot of my colleagues think we’re headed in informatics and how we can utilize informatics to really capitalize on this. So to give a better example, though, of what this might look like as it applies to us is — a classic example is identifying whether a tumor is benign or malignant. And the way you do that, specifically using machine learning, which is a subset or Artificial Intelligence, is basically teaching a computer. And how you do that is you usually have a training set of data. So think of like an Excel spreadsheet. And that Excel spreadsheet has a lot of different variables in it: maybe the age of a patient, their ethnicity, their gender, those kind of things. And basically, those are your predictors or your variables. And you have some type of outcome. And in this example, it would be benign or malignant. So you feed them this training set of data and say, “Based on these variables, it’s benign. Based on these variables, it’s malignant.” And so the next time you have a tumor, you can feed it to this computer and they’ll help predict — you know, there’s nothing that will tell you if it’s malignant or benign because it’s not in the data set, but it will predict what it will likely be. So that’s what we’re talking about, to give a better, concrete example. And a lot of that has to do with stats. It’s basically math and statistics. And I think it’s such an amazing opportunity that many of us I don’t think really are aware of or how we can use it or how we can learn it. And it’s definitely the way I think myself and my colleagues think we’re moving toward. And because of that, I think that reporting and analytics will also be an important skill set to have. You know, many of us have or have worked with Electronic Health Records, and they generate massive amounts of data. So much that we need individuals that know how to analyze it. What does all this data mean? Interpret it, and then actually present them and make business decisions based on them. So in regards to like another area of the future of informatics, we need individuals that know how to do that. And because of those two things combined, I think two skill sets that may be important for those who are interested in informatics to look into, one is communication, which for current informatics, you definitely need that as well. But being able to take all this data and articulate it in a way that makes sense for individuals will be really important. And two, something that I commonly don’t tell people but I think as we move toward the future may be more important is the technical skills. Many of us in informatics don’t feel technical skills are as important. It’s mainly working with SMEs — not SMEs, the clinical practice folks and your technical folks — so you don’t really need to know the technical data, the technical speak, I guess, or jargon, but mainly how to liaise between the two. But technical skills in terms of like statistics, math, linear algebra, may become more important as we move more into this reporting analytical world and machine learning world. So I think that’s something to consider. And then outside of that, I think that the landscape of pharmacy as a whole may be changing quite a bit. You know, there’s a lot of talks about automation and robotics, especially with those other things that we just talked about, may give us more opportunities to automate a lot of the tests that we’re doing. And I think a lot of people talk about the community space, where you have robots doing a lot of this checking and packing of pills. So I think there’s a lot of opportunity there, and yeah, just some of the thoughts on the future of pharmacy informatics.
HB: Awesome. There’s certainly a lot of opportunity there. So thanks for sharing a little bit about that. So Brian, back in the beginning, we talked a little bit about your work with informatics and combining that with infectious disease. You’re leading a big project, I’m sure a lot of pharmacists have antimicrobial stewardship on top of mind. Maybe share a little bit about some of the importance of that work that you’re doing and then maybe even some perspective from a public health standpoint since you’re studying that right now too.
BF: Yeah. So I will — let me start off with this disclaimer and say I’m still newish to the program. So I’m certainly not a public health professional as of yet. I’ll just preface it with that. But in regards to the importance of that work, obviously, I’m pursuing my Master’s in public health because I enjoy that field. I think what actually got me into it was because of my experience in antimicrobial stewardship. But I think there is a lot we can contribute towards it. And the area that I’m mainly interested in and why I think it’s really important for public health, especially in the work that I do, is I guess one of the — let me backtrack a little bit to the past and how I chose informatics. So originally, I was very interested in specializing in infectious disease. In fact, when I was a PGY1, I was debating whether to do a PGY2 in infectious disease or do a PGY2 in informatics. And what actually shifted me, aside from the economics of things, is I had two chats with infectious disease pharmacists. One was Dr. Rybak, Michael Rybak, who was the author of the 2009 IDSA guidelines, and his fellow, who was — I can’t pronounce their last name, I’m going to butcher it — it’s like Melissa Neushauer (?). And when I talked to her, she did a stint at the CDC. I think it was in 2012, and her project at the CDC was to basically benchmark antimicrobial use across all hospitals in the U.S. You know, how are all the hospitals doing? How can we benchmark that and get all that information to the CDC so we can analyze the data and provide that information back to the hospitals? And she basically said, it’s a huge challenge. And why is it a challenge? The challenge was because hospital systems didn’t talk with each other. You know, the information in Detroit didn’t talk with the systems in Florida. So how can you make all the hospitals send data to a federal agency like the CDC, analyze it and benchmark it? So that really piqued my interest, and she basically said, if you want to do infectious disease, you should probably do informatics. And that was a huge pivotal point for me and made me go into there. And I think it’s important because infectious disease has many use cases and examples just like the one I just talked about that allow us to better code things. And when I say code things, it’s basically if you have a medication in Detroit, you know, let’s say Lisinopril, code it with some type of standard so when you send that prescription off to the pharmacy in let’s say Australia, they will know that it’s also Lisinopril there. So I think using infectious disease as an example, there are a lot of opportunities to better standardize concepts across not only the United States but on an international level. So I think it’s important for those kind of purposes.
HB: Yeah, certainly. And so Brian, one other thing that might — from your background that might come into play is, you know, with public health and I guess as we’re moving more even into population health, the social determinants of health are playing such a big component into that. So healthcare is only about 20% of, you know, what actually — basically, your food and transportation and all of those other behaviors not associated with receiving and getting healthcare are playing the bigger factors into health. But taking it back to gaming, is there anything that you see with the gamification of, you know, we’re all looking at how do we provide the right incentives all along the healthcare system. Do you see any opportunity with using gamification to help patients, you know, pick the right foods or things like that?
BF: That’s very interesting. When you say gaming, you’re actually talking about like video games, that kind of games?
HB: Um, well, I guess maybe it’s more in terms of game theory, so that might — I think I have seen even some video games. For instance, one on PlaySpent.org is set up as an online experience where someone can feel like they’re an underserved patient and are having to make decisions on do they use their food stamps for this? Or if they have $10, do they get the bus to get to the doctor’s visit? Or OK, well, how much do they have left for their pharmacy? So I think there are more of those types of experiences that are coming about, and I was just going to get your thoughts if you had any from that background.
BF: I probably can’t speak very intelligently to game theory. I’m aware of it, I’m just probably not that articulate about it. But I will say that I’m very impressed by what you said in the beginning of your statements about population health only contributing to 20% of a population’s health. You know, that was eye-opening to me when I first started my public health program, so that’s great. And then the second thing was the social determinants of health, that’s not a term that many folks know about, which is fantastic. And I think those kind of things have really shifted my perspective on how I look at health care where there is so many different opportunities, and so I’ll say two things about that. One, in terms of we’ll just say video games, one of my colleagues, David Voo, I can’t remember exactly where the application was. He was looking to use virtual reality to help certain patients. And again, I can’t really speak to how to articulate that, but there was another thing too. University of Utah, where I did my residency, they were using video games for little kids who had cancer, specifically the ones that were undergoing wasting, video games that would help them move around more to gain muscle. So I guess that’s from the application video game perspective. And then in terms of, you know, maybe driving patients to better healthcare, that it’s not directly related to the other social determinants of health, I think one of the things I’m interested in personally — and maybe this is getting a little away from your question — is social media. I think that there’s a huge opportunity to use social media to better drive patient behavior out there. You know? So a lot of cases, the young kids nowadays might not be watching TV, but they might be watching YouTube. And some of those kids, we can use social media like YouTube or Twitter or Facebook to drive them to do things like stop smoking. Let’s gain more political or social will to create parks so people walk more. Things like that. So I think — I don’t know if that really answers your question, but I think there’s a huge, huge opportunity to capitalize on social media, though, to focus on those other social determinants of health.
HB: Absolutely. That’s such a great point. And you know, I think that pharmacists should really start looking towards social media because there are other experts out there — or not even experts but people in different fields like nutrition or yoga or other fitness types that are already using those channels to educate people on health. And you know, I think 1 in 20 Google searches is related to a health question. So people are looking for answers, and it’s a great opportunity for pharmacists to step into that space. So thanks for bringing that point up. So Brian, as our final question, what is some advice that you would tell your younger self or for other pharmacists who are just getting started in their career?
BF: Yeah, that’s always a tough question for some reason. Do you want that tailored to pharmacy overall? Or informatics pharmacy?
HB: However you’d like to — you could do both, or you could pick one. It’s totally up to you.
BF: OK. A piece of advice that I would offer that’s probably applicable to both would be to probably find mentors. I think mentorship is huge in any industry out there. And I think some of the things that have shaped me today stem from the mentors that I had, unfortunately, not at an early age. You know, I found mentors that I identified with and looked up to at a later stage in my pharmacy career. And I really, really wish they stressed that a little bit more during pharmacy. And maybe they did, and I just didn’t capitalize on it, but mentorship. Seek out mentors early. See what works. A lot of those individuals that are in the mentorship space, we want to help students, we want to mentor them, and we all want to give back. So I think that would be probably the best advice I would suggest.
HB: I think that’s great advice. And I agree. I think that was something that I struggled with as well first graduating because, yeah, you don’t really realize the importance of having those people who’ve maybe already been carved a path or have already got a little bit of wisdom that they can share. And maybe it was just because I wasn’t self-aware enough to know that I needed a mentor, but I think that a lot of guests that are sharing, now that they’ve been successful in their careers just like you, I think that they often credit having great mentors who have helped to guide them along the way. So appreciate all of the great information and excited to have you as a guest on the Talk to Your Pharmacist podcast.
BF: This went by pretty fast. Thanks so much again. Really appreciate it. I really had a good time.
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