IT和药剂师：经验与技术的结合-IT and pharmacist: the combination of experience and technology

ABSTRACT  摘要
 

Along with the development of information technology, great changes also take place in the profession of pharmacist accordingly. Generally speaking, IT provides useful communication tools and knowledge storage for pharmacist, enabling them to learn from all sources and have more excellent communication with the medicine producers, the hospitals and also the patients. Due to the appearance of CSCW (Computer Supported Cooperative work), EMR (Electronic Medical Record), CADS (Computer Assist Diagnosis System) and other kinds of IT equipments, the pharmacists are armed by more advanced skills and tools for cooperate with other partners in the medicine R&D, prescription and disease diagnosis. On the other hand, IT imposes great influence on pharmacists’ thought and behavior mode, sometimes even makes pharmacists rely on the technology but not their knowledge and experience, which proves to be harmful for the professional and also undermines the welfare of patients. IT brings the profession of pharmacists to a new stage but also provokes us to reconsider the meaning of IT for human society progress and development.
随着信息技术的发展，药师的专业也相应发生着巨大的变化。一般来说，它提供了药剂师有用的交流工具和知识的存储，使他们从各种渠道学习和与医药生产企业，医院更优秀的沟通。由于CSCW （计算机支持的协同工作）的外观， EMR （电子病历） ， CADS （电脑辅助诊断系统）等各类IT，药师与其他合作伙伴合作，武装医药研发处方和疾病诊断。在另一方面，它对药剂师的思想和行为模式影响很大，有时药师靠的是技术而不是他们的知识和经验，这证明专业有害，也破坏了患者的福利。它带给药剂师到一个新的职业阶段，但也引发我们重新考虑IT对人类社会进步和发展的意义。
 

KEYWORDS  关键词

Information Technology; Pharmacist; Communication and cooperation; Computer and internet  信息技术;药剂师;沟通与合作;计算机与互联网

 

1.     INTRODUCTION  引言

 

Pharmacist is actually an age-old profession, whose responsibility is to analyze medicine and help patients to choose medicine and use them. In ancient time, the profession positions of doctors and pharmacists are combined together, however, they are departed when it comes to the modern times. Perhaps we are more familiar with doctors in the hospital, but pharmacists are still indispensable positions in contemporary society. Pharmacists work mainly on two fields, drugstore and pharmaceutical factory.
药剂师实际上是一个古老的职业，其职责是分析药物，帮助患者选择药物和使用它们。在古时候，医生和药剂师的职业岗位结合在一起，但是，他们当谈到近代离去。或许我们更熟悉医院的医生，药剂师，但仍然在当代社会不可或缺的地位。药剂师的工作主要在两个领域，药店和制药厂。#p#分页标题#e#

In drugstores, they give suggestions for patients who are purchasing the medicines and help them do options in thousands of medicines of the drugstore. Sometimes they also could give diagnosis for patients in terms of usual diseases and find apt and specific ways to cope with the diseases. As for the pharmacists in the pharmaceutical factory, they carry out more complicated tasks related with the chemical and medicine experiments and test the performance, function and side-effect of the medicine (Friedman,1997). Along with the society progress and living standard enhance, people become to pay more attention on the health care, on the other hand, medicines are getting more varied, it is necessary to cultivate more pharmacists to help consumers choose suitable medicines and make good use of that.
 

In the developing countries such as China, pharmacists are compared more important than that of developed countries, although it is still a new emerging profession in China. In fact, the difference of pharmacists and specialized doctor lies in that pharmacists have all-round knowledge related with diseases and health compared with specialized doctors. Due to the advantage of pharmacists, they actually bear the role of “private doctor” for the mass in developing countries, although there are still great gap between pharmacists and the real private doctor. People get used to going drugstores and ask for the suggestions of pharmacists if they suffer from some indispositions.
 

2.     What does IT means for pharmacist: a powerful tool for better communication and knowledge storehouse  IT对药剂师意味着什么：一个强大的工具，更好的沟通和知识仓库

 

Of course, in order to be more employable as “private doctor” for the mass, pharmacists should ask for the help of Information Technology (IT). As we have pointed out that, the whole-subject medical science education is still on the beginning in some developing countries, so the private doctors with professional practice certificate are so rare. Most of the students in medical school accept the specialized subject education, such as surgery, pediatrics, and orthopedics and so on. However, being a qualified private doctor or pharmacists requires more whole round medical and medicine knowledge and experience. It is necessary for pharmacists to help the patients to choose suitable medicine with overall medical knowledge in all kinds of aspects, as a result, the IT supplies the pharmacists with great amount of information resource and great knowledge storing (Ornstein,2003).

Basically, IT provides three advantages for pharmacists to improve their work; firstly, IT enforces the relationship between pharmacists and the medicines producers, which enable them to cooperate more tightly to apply the new medicine to patients. The second, IT makes the relationship between pharmacists and hospital, and provides pharmacists more assistance and useful knowledge when they give suggestions to patients. The third, IT enables the relationship between the pharmacists and customers, pharmacists could get to know the situation about the patients after they take the medicines and pay more attention to the effect and side-effect of the medicines through the network. We are discussing the topic of IT and pharmacists based on these three aspects.#p#分页标题#e#

 

2.1     The role played by IT in the relationship between pharmacists and the medicine producers

 

Medicine producing industry always focuses on great resource on the R&D, especially the new product development. Medicine R&D consumes tremendous investment input and proves to be one of the highest cost projects(Pankoke-Babatz,1997). In the process of medicine R&D, there is not only the cost spent in the lab, but also the cost to apply the new medicine on patients, in which pharmacists play important roles. For example, the medicine giants such as Pfizer, Bayer, Roche and Merk and so on, they possess thousands of cooperators spread in the whole world which provide them with medicine application situation and the patient information. The R&D of new medicines is perhaps the most expensive R&D project in all the new product development, a new kind of medicine could be used on the patients only when the medicines are proved to be harmless through many rounds of experiment for many years. For this reason, the development of new medicines is monopolized by several medicine giant producers because small enterprises don’t have the ability to afford the huge investment on the projects.

However, the cost for communication between the pharmacists and medicine producers are so huge that it makes up a great proportion in the whole medicine R&D cost(Shortliffe, 1998). In traditional communication mode, telephone, fax and mail are the most usual tools, which brings amount of cost and time waste for both pharmacists and medicine producers. In the process of new medicine R&D, there will be a plenty of medicine service condition related with patients and the process should be divided into several stages and rounds in order to make sure that the new medicine could be used on patients without any danger(Kraut, 1990). Therefore, it is very necessary for pharmacists to keep touch with medicine producers tightly, but the communication cost impose serious constrict on their information exchange. Nowadays, IT provides new tools for both of them, kinds of on-time communication methods have been used here, such as the MSN, SKYPE, and ICQ, which enable the pharmacists and the medicine R&D staff could discuss the problems just like “face to face”. And also they transfer the pictures and complicated documents through the net and on-time communication tools.

For the past several years, computer supported cooperative work (CSCW) come to people’s life and enter many field such as education, business and government decision. Actually, pharmacists and engineers in the medicine enterprises could also cooperate to finish some works through the CSCW, which means a team cooperates to fulfill the task together in the background of computer supporting and network environment. The concept of CSCW is brought by Irene Greil and Paul Cashman in 1984 of MIT, nowadays, many software systems have been developed to support the CSCW, which are called the “Groupware”(Lucy etal, 1993).#p#分页标题#e#

CSCW broaden the communication methods between pharmacists and engineers in the medicine enterprises, it provides them learning and working space based on the network, including electronic conference system, tutor system, cyber classroom and so on. They could adopt many kinds of measures to cooperate and solve problems together through email, video and audio conference system, or BBS. Not only pharmacists could get to know the chemical makeup of the new medicines from the medicine enterprise, but also medicine producers could be informed with the patients’ reflection towards the new medicines and also the side-effect from pharmacists. The interaction proves to be very important for whether the medicines could be promoted into the market and used in the practice.

 

2.2 The role played by IT in the relationship between pharmacists and hospitals

 

Actually hospitals have their own pharmacists who are responsible for medicine management and distribution. However, the requirements of these pharmacists are diffrent from that of pharmacists in the drugstore or the one doing business on their own, because the latter should learn a lot about the medicine and also the patients’ situation to judge and prescribe.

Although pharmacists have been trained to master many medical science subjects and they could cope with lots of usual diseases in daily life, but they are still in need of the help from hospitals and doctors. An important reason for this is that pharmacists consider patients’ problem mainly based on the perspective of medicine makeup, function and healing effect but the diseases themselves. Faced with some kinds of disease, the pharmacists could not help linking it with the question that “which medicine could heal the disease”, but not the question that “why the patient bears the disease and how to heal it”. The obviously different thought between pharmacists and doctors decides that they should complement each other and cooperate together in the process of diagnosis and treating the disease.

As for an important application of CSCW, Electronic Medical Record (EMR) proves to a new tool for the cooperation between pharmacists and the doctors in the hospital. EMR, also called CPR (Computer-Based Patient Record), actually digitalizes patient records which use electronic appliance to reserve, manage and transfer them(Becker,1993). As we know, patient records have all the information about the patient, including the disease diagnosis, inspection report and medicine usage, and even the surgery and nursing record if there is. Different with traditional patient record, the EMR embodies complete and systematic information about the patient in the whole life, which reserved in the digital database.

Based on the technology of EMR, pharmacists could easily get the information of the patients from hospital through the networks, which help the pharmacists to evaluate the patients’ disease and list suitable prescription for patients. On the other hand, they also could add some new information to the record based on the situation of the patient after they take the medicine. It decreases the cost between them because the EMR could be transferred through the net easily. In addition, some countries have developed the magnetic card which stores the patients’ information about the disease in which they could go for pharmacists to buy medicines with it, and we could also treat the information card as one kind of EMR. An obvious feature and also advantage of EMR is that it could avoid the situation that pharmacists and patients forget former diagnosis result and prescription when the traditional paper medical records are used. Stored as digital information and in the database, the EMR could be reserved for long time and keep the precision, getting rid of the trouble to keep the paper medical records, and of course, the cost to keep the medical records could also be lowered in this situation.#p#分页标题#e#

 

2.3 The role played by IT in the relationship between pharmacists and customers

 

Once upon, medicines are forbidden in the on line transaction, however, the ban has been abandoned as for many kinds of medicines. Customers could easily buy the medicines through the internet and the B-C business mode. Medicine is very suitable to be sold on the web; there are many reasons for that. First of all, medicine is enough small and light to be transferred or mailed after being sold to the customers(Ash, 1997). Secondly, generally speaking, medicine is enough expensive to satisfy the profit requirement of on line sales. They are standardized goods of which the function and effect could be understood easily by customers through the on line introduction and explain. And thirdly, on line sales could get rid of many intermediary sections in the process and lower the cost and price of the medicines, which decides that the on line medicine sales bear many advantages compared with traditional sales mode.

However, the on line medicine sales have not developed to a great scale, because the on line cheating behaviors are so frequent that customers can’t easily judge which on line medicine shops are selling the true medicines. On the other side, customers tend to be induced to buy excessive expensive and less effective medicines by the advertisements of the on line medicine shops. Therefore, in order to promote the development of on line medicine sales, pharmacists could play more important role in this process. There are many tasks which could be fulfilled by the pharmacists, first of all, they could help the customers to distinguish and judge the on line medicine shops, and also help the clients to decide which medicines are necessary for them and which ones are unnecessary. Secondly, pharmacists could get to know how the customers reflect after they take the medicines and keep in touch with them through kinds of news communication tools.

Actually, the IT application on the relationship between the pharmacists and patients could be linked with the EMR and CSCW which have been discussed before in this paper. As we know that, pharmacists prescribe for the patients according to their experience and professional knowledge in the traditional mode. However, single pharmacist’s skills and experiences are limited after all and he or she can’t insure the prescriptions are correct absolutely. Even if the pharmacists could give out the right solutions for the patients, it will take amounts of time and energy.

The appearance of Computer Assist Diagnosis System (CADS) helps the pharmacists to solve the problems to great extents. CADS combine the wisdom of pharmacists, doctors and also the computer professionals, and sets up mathematical models on the computer according to the technology of vague mathematics, probability statistics and artificial intelligence(Eisenhardt, 1989). It deals with the systematic information (historical and contemporary) of the patients and gives out the diagnosis, healing method and also the curing anticipation. Even the patients can’t talk and communicate with the pharmacists face to face; the CADS could still provide excellent diagnosis which pharmacists could rely on. Because the CADS combine quite a lot knowledge and information related with the patients and diseases, it will save much time and energy for the pharmacists in the process of prescription.#p#分页标题#e#
 

3        How does IT alter and transform traditional pharmacist working process and function  IT如何改变和改造传统药剂师的工作过程和函数

 

Here we know that IT plays important role in the multilateral relationships among pharmacist, customer and also the hospitan and doctor, in the following content, we intend to explore how does IT alter and transform traditional pharmacist working process and function and make necessary comparison.

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