PAI 2030 Gives Glimpse of Pharmacy's Future

The December 8 educational session Generating National Impact with the Practice Advancement Initiative (PAI) 2030 at ASHP’s 2019 Midyear Clinical Meeting in Las Vegas reviewed findings from the first decade of PAI and provided a roadmap for fulfilling health-system pharmacy’s potential over the next 10 years.

PAI’s origins date to 2010, when ASHP launched the forward-looking endeavor as the Pharmacy Practice Model Initiative, followed by the 2014 Ambulatory Care Conference and Summit. The initiatives were collectively rebranded as PAI in 2015.

Eric Maroyka, Director of ASHP’s Center on Pharmacy Practice Advancement, told session attendees that ASHP recognized the need to reimagine the second decade of PAI because many of the original initiative’s goals have already been achieved.

That multistakeholder effort produced PAI 2030, a member-focused resource whose 59 recommendations anticipate practice needs by emphasizing patient-centered care; education, training, and practice roles for pharmacists and pharmacy technicians; technology advancements; and leadership in medication use and safety.

Meghan Swarthout, Division Director of Ambulatory and Care Transitions Pharmacy for The Johns Hopkins Health System, said PAI 2030 retains the focus on accountability that helped shape PAI’s first decade.

She noted that because health systems are increasingly focusing on meeting patients’ needs outside the walls of the hospital, pharmacists must likewise be accountable for their role in population health initiatives, transitional care, and ambulatory care settings.

In developing PAI 2030, Swarthout said, “we really wanted to focus on the entire continuum of patient care.”

She also noted that although pharmacists “should be leading medication education” at their institution, the effort must involve collaborative work with other colleagues on the patient care team.

Along with residency training and board certification, PAI 2030’s recommendations on education and training underscore the view that continuing professional development, rather than simple continuing education, is necessary for the advancement of the pharmacy profession. Tied to this change in perspective is the need to establish credentialing and clinical privileging for pharmacists as a standard practice for the profession.

“This is not consistent yet across all hospitals,” Swarthout said, adding that establishing these processes “is a long-term journey” for many institutions.

PAI 2030 recognizes the large and growing role that technology plays in patient care, and the initiative recommends that the pharmacy profession establish standards for the application of artificial intelligence in the medication-use process.

“Technology is here to stay,” said Joseph Lassiter, President of The Robertson Group, an informatics and medication-use consulting service.

Lassiter indicated that adaptive and responsive programming tools that use artificial intelligence and machine learning are expected to be integrated into decision support systems — including systems that help pharmacists make clinical and inventory management decisions.

He also said consumer products, such as mobile applications, digital wearables, and digital ingestible medications, are expected to be increasingly integrated into patient care plans.

“Our patients are demanding these technologies,” he said.

Thus, Lassiter said, all pharmacists — not just informatics specialists — will need to demonstrate some level of competence with these and other emerging technologies.

PAI 2030 also calls for pharmacy departments to identify and define advanced services that pharmacy technicians can be trained to provide.

Julie Lanza, Pharmacy Compliance Specialist at Beth Israel Deaconess Medical Center, explained that technicians at some sites are already specializing in advanced clinical and administrative roles, such as purchasing, regulatory compliance, informatics, taking medication histories, and providing immunization services.

She said pharmacists whose technician colleagues take on expanded roles have more time to provide clinical services.

“There is no disadvantage to pharmacists to having technicians in advanced roles,” she said.