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Application of
computers in Pharmacy
DR. SIDDHI UPADHYAY (M.PHARM, PH.D)
H.O.D. AND ASSOCIATE PROFESSOR
DEPARTMENT OF PHARMACOGNOSY AND PHYTOCHEMISTRY
SIGMA INSTITUTE OF PHARMACY, BAKROL, WAGHODIA, VADODARA
CONTENT
 Drug information storage and
retrieval
 Pharmacokinetics
 Mathematical model in Drug
design
 Hospital and Clinical Pharmacy
 Electronic Prescribing and
discharge (EP) systems
 Barcode medicine identification
 Automated dispensing of drugs
 Mobile technology and adherence
monitoring
 Diagnostic System
 Lab-diagnostic System
 Patient Monitoring System
 Pharma Information System
Drug information storage and retrieval – 1/6
Information storage and retrieval is the systematic process
of collecting data so that they can be located and displayed
on request.
Computers and data processing techniques have made
possible the high-speed, selective retrieval of large amount
of information for government, commercial and academic
purposes.
Drug information storage and retrieval – 2/6
IDENTIFICATION OF INFORMATION STORAGE
It can refer to a place like a storage room where paper
records are kept.
It can also refer to a storage device such as a computer hard
disk , CD, DVD or similar device which can hold data.
TYPES OF STORAGE
CD/DVD, HARD DRIVE, PEN DRIVE, FLOPPY DISK
Drug information storage and retrieval – 3/6
IDENTIFICATION OF INFORMATION RETRIEVAL
Information retrieval (IR) is the process of obtaining
information system resources that are relevant to an
information need from a collection of those resources.
In simple words “the tracing and recovery of specific
information from stored data.”
Drug information storage and retrieval – 4/6
COMPONENTS OF INFORMATION RETRIEVAL (IR)
The main IR components are given below.
• DATABASE
• SEARCH ENGINE
• LANGUAGE
• INTERFACE
Drug information storage and retrieval – 5/6
DATABASE :
A database is systematic collection of data.
They support electronic storage and manipulation of data. Database make
data management easy.
SEARCH ENGINE :
A program that searches and identifies item in database that correspond
to keywords or characters specified by the user.
Search procedure can be categorised as basic or advance search
procedure.
Capacity of search mechanism determines what retrieval technique will
be available to user and how information Stored in database can be
retrieved.
Drug information storage and retrieval – 6/6
LANGUAGE :
Information relies on language when being processed, transferred or
communicated.
LANGUAGE CAN BE OF TWO TYPES. 1. NATURAL : These languages can be
easily understood and created by any user. 2. CONTROLLED: Controlled
languages are such vocabulary languages that are typically created and
maintained by a particular organization.
INTERFACE :
In computing , An interface is shared boundary across which two or more
sperate components of a computer system exchange information.
Pharmacokinetics – 1/4
Pharmacokinetics is defined as the study of the time course
of drug absorption, distribution, metabolism, and excretion.
Clinical pharmacokinetics is the application of
pharmacokinetic principles to the safe and effective
therapeutic management of drugs in an individual patient.
Pharmacokinetics – 2/4
Computers have been used extensively in the field of
pharmacokinetics as instructional tool, in addition to simulations,
data analysis, and dosage calculation.
Pharmacokinetic classes are ideal for computer-based instruction
because the different pharmacokinetic parameters that govern the
drug concentration-time play role in the body can be related
together by mathematical expressions.
This makes graphical presentation of the drug concentration-time
play role very useful for presenting the interplay between the
different pharmacokinetic parameters.
Pharmacokinetics – 3/4
Computer-based pharmacokinetic simulations can be used for
educational as well as research purposes.
Pharmacokinetic simulations can be used to visualize how the
change in any of the pharmacokinetic parameters can affect the
drug concentration-time in the body, which can be useful for
understanding the basic pharmacokinetic concepts.
For research, simulations of the gastrointestinal tract (GIT)
factors that can affect drug absorption have been used to
predict the absorption of compounds with different properties.
Pharmacokinetics – 4/4
Besides, simulation of the drug concentration-time in
different body organs based on in vitro tissue distribution
information have been used for developing physiologically
based pharmacokinetic (PBPK) models.
Furthermore, simulation of the expected drug
pharmacokinetic and pharmacodynamic behaviour under
different drug administration conditions is used for guiding
the design of clinical studies.
Mathematical model in Drug design – 1/2
Mathematical modelling and computer simulations are emerging
technologies in drug discovery, development and drug assessment
for short- and long-term biological effects.
They promise to be cheap, practical, sensitive and specific, and
capture real aspects of the disease phenotype that is accepted as
clinically and biologically meaningful.
Mathematical model in Drug design – 2/2
However, existing computer-based platforms are not
capable of integrating complex nonlinear interactions of
molecular, cellular, tissue, organ and system activities that
are required in drug discovery.
Novel software offers solutions with regard to rational
decision making at different stages of drug development.
Hospital and Clinical Pharmacy – 1/3
Hospital pharmacy is division of hospital which monitors on
the receiving and allotment of drugs and medicines and
professional supplies, stores them and dispenses to
inpatient, outpatient and may have a manufacturing
extension to manufacture pharmaceuticals and parenteral
in bulk.
Clinical pharmacy is the branch of Pharmacy where
pharmacists and pharmaconomists provide patient care that
optimizes the use of medication and promotes health,
wellness, and disease prevention.
Hospital and Clinical Pharmacy – 2/3
Patient record maintenance is vital job in hospitals but with
the help of computers, data can be maintained easily and
also updated time to time.
Maintenance of stock means inventory control can be
achieved very well by using computers. For this purpose,
periodic or perpetual inventory control systems maybe
adapted.
Hospital and Clinical Pharmacy – 3/3
Computers can play role like,
•To detect the items which have reached minimum order level.
•To prepare list of items to be purchased and their quantities.
•To prepare purchase orders for vendors and to avoid duplication.
•To detect the infrequently purchased items for possible return or elimination from pharmacy’s
drug supply.
•To produce periodic summary and purchasing and inventory control statistics.
•Maintaining patient medical record
•Drug information services.
•Patient monitoring.
Electronic Prescribing and discharge
(EP) systems – 1/2
Electronic prescribing (e-prescribing or e-Rx) is the
computer-based electronic generation, transmission, and
filling of a medical prescription, taking the place of paper
and faxed prescriptions.
E-prescribing allows a physician, pharmacist, nurse
practitioner, or physician assistant to use digital
prescription software to electronically transmit a new
prescription or renewal authorization to a community or
mail-order pharmacy.
Electronic Prescribing and discharge (EP)
systems – 2/2
It outlines the ability to send error-free, accurate, and
understandable prescriptions electronically from the healthcare
provider to the pharmacy.
E-prescribing is meant to reduce the risks associated with traditional
prescription script writing.
It is also one of the major reasons for the push for electronic medical
records.
By sharing medical prescription information, e-prescribing seeks to
connect the patient's team of healthcare providers to facilitate
knowledgeable decision making.
Barcode Medicine Identification – 1/3
Bar code medication administration (BCMA) is a bar
code system designed by Glenna Sue Kinnick to
prevent medication errors in healthcare settings and
to improve the quality and safety of medication
administration.
The overall goals of BCMA are to improve accuracy,
prevent errors, and generate online records of
medication administration.
Barcode Medicine Identification – 2/3
It consists of a bar code reader, a portable or desktop computer
with wireless connection, a computer server, and some
software.
When a nurse gives medication to a patient in a healthcare
setting, the nurse can scan the barcode on the patient's
wristband on the patient to verify the patient's identity.
The nurse can then scan the bar code on medication and use
software to verify that he/she is administering the right
medication to the right patient at the right dose, through the
right route, and at the right time ("five rights of medication
administration").
Barcode Medicine Identification – 3/3
Bar code medication administration was designed as an
additional check to aid the nurse in administering
medications; however, it cannot replace the expertise and
professional judgment of the nurse.
The implementation of BCMA has shown a decrease in
medication administration errors in the healthcare setting.
Automated Dispensing of Drugs – 1/2
Automated dispensing is a pharmacy practice in which a
device dispenses medications and fills prescriptions. The
most important thing a hospital pharmacy should enforce is
patient safety.
Wrong drug and wrong dose errors are the most common
errors associated with ADC use.
Automated Dispensing of Drugs – 2/2
Automated dispensing machines—decentralized
medication distribution systems that provide
computer-controlled storage, dispensing, and
tracking of medications—have been recommended
as one potential mechanism to improve efficiency
and patient safety, and they are now widely used in
many hospitals.
Mobile Technology and Adherence
Monitoring – 1/2
Medication adherence, or taking medications correctly, is
generally defined as the extent to which patients take
medication as prescribed by their doctors.
This involves factors such as getting prescriptions filled,
remembering to take medication on time, and
understanding the directions.
Mobile Technology and Adherence
Monitoring – 2/2
Pharmacists have a major role in improving medication
adherence in patients.
They can confirm that patients are on the correct
medications and are not taking any other treatments/drugs
that may undermine the effectiveness of important
therapies.
Diagnostic System
Systems is a global leader of products and instruments used for
diagnosing infectious diseases.
Our products are used in the clinical market to screen for microbial
presence, grow and identify organisms, and test for antibiotic
susceptibility.
In the industrial market, Diagnostic Systems’ products are used for
the testing of sterile and non-sterile pharmaceuticals and medical
devices, for environmental monitoring and to detect food pathogens.
Lab-diagnostic System – 1/2
A medical laboratory or clinical laboratory is a laboratory where
clinical pathology tests are carried out on clinical specimens to
obtain information about the health of a patient to aid in diagnosis,
treatment, and prevention of disease.
Clinical Medical laboratories are an example of applied science, as
opposed to research laboratories that focus on basic science, such as
found in some academic institutions.
Medical laboratories vary in size and complexity and so offer a
variety of testing services.
Lab-diagnostic System – 2/2
More comprehensive services can be found in acute-care
hospitals and medical centres, where 70% of clinical
decisions are based on laboratory testing.
Doctors offices and clinics, as well as skilled nursing and
long-term care facilities, may have laboratories that provide
more basic testing services.
Commercial medical laboratories operate as independent
businesses and provide testing that is otherwise not
provided in other settings due to low test volume or
complexity.
Patient Monitoring System – 1/3
The Patient Monitoring System (PMS) is a very critical
monitoring systems, it is used for monitoring physiological
signals including Electrocardiograph (ECG), Respiration ,
Invasive and Non-Invasive Blood Pressure, Oxygen
Saturation in Human Blood (SpO2), Body Temperature and
other Gases etc.
In PMS, the multiple sensor and electrodes is used for
receiving physiological signals like as ECG Electrodes, SpO2
Finger Sensor, Blood Pressure Cuff and Temperature Probe
to measure the physiological signals.
Patient Monitoring System – 2/3
During treatment, it is highly important to continuously
monitor the vital physiological signs of the patient.
Therefore , patient monitoring systems has always been
occupying a very important position in the field of medical
devices.
The continuous improvement of technologies not only helps
us transmit the vital physiological signs to the medical
personnel but also simplifies the measurement and as a
result raises the monitoring efficiency of patients.
Patient Monitoring System – 3/3
CLASSES OF PATIENT MONITORING SYSTEM
In the past, the dominant products manufactured by medical device
manufacturers are mainly those for single parameter measurement. Nowadays
however, a multi-parameter patient monitor is commonly used.
 Single-Parameters Monitoring Systems
 Multi-Parameter Patient Monitoring Systems
Pharma Information System – 1/3
The PMIS(pharmaceutical management information system)
integrates pharmaceutical data collection, processing, and
presentation of information that helps staff at all levels of a
country’s health system make evidence-based decisions to
manage pharmaceutical services.
Pharma Information System – 2/3
Function
An effective PMIS is able to synthesize the large volume of data generated
bypharmaceutical management operations.
It then processes the data into information for use in planning activities, estimating
demand, allocating resources, and monitoring and evaluating pharmaceutical
management operations.
This information is often in the form of a few key indicators.
Indicators should be targeted toward staff at all levels so that they can monitor both
their own performance and that of the units for which they are responsible.
Another important function of a PMIS is to improve accountability.
Much of the recording and reporting in a PMIS is intended to create an audit trail for
products as they enter or leave a pharmaceutical supply system.
Pharma Information System – 3/3
Importance of a pharmaceutical management information system
A good PMIS provides the necessary information to make sound
decisions in the pharmaceutical sector.
Effective pharmaceutical management requires policymakers,
program managers, and health care providers to monitor
information related to patient adherence, drug resistance,
availability of medicines and laboratory supplies, patient safety, post
market intelligence, product registration, product quality, financing
and program management, among other issues.
THANK YOU !!!

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Application of Computers in Pharmacy

  • 1. Application of computers in Pharmacy DR. SIDDHI UPADHYAY (M.PHARM, PH.D) H.O.D. AND ASSOCIATE PROFESSOR DEPARTMENT OF PHARMACOGNOSY AND PHYTOCHEMISTRY SIGMA INSTITUTE OF PHARMACY, BAKROL, WAGHODIA, VADODARA
  • 2. CONTENT  Drug information storage and retrieval  Pharmacokinetics  Mathematical model in Drug design  Hospital and Clinical Pharmacy  Electronic Prescribing and discharge (EP) systems  Barcode medicine identification  Automated dispensing of drugs  Mobile technology and adherence monitoring  Diagnostic System  Lab-diagnostic System  Patient Monitoring System  Pharma Information System
  • 3. Drug information storage and retrieval – 1/6 Information storage and retrieval is the systematic process of collecting data so that they can be located and displayed on request. Computers and data processing techniques have made possible the high-speed, selective retrieval of large amount of information for government, commercial and academic purposes.
  • 4. Drug information storage and retrieval – 2/6 IDENTIFICATION OF INFORMATION STORAGE It can refer to a place like a storage room where paper records are kept. It can also refer to a storage device such as a computer hard disk , CD, DVD or similar device which can hold data. TYPES OF STORAGE CD/DVD, HARD DRIVE, PEN DRIVE, FLOPPY DISK
  • 5. Drug information storage and retrieval – 3/6 IDENTIFICATION OF INFORMATION RETRIEVAL Information retrieval (IR) is the process of obtaining information system resources that are relevant to an information need from a collection of those resources. In simple words “the tracing and recovery of specific information from stored data.”
  • 6. Drug information storage and retrieval – 4/6 COMPONENTS OF INFORMATION RETRIEVAL (IR) The main IR components are given below. • DATABASE • SEARCH ENGINE • LANGUAGE • INTERFACE
  • 7. Drug information storage and retrieval – 5/6 DATABASE : A database is systematic collection of data. They support electronic storage and manipulation of data. Database make data management easy. SEARCH ENGINE : A program that searches and identifies item in database that correspond to keywords or characters specified by the user. Search procedure can be categorised as basic or advance search procedure. Capacity of search mechanism determines what retrieval technique will be available to user and how information Stored in database can be retrieved.
  • 8. Drug information storage and retrieval – 6/6 LANGUAGE : Information relies on language when being processed, transferred or communicated. LANGUAGE CAN BE OF TWO TYPES. 1. NATURAL : These languages can be easily understood and created by any user. 2. CONTROLLED: Controlled languages are such vocabulary languages that are typically created and maintained by a particular organization. INTERFACE : In computing , An interface is shared boundary across which two or more sperate components of a computer system exchange information.
  • 9. Pharmacokinetics – 1/4 Pharmacokinetics is defined as the study of the time course of drug absorption, distribution, metabolism, and excretion. Clinical pharmacokinetics is the application of pharmacokinetic principles to the safe and effective therapeutic management of drugs in an individual patient.
  • 10. Pharmacokinetics – 2/4 Computers have been used extensively in the field of pharmacokinetics as instructional tool, in addition to simulations, data analysis, and dosage calculation. Pharmacokinetic classes are ideal for computer-based instruction because the different pharmacokinetic parameters that govern the drug concentration-time play role in the body can be related together by mathematical expressions. This makes graphical presentation of the drug concentration-time play role very useful for presenting the interplay between the different pharmacokinetic parameters.
  • 11. Pharmacokinetics – 3/4 Computer-based pharmacokinetic simulations can be used for educational as well as research purposes. Pharmacokinetic simulations can be used to visualize how the change in any of the pharmacokinetic parameters can affect the drug concentration-time in the body, which can be useful for understanding the basic pharmacokinetic concepts. For research, simulations of the gastrointestinal tract (GIT) factors that can affect drug absorption have been used to predict the absorption of compounds with different properties.
  • 12. Pharmacokinetics – 4/4 Besides, simulation of the drug concentration-time in different body organs based on in vitro tissue distribution information have been used for developing physiologically based pharmacokinetic (PBPK) models. Furthermore, simulation of the expected drug pharmacokinetic and pharmacodynamic behaviour under different drug administration conditions is used for guiding the design of clinical studies.
  • 13. Mathematical model in Drug design – 1/2 Mathematical modelling and computer simulations are emerging technologies in drug discovery, development and drug assessment for short- and long-term biological effects. They promise to be cheap, practical, sensitive and specific, and capture real aspects of the disease phenotype that is accepted as clinically and biologically meaningful.
  • 14. Mathematical model in Drug design – 2/2 However, existing computer-based platforms are not capable of integrating complex nonlinear interactions of molecular, cellular, tissue, organ and system activities that are required in drug discovery. Novel software offers solutions with regard to rational decision making at different stages of drug development.
  • 15. Hospital and Clinical Pharmacy – 1/3 Hospital pharmacy is division of hospital which monitors on the receiving and allotment of drugs and medicines and professional supplies, stores them and dispenses to inpatient, outpatient and may have a manufacturing extension to manufacture pharmaceuticals and parenteral in bulk. Clinical pharmacy is the branch of Pharmacy where pharmacists and pharmaconomists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention.
  • 16. Hospital and Clinical Pharmacy – 2/3 Patient record maintenance is vital job in hospitals but with the help of computers, data can be maintained easily and also updated time to time. Maintenance of stock means inventory control can be achieved very well by using computers. For this purpose, periodic or perpetual inventory control systems maybe adapted.
  • 17. Hospital and Clinical Pharmacy – 3/3 Computers can play role like, •To detect the items which have reached minimum order level. •To prepare list of items to be purchased and their quantities. •To prepare purchase orders for vendors and to avoid duplication. •To detect the infrequently purchased items for possible return or elimination from pharmacy’s drug supply. •To produce periodic summary and purchasing and inventory control statistics. •Maintaining patient medical record •Drug information services. •Patient monitoring.
  • 18. Electronic Prescribing and discharge (EP) systems – 1/2 Electronic prescribing (e-prescribing or e-Rx) is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, pharmacist, nurse practitioner, or physician assistant to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy.
  • 19. Electronic Prescribing and discharge (EP) systems – 2/2 It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.
  • 20. Barcode Medicine Identification – 1/3 Bar code medication administration (BCMA) is a bar code system designed by Glenna Sue Kinnick to prevent medication errors in healthcare settings and to improve the quality and safety of medication administration. The overall goals of BCMA are to improve accuracy, prevent errors, and generate online records of medication administration.
  • 21. Barcode Medicine Identification – 2/3 It consists of a bar code reader, a portable or desktop computer with wireless connection, a computer server, and some software. When a nurse gives medication to a patient in a healthcare setting, the nurse can scan the barcode on the patient's wristband on the patient to verify the patient's identity. The nurse can then scan the bar code on medication and use software to verify that he/she is administering the right medication to the right patient at the right dose, through the right route, and at the right time ("five rights of medication administration").
  • 22. Barcode Medicine Identification – 3/3 Bar code medication administration was designed as an additional check to aid the nurse in administering medications; however, it cannot replace the expertise and professional judgment of the nurse. The implementation of BCMA has shown a decrease in medication administration errors in the healthcare setting.
  • 23. Automated Dispensing of Drugs – 1/2 Automated dispensing is a pharmacy practice in which a device dispenses medications and fills prescriptions. The most important thing a hospital pharmacy should enforce is patient safety. Wrong drug and wrong dose errors are the most common errors associated with ADC use.
  • 24. Automated Dispensing of Drugs – 2/2 Automated dispensing machines—decentralized medication distribution systems that provide computer-controlled storage, dispensing, and tracking of medications—have been recommended as one potential mechanism to improve efficiency and patient safety, and they are now widely used in many hospitals.
  • 25. Mobile Technology and Adherence Monitoring – 1/2 Medication adherence, or taking medications correctly, is generally defined as the extent to which patients take medication as prescribed by their doctors. This involves factors such as getting prescriptions filled, remembering to take medication on time, and understanding the directions.
  • 26. Mobile Technology and Adherence Monitoring – 2/2 Pharmacists have a major role in improving medication adherence in patients. They can confirm that patients are on the correct medications and are not taking any other treatments/drugs that may undermine the effectiveness of important therapies.
  • 27. Diagnostic System Systems is a global leader of products and instruments used for diagnosing infectious diseases. Our products are used in the clinical market to screen for microbial presence, grow and identify organisms, and test for antibiotic susceptibility. In the industrial market, Diagnostic Systems’ products are used for the testing of sterile and non-sterile pharmaceuticals and medical devices, for environmental monitoring and to detect food pathogens.
  • 28. Lab-diagnostic System – 1/2 A medical laboratory or clinical laboratory is a laboratory where clinical pathology tests are carried out on clinical specimens to obtain information about the health of a patient to aid in diagnosis, treatment, and prevention of disease. Clinical Medical laboratories are an example of applied science, as opposed to research laboratories that focus on basic science, such as found in some academic institutions. Medical laboratories vary in size and complexity and so offer a variety of testing services.
  • 29. Lab-diagnostic System – 2/2 More comprehensive services can be found in acute-care hospitals and medical centres, where 70% of clinical decisions are based on laboratory testing. Doctors offices and clinics, as well as skilled nursing and long-term care facilities, may have laboratories that provide more basic testing services. Commercial medical laboratories operate as independent businesses and provide testing that is otherwise not provided in other settings due to low test volume or complexity.
  • 30. Patient Monitoring System – 1/3 The Patient Monitoring System (PMS) is a very critical monitoring systems, it is used for monitoring physiological signals including Electrocardiograph (ECG), Respiration , Invasive and Non-Invasive Blood Pressure, Oxygen Saturation in Human Blood (SpO2), Body Temperature and other Gases etc. In PMS, the multiple sensor and electrodes is used for receiving physiological signals like as ECG Electrodes, SpO2 Finger Sensor, Blood Pressure Cuff and Temperature Probe to measure the physiological signals.
  • 31. Patient Monitoring System – 2/3 During treatment, it is highly important to continuously monitor the vital physiological signs of the patient. Therefore , patient monitoring systems has always been occupying a very important position in the field of medical devices. The continuous improvement of technologies not only helps us transmit the vital physiological signs to the medical personnel but also simplifies the measurement and as a result raises the monitoring efficiency of patients.
  • 32. Patient Monitoring System – 3/3 CLASSES OF PATIENT MONITORING SYSTEM In the past, the dominant products manufactured by medical device manufacturers are mainly those for single parameter measurement. Nowadays however, a multi-parameter patient monitor is commonly used.  Single-Parameters Monitoring Systems  Multi-Parameter Patient Monitoring Systems
  • 33. Pharma Information System – 1/3 The PMIS(pharmaceutical management information system) integrates pharmaceutical data collection, processing, and presentation of information that helps staff at all levels of a country’s health system make evidence-based decisions to manage pharmaceutical services.
  • 34. Pharma Information System – 2/3 Function An effective PMIS is able to synthesize the large volume of data generated bypharmaceutical management operations. It then processes the data into information for use in planning activities, estimating demand, allocating resources, and monitoring and evaluating pharmaceutical management operations. This information is often in the form of a few key indicators. Indicators should be targeted toward staff at all levels so that they can monitor both their own performance and that of the units for which they are responsible. Another important function of a PMIS is to improve accountability. Much of the recording and reporting in a PMIS is intended to create an audit trail for products as they enter or leave a pharmaceutical supply system.
  • 35. Pharma Information System – 3/3 Importance of a pharmaceutical management information system A good PMIS provides the necessary information to make sound decisions in the pharmaceutical sector. Effective pharmaceutical management requires policymakers, program managers, and health care providers to monitor information related to patient adherence, drug resistance, availability of medicines and laboratory supplies, patient safety, post market intelligence, product registration, product quality, financing and program management, among other issues.