Desire to see more collaboration between pharmacies and local universities

Bitwise Industries in Fresno is an interesting place. It’s basically a tech hub pulled together by some great local minds. Located in a nice little area in downtown Fresno, BitWise has tasked itself with taking “a burgeoning tech industry that was growing in silos in California’s heartland, add places that inspire community, collaboration, and growth, create accessible education that equips and empowers a homegrown army of technologists, deploy talent to execute technology success stories”. I visited the facility with my brother, Robert when it first opened. Impressive and inspiring.

But this post is not about BitWise. It’s about something I’ve been thinking about for a couple of years. BitWise was simply a catalyst to remind me to revisit my idea.
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Moving from the Motorola Moto X to the Samsung Galaxy S5

s5_blackA short time ago I was an unwilling participant in my Moto X being dropped on a concrete floor.

Over the past year or so I’ve been working with a colleague on a book about the state of automation and technology in pharmacy IV rooms. During this time I’ve made several site visits to acute care pharmacies to look at the technology, workflow, etc in their IV rooms. As part of the data collection process I not only take a lot of notes, but snap lots of photos and record video of technicians working with the technology. I find the photos and video invaluable when reviewing my notes.

Prior to entering the cleanroom at one large hospital back east, the pharmacist in charge insisted that he wipe down my Moto X with alcohol. I wasn’t thrilled with the idea, but it was either let him do it or not take it in. I opted to let him wipe it down. During the process he dropped my Moto X. It hit the concrete floor pretty hard and bounced. The back popped halfway off. Not good. Since that time my Moto X has been acting weird, freezing up, not taking voice commands, and so on. I finally decided to replace it through the insurance I carry on the device.
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Color labels for pharmacy – Quick Label Systems

QuickLabel

I was rummaging through my travel bag and found some items that I collected during the ASHP Summer Meeting back in June. Most of the information had to do with IV room systems, tablet identification, and so on. But there was one item that caught my eye that didn’t fit with the rest: color labels.

I’ve written about the use of color on pharmacy labels before. It has its place, but in my opinion the major barriers have been cost and label quality. That’s why I was so interested when I saw the booth from Quick Label Systems at the ASHP Summer Meeting. The labels they had on display were spectacular. It’s difficult to see in my photo, but the image quality and label stock are top notch. The labels are tough –  really tough – resistant to water, and don’t smear. Very nice.

The quality of the label and print gives users the ability to place a crazy array of information on the label, including the ability to embed audio or links to video using bar code technology. It’s pretty cool.

The company isn’t a pharmacy solution in the traditional sense, but do provide OEM services for other companies. In other words, if you have a need for color labels Quick Label Systems will build color label printers with your name on them.

Not every product that leaves the pharmacy needs a color label, but they could certainly be useful in the IV room. Using color to differentiate or highlight something that requires special attention like chemotherapy is always helpful to pharmacy and nursing.

I’ll try to get the rest of my bag’s contents up over the next few days.

Medication Therapy Management as a tool for reduced cost of care and fewer readmissions

A colleague asked me if I had any information on the use of Medication Therapy Management (MTM) as a way to reduce healthcare cost and prevent, or decrease, readmissions.

I’m kind of a digital packrat and I knew that I had some stuff sitting in Evernote, so I spent the better part of a day rummaging through the information I had. The deeper I dug the more I realized that MTM is a no-brainer. There’s enough information out there to convince even the staunchest opposition.

Some thoughts I had as I read through my Evernote notes:

  1. I find it interesting that we’ve coined the phrase Medication Therapy Management (MTM) for something that pharmacists have been doing for decades. I remember interning for a community pharmacy back in the late 90’s. Speaking to the patient about their medication, adherence, compliance, adverse effects, etc was simply part of the job. Have we forgotten about that?
  2. MTM comes in many forms. Positive intervention can be achieved over the phone, via Telepharmacy, face-to-face with a pharmacist or technician, and so on. It is not a one size fits all approach.
  3. Even the simplest interaction between provider and patient can create a positive impact.
  4. MTM should start when a patient is admitted for any condition, continue throughout their hospital stay, and follow the patient out the door to their homes. In other words it should be continuous.
  5. Not everyone will need pharmacist intervention once they leave the hospital. Healthcare systems should first target patients with chronic conditions, problems with cognition, poor history of compliance, or a heavy medication burdens. Like everything else in the world around us, some people will do better with more help while others will prefer less.
  6. mHealth and sensors should be part of MTM. Continuous glucose monitoring, heart monitors, blood pressure sensors, smart bottles, devices to monitor and record inhaler use – classic area for pharmacist intervention, wireless digital scales for weight – think heart failure, and so on . This information should be fed directly into the patients MTM record for review by the pharmacist, physician and nurse.

Below is a summary of the MTM information I sent my colleague.
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Using facial recognition for medication adherence?

While doing a routine search of Twitter I came across AiCure (@AiCureTech), which touts itself as “Computer vision and facial recognition technology to confirm medication adherence on mobile devices”. Ok, you got my attention. Unfortunately the Twitter account appears to be dead as the last Tweet listed on the account was from September 25, 2013. The AiCure website is a bit more recent, however. The last item posted to their News & Events section was from March of this year.

There’s a video on the website that gives a basic overview of the process. I would have embedded the video here, but couldn’t figure out how to grab it, which is a real shame because it’s in their best interest to make information easy to share.

After watching the video I’m not entirely sure that the process makes sense to me. The video shows a jogger running on a pier. The jogger receives a notification on her smartphone reminding her to take her medicine. She stops, pops the tablet in her mouth, records the transaction via facial recognition on her smartphone, and then merrily continues on her way. In my experience people that are as “with it” as the person portrayed in the video don’t have any trouble remembering to take their meds; calendar reminders, pill bottle next to the coffee pot, etc. And why is the jogger carrying her medication with her while out jogging? I assume her jogging session wouldn’t last more than an hour or two. Take the med before or after. There’s no sense of the importance of the medication to the patient’s condition, nor is their any sense of the person being so busy that they couldn’t remember to take their medication. It would have made more sense to show some teenager with a serious medication-dependent disease state going through a busy school day. Right? Having so much fun with their friends that they forget to take their medication?

Thoughts on marketing aside, the concept of using facial recognition is intriguing.

From the AiCure website:

The combination of automated computer vision technology with dynamic patient feedback, offers a new gold standard in medication adherence monitoring. The computer vision platform is being extended to develop a robust identification and authentication system for medication.

Much like a voice recognition system, which understands what the user says, AiCure’s sophisticated, patented computer vision system visually understands what the user is doing.

The software-based technology is uploaded onto a smartphone or tablet computer. The user follows a series of pre-determined steps that are instantly recognized and confirmed through the webcam.

Automated DOT® [Directly Observed Therapy] confirms facial identity, medication dosage, correct ingestion, and time of ingestion. In addition, built-in data tools allow for ongoing patient-provider feedback; reminders in case of nonadherence; positive feedback; self-reported data by the patient; and therapy information – all designed to ensure real-time adherence monitoring and improved patient adherence over time.

Additional thoughts on the use of gravimetrics for I.V. compounding

Scale in PECSeveral months ago I wrote about my thoughts on using gravimetrics for I.V. compounding. At the time I wasn’t convinced of the utility, but my thoughts on the matter have changed. Over the past several months I’ve had the opportunity to dig deeper and mull over my thoughts on the matter.

There was a session at ASHP Midyear back in December titled New and Emerging Strategies for Minimizing Errors in I.V. Preparation: Focus on Safety and Workflow Efficiency. The presentation covered several topics, but one thing that caught my attention was data presented on error rates for the preparation of compounded sterile products (CSPs)1 and the benefits of using gravimetrics in the process. I was skeptical about some of the numbers that were presented. Data is only as good as how it was collected, what it’s compare against, and how it’s presented. One should always question the data, especially when it runs contrary to previously held beliefs.
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Access to information and learning

Intellectual growth should commence at birth and cease only at death.” ― Albert Einstein

I’ve recently returned from the ASHP Summer Meeting. I learned some new things, which serves as a reminder to me of the importance of continuous learning and access to information in our profession.

As a pharmacist I’ve been involved in a lot of systems over the years designed to keep me up to date. All have been successful in their own way, but obviously some were better than others.
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New Medscape Pill Identifier Tool [reference]

Medscape Pill IdentifierI received an email this morning from Medscape introducing me to their new Pill Identifier Tool.

The tool is pretty simple to use. When you click on the link above you’ll be taken to the Pill Identifier Tool site where you can begin your search. Any pharmacist, nurse, or physician that’s ever used a reference to identify an oral medication will be familiar with the process.

Across the top of the Pill Identifier you will find several fields to help narrow your search: IMPRINT, SHAPE, COLOR, FORM, SCORING. I’ve always found that if you have the imprint you’re about 80% there.

Clicking on a medication will give you additional information. There’s even an option to view the Drug Monograph.
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Monitoring Pharmaceutical Products in Twitter [article]

Pharmacovigilance of TwitterThere’s an interesting article in the April 2014 edition of Drug Safety that looks at English Twitter posts from November 2012 through May 2013 to see if there is any correlation between adverse event (AEs) reporting via Twitter and more “official” channels.

The authors collected public Tweets, which were subsequently stored for analysis using Amazon Web Services. See how they did that? Nothing magical about it. They used readily available information and a commercially available storage source.

Through the use of some human ingenuity, a “tree-based dictionary-matching algorithm”, and some manual labor, the authors collected 6.9 million Tweets, of which 61,402 were examined, ultimately leading to 4,401 AEs identified; referred to as Proto-AEs by the authors. During the same period 1,400 events were reported by consumers to the FDA.

While not perfect, and most certainly limited, I think the results were surprising, encouraging, and disappointing all at once.

Surprising because of the number of Proto-AEs found in the Twitter stream. People are savvy. “There was evidence that patients intend to passively report AEs in social media, as evidenced by hashtags and mentions such as #accutaneprobz and @EssureProblems. Even within 140 characters, some tweets demonstrate an understanding of basic concepts of causation in drug safety, such as alleviation of the AE after discontinuation of the drug.

Encouraging because being able to mine social media streams like Twitter could open up an entirely new avenue of real-time AE tracking; we all know that AEs are under reported, which leads to a lack of information for pharmacists and other healthcare professionals.

Disappointing because of the limited number of AEs reported to the FDA. I used to see AEs in the hospital that were never reported. I’m as guilty as many for not reporting AEs.

More work needs to be done in this area before we can begin to rely on data mined from social media, but they again it’s probably as reliable as information collected elsewhere.

The article is open access and the full version is online for free, so there’s no excuse not to read it.