Has interest in technology come and gone for pharmacsits?

I spent some time yesterday talking with some good people over at Pharmacy OneSource about pharmacy technology, clinical decision support, data mining, and a whole bunch of other interesting items. During one point of a conversations the history of Pharmacy OneSource came up. Part of that history includes the merger of Pharmacy OneSource with HealthProLink (HPL) sometime in late 2005.

The mention of HealthProLink (HPL) brought back fond memories of a time when pharmacy informatics was really starting to take off and I was infatuated with the Palm Pilot <insert flashback sequence here>. HPL was a set of software tools for collecting and quantifying pharmacist intervention data as well as ADR/ADE information. In addition, the application offered access to several clinical calculators and a fairly robust reporting system. I was part of the implementation team for HPL when I worked at Community Medical Centers – Fresno and used it daily for a couple of years.

This was also a time when Palm Pilots were all the rage and every pharmacist I knew carried one in their lab coat pocket. The Palm OS was a stroke of genius because of its minimalistic approach to the user interface. Anyone could pick up a device using the Palm OS and figure out how to use it in a matter of minutes. They were a model of simplicity and functionality. In addition, several development environments were available for application development as well as several “readers” and database applications. This led to the development of hundreds of medical references, medical calculators, free and commercial peripheral brains and countless ways to track patients, labs, and medications available for devices running the Palm OS. It is the only time in my career as a pharmacist that the entire profession embraced a new technology and used it to their advantage. The literature was full of “studies” using handheld devices for documenting clinical interventions1-4, carrying individually created documents and “peripheral brains”5,6 performing pharmacokinetic calculations, accessing drug information and performing drug interaction checking.7-12 The entire handheld movement was quite impressive to watch.

In fact, the technology remained popular with pharmacists up until just a couple of years ago. The facility I work for now was still using Compaq iPAQ Pocket PCs as a mobile drug reference during rounds when I came on board in November of 2008. I had to pry them from the pharmacist’s hands when I introduced them to tablet PCs less than a year later. They would have preferred to keep the Pocket PC devices, but they were old, slow, wouldn’t hold a charge any longer, had limited wireless connectivity and memory, and were getting harder and harder to support.

The tablet PCs have not been accepted with similar enthusiasm. While they are more powerful than their predecessors and offer greater access to information, they are larger, more cumbersome, more fragile, have less battery life and present challenges not previously predicted. I still believe they offer several advantages over previous handheld devices, but some  pharmacists would take the latter given the choice.

The trend of embracing emerging mobile technology has not transitioned to the more advanced platforms in use today. Of course I’m speaking of technologies like the iPhone, the Motorola DROID and a host of other popular smartphones. Several pharmacists I know carry smartphones, but they do not use them in a similar fashion to the Palm handhelds of the past. An impromptu survey of my department revealed that of the five iPhones in use by pharmacists, none were used as a drug information resource. Half of those did not have any type of medical reference material installed at all. Only one pharmacist in the department expressed interest in using a smartphone or similar device on rounds and he doesn’t currently own a device capable of doing it.

Is pharmacy technology more advanced than it was eight years ago? Of course it is. We have advanced rules engines, clinical decision support software, unprecedented access to data, BCMA, CPOE, improved ADCs, automated carousels, automated packaging, automated IV preparation robots, smart infusion pumps, and so on and so forth. In addition to the advancing technology we have a growing interest in pharmacy informatics from a great many pharmacists throughout the country. This is a good thing. However, what we don’t have is interest in this advancing technology from the masses. This isn’t true with other healthcare professionals such as physicians. Physicians have embraced the mobile frontier that sprang from the early days of the Palm Pilot. Many physicians carry smartphones and use them as a valuable part of their practice. These devices save physicians time while giving them better and faster access to patient information. Nursing appears to be adopting this technology at a faster rate than pharmacy, but they outnumber pharmacists >30:1 in the hospital so it is difficult to gage the real impact of handheld devices on nursing practice.

Why haven’t pharmacists embraced the successor to the Palm Pilot? It is hard to say, but I believe the greatest interest in technology among practicing pharmacists may have passed us by.

1. Bosinski T, Campbell L, Schwartz S. Using a personal digital assistant to document pharmacotherapuetic interventions. Am J Health Syst Pharm. 2004;61(9):921-934.

2. Clark J, Klauck J. Recording pharmacists’ interventions with a personal digital assistant. Am J Health Syst Pharm. 2003;60(17):1772-4.

3. Ford S, Illich S, Smith L, Franklin A. Implementing personal digital assistant documentation of pharmacist interventions in a military treatment facility. J Am Pharm Assoc. 2006;46(5):589-593.

4. Fox BI, Felkey BG, Bruce A Berger, Krueger KP, Rainer RK. Use of personal digital assistants for documentation of pharmacists’ interventions: A literature review. Am J Health Syst Pharm. 2007;64(14):1516-1525.

5. Felkey BG, Fox BI. Pharmacist PDA document managment considerations. Hosp Pharm. 2008;43(6):518-519.

6. Felkey BG, Fox BI. Creating the digital peripheral brain. Hosp Pharm. 2002;37(11):1222-1224.

7. Honeybourne C, Sutton S, Ward L. Knowledge in the Palm of your hands: PDAs in the clinical setting. Health Info Libr J. 2006;23(1):51-9.

8. Galt K, Rule A, Houghton B, Young D, Remington G. Personal digital assistant-based drug information sources: potential to improve medication safety. J Med Libr Assoc. 2005;93(2):229-36.

9. Clauson K, Seamon M, Clauson A, Van T. Evaluation of drug information databases for personal digital assistants. Am J Health Syst Pharm. 2004;61(10):1015-24.

10. Perkins N, Murphy J, Malone D, Armstrong E. Performance of drug-drug interaction software for personal digital assistants. Ann Pharmacother. 2006;40(5):850-855.

11. Robinson RL, Burk MS. Identification of drug-drug interactions with personal digital assistant-based software. Am J Med. 2004;116(5):357-8.

12. Barrons R. Evaluation of personal digital assistant software for drug interactions. Am J Health Syst Pharm. 2004;61(4):380-5.

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