Requirements for bar code scan verification set too low in meaningful use guidelines

homer-simpson-dohOver the weekend I read an article at HealthBiz Decoded about bar code requirements and meaningful use (MU). I knew that there was some language in Stage 2, but never took the time to read through it carefully. The meaningful use documentation is exactly what you’d expect from years of bureaucrats sitting around trying to generate a document worthy of the governments typical high standard. Yeah, it’s a big ol’ pile of crap. One thing’s for sure, it’s going to create an entire generation of consulting business for a lot of people. I digress.

According to the article, “Hospitals will be required next year to use bar codes to verify 10 percent of medication orders under government health IT rules.”  That number seems pretty low, even for our low reaching federal bureaucracy. And some people have noticed.

The article quotes Mark Neuenschwander, a barcoding evangelist, as saying “We should be striving for a higher percentage because errors can happen in the other 90 percent as easily as they can happen in the 10 percent.” True enough. Anyone out there have a job where 10 percent accuracy, completion or participation is acceptable? If so please give me a jingle if/when you have an opening.

It’s hard for me to imagine what someone was thinking when they pulled 10 percent out of thin air. I’m not naïve enough to think we’ll ever get to 100 percent, but c’mon man, 10 percent! Really? Fifty percent would have been low, but 10 percent is comical.

I think bar coding technology has a place in healthcare. It offers up some real advantages when used appropriately, and I find it disturbing that the MU guidelines find 10 percent scan rates acceptable. That’s some serious weak sauce right there.

Is it just me or is the pharmacy presence on Twitter growing?

My daughter had a three-day volleyball tournament over the weekend. While there’s a lot of action during these tournaments, there’s also some downtime. I usually pass the downtime by reading through my social media streams. I have a system that typically goes something like this: Twitter –> Google+ –> Facebook –> LinkedIn –> RSS-feed-reader-of-the-week –> start over.

This weekend I found myself clicking on, and reading, a lot more pharmacy related Tweets than usual.
Continue reading Is it just me or is the pharmacy presence on Twitter growing?

Saturday morning coffee [May 25 2013]

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee cup below is several years old. It’s a plastic Starbucks cup that I picked up somewhere in either Fresno or Visalia, California during my time as an IT Pharmacist at Kaweah Delat Medical Center in Visalia. The commute from my front door to Kaweah is just under an hour. There’s a Starbucks around the corner from my house and I used to swing by there on the way to work several mornings each week. Seemed like a shame to throw away all those cups, so I bought this dude. This weekend it’s sitting on the desk of a hotel room in San Mateo, California as I wait for my crew to stir so we can make our way to my daughter’s volleyball tournament.


Continue reading Saturday morning coffee [May 25 2013]

Pharmacists should learn to write code

You know what’s missing in healthcare? Pharmacists that write code and work on application development, that’s what’s missing. It’s the only way to ensure that applications have the right look, feel and functionality. Who knows better than a pharmacist, or pharmacy technician, how a pharmacy application should behave? No one, that’s who. Trying to explain healthcare workflow to a non-healthcare person is like trying to explain calculus to a dog; not that I think people outside healthcare are dogs. It’s just a metaphor.

Anyone can learn to code the basics, much the same way anyone can learn the basics of being a pharmacist. I could teach an average sixth grader how to perform the basic functions of a pharmacist; no lie. Of course things get a lot more complicated once you get past the basics, and that’s when you need people with more experience, expertise and wisdom.

I’ve dabbled in “programming” here and there, mostly out of necessity. At one time or another I’ve taught myself to code with visual basic, C# and some scripting languages like Javascript, PERL, and HTML. I also spent a couple years learning the ins and outs of database design and writing queries. But I was never all that good at it. I could do the basics, but it was neither my profession nor passion.

I wrote a couple of small apps to help me do my job – desktop and web-based – and built some databases to handle pharmacokinetic tracking and pharmacist interventions. Everything worked, but they were nothing that would have wowed anyone. What I needed was someone with a lot more experience to take those applications and turn them into something spectacular. That’s where having a real “programmer” would come in handy; someone with years of experience, expertise and wisdom.

However, back to my original point. Healthcare needs pharmacists that know how to write code to jump start the development process and drive things forward when things stall. Sometimes pictures and words simply don’t work.

Just an opinion. Take it for what it worth.

Thoughts on the Xbox One announcement

I’ve had an Xbox system in one form or another for a long time. I currently have an Xbox 360 in my home, and there’s a Kinect attached to it. We use the system for games and movies. Typical stuff.

Microsoft’s newest Xbox, dubbed Xbox One, is taking things to a whole new level. I sat with my wife the other night and watched the announcement as it replayed on my Xbox.

Some things that caught my attention during the announcement:

  1. Three operating systems. One based on the Windows NT kernel for apps like Netflix, Skype, YouTube, Twitter, etc.  The second is dedicated to games.  The third allows the other two to communicate with each. All this is designed to provide instant switching between apps. The demo was impressive.
  2. New Kinect. People in healthcare have been experimenting with Kinect for a while. After all Microsoft offers an SDK for anyone that’s ready, willing and able. Several groups have taken advantage of the technology. It’s surprising to me that no one in pharmacy has done anything with Kinect technology inside the IV hood. I fully expected to see something this year, but nothing has materialized. Why is that? Do you think any schools of pharmacy are looking at this type of technology? Don’t some schools claim to have strong “pharmacy informatics” programs? What do they do?
  3. The improved dashboard. This goes hand and hand with item #1 above. The instant switching, the ability to snap items and multi-task is pretty cool. I’ve been in pharmacy for a long time, and I can say without hesitation that all the pharmacy information systems I’ve used are nothing short of craptacular. Xbox One is an entertainments system that will most certainly cost less than $999; likely half that. It’s connected to the cloud and offers the ability for millions of people to be connected at the same time; as I look up from my laptop I can see that there are 87,043 people online playing COD Black Ops II at this very moment. That’s one game at 10:30PM PST.
  4. Voice and gesture control. Self-explanatory and awesome. Pharmacy systems should be voice and gesture controlled; packagers, carousels, robots, etc. The idea of using a keyboard and mouse on these systems just seems silly to me.

Xbox One could be an interesting foundation upon which to build some pretty cool pharmacy functionality. The new HD-capable Kinect with Skype is an out of the box telepharmacy system. The system could also be used to bring educational videos and games (gamification) right into the living room of patients. How about using the SDK to build medication adherence applications that tie into things like the AdhereTech smart bottle? And as mentioned above in item #2, Kinect offers up some interesting ideas for gesture control/recognition for certain pharmacy operations.

It’s exciting and disappointing to think of the potential for an entertainment system such as Xbox One. Exciting because the technology is staggeringly cool. Disappointing because healthcare continues to wallow in failure when it comes to technology. Crud, we still can’t figure out how to keep electronic records. My Xbox Live account knows more about me and certainly has more accurate information about me than my GP.

Saturday morning coffee [May 18 2013]

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug below was a gift that I received from the unSUMMIT U for giving a barcoding webinar back in January. For those of you that don’t know, the unSUMMIT is all about barcoding, of which I have a fair amount of experience/expertise.  The unSUMMIT U is an extension of the unSUMMIT that offers webinars about barcoding throughout the year. I’ve attended a couple.

Continue reading Saturday morning coffee [May 18 2013]

A view of pharmacy through Google Glass [simulated]

I haven’t been this excited about a technology in quite some time. Google Glass makes hands-free operation a reality in the pharmacy. I don’t think it’s a long term fix as I believe that robotics will likely take over the distribution process someday, but not today. Today robotics remains expensive and clumsy.

Unfortunately Google Glass is hard to come by. And there’s little chance I’ll get my hands on any (one?) in the foreseeable future. I did however stumble across a website that allows one to create a reasonable facsimile of what the view through Google Glass might be like.

So I took a minute and did a quick mock-up of what a pharmacy technician might see if they were directed to pull a medication from a static shelf while wearing Google Glass. Click on the image below to get the full effect. A little information along with a little augmented reality (red box and arrow) would be cool.



I think technology like this would be a great addition to any product that utilizes barcode scanning or requires photos. “Ok, glass, take photo”. Products like DoseEdge or Pharm-Q In The Hood that utilize cameras to document the compounding process could benefit from being able to snap a quick hands-free photo with only a voice command. Crud, you’re already looking at the product, which means Glass is too.

Medication therapy management at TEDxUniversity [video]

Thanks to Megan Hartranft (@MeganPharmD) and John Poikonen (@poikonen) for tweeting this. It’s nothing earth shattering, but it sums up why pharmacists should be more involved. Tim Ulbrich does a really nice job.

Pharmacy schools should show this short video to all their pharmacy students before turning them loose on the world. I talked about some of this in my presentation at the HIMSS Southern California Annual Clinical Informatics Summit a couple of weeks ago.

There was a time when I thought that the best place to engage patients was in the hospital, but I’m starting to rethink that position. If you think about it, engaging patients in the hospital is a bit of a reactive approach. We need to engage patients before they’re hospitalized to get the most bang for our buck.

Saturday morning coffee [May 11 2013]

MUG_Talyst3So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug to the right is from the company I work for. Strange little story to go along with how I ended up working there, but that’s probably better saved for another time. I ended up with a mug from the company long before I came on board. It was part of a swag bag at one of the past user group meetings that I attended as a customer. I believe it was my first ASHP Summer meeting way back in June of 2009; can’t be sure though.

Iron Man 3 was #1 at the box office last weekend raking in a cool $174 million. No surprise there as Iron Man 3 was expected to be a blockbuster. I wasn’t able to see it over the weekend, but did manage to catch it Monday night. Was it good? Absolutely, it was a very good move. However, I was a bit disappointed. There was a lot going on in the movie, and some of it felt “off”. I’d still see it again. It’s a bummer that this is likely the end of the Iron Man franchise. Oh, just in case you were wondering Pain and Gain was a close second with $7.5 million in weekend gross; a mere 23 fold difference.
Continue reading Saturday morning coffee [May 11 2013]

Info packets instead of a pharmacist used in attempt to improve medication adherence

angry_monkeyI came across an article today in The Baltimore Sun that caught my attention.

According to the article: “In a test of services geared toward making sure patients took their prescribed medications after leaving the emergency room, none made a difference, a large new study suggests.

Based on the experiment involving nearly 4,000 ER patients, researchers found that information packets, personal assistance and even access to an on-call medical librarian to answer questions about the drugs did not lead patients to fill more prescriptions or to take them as directed when they left the hospital.”

The best line from the article has to be that patients were given “access to an on-call medical librarian to answer questions about the drugs [they were prescribed]” This has to get the head-scratcher of the year award. The lunacy of healthcare never ceases to amaze me. Why, oh why would you give patients access to a medical librarian to answer drug questions. I have great respect for medical librarians, but that’s not their domain.

And as a surprise to no one, “One week after ER discharge, 88 percent of patients had filled their prescription, according to pharmacy records, and in a phone interview 48 percent reported taking the medication as prescribed. Those percentages did not differ between the participating groups.”

No kidding. Medication adherence is an incredibly complex problem with many different reasons why patients choose not to get their prescriptions filled or fail to take them consistently and accurately.

Depending on the study you read, medication adherence costs the United States anywhere from $100 billion to $290 billion annually, including increased morbidity, lost time from work, readmissions, etc. Pharmacists have been shown to help. Handing out pamphlets has not.

Honestly, I’m surprised that the Annals of Emergency Medicine would publish such crap. My cats leave equivalent work in the yard all the time, but at least they try to cover it up.

The article – Does Providing Prescription Information or Services Improve Medication Adherence Among Patients Discharged From the Emergency Department? A Randomized Controlled Trial – can be found here.