Jerry Fahrni

Month: September 2013

  • Homegrown medication tracking at Children’s Hospital Boston

    Children’s Hospital Boston is a 395-bed children’s hospital located in the Longwood Medical Center area of Boston Massachusetts. It’s a pretty cool place near Harvard School of Medicine as well as the Massachusetts College of Pharmacy and Health Sciences; not to mention that it’s literally right across the street from the famous Brigham and Women’s Hospital.

    I’ve had the pleasure of visiting Children’s Hospital and receiving a grand tour of the pharmacy and all its operations. The Pharmacy Director and IT Pharmacist have a great vision for what can be accomplished with the appropriate use of pharmacy automation and technology. They’re both quite practical about their decisions in this area.

    The pharmacy itself makes great use of technology like the Cerner Pharmacy Information System, carousels, high-speed automated packagers, DoseEdge IV Workflow Management system, as well as a homegrown medication tracking system, which I found fascinating. The medication tracking system has been in use for some time now. Children’s built the system themselves, which makes it all the more impressive. You just don’t see that kind of thing these days.

    The Director of Pharmacy at Children’s Hospital Boston provided me with a link to the YouTube video below. The video shows the nuts and bolts of their medication tracking system. While not detailed, it’ll give you a general idea of what it does.

  • Getting creative with pharmacy labels: dosing calculations

    I was searching for inpatient pharmacy label examples, specifically IV label examples, for a project that I’m working on and came across a site called RxLabelToolkit.com. It’s a neat little site that offers quite a bit of information on label design. I don’t know if the business is still active as the most recent post I can find on their blog is from December, but it’s worth a few minutes of your time to stop and have a look.

    RxLabelToolkit.com: “One of the most valuable features of BarTender for pharmacy, is the ability to perform pharmaceutical calculations right within the label application. This allows us to build a label that can calculate a dose, an infusion rate, expiration date or a taper schedule. Any mathematical formula needed can be performed right in the label application.”

    The site has some pretty cool examples. The ampicillin label below is my favorite. There’s also a brief slide presentation that walks you through all the fields on the example label.

    Ampicillin1gmLabel

     

  • Biologists develop new method for discovering antibiotics

    Science Daily: “Biologists at the University of California, San Diego have developed a revolutionary new method for identifying and characterizing antibiotics, an advance that could lead to the discovery of new antibiotics to treat antibiotic resistant bacteria. The researchers made their discovery by developing a way to perform the equivalent of an autopsy on bacterial cells. “This will provide a powerful new tool for identifying compounds that kill bacteria and determining how they work,” said Joseph Pogliano, a professor of biology at UC San Diego who headed the research team.”” – An “autopsy on bacterial cells”, how cool is that. This is a tremendous discovery as we’ve been slowly losing the war on bacteria for more than a decade. The last time I practiced “clinical pharmacy” was about six years ago and antibiotic resistance was a scary issue back then.

    Journal reference:
    Poochit Nonejuie, Michael Burkart, Kit Pogliano, and Joe Pogliano. Bacterial cytological profiling rapidly identifies the cellular pathways targeted by antibacterial molecules. Proceedings of the National Academy of Sciences, September 2013; DOI: 10.1073/pnas.1311066110

    superbug

    (Image taken from The Microbiologist, where source is liked to CNN)

  • Thoughts on the current state of mobile computing

    The phrase “mobile computing” has been around for a long time. Remember the “Ultra-Mobile PC” (UMPC) movement back in the late 1990’s and early 2000’s? That was an exciting time for mobile computing. Unfortunately the excitement was limited to a very small circle. Back then, the technology simply wasn’t ready for widespread consumer adoption. The machines were cool, but clunky, slow, and insanely expensive. People were not ready to embrace something that required more than a cursory knowledge of technology. Even though the technology was not anywhere near what it is today, I firmly believe that many of the concepts floating around during the UMPC days were fundamentally better than much of what we have on the market today. We’ve progressed forward in many ways, but slid backward in others. It’s unfortunate that society wasn’t ready for the concepts back then. Imagine where we would be today if we would have continued to develop the UMPC concepts and ideas from the 90’s.

    OQO2
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  • The future of 340B, my perspective

    The snippets below are taken from a recent article in Pharmacy Times: The Future of 340B: It’s All About Perspective

    “Established more than 20 years ago [the 340B Drug Discount Program], this legislation was enacted to assist different health care settings in providing excellent care for indigent and vulnerable patients. To allow this to happen, safety net providers have access to discounted outpatient drugs from manufacturers. By being able to purchase the discounted medications, these qualifying organizations are able to utilize the savings to provide care for those uninsured and underinsured patients. “ – The 340B Drug Discount Program can be a great thing for healthcare systems that care for a lot of ‘uninsured’ or ‘underinsured’ patients. These are often time indigent patients.
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  • Back in the saddle again

    “I`m back in the saddle again, out where a friend is a friend” – Gene Autry

    It was 49 days between the time I was unceremoniously released from duty as a product manager by my previous employer until I finally went back to work. You can see my thoughts on my search for a job here.

    On Thursday, September 12, 2013 I found myself in familiar territory as I reported for duty as a per diem IT Pharmacist at Kaweah Delta Medical Center. The position calls for two shifts a week. It’s a start.

    For those of you that don’t know, Kaweah Delta is where I got my start as an IT Pharmacist back in November 2007. the idea of an IT Pharmacist was new and it was an exciting time. I spent about three years at Kaweah Delta implementing technology and automation left and right. I was fortunate to have been involved with a pharmacy remodel, smart pump implementation, BCMA implementation, the first stages of CPOE implementation, the early stages of mobile technology, among other things. It was also during that time that I started experimenting with this blog and social media. I learned a lot during my time at Kaweah Delta. They were good to me, but I left in 2010 to explore other opportunities.

    When I left Kaweah Delta in 2010 the IT Pharmacy department was one person, me. Since that time they’ve grown the service to include 2.5 full-time pharmacists and a full-time pharmacy technician. They’ve done a lot of good things since 2010, and thankfully they’re doing a lot more. They are currently preparing to implement the NEPS Labeling Solution for their labeling needs as well as implementing DoseEdge in their IV room. Fortunately for me they ran out of bodies to do all the work and were contemplating hiring another pharmacist when I made contact in search of employment. Timing is everything they say.

    I won’t lie, the first two days in the “new” position were a bit humbling. I felt like the kid that went away to college at the big university only to find out that he couldn’t make it and had to return home and start over at the local junior college. I am now at the bottom of the very ladder of which I used to sit atop. My excursion into the world outside the pharmacy walls has literally cost me six years of career path time, i.e. I’m right where I was in November of 2007. Actually, that’s not true. In the strictest sense I’m in a position lower than I was in November 2007.  So in reality it’s more like ten years of career path time, unless pharmacy career time is like dog years. In that case I should be ok unless I have the dog years thing backward, at which point I’m screwed.

    Everyone at Kaweah Delta has been great. I’ve had to explain my situation to several people, but no one has openly mocked me yet, which I believe the pharmacist code allows. Regardless of all that, it feels good to be back in the saddle again.

  • Saturday morning coffee [September 6 2013]: The Butler, Surface, Med Adherence, Note 3

    “Hardships often prepare ordinary people for an extraordinary destiny.” ~ C.S.Lewis

    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….

    I have officially run out of coffee mugs from which to pull for my SMC posts. The coffee mug below was a Christmas present from my youngest daughter, Mikaela, and will be used as my official SMC mug for the time being.

    MUG_SMC
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  • HIPAA poses threat to innovative healthcare technology

    HIPAA, the Health Insurance Portability and Accountability Act, was enacted back in 1996 as a way to protect the privacy of individual patients, among other things. It all sounds good in theory, but in practice HIPAA creates more problems than it fixes. The regulatory burden of the act creates a black hole of endless tail-chasing as healthcare facilities spend precious resources ensuring that they’re in compliance. Trust me when I say that the red tape is labor intensive and costly.

    It seems that I’m not the only one that thinks HIPAA is problematic for healthcare. According to a recent article at mobihealthnews:

    “…the regulations [HIPAA] still are not flexible enough to keep up with the pace of innovation in digital health, according to a newly published commentary in the Journal of the American Medical Association (JAMA).** Plus, the authors contend, the new requirement that business associates such as vendors be subject to the same HIPAA requirements as covered entities – healthcare providers, insurance companies and the like – poses a serious threat to startup companies…the final rule may impose an unfunded mandate for organizations, which ironically may impede adoption of innovation in mobile health,” wrote Dr. C. Jason Wang, Stanford University, associate professor of pediatrics at the Stanford University Center for Policy, Outcomes and Prevention, and Delphine J. Huang, a medical student at the University of California, San Francisco.”

    I understand the spirit of HIPAA, but like all bureaucratic solutions to simple problems it lacks common sense.  Is HIPAA really necessary? I believe you could make an equally solid case for or against it depending on where you fall on regulatory necessity. Regardless of your view, it’s obvious to me that HIPAA needs a serious overhaul.

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    **The commentary in JAMA is available for free and can be found here.

  • Real-time medication tracking: Pharmtrac.PD by PlusDelta Technologies

    I’ve been revisiting some of the pharmacy technology that I’ve covered over the past few years. Partly to see what advances have been made, if any, and partly to see if some of the smaller guys I’ve come across are still in business.

    PlusDelta Technologies is an interesting little company that I discovered at the ASHP Summer Meeting in Denver in 2011. I was impressed with their vision, and with their use of mobile technology to track medications throughout the distribution process. At the time the company had a small suite of products, but as I sit here looking at their website it appears that they’ve whittled it down to just one: Pharmtrac.PD. Focus people, that’s called focus.
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