Category Archives: Pharmacy Informatics

Quick Hit: Update on keeping up with medical literature with MedInfoNow

Wow, it’s hard to believe that it’s been over four months since I posted this piece on using MedInfoNow. The post caught the attention of someone at MedInfoNow, which resulted in some interesting dialogue in the form of email exchange and a couple of phone calls. I found the company to be genuinely interested in how their customers (clients?) use their product and what they can do to improve the experience.
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Reviewing an #archetype

I’ve been meaning to write this for a while, but you know how things go.

While at HIMSS12 in Las Vegas last month I was asked to do a little review work. That’s not all that uncommon. People ask me to do things on occasion; review a blog post, review an app, give my opinion on something and so on. But this was completely different as Dr. Heather Leslie (@omowizzrd), Director of Clinical Modeling for Ocean Informatics and Editor for the openEHR Clinical Knowledge Manager asked me to review an archetype. A what? Yeah, that was my response when Heather and I first spoke about the topic nearly two years ago.

According to good ol’ Merriam-Webster an archetype is “the original pattern or model of which all things of the same type are representations or copies: also : a perfect example“. Simple enough, but still too vague for my brain so I went in search of a better explanation which I found at Heather’s blog – Archetypical.
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#HIMSS12 Day 3

Actually Day 3 was yesterday, but I’m just now getting around to putting some thoughts on paper.

Best session I attended was Care Coordination in Practice: Managing Data Volume and Data
Reconciliation
. The presentation was all about big data and how we’re failing to use it appropriately in healthcare. The slide deck was great. It’s available here if you’re interested.

A couple of things I found interesting in the presentation:

  1. There are approximately 1-2 billion clinical documents produced in the United States each year. That’s mind boggling if you stop and think about for a minute.
  2. More than 60% of key clinical data are not found in coded lists.The remainder of the information is found in free text, scanned documents, etc. That’s a problem because a lot of clinical decision support is based on information in coded lists. So what are we missing? A lot.

The takeaway from the presentation: “Get massive amounts of data flowing, then build structure slowly and incrementally. Don’t wait.” The presenter referred to this as “the Google approach to data”. I’m a fan of all things Google so that works for me.

I had coffee with Pauline Sweetman yesterday (@psweetman). Pauline is a pharmacist from the UK that I’ve been tweeting back and forth with for a couple of years. We had a pretty interesting conversation around the differences and similarities between hospital pharmacy practice in the U.S. and UK. Good stuff.

I also had a great conversation with Dr. Heather Leslie (@omowizard), a physician out of Melbourne, Austrialia that’s doing a lot of work with the openEHR project. During our short visit she persuaded me to participate in their Adverse Reaction archetype review; as a pharmacist of course.She’s always looking for additional help if anyone is interested. It’s a worthwhile project so at least have a look.

I spent more time roaming around the exhibitor area, specifically looking at RFID technology. I’m a fan of RFID, but it doesn’t seem to be catching on in healthcare. There are several reasons why, but we should still be looking hard at it’s application. I’m not sure whether RFID will become important or it it’s a bridge technology to something else. But the only way to find out is start using it and see where it goes.

One product that uses RFID technology that I found particularly interesting comes from a company called MEPS Real Time, Inc. Their product features a dispensing cabinet with real-time RFID driven inventory management to go along with a RFID med tray tracking system. Of course you wouldn’t use RFID for everything because it would be labor intensive and expensive, but for high dollar drugs it might make sense. It was pretty impressive.

MEPS_HIMSS12

#HIMSS12 Day 2

Today was the first real day of action for me at HIMSS12. I attended a couple of sessions and spent some time in the exhibitor area. The education sessions I attended were pretty vanilla. The most interesting of them was the first one I sat in on called “Got Smartphones? Leveraging Physician’s Smartphone Usage in HIT”. Rebecca Kennis and Dr. Afzal ur Rehman from UHS Hospitals described their journey toward building an iOS application for physicians to access clinical information from their HIS.

The application, called iCare, was quite nice. It had a nice flow to it and some pretty solid functionality. It gave physicians access to the patient medical record, medication lists, laboratory results, in addition to allowing physicians to record billing information and generate sign out notes for other physicians. It’s an Apple fanboy’s wet dream.

A few things that I thought were of particular interest:

  • Dr. Rehman said that they didn’t ask for help collecting data from any of their vendors because “they wouldn’t get it [the help they needed]”. That speaks volumes for what UHS thinks of their HIT vendors.
  • Dr. Rehman eluded to the fact that UHS was willing to dummy down their security measures because physicians didn’t like long passwords. Someone from the audience pointed this out and asked how he was able to convince IT to allow 4 character passwords. His response was a bit of a grin and “we had to twist their arms”.
  • UHS has given the iCare application to physicians with iPhones, but will not allow nurses to use it because they feel it is too big of a security risk. I can’t decide exactly what that means. The security risk is the same whether it is a physician or nurse. Are they saying that the number of nurses represents a greater potential for risk, or does it mean that they don’t trust nurses? I didn’t have the opportunity to ask the question.

I attended my first ever Tweepup at the HP booth in the exhibitor area. The event was sponsored by HP and brought together about 10 participants. I was able to meet Dr. Joseph Kim, which was a treat. I read a lot of his blog posts and share his interest in all things tablet PC related. We only had a few minutes to talk, but I enjoyed it.

The exhibitor area for HIMSS12 dwarfs the exhibitor area for ASHP Midyear. I couldn’t see everything today. I’ll have to go back for more tomorrow; maybe even on Thursday depending on how far I get. Two things I took away from what I was able to see today:

  1. It’s all about the data. Everyone had something to say about collecting data, mining it and using business intelligence to put it to good use. There were a number of products on display in the vendor area, including small standalone systems to large integrated solutions from some of the big boys. How important will data be to the future of healthcare? Hard to say, but a lot of people are betting the house on it.
  2. Tablets are pervasive in healthcare. Tablets are the new smartphone. Everyone is carrying one and all the vendors are trying to take advantage of it. Anyone trying to sell any type of EHR, documentation system, imaging system, etc. is pushing the idea of using a tablet. Companies like Panasonic, Motion Computing, HP and Fujitsu had their lineup displayed in full force. To top it off just about every vendor in the place is offering up an iPad2 as a drawing prize. Have we seen the end of the desktop? Hardly, but it’s obvious where we’re headed.

Overall I’d call day 2 a rousing success

#HIMSS12 Day 1

The Healthcare Information and Management Systems Society Annual Conference & Exhibition, i.e. HIMSS12, started today in Las Vegas. Actually a lot of pre-conference stuff started today. I didn’t do much besides get situated, print my registration badge, figure out where everything was, visit the HIMSS bookstore and Social Media Pavilion, etc.

The real action for me will start tomorrow with the opening keynote delivered by Biz Stone, Co-founder of Twitter at 8:00 am. From there it’s pretty much one session after another until the Exhibit area opens at 1:00 pm, which is always my favorite part of a conference like this. The exhibit area is a place to see what’s going on in healthcare without having to stick to a schedule. There’s a Tweetup hosted by @HPHealthcare at 3:00 pm in the Sands Expo and Convention Center that I’m planning on attending as well. Should be a good day.

The only problem I see is the tough choices I’ll have to make on which sessions to attend; it’s a pretty impressive list.

I’ll be Tweeting off and on all week using the #HIMSS12 Hashtag (@JFahrni).

Digital edition of U.S. Pharmacist off to a bad start

I received the announcement below in my email just a short time ago. So being the good little pharmacist that I am, I headed on over to the U.S. Pharmacist website to check it out. Imagine my surprise when I clicked on the digital issue link and was greeted with a “Service Unavailable” message (bottom image). Bummer. Hopefully they’ll get it up and running shortly.

Update: Looks like they got it working within 5 minutes of me posting this. It’s a nice format. Check it out for yourself here.

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Domain expertise in healthcare can go a long way

mobilehealthnews: “[John] Sculley said [while speaking at the Digital Health Summit, CES 2012] that some companies have put too much emphasis on style over substance.

“The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,””

I think these comments ring true for many of us that realize the disconnect between the people designing and building products for healthcare, and those actually using them. I can attest to the fact that it exists in many aspects of pharmacy automation and technology where things have a way of being forced down your throat. It becomes a game of which product is the “least bad”. It’s called settling for something, and it never really makes anyone happy. That’s why we’ve seen so many homegrown systems in pharmacies over the years.

There once was time when terrible usability at least meant great functionality. Unfortunately many companies have chosen to improve the usability at the expense of the functionality, which ultimately leads to a crappy product. I’ve experienced this many times during my career, especially with pharmacy information systems where improved UI’s have often resulted in poor performance, more mouse clicks and frustration.

Do the industry a favor and ask the end users what they need, instead of giving them what you think they want.

Staying up to date with medical literature isn’t easy

One of the problems I’ve experienced since leaving pharmacy is keeping up with the medical literature. I no longer have unlimited access to pharmacy journals, medical journals, engineering journals, etc; not to mention less mainstream literature.

While looking at the table of contents from my favorite journals and reading through the abstracts has value, it falls short of providing the same level of information one gets from digging into an article, looking at the data, viewing the tables and graphs, etc.

In an attempt to improve my access to information I signed up for a service called MedInfoNow.

MedInfoNow touts itself as “A personalized weekly email that quickly summarizes the latest journal article abstracts and citations from Medline® important to you.”

MedInfoNow is easy to use. You simply select topics that interest you, the services searches through those topics, puts them into a simple summary and emails them to you once a week. The service provides obvious value by giving me access to several journals in a single location, but MedInfoNow definitely falls short of my expectations. I was already doing much of what the service provides via RSS feeds, Twitter and frequent visits to my favorite informational websites.

The one thing I really need is access to full-text articles. Unfortunately MedInfoNow doesn’t do that. While it does provide links to some full-text articles, those articles are freely available to anyone and don’t require a paid subscription to the journal or MedInfoNow. Bummer.

Is MedInfoNow worth the $129/year I’m paying? Hardly. My subscription expires in June 2012. I won’t be renewing.

Effects of interruptions in healthcare [article]

A recent article in the Journal of the American Medical Informatics Association1 caught my eye. The article, A systematic review of the psychological literature on interruption and its patient safety implications, looks at various tasks and variables associated with interruptions in healthcare. The article is a meta-analysis, and we all know what that means, but it is interesting nonetheless. The authors of the article say that it’s a complex issue, but I think at the heart of the matter interruptions are simply bad. Our brains just don’t multi-task the way we’d like them to, and interruptions cause a break in concentration and therefore a break in our focus. I know it always takes me a few seconds to regain my thoughts when someone interrupts me. This is especially true when I’m performing a complex task. And wouldn’t you consider providing care to patients a complex task? I would.

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