You can see more of his musings on Twitter – @TheCynicalRPH

TCP makes some great points in his comment, and in my opinion his thoughts reflects the sentiment of many pharmacists practicing in the real world. I was going to refer you to the comment, but felt it would be better to post the meat of it below:

…………

Here’s my opinions -

I agree with you that pharmacy is on a precipice of massive change, and like everything else in this world, it’s all about money and power.

Subtle clues convinced me that it was headed this way long ago. If one reads the various medical, nursing, and pharmacy journal articles, it’s easy to notice. The medical and nursing journal articles NEVER have authors telling them what their roles should be, or how they should practice their profession. Almost every other pharmacy journal article has the phrase “the role of the pharmacist” somewhere in it’s description. It seems to me that we’ve always been desperately looking to find and describe a role for us since 3rd parties came into the picture. Now, it’s supposedly MMT.

These articles also point out a reason why pharmacy is so fragmented and why we haven’t fully been able to communicate with each other and work together. These same authors are often “telling” pharmacists “how” they need to practice their profession, as if we are beneath them instead of being their equals, or like we aren’t capable of doing it right. It sends a negative subconscious message to other pharmacists.

In my experiences, pharmacists also waste inordinate amounts of time competing with each other contemptuously in order to prove to themselves that they are smarter, richer, or somehow “better” than the “other” pharmacists. It seems that way since I’ve been a pharmacist, and I first experienced it in school. While we were foolishly fighting with each other about what pharmacists should be doing, how to do it, and who’s better, the profession’s enemies did away with us.

Like they say.. divide and conquer.

Also, while we were bullshitted by our leaders years ago that technology will “help” the pharmacist, I believe it will eventually replace us. If you ever visit or work for a PBM, you’ll see that robotics has already replaced pharmacists, and the BOPs give them special preferences because of their robotics are more accurate. Think about this too – how many hospital pharmacists do you know whom carry smart phones or other hand-held devices that they automatically pull out when asked a question by a doctor or nurse? Everyone, right? So, what’s to stop those other healthcare providers from doing the same thing? Why try to find, and consult with, the pharmacist, especially one they don’t like, when they can use the same devices the pharmacist does, but quicker and with less effort?

The same goes with community pharmacy. It’s “been” a given that third parties, and some of our chain “colleagues” have already, and will finally, make it so that no individual pharmacist can make a living through “legally” operating an independent pharmacy. Even the chains are finding it difficult now.

In chain pharmacy, everything has become automated and computerized, with improving capabilities being discovered daily. Corporate powers concerned with the bottom line, again with help from some of our “colleagues”, have enabled technicians to take over our traditional roles altogether, and have almost fully pushed us out of the pharmacy. So, where are we to go?

Of course, our “colleagues” in higher education, probably fearful of losing their jobs, or of having to work front line positions that they may consider “beneath them”, try to find ways where the system can use pharmacists. Again, we don’t have a defined role anymore. It’s always changed throughout the years, and like I said before, now it’s MTM.. or what I like to call “babysitting”.

But, of course, we are not “smart enough” or “capable enough” to handle that job. In order to teach us to be almost as equal to our journal colleagues, we must pay higher tuition rates, enlist in residencies and become certified. Instead of 6-years of college education we have, we’re now “unofficially” required to have 8-years or more of education in order to considered “good enough” to provide the same services we’ve been already providing for years.

So, now that would give us the same amount of education required to becoming a physician – someone considered a “provider” by Medicare, someone who can bill insurances for their services, a decision-maker, someone who is able to make their own treatment decisions and prescribe, or even someone who can command an equally-educated pharmacist to be his/her handmaiden.

If you ask me, why spend the time and money becoming a pharmacist instead of a physician, or why not even spend less time and money becoming a nurse, whose roles are already defined, and who seemingly have the ability to bring their profession together as a whole?

With that said, I have hope for pharmacy. My hope is fading quickly, but it’s there in the back of my mind. Things like ASHP’s Pharmacy Practice Model Initiative (PPMI) are encouraging, although the enthusiasm for the initiative seems to be fading just as quickly as it rose. The PPMI Summit, which was held in November of 2010, pulled together some of the brightest minds in pharmacy to ponder the need for changes to the profession. The result of the Summit was a long list of recommendations designed to help transform pharmacy practice. You can read all about it in the June 15, 2011 issue of AJHP if you’re interested.

More than a year has passed and I still run into pharmacists across the country that have no idea what the PPMI is or that an initiative for practice change even exists. How is that possible? Some blame ASHP, but I hardly think that’s fair. It’s not their responsibility to change our practice environment. It’s yours and my responsibility to do that. Change has to come from the trenches. If you don’t like your situation, then change it. If you’re expecting pharmacy organizations to take you by the nose and drag you into the future, then you’ve got it all wrong. You have to create the pharmacy practice you want. For the record, I do believe that pharmacy organizations can help. They have resources to make changes to laws and regulatory processes that will go a long way in improving the profession’s chances of changing how we practice, but ultimately it’s not up to them to force a change.

My words may lead some to believe that I don’t like pharmacy, but that’s not the case. I love the profession and I like being a pharmacist. I just don’t like the practice of pharmacy. There is a difference. Sometimes I jokingly tell my daughter that I love her, but I don’t love her behavior. It’s an important distinction. Pharmacy is like that for me. And even though I complain about pharmacists, I have great respect for them. There are some really smart people in pharmacy. I often feel quite small when gathered with some of the big names in the profession; they cast a big shadow.

People don’t become pharmacists because they can’t do anything else. They become pharmacists because they want to be pharmacists. What that means is different for everyone, but the pharmacists in the audience understand what I mean. Even though I no longer practice traditional pharmacy, I’m proud of the fact that I went to pharmacy school and have a license to practice in the state of California.

Regardless of my opinion, pharmacy has ultimately defined an endpoint, which is “to significantly advance the health and well being of patients by developing and disseminating a futuristic practice model that supports the most effective use of pharmacists as direct patient care providers.” Unfortunately it’s clear to me that we’re failed to create an infrastructure strong enough to reach that endpoint. Pharmacists have been talking about what they want for years, and this new round of “change” appears to be little more than talk as well. To paraphase Theodore Roosevelt, “Rhetoric is a poor substitute for action, and we have trusted only to rhetoric. If we are really to be a great [profession], we must not merely talk; we must act big.”

Some healthcare systems have taken the plunge and started the process of investing in the future and changing how they practice. As a result they have become examples for the rest of us. But those examples are few and far between. The ideas necessary to make wide-sweeping changes to our profession have failed to take hold. It’s difficult to say exactly why, but some of the barriers are evident.

The profession is segmented
Pharmacy is a segmented profession. All you have to do is look at the different practice settings to know that I speak the truth. Retail practice seems to focus more on the business, i.e. the money of pharmacy. Acute care, i.e. hospital pharmacy tends to over focus on the clinical side of things. And long-term care pharmacies tend to focus on operations, i.e. how can I make this more efficient. Of course the focus of long-term care is designed to squeeze money out of the process, but nonetheless the result is a highly effective distribution process. There really is very little common ground among the practice settings.

By itself, the difference between practice settings matters little, but when it spills over into everything we do it creates dissension between pharmacists. In fact, I would go as far as to say that most pharmacists stick to “their own kind”. I was taught early on in my professional education to look down on retail pharmacists (not to be mistaken with community or outpatient services). I find myself doing it today even though I make a conscious effort not to. I have friends in the retail world and I find it difficult to feel compassion for them when they talk about their working conditions, the lack of help, the lack of time to consult with patients and all the troubleshooting they have to do with insurance companies. I don’t understand why they do what they do. I’ve tried working in retail a couple of times during my career and each time I’ve quickly discovered that I hate it. That’s why a vast majority of my career has been spent in the hospital setting.

With that said, hospital pharmacist have their own issues. Hospital pharmacists are so focused on being “clinical” that they often forget about everything else. “Clinicians” don’t want to be bothered with operations. “Clinicians” don’t want to be troubled with regulatory affairs. “Clinicians” don’t want to have to deal with billing and business practices because they’re nothing more than a nuisance. Unfortunately the result is an incomplete practice environment. I’m as guilty as the next pharmacist of contributing to this failure. Until quite recently my beliefs were as described above. Even as an informatics pharmacists I always felt inferior to the clinicians. After all, clinicians are the jocks of pharmacy practice, and who doesn’t love jocks.

And what about long-term care pharmacists? There are two types of “long-term care pharmacists”: those that work in operations and those that act as consultants to the care facilities. I won’t talk about the consultants as it’s a fairly unique niche. I did the whole “consultant thing” for a while and quickly became bored by the redundant nature of the job. The consultants could probably be lumped in with the “clinicians” in terms of desires and personalities, but I won’t go there.

Long-term care pharmacy is all about distribution; getting as much product out the door as quickly as possible. And let me tell you something, it ain’t no joke. I spent a year working in a large long-term care pharmacy and it was amazing to witness the efficiency of the distribution process. It would make any retail or hospital pharmacy green with envy. And why are they so good at distribution? It’s really quite simple. They operate on razor thin margins so they have to be as efficient as possible. They make good use of technology and great use of their pharmacy technicians. Hospital pharmacy could learn a lot from a long-term care operations model. As a pharmacist, however, the job is terrible. I spent hours simply standing in one place verifying the contents of punch cards using bar code scanning. Beep-beep. Beep-beep. Beep-beeeeeep! Oops, that one doesn’t match. Send it back through. Beep-beep. Beep-beep, Beep-beeeeeep! Oops, that one doesn’t match. Send it back through. And so on, ad infinitum….. Hours felt like days.

Ultimately if you combined the three different practice environments you would probably end up with a complete “pharmacy model”; clinical, operations, business. I doubt that will ever happen, but integration across the continuum, changes in laws and the automation of many processes are ultimately what’s needed to bring pharmacy together into a global practice model.

Regardless of how things look in the future everyone has to decide on the practice setting that best suits their interests and needs, and that has to be acceptable within the profession.

Lack of strong leadership
Pharmacists are, by their very nature, introverts. I don’t know if the profession attracts them or creates them; chicken and egg argument. Pharmacists tend to work better alone, standing in the corner with a calculator and a pencil working on one difficult problem after another. It’s not simple shyness, but rather the desire to stay away from the masses in healthcare. Like many other pharmacists I prefer to work alone. I don’t like relying on other people to get things done because they will ultimately come up short and let you down. Don’t look at me like that. It is what it is. I didn’t create human nature.

In and of itself being introverted isn’t a bad thing, but it ultimately keeps the profession from progressing; out of sight, out of mind. I don’t like to admit it, but nurses and physicians are much better at cultivating leaders capable of making change inside a healthcare organization. This is evident when looking at the hierarchical structure in a large healthcare system. It’s not uncommon to see physicians and nurses in positions of power, while it is rare to see pharmacists in similar positions. Do pharmacists fear the responsibility of making decisions? Certainly not. Pharmacists make countless decisions every day that directly impact patient care. They take on great responsibility. Nonetheless, it is uncommon to see pharmacists striving for leadership roles, which creates a conundrum because the most effective place to implement change is from a position of power. Pharmacy needs a pulpit from which to preach the message. Without it, pharmacy change will likely not occur in my lifetime, nor will it likely change in the direction of our choosing.

Pharmacy Education
Let’s face it, people that chose to attend pharmacy school aren’t typically looking for a career in finance, business or administration. By in large, people attending pharmacy school want to be healthcare providers. At least that’s what I wanted. Unfortunately pharmacy schools fall short of giving students a realistic view of pharmacy practice. Everything in pharmacy school is sunshine and butterflies. Transitioning form the role of pharmacy student to full-fledged pharmacist is difficult. The reality check brought on by real-life pharmacy practice can leave freshly minted pharmacists bitter and frustrated with a job that is clearly not what they expected. There are ideal practice settings to be sure, but they are rare and do not accurately represent the majority of pharmacy work environments.

So how do we fix the pharmacy education issue? That’s a very good question, and I don’t have the answer. It certainly won’t be an easy fix as one wouldn’t want to give up the current crop of didactic courses and clinical focus in exchange for something else. It will take years to make the necessary changes. Do we have years? Only time will tell.

Failure to understand the business of pharmacy
Ultimately pharmacy is a business. Pharmacists provide two products: information and medications. Unfortunately pharmacy doesn’t get paid to provide information, and thanks to a poor job by retail pharmacies and healthcare systems, pharmacies don’t earn much from the distribution of medications. And that leads to a fundamental problem: pharmacists cost healthcare systems a lot, but they don’t make a lot of money for the healthcare system in return. In other words, our profession has failed to provide a ROI, which makes it difficult to justify potentially costly changes.

As much as I hate to say it, money is power. Pharmacy doesn’t make enough money, and therefore has little power inside the structure of a healthcare system. How many times during your career have you, as a pharmacist, had a problem with a department inside your hospital only to be told nothing could be done “because they make a lot of money for the hospital”? There are people reading this right now nodding in agreement with a smirk on their face because they’ve been there.

Fortunately all is not lost. We have opportunities, but until recently have missed the mark. Pharmacists aren’t trained or educated in the way of the busy savvy executive. Quite the contrary. Most pharmacists I know, including myself, are quite ignorant about business practices. I’ve gone out of my way to avoid the business side of pharmacy. Why? Because I’m a pharmacist. I didn’t get a degree in finance or business, I got a degree in pharmacy. I’m not alone, and that has ultimately resulted in pharmacy leaders that don’t have a clue.

It’s time for pharmacists to embrace the business side of pharmacy. As silly as that sounds it must happen for us to be successful. Without it the profession is likely to end up with “business men” making decisions for pharmacists instead of pharmacists making business decisions for the profession.

Complacency
The mantra of pharmacy should be “if it ain’t broke, don’t fix it“, and that’s not a good thing. The process of making an IV admixture hasn’t changed since we began mixing IV’s. Pharmacy distribution, whether it be in retail or acute care hasn’t changed since its inception. And so on. Sure, we use better technology and have managed to make slight improvements here and there, but ultimately the nuts and bolts of the process remain relatively unchanged over the past 20 years; possibly longer.

We should be asking ourselves what we want the practice to look like and work backward toward a solution. I guarantee you that solution won’t be what we have today.

No players at the table
I’ve been part of several pharmacy projects. Nothing strange about that. However, in a majority of those projects the person in charge wasn’t a pharmacist; that’s a little strange. Why would a non-pharmacist be in charge of a pharmacy project? The only thing that makes sense is that pharmacy has little to no power inside a healthcare system. The reasons are basically what I’ve outlined above, i.e. lack of strong leadership, incomplete educational structure, failure to understand the business of pharmacy and complacency. When pharmacists aren’t making decisions that impact their practice environment there’s a problem.

Lack of communication
There are basically three ways that pharmacists communicate: 1) conferences, 2) through literature, and 3) directly with one another through email or other electronic means (texting, social media, etc).

Conferences are great for gaining new practice insights, but they fail to muster the right atmosphere to talk about change. When pharmacists attend the ASHP Midyear Meeting, for example, they are there to learn. They go to see what’s new to the practice; most commonly clinical practice. To drive change organizations like ASHP would have to create something like an annual PPMI Summitt and make it open to anyone that would like to attend. I’m not sure that would actually do much good, but it might be worth a try.

Literature is quite possibly the most poorly designed method for communication in the digital age. Journal articles are often out of date by the time the information is published. The process is too slow to be an effective means of communication. In this day and age I find it incomprehensible that journals can’t push out information more quickly. In addition to the glacial pace of journal publications a subscription is typically required for access. This creates yet another barrier to the information. Information should be readily available for free (we need an open source pharmacy information movement – discussion for another time). Plenty of information can be found online, but you have to be willing to dig, and most people aren’t.

And finally, pharmacists communicate directly with each other…on occasion. There are two problems with such a strategy. First, your information is only as good as the smartest friend you have. Don’t get me wrong. Some of my pharmacy friends are brilliant, but there’s always someone smarter and odds are I don’t know them. And second, you tend to befriend people that have like opinions and thoughts, which ultimately limits the scope of one’s search for enlightenment. Introverts, remember?

Unwillingness to be bold
The theme throughout much of the PPMI Summit was to “be bold”. Unfortunately the profession has not only failed to be bold, but they’ve crawled under a rock since the initial flutter of activity following the PPMI Summit. I hear things about the PPMI occasionally, but it’s less and less often as time goes by. We don’t have to constantly talk about the PPMI, but it would be nice to hear a lot more about change.

I follow a lot of pharmacy discussion on various forums, websites and social media platforms and I don’t hear much about radical changes. It is increasingly rare when I see real thought provoking discussion about expanding the practice and moving toward the future. A majority of pharmacists are simply trying to find better ways to do the jobs they have. I certainly can’t blame them because that’s all most people want. But then again we’re a profession in search of significant change.

And there you have it. All we need to do is develop strong, well spoken, charismatic, highly educated, business savvy, well-rounded, bold pharmacists. Sounds simple enough.

Clinical Reference Updates – January 2012 Summary for Medscape App for Android™

• 487 diseases & conditions updated
• 114 drug monographs updated
• 4 new drug monographs added

Featured Content of the Month – Heart Failure

This month we bring you an expanded collection of over 30 Heart Failure topics that have been updated with the most recent developments from medical literature and guideline recommendations from the American Heart Association, the New York Heart Association, and the European Society of Cardiology.

Comprehensive coverage on Heart Failure, including:

Heart Failure – includes the latest guidelines from the ACCF/AHA, NYHA, and ESC, as well as a greatly expanded multimedia library of clinical images and videos

Echocardiography – discusses the technical aspects of 2-D and Doppler echocardiography and provides an overview of equipment and patient preparation

Transvenous Cardiac Pacing - provides details on obtaining venous access, a technique for placement of the pacing lead, and complications that may occur

Permanent Pacemaker Insertion – offers information on devices and equipment, details on the implantation technique, and a discussion of technical considerations

New Drug Monographs

azilsartan/chlorthalidone (Edarbyclor)
New drug combination of an angiotensin II receptor blocker and thiazide-like diuretic indicated for treatment of hypertension.

glucarpidase (Voraxaze)
New carboxypeptidase enzyme indicated for toxic plasma methotrexate concentrations in patients with delayed methotrexate clearance due to impaired renal function.

Drug Monograph Updates

brentuximab (Adcetris)
A new black box warning was added that describes cases of progressive multifocal leukoencephalopathy, a rare but serious brain infection that can result in death.

C1 inhibitor human (Berinert)
Expanded indication includes treatment of acute attacks for laryngeal hereditary angioedema.

pneumococcal vaccine 13-valent (Prevnar 13)
New indication for prevention of pneumonia caused by Streptococcus pneumoniae in adults aged 50 years or older.

raltegravir (Isentress)
New pediatric indication for HIV-1 infection in children aged 2 years or older.

Fentanyl transmucosal (Subsys)
New sublingual spray indicated for breakthrough cancer pain.

Practice Changing Updates

Our app is continually being updated with new FDA drug approvals, the latest clinical updates from medical literature and current guidelines to help you stay informed and make the best decisions in the treatment of your patients. Here are this month’s featured updates:

Bacterial Pneumonia – Prevnar 13, a pneumococcal 13-valent conjugate vaccine, has been approved by the U.S. Food and Drug Administration for people aged 50 years and older to prevent pneumonia and invasive disease caused by the bacterium, Streptococcus pneumoniae.

Human Papillomavirus – The CDC now recommends the quadrivalent HPV vaccine (Gardasil) for routine use in boys aged 11 or 12 years. Current recommendations advise vaccination for males aged 13-21 years who have not been vaccinated previously or who have not completed the 3-dose series.

Abstract

Satisfactory adherence to aptly prescribed medications is essential for good outcomes of patient care and reliable evaluation of competing modes of drug treatment. The measure of satisfactory adherence is a dosing history that includes timely initiation of dosing plus punctual and persistent execution of the dosing regimen throughout the specified duration of treatment. Standardized terminology for initiation, execution, and persistence of drug dosing is essential for clarity of communication and scientific progress. Electronic methods for compiling drug dosing histories are now the recognized standard for quantifying adherence, the parameters of which support model-based, continuous projections of drug actions and concentrations in plasma that are confirmable by intermittent, direct measurements at single time points. The frequency of inadequate adherence is usually underestimated by pre-electronic methods and thus is clinically unrecognized as a frequent cause of failed treatment or underestimated effectiveness. Intermittent lapses in dosing are potential sources of toxicity through hazardous rebound effects or recurrent first-dose effects.

Reliance on pharma-sponsored digital resources among online U.S. adults is significant. The research found “51% of online U.S. adults (ages 18+) use pharma-sponsored digital resources, such as condition and treatment information, disease management tools, doctor discussion guides, or mobile apps or websites.” This validates that the interactive information and tools produced by biopharma are being utilized and appreciated.

Use of these materials results in action: a conversation about a prescription drug. The study learned “43% of consumers using pharma-sponsored digital resources have discussed prescription drugs with a doctor, nurse, or pharmacist as a result.” This data point supports the business objective behind providing these interactive resources: generating a conversation with a healthcare professional. Note that the study was fielded online among 6,634 U.S. adults, ages 18+ during Q4 2011.

For comparison, Prevention Magazine’s Direct to Consumer Study 2011 found that as a result of seeing an advertisement – not necessarily online – 77% of survey respondents talked to a doctor and 23% asked for a prescription.

How scary is this! Getting consumers to talk about their medication with their physician is a good thing; talking with their pharmacist even better. However, many times this type of advertising (“digital resource”) results in consumers asking about something completely inappropriate. Which, as we all know, can lead to  a physician prescribing an unnecessary medication, using something that they’re not familiar with or prescribing something they wouldn’t consider first line.

All you have to do is look at the top 5 “patient and caregiver groups to agree that pharma should be involved in online health consumer communities” to understand why this is such a bad idea.

1. ADD/ADHD Caregivers
2. Bipolar Disorder Caregivers
3. Epilepsy Caregivers
4. Cystic Fibrosis Patients
5. Rheumatoid Arthritis Patients

Yikes! Choosing drug therapy is quite a bit different than picking out a book on Amazon and it should be treated that way.

I really think the hybrid design of the TFP is ideal for many situations, especially for those people that truly want to carry a single device. As much as I like tablets I find that I still need a keyboard for any significant data entry chores, whether it be with a spreadsheet, word processor, etc.

I would really like to see tablet PC manufacturers like Lenovo and Samsung do something similar, i.e. a keyboard dock that increases battery life and folds into a laptop style portfolio with the tablet docked. My dream machine would be a Samsung Series 7 Slate with a laptop dock similar to the TFP. It doesn’t appear that Samsung is interested in such a docking solution, but I’m hopeful that a third party will take the hint and do it anyway.

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.

Abstract

Anti-infective shortages pose significant logistical and clinical challenges to hospitals and may be considered a public health emergency. Anti-infectives often represent irreplaceable life-saving treatments. Furthermore, few new agents are available to treat increasingly prevalent multidrug-resistant pathogens. Frequent anti-infective shortages have substantially altered patient care and may lead to inferior patient outcomes. Because many of the shortages stem from problems with manufacturing and distribution, federal legislation has been introduced but not yet enacted to provide oversight for the adequate supply of critical medications. At the local level, hospitals should develop strategies to anticipate the impact and extent of shortages, to identify therapeutic alternatives, and to mitigate potential adverse outcomes. Here we describe the scope of recent anti-infective shortages in the United States and explore the reasons for inadequate drug supply.

Unfortunately the abstract doesn’t say much and a subscription is required to read the full article [grrr!]. The authors of the article basically evaluate the shortage of anti-infective agents over a multi-year period (2005-2010) and conclude that “anti-infective drug shortages continue to pose significant problems for clinicians and are a rapidly evolving public health emergency.” In addition they call for further research “regarding the clinical impact of drug shortages on patient outcomes”. How would one perform such a study?

Drug shortages have received a lot of attention lately. Shortages are certainly nothing new, but they seem to have become a bigger issue lately as the sheer number of unavailable medications is staggering. Areas like oncology and infectious disease are particularly hard hit as the number of treatment options in these specialties are limited to start with.

While there is no doubt that the shortages have impacted healthcare, I tend to agree with the authors of a commentary piece on the article that conclude that " it is difficult to systematically measure the resulting clinical problem or draw quantitative conclusions about differences in outcomes." Sounds overly simplified, but it’s true.

For more information on drug shortages make sure to visit the ASHP Drug Shortages Resource Center. Over 200 drugs and counting…

I’ve said it many times before, the IV room (a.k.a. the cleanroom) in hospital pharmacies is in need of a major overhaul. Sure, we went through the big USP <797> thing a few years ago, but we didn’t really change anything inside the IV room.

After following the stream of cool technology coming out of CES 2012 a couple of weeks ago I’ve decided that new IV hoods need to make use of the following:

- Continuous data collection. An IV hood should be smart. It should collect information in real time; air quality, flow, etc, and provide feedback to the user as well as anyone else that needs to monitor these things.

- IV hoods need to have a heads-up display made from Samsung’s Transparent Smart Window. Basically it’s a full blown Windows 7 machine built into a transparent LCD screen; pretty stinking cool. It could be used to view patient information like allergies, current medication regimen, labs, etc. In addition the Smart Window could offer the person in the hood feedback on what they’re making. Two-way video communication with a pharmacist outside the IV room? No problem. Or you could just use it to check your social media.

- The surface of the hood should be something similar to Microsoft Surface. As things are placed inside the hood the surface could collect and analyze information on the item, including what it is (barcode, RFID, NFC), whether or not it’s compatible with other things in the hood, if air flow is blocked, check the items against the patient for whom the compounded is being made via clinical decision support tools, and so on. Real-time clinical and operational information. 

“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.