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 is from the Netherlands. Just in case you’ve forgotten, I stopped in Amsterdam back in November 2011 on my way to Germany for work. Amsterdam is the largest city in the Netherlands and serves as the regions capital. It’s also a dirty city with a weird vibe to it. Didn’t care for it. I would return to Germany in a heartbeat, but wouldn’t choose to spend any personal time in Amsterdam. I can’t really say much about the rest of the Netherlands.

What’s the best way to brew a great cup of coffee from home? Well, according to The Wall Street Journal it might just be a “pour-over”. “With a pour-over, the grounds are doused in stages, rather than left to soak as in a French press. That’s partially why a pour-over is lighter: The extraction is gentler. Plus, the paper filter captures particles and oil.” I’m up for giving it a try, but I drink a lot of coffee and doing this 10 times a day would get old. Check the article for detailed instructions.

The Purge was #1 at the box office last weekend pulling in just over $34 million. That’s a respectable number considering the movie had a budget of only $3 million; in comparison Star Trek Into Darkness had a budget of $190 million. Don’t expect The Purge to keep the #1 spot for very long because Man of Steel will likely pull down $100 million plus in its debut weekend. The only question is whether or not it can take the opening weekend record for June away from Toy Story 3 ($110 million). My daughter saw Man of Steel Thursday afternoon; special sneak peak tickets from a friend. Based on her review the rest of the Fahrni crew went to see it yesterday evening.  Good movie, highly recommended. The first 20 minutes pulls you in and the rest of the movie keeps you there.

The top post at jerryfahrni.com over the past 7 days was Why pharmacy continues to fail, again. It’s amazing to me that of all the things I throw up on my blog, this is what gets the most attention. I think that speaks volumes about the status of the profession. I received an email from a pharmacy student this week contemplating what to do as this particular person thinks the profession is in deep trouble based on what’s she’s seen and heard.

TED Blog: “The Nanopatch, a tiny square (smaller than a postage stamp) that can deliver a dose of vaccine. But beyond solving needle-phobia, the Nanopatch could solve many other problems that now keep vaccines from being completely effective. The Nanopatch is designed with thousands of tiny projections dry-coated with vaccine. When the Nanopatch is stuck on the skin, the vaccine is delivered to the right cells, just under the outer layer of skin. Kendall’s research in animals shows that a 450 ng dose of an influenza vaccine was far more effective delivered through the patch than 600 ng of the same vaccine delivered via a needle.” - Needles, I hate needles. This will be a welcome addition.

Photo: James Duncan Davidson

I’ve been reading quite a bit about medication adherence lately, specifically how technology can help. There’s plenty of data out there to suggest that various types of technology – from text reminders to fully automated med boxes – can have a positive impact on adherence. However, I came across an article in Frontiers in Pharmacology (Front. Pharmacol. 4:69. doi: 10.3389/fphar.2013.00069) that indicates that electronic reminder devices (ERDs) may not work in elderly patients taking lipid-lowering agents. The article reports on a multicenter, community pharmacy-based, randomized controlled trial that was conducted in 24 pharmacies in the Netherlands among patients aged 65 years or older. They measured refill adherence rates using ERDs. The data found that there was no statistically significant improvement in refill adherence. However, women using statins for secondary prevention had improved adherence when using an ERD.

Text Message Smoking Cessation Program Sees Success Among Teens: “The National Cancer Institute’s smartphone-based smoking cessation program, called SmokefreeTXT, has had a higher success rate among teenagers than traditional anti-smoking methods. The application checks in daily with users on their smoking cessation efforts and personalizes text messages based on participants’ responses.” – I’m amazed that anyone would ever pick up a cigarette these days, much less a teenager.

“The world’s foremost thinkers, creators and innovators convene at the OME Summit at UC San Francisco to make precision medicine a reality. Hailing from diverse backgrounds — from government leaders to physicians and tech entrepreneurs — they come together to identify and take action on new approaches and projects that could harness the wealth of information from genetics and health records to transform medicine worldwide.” To join the movement: www.MeForYou.org. More information on the campaign from UCSF can be found here.

I’ve been trying to distance myself from Microsoft Office this week. I just feel like I’d like to use something else. I’ve experimented with Kingsoft Office and Libre Office, and I’m sad to report that the experiment hasn’t gone well. I have been using Microsoft’s Office Suite for a long, long time and have become quite accustomed to the functionality, but more importantly I’ve gotten used to the look and feel. It’s frustrating when I go to make a small formatting change and can’t find the place to do it.

Retail pharmacies are beginning to see the benefits of mobile technology and many are developing applications to help users keep up with their medications. Mobile Health News has a nice summary of what’s available from several of the retail chains. The most progressive of the retail pharmacy chains appears to be Walgreens. “This February, Walgreens introduced an API that allows mobile developers to integrate Walgreens’ prescription refill technology with a different app. While a regular customer at Walgreens might already be content with the store’s mobile app offerings, someone else might prefer the refill technology added to an app he or she is already using.” Having an API is all too rare these days and I applaud Walgreens for being bold enough to offer one.

This is great: Best 5 Android Launchers/ Themes 2013. I currently use Nova Launcher Prime; great launcher. Everything.me Home is also really cool. Different, but cool.

Still using Feedly as my RSS reader of choice. I’m finally starting to feel comfortable with it, and have started making good use of “save for later” and tags. I find that using keyboard shortcuts are more efficient than using a mouse. Interesting side note: my reliance on keyboard shortcuts has generated a bit of a usability problem on my Windows 8 slate tablet, i.e. no physical keyboard. Here are some of the keyboard shortcuts that I use most often:

G A                         Show All
Shift + J                Navigate Next Feed or Category
J                              Inline Next Article
K                             Inline Previous Article
M                            Toggle Mark as Read
S                              Save for Later
Shift + V               Preview

One of the things I really like about Samsung is the variety of products they offer. “An infographic shows the staggering variety of devices that Samsung has brought to market in the UK over the past year.” Part of the infographic is shown below. Taken from British gadget technology site Which?.

Ever heard of the Gallon milk challenge? I came across this concept earlier week while watching cartoons with my daughter. “The rules are simple. The challenger has to drink a gallon of milk (2% or more and no chocolate) in an hour, and then hold it down for another hour. The beauty of it is that it can’t be done, and your friend always ends up yacking all over himself.” It’s unclear to me why the challenge is so difficult, but the most plausible explanation I’ve read has to do with the limited size of your stomach. I believe there is more to it than that. I’ve seen guys drink a gallon of water in about the same amount of time without blowing chunks. I think it’s likely to do with the amount of casein and fat in the milk, and the effect it has on gastric emptying, etc. Anyway, if you feel the need for a little entertainment have a gallon-milk-challenge party and let the fun begin.

Speaking of cartoons, what’s your favorite? I still watch the original Scooby-Doo when I come across them on TV. The ones that ran from 1969 to 1973, before they jacked it up. I wonder what they’d look like if someone redid them with CGI? They could even use the same soundtracks. That’s something I’d like to see.

I am an AC/DC fan. Love their music, as do people all over the world. The epic nature of their popularity can be seen is this video below – Thunderstruc (Live At Donington). The size of the crowd is staggering. I’ve always wanted to see them live, but fear that my window for that has closed.

Computerized Physician Order Entry (CPOE) has been around for a while. According to the most recent ASHP survey (AJHP May 1, 2013 vol. 70 no. 9) “54.4% of hospitals have CPOE systems that include clinical decision support (CDS). During the past nine years, the percentage of hospitals with CPOE systems has slowly increased (just 2.7% of hospitals had such systems in 2003).” Expect the numbers to continue upward as Meaningful Use will continue to drive adoption. I think CPOE is a good thing, but I’m not convinced that it’s the panacea that everyone thinks it is. If you’re interested in getting a quick and dirty summary of the current state of CPOE I’d recommend reading the AHRQ Patient Safety Primer on CPOE.

For those that just like to read about technology I recommend stopping by the Future Tech Report site. You’ll keep yourself busy for hours.

I thought this was brilliant: Dear NSA, let me take care of your slides:

There’s an interesting article in the April edition of Pharmacy Purchasing & Products that talks about the use of barcodes to help with anticoagulation education. Anticoagulation is a hot topic because of TJC’s NPSG 03.05.01; regulatory B.S. “The development and implementation of patient education cards was the crux of our program’s success. Pharmacy produces the cards, which are stored in the medication carousels in the pharmacy and then stocked in the ADCs on nursing units. The cards are bar coded by pharmacy and entered into the PIS as medications. The cards are stocked in separate bins from the corresponding drug and appear on the ADC profile as an active medication; they also appear as a due medication in BCMA. When the nurse enters the patient’s information, the ADC displays the profile and the nurse obtains both the medication and the card. The nurse must remove and scan both at the patient’s bedside; otherwise, the administration will not appear in the bar code administration system as administered. The benefit of this system is that medication and education are delivered simultaneously, and documentation is automatically generated.” Creative use of barcode technology to help keep track of anticoagulation education.

Ever heard of “pullquote”? It’s a pretty cool extension/app. “Use Pullquote to create a link to a paragraph or sentence on a web page. Share the link with just one click, then watch clickthrus rise in your browser’s toolbar. Pullquote is great for tweeting, micro-bookmarking and sharing key ideas.” I’ve been playing with it off and on. Haven’t found where it fits in the whole scheme of things, but it’s pretty slick.

I’ve been looking for a new smartphone. My Samsung Galaxy Nexus is great, but there are just too many awesome phones out there for me to just sit idly by. For the first time in a while I have a lot of great choices: Android, Windows 8 and BlackBerry. I’ve narrowed it down to the Nokia 928, the HTC One and the BlackBerry Q10. I’ve been petting the BB Q10 off and on for a couple of weeks. Love the concept and the physical keyboard, but I’m not sure about the future of BB. The Nokia phones are appealing to me because I like the interoperability with my other Windows machines, not to mention the 928 has a spectacular camera. The HTC One sucked me in. I was looking at the BB Q10 earlier this week and made the mistake of picking up the HTC One. All I can say is that I believe this is the new flagship device for the Android platform.

Geek humor: When life gives you C₆H₈O₇ make H₂O + C₁₂H₂₂O₁₁ + C₆H₈O₇

Only 82 days until the NFL season kicks off. It can’t happen soon enough. I was flipping channels the other night and I think I saw a basketball game on. Can’t be sure as I didn’t stop, but I think it was basketball. I think there’s some baseball on as well. It’s possible that people might be interested in that. Can’t imagine that that’s true, but the world is full of weirdos. No football though.

That’s it folks. Happy Father’s Day everyone.

Tablets are changing the way healthcare professionals practice medicine.

Purdue.edu: “Matthew Murawski, a Purdue University associate professor of pharmacy administration, created a new tool that presents patients with a five-question checklist that catches up to 60 percent of all known medication side effects….”This tool makes the few minutes available for counseling much more rewarding. The checklist results allow the pharmacist to immediately see side effects the patient is experiencing and target their time to solving these problems and improving the patient’s quality of life.” …Murawski’s method, named Pharmaceutical Therapy-Related Quality of Life or PTRQoL, began as paper checklists that took up multiple file folders behind a pharmacist’s desk.”

Purdue University does some cool stuff around the practice of pharmacy. The only thing that makes me cringe is the line “patent pending” (approx. 1:05 into the video). Nothing that is developed utilizing University resources should ever be allowed to be patented. It should all be open source.

J Asthma. 2013 Jun 5. [Epub ahead of print], Rust G, Zhang S, Reynolds J.

Abstract
Objectives: Asthma is the most prevalent chronic disease among children enrolled in Medicaid. This study measured real-world adherence and outcomes after an initial prescription for inhaled corticosteroid therapy in a multi-state Medicaid population.

Methods: We conducted a retrospective study among Medicaid-enrolled children aged 5-12 with asthma in 14 southern states using 2007 Medicaid Analytic Extract (MAX) file claims data to assess adherence and outcomes over the three months following an initial prescription drug claim for inhaled corticosteroids (ICS-Rx). Adherence was measured by the long-term controller to total asthma drug claims ratio.

Results: Only one-third of children (33.4%) with an initial ICS-Rx achieved a controller to total drug ratio greater than 0.5 over the next 90-days. Children for whom long-term control drugs represented less than half of their total asthma drug claims had a 21% higher risk of emergency department visit (AOR 1.21 [95% CI 1.14, 1.27]), and a 70% higher risk of hospital admission (AOR 1.70 [95% CI 1.45, 1.98]) than those with a controller to total asthma drug ratio greater than 0.5.

Conclusion: Real-world adherence to long-term controller medications is quite low in this racially-diverse, low-income segment of the population, despite Medicaid coverage of medications. Adherence to long-term controller therapy had a measurable impact on real-world outcomes. Medicaid programs are a potential surveillance system for both medication adherence and emergency department utilization.

Posted online on June 5, 2013. (doi:10.3109/02770903.2013.799687)

Two things to consider:

First this seems like a good place for a pharmacist, and second it seems like a good opportunity to use some medication adherence technology specifically designed for asthma.

A couple that come to mind include Asthmapolis and GeckoCap.

Asthmapolis - Asthmapolis is an interesting little device that goes on top of a patients existing inhaler. The device sits on the inhaler and is paired to a smartphone via Bluetooth. When the patient uses the inhaler it automatically captures not only when the inhaler was used, but the patients proximity as well. Yep, it records both the time and place to help patients better understand potential triggers for their asthma. The information is synched up and can be shared with healthcare providers or loved ones.

The beauty of Asthmapolis is that is leverages some of the anonymous data that it captures, aggregates it and can potentially be used to create trigger hot spots within communities. Information like this can be valuable for patients who have severe asthma and need to stay out of problem areas.

• Pairs to smartphone via Bluetooth
• Data is automatically captured when within proximity
• Records time and place inhaler used
• Data synced when in range
• Data can be shared
• iOS or Android based device

GeckoCap - Here’s a little ditty called the GeckoCap. It was dreamed up some pediatricians, engineers and designers at MIT. The GeckoCap is a small Bluetooth-enabled rubber accessory that sits atop your child’s inhaler. The cap has a tiny, colored LED light that starts flashing when it’s time for your child to use the inhaler, and it won’t stop until they do.

When you press down on the GeckoCap it transmits the usage data to the GeckoCap website via Bluetooth pairing. That information is available to the parent or the physician.

Similar to the Mango Health app, the GeckoCap uses a gamification strategy where the parents can set goals for the child and track their progress.

I’ve talked about technology for the i.v. room extensively on this weblog. It’s no secret that I think the i.v. room is the next frontier for pharmacy technology. The reason I think this is simple, the i.v. room is dangerous, and precious few healthcare systems are using technology to its fullest in that environment.

I’m not the only one that thinks the i.v. room is important. As of December of 2012 I knew of basically four i.v. room workflow management systems: DoseEdg DoseEdge by Baxa, Pharm-Q In The Hood by Envision Telepharmacy, SP Central Telepharmacy System by ScriptPro, and Phocus Rx by Grifols.

Joining the fray are at least two more systems that I saw at the ASHP Summer Meeting just last week: Cato software, which is now owned by DB, and Drugcam Assist by Getinge. Unfortunately you won’t find much about Drugcam Assist online, which is really too bad because it’s an amazing system. The website offers more information and a video demonstration for those that are willing to fill out a form and register. I was not willing.

Drugcam operates under the same premise as the i.v. room workflow management systems named above, which is to say that it walks the user through specific steps to compound an i.v. product while keeping a record of the process for a pharmacist to review via teleprescence. But that’s where the similarities end. So what’s so special about Drugcam? Let me tell you.

1. Drugcam uses two cameras to automatically detect the items being used in the compounding process. That’s right, no barcode scanning necessary. As the user passes the vial in front of the camera it is automatically identified. The user is clearly notified if the incorrect item is pulled into the camera’s viewing area.
2. Drugcam uses the same cameras and technology to automatically detect the volume of fluid pulled into syringes. Yep, the user pulls solution into the syringe, places it in the camera’s viewing area and waits for it to tell you whether or not you did a good job. It really was quite impressive. During the demonstration the technician making the i.v. was instructed to pull up 25mL of a drug (can’t recall which one). On the first try the technician pulled up 24mL. When the syringe was passed in front of the camera it alerted the technician that the syringe contained only 24mL and informed them to try again. The second pull resulted in the correct volume.
3. Drugcam uses the same method in #2 above to determine the entire contents of the syringe has been placed in the bag. Simply put, Drugcam can identify whether or not the syringe is empty.
4. Drugcam not only takes photos of each step – automatically I may add – but it takes a video of the entire process. Upon completion the pharmacist can review photos of key steps in the process or review the video at any point in the process should the need arise.

I found the system to be quite impressive. The software was intuitive and the functionality is off the charts. The most amazing thing to me is that this is the first iteration for commercial sale in the U.S. I can’t wait to see what iteration 2, 3, 4, etc bring.

There are two negatives for Drugcam. First, the system is currently unavailable in the U.S. but the representatives at the show told me that the product will be available for purchase in the U.S. in October of this year. And second, the system is only available in the Getinge isolation boxes. I asked the people in the booth if they had plans for a standalone solution. They hesitated, but ultimately said “not at this time”. In my mind that means they’re working on it.

Drugcam incorporates technology that I was told at one point or another over the past couple of years couldn’t be done, or was simply “too difficult” (Note to self: stop listening to people). I’m specifically talking about the automatic product identification as well as the automatic detection of syringe volume. Well guess what, it appears these guys have done it. They deserve recognition for a job well done. Whether or not the product will be well received or simply fade into oblivion remains to be seen.

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 headline for SMC is a bit different today in case you haven’t noticed. I’ve taken the advice of a Twitter colleague, Charles Webster, MD (@EHRworkflow). Charles has recommended a couple of times now that I make my headline more descriptive. I like the idea so I’m giving it a shot. Feedback welcome.

My trip to Minneapolis, MN for the ASHP Summer Meeting has me waxing nostalgic. The coffee cup below was my trophy for winning the first ever ASHP Midyear Meeting Twitter contest. I’m not even sure what year it was, but I believe it was 2009; don’t hold me to that recollection though. At that time ASHP  was unable to use any of the official Twitter logos due to some time of licensing issues. So instead they generated a Wordle from my website and placed it on the mug you see below. My Twitter handle (@JFahrni) and web address (JerryFahrni.com) are displayed on the back near the handle.

Fast & Furious 6 continues to generate pretty decent numbers as it was #1 at the box office again last weekend. I still haven’t seen it, but it’s on my short list.  The Internship hits the theaters this weekend, but I don’t expect it to be a blockbuster in any sense of the word. I’ll likely go see it at some point, but I just don’t get a good vibe from the previews. I actually think The Purge would be a more worthy recipient of my movie-going dollars. I’m not saying that The Purge will be a great movie, but the concept intrigues me. We’ll see. One thing is for certain, After Earth, as predicted is quickly becoming a box office flop. I’m actually quite happy about that; it’s the little things in life.

The most viewed post at jerryfahrni.com over the past 7 days was Why pharmacy continues to fail, again. It’s also the most visited post for the previous 30 and 90 days as well as for the whole of 2013 thus far; by a wide margin I might add. That particular post is more than a year old. Here’s the funny part, it still hold true today.

Great little article over at Medium.com about coffee vs. beer. “The best time to have a beer (or two) would be when you’re searching for an initial idea. Because alcohol helps decrease your working memory (making you feel relaxed and less worried about what’s going on around you), you’ll have more brain power dedicated to making deeper connections….Coffee meanwhile, doesn’t necessarily help you access more creative parts of your brain like a couple pints of beer. If you’ve already got an idea or an outline of where you want to go with your project, a cup of coffee would do wonders compared to having a beer to execute on your idea.” And there you have it, when to drink coffee and when to drink beer. Read the entire article, the author has some really interesting little tid-bits in there.

The Life of a Simple Chef: Skillet Peach Cobbler….dude, this looks good.

Ingredients:
2C all-purpose flour
1 1/2C sugar
2 teaspoons baking powder
1 1/2 teaspoons salt
2 large eggs, beaten to blend
1/2C sour cream
1C whole milk
2 teaspoons vanilla extract
1/4C (1/2 stick) unsalted butter
2 pounds peeled & pitted peaches cut into wedges
2 tsp ground cinnamon
1C peach preserves

Method:
Preheat oven to 350°.
Whisk flour, sugar, baking powder, and salt together. Set aside.
Whisk eggs, sour cream, milk, and vanilla in another bowl.
Add egg mixture to dry ingredients; whisk until smooth.
Melt butter in a 12 inch cast-iron skillet over medium heat. Swirl pan to coat with butter.
Remove from heat.
Add batter to pan over the top of melted butter.
Mix cut peaches with ground cinnamon.
Scatter spiced peaches over batter.
Spoon dollops of preserves evenly over batter.
Bake until center of cobbler comes out clean
Bake @ 350 for 45-50 minutes

I had an interesting conversation with a friend this week about how I come up with my SMC topics. It’s really quite simple, just as I say in the opening sentence above I write a little blurb about each of the tabs I have open in my Chrome browser. Seriously, that’s it. When I see something that I might like to blog about I pop it open in a new tab. These days I rarely find time to write so I leave the tab open until Saturday morning. As I read the article and comment on it here I close the tab.

Unless you were under a rock this week, or simply disconnected from reality, you’ve probably heard about the big scandal swirling around the government illegally collecting data on U.S. citizens. The Washington Post dropped the bomb. “The National Security Agency and the FBI are tapping directly into the central servers of nine leading U.S. Internet companies, extracting audio and video chats, photographs, e-mails, documents, and connection logs that enable analysts to track foreign targets, according to a top-secret document obtained by The Washington Post. The program, code-named PRISM, has not been made public until now.” Both Google and Facebook are denying the allegations. Things that make you go hmmm.

Have you seen the 3D Printing section at Amazon? Yeah, it’s sic. I’ve been thinking about doing some 3D printing, but my company won’t let me touch theirs; apparently it’s too expensive for “just anyone to use”. My daughter’s high school engineering class has one and she brings home some pretty cool stuff. She’s offered to take my ideas to school and print them for me. That’s funny and cool.

I’m thinking about getting a Roku 3. These little dudes are impressive. I don’t watch a lot of “regular” TV anymore. Over the past couple of years I’ve slowly migrated toward Netflix, Amazon Prime, etc. The only question I have is about football. I watch a lot of football during football season; both NCAA and NFL. If I can’t watch 20+ hours of football on Saturday and Sunday then it won’t be worth it.

The FDA this week eased up on Avandia (rosiglitazone) after hearing a new analysis of Avandia’s cardiovascular safety performed by Duke University’s Clinical Research Institute. The AP is reporting that “A majority on a Food and Drug Administration advisory panel voted Thursday to modify or remove measures that currently limit patient access to GlaxoSmithKline’s Avandia. Among those requirements, patients must sign a waiver before getting a prescription that they understand the drug’s risks.” That’s good news for GlaxoSmithKline, but it doesn’t really matter as the damage to rosiglitazone’s reputation was done long ago.

When I was still practicing pharmacy, one of my favorite areas of interest was pharmacokinetics. If you know anything about pharmacokinetics, then you’ll know that renal function can often play a significant role in calculations for several different drugs. The king of equations for estimating renal has always been the Cockcroft-Gault (CG) equation. People have tried to come up with a better method, and some have found niches where they work better, but the CG equation has always worked well for me. A recent article in the Journal of the American Pharmacists Association (J Am Pharm Assoc. 2013;53(1):54-57) compares the Modification of Diet in Renal Disease (MDRD) equation to CG for renal dosing.  The MDRD came on the scene many years ago, and in my opinion has failed to live up to the hype that surrounded it. The nuts and bolts of the paper were that the MDRD and CG equations gave significantly different results. In other words they aren’t interchangeable when calculating dosages based adjustments for decreased renal function. Want my advice? Choose one and stick with it. Consistency means a lot as you develop your skill set in your specific practice setting. Learning how to evaluate the situation and apply the principles is more important than crunching the numbers, trust me.

Here’s a great slide deck from the 3G Doctor presented at the Scottish Telehealth and Telecare Summit. Interesting 4 or 5 slides starting at #29; pharmacy, dude. Telehealth is going to continue to improve and grow in my opinion. The continued advancement of technology, especially mobile technology, will eventually drive consumers to become more comfortable with the concept. Just look at the generation that’s in school now. They are extremely comfortable using mobile devices for all kinds of communication.

There was a time when I worked as a compounding pharmacist in the Bay Area or California. Some of the most difficult things to make, but also coolest, were tablet triturates. There’s a great video at the UNC Pharmaceutics and Compounding Laboratory website on how to prepare and make tablet triturates. I would have embedded the video here, but couldn’t figure out how. If you have some time rummage around the UNC site, it has some cool compounding stuff. Compounding is an art form. It’s a shame that it’s going to be non-existent in another 10 years. I digress. While I was searching for information on compounding tablets I came across the video below from a company called LFA Tablet Presses. They sell a small hand held pill press. Never seen anything like it, until now.

Yesterday I came across the CVS Caremark medication adherence site. Say what you will about retail pharmacies, but this site has a wealth of information regarding medication adherence. “The information was compiled using CVS Caremark’s comprehensive database and looking at medication adherence factors for four common chronic disease states – hypertension, dyslipidemia (high cholesterol), diabetes and depression.” The interactive map allows you to drill down to various data points for each state. It’s pretty impressive. It’s also eye-opening.

There’s an interesting conversation taking place at ASHP Connect about cart-fill models versus cart-less models for inpatient pharmacy distribution. It’s interesting because it appears that things are beginning to cycle back around. I see quite a mix when I’m out visiting pharmacies. I would say that the cart-less, decentralized model remains the predominant model at the moment. I have, however, come across several pharmacies that are moving away from a cart-less, decentralized dispensing model in favor of “just in time dispensing”. That’s a bit of a misnomer because it’s not really just-in-time, but rather several small batches generated at key times throughout the day. The pharmacies that I’ve come across using this model seem quite satisfied with it. Honestly it’s six of one, half dozen of another if you ask me. The facilities that appear to be most satisfied with either model are those that have strong leadership and workflows that have been well designed to meet the needs of their particular practice environment.

MedPod by DayaMed is a pretty interesting piece of technology. I discovered it after following a Tweet from Charles Webster, MD. The article referenced in his Tweet has to do with using BlackBerry QNX in medical devices. From the article: “DayaMed, a developer, manufacturer and distributor of pharmaceuticals and consumer medical devices, is one company that has gotten behind QNX and the BlackBerry platform.” The device is slightly bigger than I thought it would be. Watch the video below for a better explanation of what the MedPod does; try to get past the cheesy marketing verbiage. Is it just me me, or do the menu buttons on the device (approximately 2:20) look like Android navigation?

The Candid Pharmacist: “A key tool in the implementation and success of the ACA is the creation of Accountable Care Organizations (ACOs).  These healthcare organizations are designed to tie provider reimbursement to “quality” metrics and reductions in the total cost of care for the patient population within the ACO. As you and I know in the case of pharmacy “quality” metrics can mean only one thing – churn out the scripts faster! …The only way to meaningfully lower labor costs in a pharmacy is to cut pharmacist wages and hours….These trends are onerous and fraught with danger for the patient.  There will be even fewer pharmacists checking more prescriptions with less time to screen for interactions and incompatibilities and less time to counsel.  Patients will leave the pharmacy not understanding how to correctly take their medication,  what side effects are possible, what the medication is for or what other drugs and foods they should avoid while taking it.” – The article is longer, and I’ve only taken bits and pieces of it, but I believe what he sees as a problem I see as the opportunity. Pharmacists shouldn’t “churn out prescriptions” nor should they be “checking more prescriptions”. This is the fundamental problem of the profession. Technology should be churning our prescriptions and a combination of technology and pharmacy technicians should be checking them. Pharmacists should be on the front end of things evaluating therapy, speaking with patients, developing methods to improve medication adherence, performing medication therapy management and so on. To do otherwise means the death of a profession.

I used my Samsung ATIV tablet extensively while at the ASHP Summer Meeting to take notes in Microsoft OneNote as well as follow along with presenter’s slide deck with PDF versions of their presentations. Even with the ATIV’s exceptional battery life – Atom processor – I ran into problems on a couple of long days. This makes me happy that I went with the Atom processor over the Core i5. The Core i5 machine would have been quicker, but honestly would have given me only about 50-70% of the Atom’s battery life. As a technology enthusiast I have to believe that battery technology is the next frontier for mobile computing.

It appears that Microsoft may be ready to drop the price on their Surface RT tablets. That makes sense to me as the Surface RT hasn’t garnered nearly the good press that the Atom-based Windows 8 machines in the same price point have. If the Surface RT really does drop to $399 I might pick one up just for my own experimentation. I’ll be in Los Angeles next week picking up my daughter from UCLA for the Summer, and there just so happens to be a Microsoft Store a couple of miles from the UCLA campus. Sounds like a visit is in order.

I am a big fan of hot chocolate. It’s the perfect companion on a cold morning, and I have my favorite recipes. With that said, I’ve never seen the method shown below. Katherine Anne Confections in Chicago has a pretty unique take on one of my all-time favorite drinks. Of course I won’t be making this anytime soon, but I’ll file it away for winter.

Only 89 days until the NFL season kicks off.

Have you ever wondered what would happen between Bugs Bunny and Elmer Fudd in real life? Well, now  you know…

That’s it folks, I am outta’ here. My goals for the day are to put up a new mailbox and rip out a tree before the mercury tops 100 degrees F. The high today is supposed to be 110. Yeah, welcome to the Central Valley.

I’ve just returned from the ASHP Summer Meeting in Minneapolis, MN. I was there for work, but managed to squeeze in some sessions; just like a real pharmacist.

For those of you that don’t know, the ASHP Summer Meeting is small, really small. It pales in comparison to the ASHP Midyear Meeting that’s held each year in December. Being small doesn’t make it bad, it just makes it small. The sessions are smaller and less grand, and the exhibitor area is quite a bit smaller than Midyear as well.

Sessions:
As mentioned above I was able to take in a few sessions while at the Summer Meeting, but none was as impressive as the Opening Keynote: Exponential Technologies Causing Disruptive Innovation delivered by Peter Diamandis (@PeterDiamandis). Peter was inspiring. He didn’t talk about anything new, in fact I’ve blogged about most of what he mentioned during his presentation, but it was good to hear somebody talking about it. It was good to hear someone saying it out loud. The voices in my head appreciate the company. He has single-handedly reinvigorated by desire to think about this stuff.

Unfortunately I went from the Opening Keynote to a session on 340B Drug Pricing. 340B isn’t my area of expertise, which exactly why I went to the session. There’s a lot of talk about 340B in the pharmacy industry at the moment and I thought I should at least get a peak at what’s going on. I would have been much better off attending the HITECH Update. It’s clear to me that 340B has nothing to do with pharmacy. Not sure who should be paying attention – maybe accountants, lawyers and “business” types – but it’s about as far from practicing pharmacy as insurance billing is in the retail pharmacy sector. I have lots of thoughts on the topic, but they don’t belong in this space.

The last session I attended on Monday was Developing mHealth Tools for Providers and Patients: There’s an App for That. I had certain expectations in mind for this session, but they weren’t met. I wanted to hear what was going on in the mHealth space from experts in the field. I wanted to see some innovative mHealth solutions to common pharmacy problems. I wanted to see how the profession was engaging patients where they live and play, i.e. mobile technologies. The session was all about how the Navy developed an outpatient pharmacy application for their patients. Ok, that’s good. The app appeared to be cool, but the presenter spent a lot of time running through the process of the project…zzzzzzz. His presentation style didn’t help. Presentation Zen was conspicuously absent from the ASHP Summer Meeting. Insert an image people. Show some emotion. Be passionate. Anyway, I did manage to pick up a couple of little tid-bits from the session like the time involved in developing a mobile application as well as the cost associated with this type of project. Not a total loss.

My goal for Tuesday was to attend some “clinical” sessions. I only managed to get to one session before getting sucked into something for work, but it was a good one - New Hypertension and Cholesterol Guidelines: Stay Tuned. I’ve been removed from the day-to-day practice of pharmacy for several years now and I wanted to see if my brain could still handle this type of information. Scratch that, I needed to see if my brain could still handle it. It can. I was pleasantly surprised to find that I knew most of what the speaker was covering, was familiar with the treatment strategies, and was able to recognize drugs, recall use-case scenarios, dosages, etc. It felt good. I sometimes miss that part of pharmacy. Not enough to give up on my interests in technology, but enough to engage my brain from time to time. And to top things off the guy presenting did an excellent job. It was clear that he knew what he was talking about, he was engaging, and you could tell that he was passionate about what he was doing. It made for a great presentation on some rather dry information.

Exhibitors:
The exhibitor area was really quite small. None of the big boys were present, but I did find some things that stimulated my brain. I continue to be amazed at the number of companies moving into the IV room space, and at the number of different approaches I’m seeing. I’m pleased with what being developed as it appears that the collective minds are beginning to innovate again. Health Robotics had a newly redesigned IV room solution, BD (yep, that BD) was showing off a new (sort of) IV workflow solution, ICU Medical was there with a slightly different take on safe IV administration, and Getinge – a company from France – was there with what I think is the most innovative piece of IV room technology I’ve seen in a long time. I will be posting more on that later. I’m still mulling over what I saw, but it was impressive. It’s made me go back and rethink some of the things I’ve been told couldn’t be done; these guys did it.

That’s pretty much it. A little work, a few sessions, some CE on the side, and the chance to see some things to rekindle my imagination. Good stuff.

Check out the video below from AR-Media using augmented reality (AR) and digital technology blended with real world scenarios to create an app to help would-be mechanics work on their cars. What a great, and practical use for AR. Reading instruction manuals for toy assembly at 2:00 AM on Christmas morning just went right out the window; been there.

Now pair that same technology with Google Glass, develop an application that blends AR with medication identification technology and, BOOM, something really cool.

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….

Is it really June 1st already? Wow, time is flying by this year.

The coffee cup below is a simple, cheesy mug used by some place here in the Denver airport to serve coffee. I’m passing through on my way to the ASHP Summer Meeting in Minneapolis, MN. I get in later this afternoon. The festivities will start for me tonight and go through Tuesday. I plan on spending some time attending sessions as a real pharmacist. I have to admit, I’m a little excited by the idea. I’ve been unable to attend an educational session at a conference in approximately two years. I’m looking forward to having my brain cleansed by some good old fashioned pharmacy information.

Fast & Furious 6 was #1 at the box office last weekend. I haven’t seen it yet, but I plan to. My wife has a think for Dwayne Johnson (cough…steroids). Yesterday evening, however, my family and I decided to catch Now You See Me. I didn’t know what to expect, but was pleasantly surprised. It was a very entertaining and engaging film. I would recommend it to anyone without hesitation. One movie that I will not be seeing is After Earth. My favorite review of After Earth has to be from Peter Travers of Rolling Stone: “After Earth merits comparison with 2000’s Battlefield Earth….Yes, it’s that bad”. Classic.

I love these guys. How Iron Man 3 Should Have Ended

Have you seen the Aspire R7? It’s an interesting laptop design that uses a hinge system to allow the user to make adjustments to the screen position. It’s an interesting concept. Not saying that I want one, but at least Acer is trying something new. I’m not the only one that feels this way. David Pierce at the Verge reviewed the unit and had some good things to say about it, but in the end he wasn’t impressed enough to want one as a daily-driver. “The Ezel hinge is cool, there’s no question, and I could see myself using a laptop in some of the ways it allows. I’d also love an all-in-one that was this flexible. But I’m not ready to give up the trackpad, and neither is Windows. Until Acer figures out how to make a crazy laptop that’s also a normal laptop, I’m not interested.”

I’ve been using the new Google Music All Access service all week. It’s pretty amazing stuff. The service recommends music channels based on the music in my library, and those channels become customized to my taste as I listen and provide feedback; similar to all the other big music services I’m sure. The ability for Google to introduce me to new music that suits my taste is remarkable. The service runs $7.99 per month if you get on board before June 30. I’m in week two of my 30 trial period. Not sure if it’s worth keeping or not. I’ll keep you posted.

I continue to use feedly as my RSS reader of choice on my computers. I’m getting better with the navigation and the feedly group continues to add and refine features. It’s a far cry better than when I first started using it.

Dcurt.is: “All fashion issues aside–and there are many, of course, because the device looks kind of ridiculous to the uninitiated–it is extremely unnerving to be conversing with someone who has a camera and microphone on their face, pointed directly at you, with the ability to record. In the presence of someone wearing Glass, you can never have privacy. I had anticipated a feeling of uneasiness, but after experiencing it, I was surprised by how much it bothered me on a visceral level.” – Glass isn’t for everyone. The article at dcurt.is is a rather good opinion piece on Google Glass. If you have a few minutes I recommend you read it.

mobihealthnews: “…No other device, with the exception of the smartphone, will do more for the evolution of health technology than the Kinect 2.0 on the new Xbox One… the new Kinect comes packed with lots of high-end gear like a high-resolution digital camera, an infrared camera and several high-fidelity microphones. But those are just sensors, the magic happens on the software. Microsoft released the first Kinect just three years ago, but they’ve been working on the software for more than a decade, and they’ve built a platform, which means new apps (not only games) will be able to tap into an amazing source of information on our body.” – The potential for Xbox One as an out-of-the-box “healthcare appliance” is staggering.

Anyone ever heard of Ginger.io? I’m intrigued by the platform and what they’re trying to accomplish. Seems like a good place to start if someone wanted to build, oh, I don’t know, say some applications for outpatient pharmacy use; think medication therapy management.

PBA Health – Why Your Pharmacy Needs an Adherence Program: “The United States loses $290 billion every year because patients don’t take their prescribed medications or they take them incorreclty, according to a 2009 study by The New England Health Institute. The same study found that mortality rates among patients who did not adhere to their medications were nearly double the rates of those who took their medications as prescribed. A 2012 report from the World Health Organization (WHO) found that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of a population than any improvement in specific medical treatments….Adherence programs and the current healthcare environment are the opportunities pharmacists have been waiting for..” – That about sums it up.

jweekly.com: “Vaica’s SimpleMed is a cloud-communicating device that can be programmed for seven days a week, at four intervals throughout the day. It sends flashing light and sound reminders when a pill needs to be taken, and if desired can alert primary caregivers or the Vaica call center when a pill is skipped. After a slot has been opened and the contents removed, the pill is registered as taken.” – It is amazing how many medication adherence devices I’m starting to see in the wild. Take your pick. Need a smart pill box? Boom! How about a bottle that can measure the contents of the liquid inside? Why not. Need an app? Ok. Little gamification? Sure. Sorry, but I’m low-tech and only have a flip phone. No problem, we’ll just use simple SMS text messages. Pick your poison, people. You can find more information on Vaica’s SimpleMed device here.

I’ve been enjoying my Samsung ATIV tablet more and more. Lately I’ve been playing Guns 4 Hire quite a bit. Fun stuff. Highly recommended for its entertainment value, not to mention that you get to blow stuff up.

Windows 8.1 is looming on the horizon. TechRadar has a nice summary of what everyone expects to see. I have to hand it to Microsoft, they’re trying really hard to make Windows 8 a winner. I’ve found a few things that I’d change, but overall I’ve enjoyed the experience. With that said, I’ve come to the conclusion that Windows 8 makes a much better tablet OS than a desktop OS. A lot of people feel that way, which is why it appears that Microsoft will allow users to launch into standard desktop mode as a configurable option with Windows 8.1.

Only 96 days until the NFL season kicks off.

That’s it folks, my abbreviated Saturday morning coffee. I gotta’ hit the bricks and catch my flight to Minneapolis for the ASHP Summer Meeting. If you find yourself at the meeting with nothing better to do, give me a buzz and we’ll grab a cup o’ joe. If you’re interested in following the Twitter stream for the Summer Meeting I believe they’re using #ashpsm.

Over 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.

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.

Is it just me or is Twitter finally starting to come alive with pharmacist that provide valuable content? Feels like it, and that’s good.

— Jerry Fahrni (@JFahrni) May 27, 2013

When I first started playing around with Twitter a few years back the pharmacy landscape was barren. I tried following pharmacists, but typically stopped because most of the pharmacy people at the time were whinny retail guys that hated their lives almost as much as they hated pharmacy. Of course there were exceptions such as Dave Walker (@drwalker_RPH). Dave’s been a rock-solid staple of information since the beginning.

I tried trimming out the crap by creating a pharmacy related list - a place where I could quickly go to see all pharmacy related information at once – but my use of lists has never been good. I can never remember to look at my lists, which makes them virtually useless.

Recently, however, I’ve found a resurgence(?) of pharmacy related people on Twitter worth following. My criteria for following someone on Twitter is really quite simple. If they provide valuable information, i.e. I’m willing to click on a link they provide, then I follow them; if not I don’t. Told you it was simple.

Based on my criteria, here’s some people worth looking at for pharmacy specific information:

Dave Walker (@drwalker_RPH) – Dave is probably the most prolific Tweeting pharmacist on the ‘net, and he consistently throws out valuable content.

Honest Apothecary (@jasonpoquette – http://www.thehonestapothecary.com/) – I’m not entirely sure, but I think Jason is a retail pharmacist. Go figure. Don’t hold it against him though, his Tweets are both thoughtful and worthwhile.

Brent Reed, PharmD (@brentnreed – http://reedb.blogspot.com/) – Based on Brent’s Twitter feed and blog topics I would wager that he’s practicing in a hospital somewhere. Nothing wrong with a little clinical Twitter goodness.

Pharmacy Podcast (@PharmacyPodcast – http://www.pharmacypodcast.com/) – Not operated by a pharmacist per se, but definitely supports the profession. I find myself following quite a few links embedded in these Tweets.

The two Twitter accounts below belong to “throw-away” journals, but you know something, I find their content relevant, timely and valuable. You simply can’t say that about a lot of pharmacy journals these days. Some of the other “professional” journals could take a page from these guys.

Pharmacy Times (@Pharmacy_Times – http://www.pharmacytimes.com)

Pharmacy Practice News (@PharmPracNews – http://www.pharmacypracticenews.com)