The ASHP Midyear 2011 Conference basically concluded for me today. I’d like to evaluate the meeting, but honestly have very little to say. This was my first year working in the role of Product Manager for a vendor, and not acting as an “attendee”, i.e I was here for work. The conference took on an entirely different feel this year as I wasn’t able to attend any of the sessions. For the most part I was stuck in the company booth playing the role of demo jockey. It was a strange feeling to say the least. I tried to follow the Twitter stream (#ashpmidyear) a bit, but finally relented and gave up.

I ran into a few old friends that came by the booth to mock me. It was good to talk pharmacy for a while here and there, but it was far and few between. I would have liked to seen and talked with more colleagues and friends, but it wasn’t meant to be. I wonder why I didn’t see more familiar faces in the exhibit area? Hmm.

Anyway, I found a few minutes here and there to wonder the exhibitor area and check things out, but nothing like previous years. The exhibitor area used to be one of my favorite places to be as it’s typically full of all kinds of cool automation, technology and new ideas.

Some vendors were worth visiting such as Omnicell, CareFusion, Baxa and Healthcare Logistics (HCL). Those were really the only booths I took time to peak at in any detail. Both Omnicell and Carefusion are doing some cool new stuff. Looks like both companies see a change in the future and are making moves to get ahead of the curve. Baxa had some great IV room stuff. Simply put, they’re kicking the crap out of everyone else. And HCL always has a great booth with a cool design. This year was no exception; Scottish theme complete with castle, kilts and Loch Ness Monster. Sorry, but I didn’t think to snap a picture.

I was thrown out of a vendor booth for the first time ever. That was pretty exciting. Apparently they didn’t think another vendor should be snooping around. The most interesting thing about the whole ordeal is that this particular vendor and my company aren’t doing any of the same things. Weird.

One of the most innovative things I’ve seen in a long time had to be IV Check by SEA Medical Systems. I’ll blog more about that later. Needless to say, I was impressed.

On the upside, New Orleans was an interesting place to visit. The city certainly has its share of night life activity and there’s no shortage of good food. The highlight of my entire visit, however, had to be my trip to the Superdome to watch the Saints take on the Lions on Sunday Night Football. What a great experience.

• Tangled was #1 at the box office last weekend. I haven’t seen it, so really can’t comment on the movie. My wife and I went to see Faster instead. It was exactly what you would expect from Dwayne Johnson playing a touch good-bad guy. I’d see it again.
• I found an interesting article about a company called RCG Holdings Limited. RCG specializes in the commercialization of RFID and biometrics technology. “The Group offers a vast service of products and solutions, including RFID-enabled asset management systems, machine to machine (M2M) and Internet of Things (IoT) applications. It has developed an intelligent surveillance system using facial recognition technology called Fx Guard Windows Logon, which has been adopted by international computer manufacturers like Acer and NEC.” The FxGuard Windows Logon really caught my attention. You can find more information here. It’s pretty cool stuff.
• GottaBeMobile: “The QNX operating system was unveiled for the company’s forthcoming BlackBerry PlayBooktablet, which boasts a smooth operation with multimedia prowess and multitasking capabilities. Since the PlayBook was unveiled, RIM has been forthcoming in saying that the next-generation OS would appear in the company’s smartphone offerings as well and won’t be limited to tablets, demonstrating the scalability of QNX much like what Apple has done with iOS, Google with Android, and Nokia and Intel with MeeGo.” –RIM is doing some remarkable things, evident by the video below. My only concern is that it may be a little too late as the iOS and Android operating systems are slowly becoming the two giants in the industry. Only time will tell.

• There’s a great article at EMR Daily News that discusses the differences between SaaS and hosted solutions. As so eloquently put in the article “These terms [SaaS and hosted] are sometimes used interchangeably and they shouldn’t be. If you’re hearing these terms from the vendors you are speaking with you need to understand the difference.”
• I found an excellent list of things to consider when designing a user interface (UI) at the Ellen Beldner website. The list includes great tid-bits like “When in doubt, take it out” and “Users matter more than we do”. Healthcare vendors could certainly learn something from this list of recommendations for UI design.
• There’s been a lot said recently about the use of telemedicine including telemonitoring of patients and telepharmacy to handle remote checking. I think the concept is great, but I’m not quite sure where it fits in the overall scope of things. A recent New England Journal of Medicine (N Engl J Med 2010; 363:2301-2309) article found that using telemonitoring for patients with chronic heart disease didn’t improve outcomes. I can’t say that I’m surprised by this, as heart failure may not be the right disease state to employ heightened monitoring and interaction. Disease states where medication timing and compliance is crucial like diabetes and HIV might be worth exploration. Information presented at the mHealth session at ASHP Midyear where SMS reminders were successfully utilized in those disease states reinforces this idea.
• Clinical Transplantation “Taking Immunosuppressive Medications Effectively: A pilot randomized controlled trial in adult kidney transplant recipients” ( published online Nov. 16): “Using a randomized controlled trial design, 30 adult renal transplant recipients were screened for medication non-adherence using electronic monitoring. Fifteen non-adherent participants were randomized to receive either a continuous self-improvement intervention or attention control management.” The electronic monitoring consisted of medication bottles with microcircuits that recorded information on medication compliance and wirelessly transmitted the data to the healthcare provider. The study concluded that “The continuous self-improvement intervention shows promise as an effective and feasible approach to improve medication adherence in adult renal transplant recipients.” So a little bit of technology plus gentle reminders equals better compliance. Go figure.
• Pharmacotherpy: “Clinical pharmacists have served as principal investigators on a wide range of grants and contracts from all available funding sources, including peer-reviewed funding from the National Institutes of Health (NIH). Most important, clinical pharmacist development needs to be an academic and practice priority to ensure an adequate supply of clinical pharmacists as principal investigators to continue making substantial and meaningful contributions in meeting the needs of patients, improving public health, and expanding the roles of clinical pharmacists.” Well there you have it. I find it interesting that people keep saying the same thing over and over again. All pharmacists know this, so what are you going to do about it? Writing another article with outdated information certainly doesn’t help.
• Here’s an interesting product at IDAutomation.com: Native Barcode Generator for Google Docs. It’s a little pricey, but worth a look.
• This video at the Beacon Community site says it all. “Death by decimal point” and “it’s about system design”. Someone gets it.

• Wolters Kluwer is busy gobbling up various pieces of the healthcare market. From the EMR Daily News site: “Wolters Kluwer Health’s unit Lippincott Williams & Wilkins (LWW) today announced the acquisition of iCare LLC, makers of iCare EMR, an educational Electronic Medical Record (EMR) software program.” Last week they acquired Pharmacy OneSource, the maker of some pretty cool pharmacy applications. What are they up to?
• Interested in an eSeminar on mHealth? Well look no further than the HIMSS Event Center website where you can register for “Mobility and Population Health: A Clinical Case Study on the Role of Mobile Devices – The mCare Project”.
• MobileBeat: “Google’s Andy Rubin tweeted last night that over 300,000 Android phones are activated daily— that’s up from 200,000 daily activations in August. The news puts Android’s daily activations over both the iPhone and BlackBerry, and it even surpasses Nokia’s 260,000 daily Symbian activations (though research firm Canalys says those numbers may be closer to 325,000), Fortune reports. Android’s daily activations also point to Google nearing 10 million Android activations a month.” – It appears that people throughout the universe are beginning to realize they have a choice in the matter. Hmm, why would anyone want a choice? According to Apple we’re all supposed to just shut up and do as we’re told. Fickle people.
• I really love Acer’s ingenuity. At a press release last week, they announced the details for a dual-screen tablet, the Iconia. It sports a pair of 14-inch touchscreens. Here’s hoping it makes it to the market so we can all have the opportunity to drool on it.
• Google just keeps rolling along. It looks like the Google operating system and Chrome OS notebook will be available sometime early next year. Take a look at the video below showing a demo model of the Cr-48 Google OS notebook. I must say that I like the looks of the thing. They’ve clearly taken queues from Apple and their line of MacBook laptops. Nothing wrong with that. I’ve been wondering for quite some time when someone was going to start doing that. I love you Google.

• The activity at my site was pretty much status quo, but between Sunday, December 5 and Friday, December 10 the posts on Midyear were clearly on everyone’s mind. Here are the top four posts from those dates. See a trend?:

1. #ASHPMidyear rolls on
2. #AHSPMidyear, the end
3. #ASHPMidyear 2010 part deux
4. #ASHPMidyear day one comes to an end

• Time for a quick rant. Please avert your eyes if you don’t want to see it. Twice while at ASHP Midyear someone commented on the fact that I wasn’t wearing a “coat and tie”. I don’t like to wear a coat and tie. Never have and never will. I come from a fairly humble background and didn’t consider wearing a suit until much later in life. Will I wear one when required by my employer for my job? Of course I will. Someone is paying me to be a cog in the wheel. A grunt if you will, and as long as I take their money I’ll do as they ask. As I’ve said before either live with it, change it, or move on. However, when I’m on my own time I wear what I like. I dress in a professional manner most of the time and that should be enough. For some reason people equate a business suite with intelligence and station in life. I don’t. My initial thought of someone in a suit is that they’re trying to distract me from the important stuff by presenting me with something shiny, i.e. like a used car salesman. So, if you want to sit down with me and shoot the breeze or talk about informatics, pharmacy, life, kids, football, or whatever, feel free to approach me. I’d be happy to talk your ear off. On the other hand, if you want to size me up by what I’m wearing, don’t bother. I’m just sayin’.

Before I talk about the presentation here are some general observations from this year’s ASHP Midyear:

• I love the exhibit hall and try to spend as much time as possible walking around taking it all in. This year’s exhibit hall contained more automation and technology than I’ve seen at previous ASHP Midyear meetings. This is encouraging as it appears that pharmacy as a whole is starting to understand the need for automation and technology in our profession. Unfortunately there is also a bit of a downside as well. While there were plenty of vendors displaying automation and technology, none of it was new and exciting. Most of what I saw could affectionately be called “me-too” technology. Still, increased vendor participation means increased competition which ultimately leads to better products.
• Android phones were every bit as popular as iPhones this year. If you know me at all, then you know that I can’t look at someone without looking at what type of smartphone they carry, and I saw a lot of Android devices. I saw a lot of iPhones too, but there’s clearly a shift in user choice. More interesting yet was the carrier mix by Android phone users. I saw Android devices from every major carrier. Cool.
• I spied two Samsung 7-inch tablets in the wild at Midyear along with a slew of iPads. The tablet market is heating up and I can’t wait.
• There was a lot of excitement in the air this year from pharmacists I spoke to as it appears the profession has made a commitment to push their way into healthcare with force. Finally.
• ASHP did an incredible job this year with their media at Midyear. Videos, newspapers, Twitter updates, etc. It was great. The Tweetstream from this year’s event was impressive. I consider myself a fair Twitter user, but I’m happy to say that I found myself dwarfed this year as Tweets were coming in from all directions. The ashptv.com site was also a welcome addition. I found myself watching video clips in the hotel room prior to retiring for the night. Bravo ASHP.
• From what I gathered from colleagues and prospective employers, this year’s class of residents was the best they’ve seen. I’m encouraged by that and optimistic for the future of pharmacy practice. Conversations about the right things were taking place everywhere I turned.
• In addition to the great host of residents this year, I found myself speaking with pharmacists about grassroots movements to change the way we practice. Excellent

The final session:

I had the absolute pleasure of being part of a presentation panel on mHealth at this year’s ASHP Midyear. The moderator for the session was Kevin Clauson (@kevinclauson) from NOVA Southeastern University in Florida. I’ve known Kevin for about a year and have great respect for him and his work in mHealth, Web 2.0 and social media. The other panelists were Elizabeth Sherman, PharmD, also from NOVA, who presented on her work utilizing SMS reminders to service HIV patients; and Dr. Jennifer Dyer (@EndoGoddes) who shared her success with SMS text messaging for teens with Diabetes. My part of the panel presentation focused on the use of the iPad in acute care pharmacy, which can be found below. I’ll post the entire slideset when it is available.

• I was fortunate enough to start my day by discussing RFID tracking of medications with a colleague over breakfast. MedKeeper is working with Swisslog to utilize the RFID tracking capabilities of their Pneumatic Tube System. You can read more about Swisslog’s RFID for pneumatic tube systems here.
• There was an interesting impromptu get together among several informatics pharmacists this morning to discuss the future of pharmacy practice and the results of the recent ASHP PPMI Summit. There were some great ideas tossed around. Obviously the future of pharmacy practice isn’t something you work through in a couple of hours, but one thing is for certain: the future of pharmacy will be patient centric and make judicious use of technology as the pharmacists move away from the physical drug. Other themes that popped up were the increased use of pharmacy technicians in an expanded role, and the need to collect and analyze data from cutting edge practice models currently in existence. One item that I found particularly interesting was the notion that the act of prescribing a medication will someday be obsolete. I initially dismissed the idea, but the more I thought about it the more I realized it may not be outside the realm of possibility. Think of the number of standardized protocols, initiatives and treatment guidelines that are used today. Couple that with the advancing field of pharmacogenomics and you have a recipe for therapy directed completely by disease state and genetic typing. Not too futuristic after all.
• The Midday Symposium of choice today was The Power of Control, which was supposed to be a presentation on patient safety, lean pharmacy and data management and reporting. Unfortunately it turned into a long infomercial for DoseEdge. I believe DoseEdge is awesome technology that I’ve blogged about before, but the presenters spent a little too much time praising the workflow manager instead of talking about the importance of other pieces of the puzzle in the IV room. Good points were presented by all the speakers, but I felt that Pranish Kantesaria, the Director of Pharmacy at Riley Children’s Hospital in Indianapolis, IN did the best job of presenting the reason for pushing for safety in the IV room. He talked about the human brain’s inability to multi-task, distractions in the IV room and trust bias. In addition he presented some great information on how to measure the reliability of a process as well as what constitutes the hierarchy of controls in patient safety. I took away a lot of good information from his section of the talk.
• Secondary to my discussion on RFID medication tracking earlier in the day, I ventured over to the exhibit hall after the Midday Symposium to visit the Aethon booth and get a demonstration of their asset tracking and recovery solution that makes use of RFID tags, a tracking board and a little TUG robot. Overall the system was quite impressive, and the technology is exciting. The video below gives you a basic idea of what the TUG robot can do, but appears to be a little dated. The TUG unit I observed today looked a lot more up to date than the one in the video.

• After my jaunt through the exhibit hall I had a meeting with another group of informatics pharmacists where we discussed a project by the National Library of Medicine (NLM) involving Pillbox. There’s quite an effort underway to develop a standardized library of images that can be used to better identify tablets using readily available technology. Words like “the cloud”, “high resolution imaging”, “pixel recognition”, etc were used. Absolutely fascinating stuff.
• My day concluded with the 13th annual ISMP Cheers Awards Reception and Dinner at Anaheim Stadium. I was excited to be there as it was the first time I’d ever attended an event like that. Barbara Olson (@SafetyNurse) was honored with the ISMP Volunteer Award for her efforts centered on the use of social media to increase awareness of patient safety issues. Barbara is a great advocate of patient safety and a positive example of how one can use social media to advance knowledge. Mark Neuenschwander (@hospitalrx) received the ISMP Lifetime Achievement Award for his tireless work in advancing patient safety through the use of bar-code technology at the point of care. I’ve had the pleasure of speaking with Mark on several occasions and have been impressed with his knowledge and passion about healthcare and patient safety. Congratulations to both Barbara and Mark for their achievements.

Time to get some sleep and hit it again tomorrow.

I spent the day tracking down pharmacy automation and technology. Did you really expect me to do anything else? I don’t ever recall being as excited as a clinician as I am being an informatics pharmacist. Anyway, here are some things I found interesting:

• The first session I attended today was Better Patient Care and Safer Staff with IV Compounding Automation presented by Eric Kastango, RPh and Tom Crampton, PharmD.
  • Kastango shared some great information on how automation can be used to not only assist pharmacies in meeting USP <797> standards, but provide increased patient safety as well. He presented some eye opening facts regarding the number and severity of mistakes created during the IV compounding process. While he didn’t speak specifically about a single automated compounding device (ACD), he did present the conceptual value of such devices. He referred to them as “idiot savants”, which I find strangely accurate. My favorite quote from his presentation comes from Bill Gates, “The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.” This is a truism.
  • Tom Crampton spoke about his experiences with automation and technology in IV preparation as the director of pharmacy at Allegiance Health in Michigan. He laid out quite an extensive history of their journey from little automation to where they are today. In addition he presented some great data showing the value that automation has brought to his department as well as how it has had a positive impact on patient safety. One take-away from Crampton’s talk was that you shouldn’t forget about the human element while implementing automation and technology because as humans we always find a way to mess things up. I was impressed by his vision and implementation of pharmacy automation and technology. Allegiance Health would be a great place to visit.
  • I walked away from this presentation with a question burning in my mind; has the implementation of USP <797> been shown to reduce drug errors and decrease patient infection rates? Seriously, I don’t know. Presenters talk about USP <797> with absolute confidence, but I don’t recall ever seeing any solid evidence that it alone has made a significant difference in drug errors or patient safety. If anyone knows differently please don’t hesitate to educate me.
• Following the presentation on ACDs I took a field trip to the exhibit hall where I spent some time looking at all the different ACD vendors. The two devices that caught my attention were RIVA and i.v.STATION, and of those two I was more impressed with i.v.STATION. The i.v.STATION device had a much smaller footprint and moved smoothly and efficiently through the compounding process. I thought it was pretty cool. Here’s a video courtesy of McKesson and Health Robotics showing i.v.STATION in action.

• I spent the late morning and early afternoon meeting with some colleagues and talking specifically about pharmacy technology in the acute care setting before making my way to the poster sessions. There were quite a variety of posters on display, from your typically IV stability studies and impact of pharmacy services on various areas of care, to how pharmacists are using social media like Twitter and Facebook. If you get the opportunity I would highly recommend checking out the posters. There’s always a couple of gems in there, you just have to root them out.
• My afternoon concluded with a session titled “Clinical Rule Development and Sharing: The Power of Collaboration” presented by John Poikonen, PharmD and Allen Flynn, CPHIMS, CHS. This session focused on the development of clinical rules for use in various pharmacy systems and the struggles associated with developing these rules in a standardized, reusable format. During the presentation John and Allen spent about 20 minutes developing a theoretical clinical rule with the help of the audience. By the time various pieces of logic were built into the rule it became obvious why developing a set of these rules is so difficult. In addition to developing the templates for the clinical rules John touched on some collaborative efforts that are under way to develop an open source cloud based set of rules that could be leveraged against existing pharmacy information systems. What a great concept.
• And just to top it off I returned to my room to discover that a Podcast interview that John Poikonen and I did with Todd Eury for Pharmacy Technology Resources had been posted.

It really doesn’t get much better than that, but then again there’s always tomorrow.

I spent a good part of my first morning at the Talyst User Group Meeting. It’s encouraging to speak with other pharmacists that use pharmacy automation and technology in interesting ways. User Groups are a great way to get focused information from end users. I always take something away from groups like this. I wish there was a way to apply the format to other areas of pharmacy informatics.

Following the user group meeting I spent some time roaming around the exhibits. Yes, before they’re open “to the public”; vendor badge. While the exhibits weren’t complete, they certainly offered a glimpse of what I can expect for the rest of the week. It also gave a me a good idea of who I’d like to visit and spend some time talking too. It’s always interesting to talk with the vendors in person. Sometimes you can get information that you simply can’t find anywhere else.

I did manage to attend a single session today titled A Hitchhiker’s Guide to Telepharmacy. I haven’t spent much time learning about telepharmacy so I thought this would be a good opportunity to gain some knowledge. To my surprise it turns out that telepharmacy isn’t at all what I thought it was. One of the first slides in the presentation defined telepharmacy as “a central pharmacy, either retail or associated with a hospital, is connected via computer, audio, and video link to one or more remote sites. A licensed pharmacist at the central site conducts remote order entry and then supervises the dispensing of medication at the remote site through the use of video conferencing technology.” (Darryl Rich, The Joint Commission, 2007). Huh? I thought telepharmacy would represent a more clinical approach to patient care through the use of audio and video.

The U.S. Department of Health & Human Services defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site.” I assumed telepharmacy would basically be the same thing. Guess not. The Joint Commission definition of telepharmacy stated above is simply remote checking. I’m not sure I like that.

At least my day ended on a positive note. I had dinner with a friend at a great little Mexican restaurant called Tortilla Jo’s in Downtown Disney. We spent a couple of hours talking about all kinds of stuff including pharmacy, informatics/automation and life. Good stuff.

Here’s looking forward to tomorrow.

As this is only my second ASHP Midyear in my career I’m excited to see if the experience matches that of last year. I’m sure it will as I continue to be impressed by the number and variety of sessions crammed into such a short period of time. Of course I’m particularly interested in the informatics sessions, but it’s ok if you find yourself sitting in on one of the talks updating you on what’s happening in the clinical world. I won’t hold it against you.

The week for me will kick off on Sunday morning with the Talyst Users Group meeting followed by a session on RFP’s and contracts put on by the ASHP Section of Pharmacy Informatics and Technology’s Advisory Group on Pharmacy Operations Automation. I’ll round out Sunday’s activities by attending the McKesson Safe Compounding Reception. And it will only get better from there as the week will be filled with sessions on clinical decision support, barcoding, telepharmacy, the application of social media to pharmacy, and so on and so forth.  My week will conclude with the session titled mHealth: There’s an App for That where I will be presenting information on the integration of the iPad into pharmacy services.

The information I’m presenting was pretty cutting edge at the time I submitted the slides, but is now clearly dated. That’s the downside of having to submit presentation slides so far in advance. Anyway, it should still be worth the time and effort. I’ve always found it educational for myself to present information to people as someone always has something interesting to add or a good question to stimulate the thought process.

I’m looking forward to the next five days. I’ll be Tweeting (@jfahrni) as much of the event as possible in addition to posting about the day’s activities whenever feasible. I hope to see you there. If you’d like to get together and talk a little pharmacy informatics/automation don’t hesitate to give me a Buzz, Tweet or email.

I am a fan of automation and technology in any setting, but especially in the acute care pharmacy. I believe that the continued use, development and advancement of pharmacy technology should be a key component of any plan to change the current pharmacy practice model. Unfortunately, the situation is problematic because current pharmacy technology is either poorly designed for the needs of the pharmacy or the pharmacy in which it is used has a poorly designed workflow that doesn’t take advantage of it. Why is that? Who’s to blame; someone, anyone, no one? Valid questions.

I had an incredible opportunity this week to spend time with some people who research, design and implement pharmacy automation and technology. It’s eye-opening and refreshing to speak with people who are passionate about the same things as me. We all sat around a table in an informal, conversational manner and threw around a lot of ideas, talked philosophically about healthcare and gained insight into a great many things. The entire session was very productive and educational. But one of the most important messages I walked away with was the understanding that the designers of pharmacy automation and technology are not the limiting factor in the advancement of pharmacy practice; we are. Their ideas and thought processes are clearly ahead of the current thinking in healthcare, specifically pharmacy. I’m not exactly sure why pharmacy is slow to consider the future, and even slower to adopt new technologies, but here are some things I think might contribute to the problem:

• There is a clear lack of pharmacist involvement in the development of pharmacy automation and technology – Sure there are some pharmacists that dabble in software development, or play around with new technologies, but overall there appears to be little interest within the profession. I see this at meetings where informatics sessions have very few attendees, while the clinical sessions are bursting at the seams with pharmacists trying to get a peek at the latest information for disease state management, clinical application, etc. The most interesting thing about this scenario is that the information presented in the “clinical sessions” is rarely cutting edge. The information is valuable to many, but most, if not all of it can easily be found in the literature. Pharmacy automation and technology information, on the other hand, is often times much harder to come by. Take a look at the recent blog by Dennis Tribble. He touches on the software side of things only, but the idea is applicable across all pharmacy automation and technology.
• Healthcare administration fails to see the big picture – Hospital administration often fails to see the advantages of automation and technology implementation in the pharmacy. If you’ve ever worked in an acute care pharmacy you know exactly what I mean. It is a rare hospital indeed that can see the benefits of spending time, energy and money on improving pharmacy operations. How do you improve pharmacy operations? You streamline the distribution process, and one way to do that is through judicious use of automation and technology. What does improved pharmacy operations get you? Efficiency, which translates to more pharmacist time for clinical activities. What does increased pharmacist clinical activity get you? Fewer drug misadventures, better and safer patient care, and a significant cost savings to the healthcare system. Simple, logical, reasonable thought, but rare in the healthcare environment.
• There is a lack of innovators in the field – Let’s face it; if pharmacists were innovative we wouldn’t still be using the same practice model that we’ve had for over two decades. Even the recent PPMI Summit put on by ASHP offered relatively little innovative thinking. I haven’t had the opportunity to go through all the PPMI presentations, but what I’ve seen to date are simply iterations on the same old theme. We continue to speak in terms of “current” practice instead of talking about “future” practice. I think it’s time to pick a goal that seems crazy on the surface, and then start designing the methods and strategy to make it work. Somewhere along the way a vision of the future will emerge. Smartpumps, automated dispensing cabinets, carousel technology, automated packaging, robotics, etc are all valuable technologies used in pharmacy today. Yes, today. While we should continue to develop, standardize and streamline today’s technology, we must begin to investigate the future; period.
• There is a clear lack of pharmacy leadership from the top down – I don’t know how else to say this, but there are few leaders in the pharmacy world that have the foresight and testicular fortitude to do what needs to be done. One of the themes of the PPMI Summit was to “be bold”. To do that pharmacy leadership from the top of the corporate ladder to the front lines of pharmacy practice are going to have to make changes, lots of changes. We cannot be afraid to fall flat on our collective faces. The detriment to innovation and development is being in a comfort zone, and being afraid to do something that might not work. Failure is a tool, one that the profession of pharmacy has failed to utilize.
• Pharmacy refuses to be empowered – Vendors give us the ability to help ourselves, but we refuse to accept it. We refuse to utilize key features and concepts of the technology we have at our disposal and we refuse to take ownership of making sure the hardware and software we use is used to its fullest potential. Several times during the scrum described above someone asked me why I simply didn’t use a particular feature of a product to do something I was lamenting over. My typical response was that I wasn’t aware of the feature they were speaking about. That’s disappointing as I should be familiar with the product’s capabilities; my fault not theirs. The vendors create a product, provide the end users with training, produce training manuals and videos, have listservs for us to bounce ideas off other users and give us “help desks” that we can access for additional information when we get ourselves in trouble. What else can they do? They can’t force an end user to use the technology correctly or to its fullest potential. I’m guilty of putting blame on the vendors because it’s easier than working harder to get the most out of their systems. I think it’s time I changed my approach.

That’s it. We’re our own worst enemy. It’s time to point the finger at ourselves and critically evaluate our endgame. Let’s be honest with ourselves and work toward the answers, whatever they may be.

I’m looking forward to ASHP Midyear in December as it will give me the opportunity to visit with other pharmacists from across the country. I’m interested in finding out what the real opinion is about our future and where pharmacy automation and technology fits in that plan. I often gain more knowledge and information by spending time with these pharmacists than I do any other way. I’m excited about it and hope to see you there.

Below is a list of opinions about a great many things that I have seen and done over the past year. Some are pharmacy related, some are technology related, some are personal, and some are just random thoughts.

Best idea for acute care pharmacy – “Auto-verification” of orders with CPOE.

Best idea for new pharmacy practice model – Technology-enabled practice:
A vision statement by the ASHP Section of Pharmacy Informatics and Technology. Am J Health Syst Pharm.2009; 66: 1573-1577.

Best idea in pharmacy that has yet to mature – Clinical Surveillance software.

Best clinical surveillance software reviewed, but not purchases – Sentri7 by Pharmacy OneSource

Best drug information resource, hardcopy – Lexi-Comp Drug Information Handbook.

Best drug information resource, handheld/electronic – Lexi-Comp Lexi-Drugs & Lexi-Interact

Best pharmacokinetics calculator, handheld/electronic – RxCalc for the iPhone, of course.

Best medical reference, electronic/web based – UpToDate. (includes access to Lexi-Drugs, online version)

Biggest fall from grace – Pyxis becoming CareFusion. Unfortunately the customer service I was used to receiving from Pyxis went in the toilet when they broke away from the mother ship to form CareFusion.

Best bar code scanner used this year – Code Reader 3500. We’ve had some problems getting it to work properly with our carousel, but it is a great little bar code scanner.

Worst bar code scanner used this year – Code Reader CR3. After using the Code Reader 3500, the CR3 feels like a relic.

Biggest bar coding challenge for me this year – Figuring out how to bar code our pediatric syringes.

Most valuable data collected – Data from our Alaris smart pumps

Least useful data collected – Pharmacist intervention data collected in Siemens. We just can’t get pharmacists to record this information.

Worst software upgrade – Siemens pharmacy system. Man, was that a fiasco. I’d like to spend a little “quality time” with the developer of that system.

Best tablet that never was – The Apple iSlate. Will I purchase one when it finally hits the market? Yeah, probably.

Best mock-up of the mythical Apple Tablet. Deemed the “MacBook Touch” by Designer Tommaso Gecchelin.

Best eReader – The Nook. Say what you will, but I purchased a Nook for my daughter and it is very nice, easy to use and just plain cool.

Best applications I discovered this year – Evernote and LiveMesh. I couldn’t live without them.

Best screen capture utility – ScreenHunter

Best tablet PC I used this year – I think it has to go to my Dell XT2 Tablet PC. It’s not the perfect tablet, but I will rank it above the Motion Computing J3400, C5, and LE1700 I used this year. I already have my eye on a Lenovo X200 tablet PC for 2010. Stay tuned.

Best not-a-tablet-not-an-ereader device – The enTourage eDGe. This device is probably my next purchase.

Best tablet pc blogger on the ‘net – Warner Crocker (@WarnerCrocker) of GottaBeMobile.com.

Best UMPC blogger on the ‘net – Steve ‘Chippy’ Paine (@chippy) of UMPCPortal.com.

Best everything moble site on the ‘net – jkOnTheRun

Best new smartphone – Hands down, the Motorola Droid.

Most exciting developments in an operating system – Android. We’re seeing it in smartphones and netbooks. It will be interesting to see where it goes in 2010.

Best smartphone user interface – The iPhone. It isn’t my smartphone of choice, but it sure has a nice UI.

Best meeting/conference attended – ASHP Midyear 2009.

Best advice I received – This one came from my brother, Robert. His advice to me: “Get a Twitter account and start blogging.” Thanks, bro.

Best presentation attended – There were two presentations I attended at Midyear that really caught my attention: 1) Integrating Technology to Improve Medication-Use Patient Safety (PDF) and 2) Pharmacy 2.0: How the Web is Changing How We Practice

Best webinar attended – Pharmacy Face-Off: BCMA vs. CPOE, Which Comes First?

Best vendor I worked with this year – Talyst

Worst vendor I worked with this year – Siemens

Best RSS Reader – Google Reader

Best online collaboration tool – Google Docs

Best new thing that people won’t use – Google Wave

Best search engine – Bing is pretty solid, but Google still rules.

Best browser for Windows machine – Hmm, tough call. Firefox still has my vote, with Google Chrome a close second.

Best tablet PC software – Microsoft OneNote

Best Twitter client for the Droid – Seesmic for Android. Still waiting for a TweetDeck Android app. Do you hear me TweetDeck people?

Best Twitter client for the desktop – TweetDeck, without question.

Best desktop operating system – While I’m impressed with Windows 7, I’m forced to give the nod to Mac OS X.

Best movies at the box office – Tough one for me as Lori and I see a lot of movies. I don’t watch movies for the plot, story line or acting. I like to be entertained. So, based on that here we go:

• Underworld: Rise of the Lycans
• Transformers: Revenge of the Fallen
• Avatar
• X-Men Origins: Wolverine
• Star Trek – This may have been the “best”

Biggest grossing movie of 2009 – Transformers: Revenge of the Fallen. It did over $400,000 at the box office.

Worst movie at the box office – Watchman. What a terrible movie; total waste of time.

Most overused word – Anything with a “2.0” in it, i.e. Web 2.0, Gov 2.0, Pharmacy 2.0, Med 2.0, Health 2.0, Cheeseburger 2.0, Coffee 2.0, etc.

Most valuable lesson learned in 2009 – Be patient.

Best thing I did for myself – Lose 40 pounds. I feel much better.

Best surprise in professional football – The Arizona Cardinals made it to the Super Bowl.

Biggest disappointment in professional football – The Arizona Cardinals lost to the Pittsburgh Steelers in the Super Bowl.

Worst coaching decision in professional football – Bill Belichick going for it on 4th down against the colts.

Dumbest play by a professional football player, on the field – Leodis McKelvin’s decision to return a kickoff instead of taking a touchback when the Buffalo Bills were leading the Patriots in the fourth quarter of a game they had won. The fumble ultimately led to the Bills losing to the Patriots 25 – 24.

Biggest disappointment in collage football – The USC Trojans not winning the Pac-10. Bummer.

Most overrated college football player – Tim Tebow

Most overrated college football team for 2009 – The Florida Gators

Worst system in the universe to determine a sports champion – The BCS. The current bowl system is all about money and has almost nothing to do with sports.

Worst professional sport to watch on TV or in person – Major League Baseball.

Here’s to a New Year full of new and wondrous things.

Most of the displays are completely worthless, but I did have a couple of goals in mind as I entered the hall.

MedBoard
I’ve heard quite a bit about MedBoard since my arrival at the ASHP Midyear. We spent a few minutes in the Talyst User Group talking about it, I spent some time talking to a group from Pharmacy OneSource about it, and it was the hot topic of discussion at the Pharmacy Automation Operations Networking Session today.

I’ve previously listed MedBoard as one of my Cool Technology for Pharmacy, but based on the current status of the product I don’t think it is right for our facility. The process could be of value in certain circumstances, but requires the introduction of manually scanning barcodes on the medication for tracking. It might be worth another looks when a more passive tracking approach becomes available, i.e. RFID.

Drug Information for the Droid
Some drug information software vendors, PEPID, ePocrates and Micromedex, said I could access their information via the Droids internet browser. No thanks. Lexi-Comp currently has drug information software for the Android OS, but not specifically for the Droid. They did tell me that the Droid version is four to six weeks away.

TheraDoc
Our hospital has owned a product called Stellara for a few years now, but haven’t done anything with it. TheraDoc inherited Stellara accounts less than a year ago and I have been asked by our pharmacy department to get the application up and running. TheraDocs can provide pharmacy users with real-time access to patient information for the pharmacy system as well as lab and ADT. In addition, rules can be designed to alert pharmacists of patients with certain high risk medication situations, allergies, inappropriate antibiotic therapy, high or low lab values, etc. It basically boils down to a clinical workflow engine designed for pharmacists.

Pharmacy OneSource offers an equivalent system called Sentri7, which I have also blogged about. Our pharmacy is currently evaluating another Pharmacy OneSource product, Simplifi 797, and I would like to stick with a single vendor. Decisions will be based on many important factors,  <cough> cost <cough> .

Alternative barcode solution
Barcoding certain dosage forms can be a headache and several of my technicians have tasked me with finding them an “easy and straightforward” solution.

Two companies that piqued my interest were Pearsonmedical and Epson. Pearsonmedical offers a very nice flag label and easy to use software called m:print. The software utilizes the NDDF formulary from First Data Bank to access drug information based on the product being used. Epson is the first company I’ve seen to date offering barcode labels with color ink. Their SecurColor On-Demand Color InkJet Printer is pretty slick. I was skeptical, but the labels look good and don’t smear.

All in all it turned out to be a successful jaunt around the exhibit hall.