Tag Archives: Bad

The benefits of an EHR may or may not be real

I’ve had reason to think about Electronic Health Records (EHRs) these past few weeks. There is a lot riding on their success or failure. There’s no question that EHRs will be the future of all documentation in healthcare, but I’m not convinced that healthcare is ready for the transition. At least not yet.

The potential advantages of EHRs are many. In theory they offer real-time information, integration of many systems across a single platform, the ability to store, access and manipulate massive amounts of data (“business intelligence”, analytics, “big data”, etc), they provide information that follows a patient regardless of where they go or who they see, the offer potential for patients to view, edit, use, and add to their own medical information, and so on.

These are all good things. If only the potential was reality. The current state of EHRs is far from their future potential.
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UCSF and Walgreens “reimagining pharmacy care”. Yeah, not so much…

baby_cryingUCSF: “A new initiative by UC San Francisco and Walgreens seeks to turn those numbers around, starting at the neighborhood pharmacy….“Walgreens at UCSF” is a pilot store that offers the most advanced level of community pharmacy care available in the United States today. It starts with the store’s unusual layout: Walk inside and the first thing you see isn’t racks of cosmetics or greeting cards; instead there’s a concierge desk where you can arrange a private consultation with a pharmacist or find out whether your prescription is ready. Pharmacists work with every customer to make sure they understand the medication they’re picking up, while also offering services such as the medication management that brought Helen to UCSF… For UCSF, it will serve as a teaching ground for student pharmacists completing their doctoral degree program, a clinical training site for pharmacy residents, and a research facility that explores new pharmacy patient-care models and programs.”

I found myself at UCSF Medical Center earlier this week and decided to visit the new Walgreens. I had previously read about the setup on Twitter and a couple of articles I found online.

Here are my thoughts and experiences regarding the “Wallgreens at UCSF”.
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5 Shady Ways Big Pharma May Be Influencing Your Doctor

AlterNet: “When it comes to acknowledging the influence of gifts and money on behavior, doctors, like everyone else, suffer from self-delusion. Most say they believe it affects the other guy, not them, and many become offended at the idea that they are “for sale.”

Trips to resorts and strip clubs will likely continue to diminish under the Physician Payments Sunshine Act, but there are many other ways, often sneaky, that Pharma can entice doctors to prescribe its expensive, patent drugs.”

Physicians, just like everyone else, are subject to bias. I rarely come across a physician that’s been practicing for more than 10 years that relies on up to date scientific data and/or guidelines to drive their prescribing habits. I can’t tell you the number of times I’ve had a physician say “because the drug rep told me” in response to my question regarding their use of a specific drug over another. That answer doesn’t instill confidence. 

Here are the 5 methods of influencing prescribing habits as listed in the article:

  1. Spying on Prescribing – “By selling the names, office addresses and practice types of almost every doctor in the US to marketing firms the AMA netted almost $50 million a year
  2. Continuing Medical Education Courses“…these classes are often “taught” for free by Pharma-funded specialists, sparing doctors from having to pay for them but providing the objectivity of a time-share presentation.
  3. Ghostwriting – “Being published in medical journals is essential to academic doctors but researching, writing and reworking papers is a formidable job. Luckily for doctors, Pharma is willing to help—as long as they write what Pharma wants.”
  4. Speakers Bureaus – “Few things combine the ego stroking and fast cash of being paid to speak—and Pharma has no trouble finding takers at $750, $1000 and more per pop.”
  5. Clinical Trials – “Pharma-funded clinical trials can be paydirt to doctors, yielding as much as $10,000 per patient in some cases.”

Worst IT pharmacist recruitment attempt ever?

I haven’t heard from a headhunter in a long time. I get blasted with useless stuff from LinkedIn on occasion, but no laser targeted attempts. But without a doubt what I’m about to show you takes the cake.

The information below landed on my website in the comment section of this post. Read it carefully and then explain to me what part of the job described requires an IT pharmacist.
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The job market for pharmacists has taken an ugly turn

There was a time when I could have found half a dozen pharmacist job openings in one afternoon. Now I find myself in a position where I can’t even find one.

It’s no secret that I was laid off several weeks ago; July 25th to be exact. I don’t know why I was laid off, only that my position was eliminated. I didn’t really think to ask any questions at the time as I was in a state of disbelief. I’ve been a pharmacist for just over 16 years and during that time I had never been laid off, fired, or “let go”. This is officially uncharted territory. I’m told that this kind of thing “happens in business”. Sucks anyway.
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Saturday morning coffee [April 20 2013]

MUG_IndianapolisSo 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 to the right comes straight from Indianapolis. I was there for work as part of a multi-city five hospital rampage through that section of the country. It was pretty nice for the most part, but trying to get home turned out to be a bit of a nightmare. Indianapolis was hit by severe thunderstorms the day I was supposed to leave – high winds, lightning, hail, and so on – which caused all sorts of chaos and delays at the airport. The delays made me miss my connection in Denver, which just happened to be the last flight out to Fresno on the night in question. I got lucky as the last flight to Los Angeles from Denver had been delayed by an hour so I grabbed an available seat and headed for the city of Angels. I landed at LAX about 1:00AM Friday morning, rented a car, got a hotel room, stole a few hours of sleep and finally drove the short four hours home. Total travel time from Indianapolis airport to my front door: approximately 20 hours. Not how I planned it. When I talk to the sales guys they tell me this is “no big deal”. If you were to talk to me I’d tell you it sucks.
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BMTS Corp goes down for the count and takes Demolizer II with it

Way back in November 2011 I posted about a cool pharmacy technology called the Demolizer II, a sharps waste eliminator system of sorts. That’s not the interesting part though. That particular post has generated more comments than any other post I’ve ever written. As of this moment there are 32 comments attached to it, mostly bad.

Starting last month comments mentioning BMTS going out of business started to appear.

Mike – December 26, 2012 at 5:27 pm
BMTS, a public company appears to be out of business. They have not filed a report with the SEC since the third quarter of 2011.

John – January 22, 2013 at 11:35 am
The IRS has placed locks on the office doors at BMTS due to back taxes. Not sure what the future holds for these guys but its not good at this point.

Sharon Wagner – January 22, 2013 at 11:38 am
I just spoke with the owner of the company, John Bricken, who apologized profusely, told me that the company is in financial dire straits and told me to do whatever I have to do because he has no way of helping me. I point blank asked him if I purchased a very expense piece of equipment that is now useless and his respose was, “yes, I’m afraid so”. I asked if there was any possibility that we would be able to eventually get the containers and use this device again and he told me if he was a betting man, he’d say no. The long and the short of my conversation with Mr. Bricken was that we might as well throw our Demolizers away because the company is going belly up! At least someone was finally honest with me!

Kind of sad really as the Demolizer II was a pretty cool product.

Saturday morning coffee [December 22 2012]

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….

Christmas MugThe coffee mug to the right comes from Jason DeVillains, better known to many as The Cynical Pharmacist. Jason and I met via Twitter(@TheCynicalRPH) and have been chitchatting via the web ever since. This Christmas themed mug is one of four that he sent me a few weeks ago. And what do you know; it just so happens to be the perfect occasion to bust out a Christmas mug. Boo-ya!  Jason also blogs over at The Cynical Pharmacist. Check it out.

The Hobbit: An Unexpected Journey was #1 at the box office last weekend. No surprise there. It did a respectable $85 Million, which is a record for weekend openings in December besting the previous record holder, I Am Legend’s $77 Million. My family and I contributed to the Hobbit’s box office success by going to see it last Sunday. Was it good? Yes, of course. Was it great? No, I don’t think it was. It was visual appealing, and never boring, but it was hard for me to wrap my brain around the idea of a trilogy of movies based on the book. I definitely recommend you see it on the big screen.
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Saturday morning coffee [December 15 2012]

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….

Pike Place Market Starbucks Coffee MugThe coffee mug to the right comes from Pike Place Market in Seattle, WA, home of the first Starbucks Store. I got the mug on my first trip to Seattle, which just so happened to be during a trip to give a presentation for the company I currently work for. I wasn’t an employee at the time, but they invited me up to talk about the automation and technology that we were using in our pharmacy at Kaweah Delta Medical Center where I was employed as an “IT Pharmacist”. One of the things I really wanted to do during my visit there was visit Pike Place Market and see the first Starbucks. My brother, Robert used to work in Seattle and he gave me a list of things to do and see. I only managed to get  to a few of things on the list, but this was one of them. The first Starbucks is different from any other Starbucks I’ve ever been to. It doesn’t have that corporate-lets-make-money feel to it.

Here’s an interesting twist at the box office, Skyfall continues to do well as it rose back to the#1 spot last weekend. Good movie, highly recommended. Rise of the Guardians came in at #2.  This of course will be short lived as The Hobbit: An Unexpected Journey will kill at the box office this weekend. There is no doubt that I will see The Hobbit, but I must say that the reviews have not been flattering. I read the book as a child and again as an adult.
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More on the meningitis outbreak caused by contaminated steroid injection

Things just keep getting worse: death toll rose to 14 and people affected was up to 172 in 11 states as of this afternoon. It’s difficult to find accurate information on the exact cause of the meningitis, but it appears that most of the cases are related to either Aspergillus or Exserohilum.

Fungal infections are notoriously difficult to treat, especially when they’re in the central nervous system (CNS). The CNS is designed like a fortress to keep things out, like fungus and bacteria, thus keeping you safe and healthy. Unfortunately it doesn’t discriminate and does a great job of keeping medications out as well. That’s why it’s hard to treat infections in the CNS.

I’ve been involved with several meningitis cases over the years, but rarely those involving a fungus. The outcome generally depends on several variables including how quickly the infection is discovered, how soon treatment is started, how aggressive the treatment is – you can never be too aggressive when treating meningitis – and the general health of the person you’re treating. A little divine intervention is always desirable as well. However, as I mentioned above, meningitis is difficult to treat and the outcomes associated with fungal meningitis aren’t great.

The CDC has released treatment recommendations. You can find them at the ASHP Pharmacy News site here.

The Centers for Disease Control and Prevention (CDC) recommends i.v. voriconazole and liposomal amphotericin B as initial therapy for patients who meet the current case definition for fungal meningitis.

According to CDC, the antifungal therapy for patients with meningitis should be administered in addition to routine empirical treatment for potential bacterial pathogens.

CDC Medical Epidemiologist Tom Chiller said during an October 10 conference call that broad-spectrum antifungal therapy is advisable because it is “unclear as to how many potential fungal pathogens could be involved” in the outbreak.

For patients who meet CDC’s current case definition for fungal meningitis, the recommended dosage of voriconazole is 6 mg/kg administered every 12 hours. Chiller said the dosage should be maintained “for as long as the patients tolerate it.”

Liposomal amphotericin B should be administered intravenously at a dosage of 7.5 mg/kg/day, according to CDC. The agency stated that liposomal amphotericin B is preferred over other lipid formulations of the drug.

The optimal duration of therapy is unknown but is presumed to be lengthy.”

Emphasis above is mine.