Jerry Fahrni

Pharmacy Informatics and Technology

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Don’t ignore the evidence for the sake of argument

Posted on April 1, 2012 by Jerry Fahrni
2 Comments

I regularly read a website called Medinnovation. It’s written by Dr. Richard Reece who tends to rant about healthcare in a refreshing way that you don’t often see online. He basically gives you his opinion with both barrels and it typically runs counter to what most people have to say. I like it.

This morning (broke my rule about Sunday morning reading, Doh!) I read his latest post, Medical Experts and the American People. This is one time when I think he got it wrong. In the article Dr. Reece basically chastises evidence based medicine (EBM). “I say “presumably” because many patients or doctors do not necessarily buy the experts’ advice [i.e. evidence based recommendations] or follow instructions.” Uh-oh.
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Categories: Pharmacy Practice | Tags: Bad, Random thought

The insidious nature of ignorance and my curiosity

Posted on March 4, 2012 by Jerry Fahrni
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There’s been a Tweet flowing through my Twitter stream for a few days now and I’ve avoided clicking on the link because I knew it would be something totally ridiculous, misleading and meaningless. Unfortunately it was a quiet Sunday morning, and while I sipped my coffee and waited for the rest of my household to come to life, I succumbed to human nature and clicked the link.

Grrr! I knew it. Something totally ridiculous, misleading and meaningless. What was I thinking? Why do I torture myself this way? One can only speculate.

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Categories: Mobile Computing | Tags: Bad, Mobile Access, Random thought

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

Posted on January 26, 2012 by Jerry Fahrni
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I received the announcement below in my email just a short time ago. So being the good little pharmacist that I am, I headed on over to the U.S. Pharmacist website to check it out. Imagine my surprise when I clicked on the digital issue link and was greeted with a “Service Unavailable” message (bottom image). Bummer. Hopefully they’ll get it up and running shortly.

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

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Categories: Pharmacy Informatics | Tags: Bad, Pharmacy Informatics

Safety, privacy and UCSF Med Center’s failure to do the right thing

Posted on December 31, 2011 by Jerry Fahrni
1 Comment

I am a UCSF School of Pharmacy alum. I consider UCSF Medical Center, along with many other people, to be one of the best medical centers in the country. And, UCSF Medical Center saved my mother’s life with a liver transplant earlier this year. However, I am frustrated with UCSF Medical Center this morning.

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Categories: Therapeutics | Tags: Bad, Random thought

Fun with Lugol’s solution…not really

Posted on December 12, 2011 by Jerry Fahrni
1 Comment

A recent ISMP Medication Safety Alert shared various errors that have occurred with Lugol’s solution over the ages. Lugol’s solution is a concentrated liquid form of potassium iodide and iodine known for its use in the treatment of hyperthyroidism. It’s also a dangerous drug because it’s typically dosed in drops, not mL’s.

Anyway, the ISMP alert shared several examples of oral overdoses with Lugol’s solution secondary to confusion between drops and mL’s. However, mixed in with all the “typical” errors, was the little gem below. Even though the error is more than a decade old, I can’t help but wonder “what the heck were they thinking!”. By the way, my initial read through had me thinking cursive “OS” (oculus sinister, i.e. LEFT eye). With that said, I wouldn’t have actually dispensed it because nothing else on the prescription fits.

image

One of the errors reported more than a decade ago involved an order to administer 10 drops of Lugol’s solution mixed with "OJ" (orange juice), but nurses misinterpreted "OJ" as OD (right eye). The patient received several doses of Lugol’s solution in his right eye. The error was identified when the patient complained to the physician about how painful the eye drops were.

Categories: Therapeutics | Tags: Bad, Medication Safety, Patient Safety

Secundum artem. Yeah, not so much

Posted on December 9, 2011 by Jerry Fahrni
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imageMerriam-Webster defines secundum artem as "according to the accepted practice of a profession or trade". In pharmacy it typically goes hand in hand with the preparation of extemporaneous compounds, i.e. when you have to make something from scratch. Pharmacists have been doing this since the profession began. Unfortunately it’s a dying art not only because of lack of interest from younger pharmacists, but secondary to increased regulation and bureaucratic red tape as well. It’s a real shame. To put it in perspective it would be like surgeons no longer performing surgery by hand because of the invention of the da Vinci Robot.

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Categories: Pharmacy Practice | Tags: Bad, Compounding, Pharmacy Practice, Random thought

Portable storage media, the scourge of patient privacy

Posted on November 4, 2011 by Jerry Fahrni
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LA Times: “Altogether, 16,288 patients’ information was taken from the home of a physician whose house was burglarized on Sept. 6, according to the UCLA Health System.

The data were on the physician’s external hard drive, officials said. Though the hard drive was encrypted, a piece of paper with the password was nearby and is also missing. The physician notified UCLA the next day and officials began identifying patients affected.”

I am continuously amazed at the number of security breaches involving patient healthcare information caused by careless use of portable storage media like external hard drives, flash drives, and even laptop hard drives. Patient information should never be stored or transported this way. I believe that utilizing cloud computing with simple browser access is a much better solution. 

What makes this particular incident so bad is the cause; reckless behavior by a physician. This wasn’t UCLA’s fault, per se. Sure, the medical center must accept a share of the responsibility, the lion’s share of the blame falls in the lap of the physician. Not only did the physician have sensitive patient information on an external hard drive, but was dumb enough to have the password to access the drive on a piece of paper next to it. Kind of defeats the purpose of encryption and passwords, doesn’t it.

For an eye-opening look at the magnitude of data loss and security breaches drop by DataLossDB.org sometime. It’s scary stuff.

Categories: Cloud Computing | Tags: Bad, Database, Security

Yeah, my Twitter account was hacked

Posted on September 21, 2011 by Jerry Fahrni
1 Comment

A couple of nights ago I fell for a phishing scam on Twitter. I pride myself on being careful while online and especially when I use social media, so you can imagine my embarrassment when I discovered that I’d been duped.

Many of my followers were kind enough to tell me I’d been hacked prior to unfollowing me. And of course Twitter followed suite several hours later by sending me an email letting me know they’d reset my password and encouraging me to check my settings for suspicious third party apps. It didn’t really matter by then as I had already changed my password a couple of times. The damage had already been done.

I don’t typically believe in violence to resolve a problem, but this is one of those rare occasions where I think violence is the perfect answer. Just me, a locked room with the person who created the hack inside, a blowtorch, some sharp objects and a long rope with a noose at the end. Sounds fair to me.

twitter_hack_notice

Categories: Uncategorized | Tags: Bad, Social Media

Not everyone’s opinion should count

Posted on August 26, 2011 by Jerry Fahrni
1 Comment

Contrary to what your mom told you as a kid, not everyone’s opinion should count.

There are several definitions for the word opinion. The one I like comes from Merriam-Webster and reads “belief stronger than impression and less strong than positive knowledge”. Opinions are beliefs; something you think. They are not rooted in fact – although facts can play a roll in forming an opinion – nor are they required to be acknowledged by anyone other than the one giving the opinion. You have your opinion and I have mine. What if they’re different? No matter because they’re opinions.

Where we get ourselves in trouble is when we start thinking of one’s opinion as fact, or something close enough to fact that is must be acted upon. I frequently see this when someone with “expert” stamped on the end of their name says something like “you should …” or “why don’t you …”. Instead of evaluating statements like these and thinking them through many people will simply accept  them as fact and act on them. This is a bad thing. Why? Because everyone has an opinion and they don’t often line up with each other. This is especially true in healthcare; pharmacy in particular.

crazyknifeWe have a habit of taking an idea, passing it around the table, collecting opinions and making every attempt to act on them all. I see this a lot with automation and technology. Hey, I’m all about functionality, but not at the expense of common sense. When you try to incorporate everyone’s opinion into a product you get the object to the right. I’m sure someone thought this was a good idea; someone must have requested all that functionality, right? Sure. It’s the most functional piece of utility equipment in the history of mankind, but practical it is not. Try putting it in your pocket. This is what many pieces of pharmacy automation and technology turn into once everyone’s opinion is taken into account.

This goes doubly when people start suggesting that something needs to be added secondary to safety; “that should be added because it’s a safety issue”. Ah, the battle cry of those that know their opinion can’t stand up to close scrutiny. I get this one all the time. I suppose walking around in a suite of chainmail armor and driving 25MPH on the freeway would be safer than the way we do things now, but I just don’t see that happening anytime soon. It’s just not practical. And at the most basic level we give up the marginal difference in safety for the efficiency and practicality of wearing jeans and t-shirts while driving 70MPH. It’s a matter of compromise between form, function and usability combined with taking a little responsibility for our actions.

You simply can’t replace human responsibility and accountability with automation and technology. We need people to be responsible for their actions. It’s the only thing that keeps us honest. Without it everyone’s life will be like Phil Connor’s (Bill Murray) in Groundhog Day before he figured it all out.

Categories: Uncategorized | Tags: Bad, Random thought

Why regulatory compliance is killing innovation in healthcare

Posted on August 25, 2011 by Jerry Fahrni
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Anyone that’s worked in healthcare knows about regulatory compliance. If not, then they should because it takes up about 50% of everyone’s time, energy and effort. I understand the theory behind regulations, i.e. protect the patient, but I think most of the time all additional regulations do is is create work for people that are already over burdened.

Ask a nurse how much time they spend documenting and double documenting things to meet some arbitrary rule or regulation. You’ll be surprised by the answer. Now ask a pharmacist or a physician. You’ll get the same ugly responses. I know a lot of my time as a clinician was spent generating documentation to cover my ass rather than helping care for a patient.

Unfortunately the need to comply with government agencies and silly rules inside the walls of healthcare has generated an unwanted side effect – lack of innovation. Why? Because all that innovative energy is spent on regulatory compliance instead of other, more useful things.

I’ve been involved in several conversations over the last month dealing with how to best use pharmacy automation and technology to increase efficiency and solve problems. Would you like to venture a guess as to what most of those conversations centered on? Yep, how to automate some documentation process or create technology to meet some new regulatory compliance. None of the discussions have been about providing better, safer, more complete patient care.

If you don’t think this is a major problem, think again. I was reading a blog by John Halamka last night in which he discusses the ‘Burden of Compliance’. In the blog John states that “[a]s we draft new regulations that impact healthcare IT organizations, we need to keep in mind that every regulation has a cost in dollars, time, and complexity.” Just remember, there is a finite amount of dollars and time floating around in healthcare these days. If a majority of those dollars and time are gobbled up by regulatory compliance, what does that leave for innovation to actually improve medication distribution, safe administration and better patient care? Precious little if you ask me.

Categories: Pharmacy Informatics | Tags: Bad, Compliance, Patient Safety, Pharmacy Future, Pharmacy Practice
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