Battle: Los Angeles was #1 at the box office last weekend; definitely my kind of movie. My family and I saw it yesterday and I thoroughly enjoyed it. It’s the kind of movie that gets your blood pumping and pulls on the American pride strings a bit. I’d see it again.

I came across an interesting article in the American Journal of Pharmaceutical Education on Selecting a Clinical Intervention Documentation System for an Academic Setting authored by Brent Fox. Brent is a pharmacist and professor at Auburn University Harrison School of Pharmacy. He’s a great guy and a brilliant informatics pharmacist. Anyway, Auburn ended up going with Quantifi by Pharmacy OneSource out of Bellevue, WA. It’s an interesting article.

Drug Topics: “Warehouse retailer Sam’s Club has launched what may be the country’s largest retail preventive health program targeting consumers and small businesses. The Prevention Plan, which costs $99 per year, is an online health screening and primary prevention program similar to plans already being marketed to employer groups. The retailer is also launching free in-store health screening programs that include an individual pharmacy consultation, blood-pressure checks, bone-density scans, BMI assessment, cholesterol and blood-glucose testing, hearing exams, and eye exams.” – Great job by Sam’s Club, and poor job by healthcare systems across the country. It’s a sad day indeed when a retail outlet begins providing better preventative care than local hospitals and clinics.

Engadget: “Soon Japanese drivers will never be far from a place to charge their EV, either. Forking Company, which oversees 1.2 million vending machines across Japan, is going to start working with Panasonic to deploy chargers for electric vehicles along with those machines. It’s a potentially perfect solution, since these stations already having power and, often, connectivity.” – I found this interesting for a couple of reasons. First, I think it would be cool to use this type of vending machine for medication dispensing. Second, isn’t the idea of sitting in your car having something cold to drink while you surf the internet waiting for your car to “charge up” funny? Yeah, I think so too.

Since seeing the UCSF robotics video several days ago I’ve been looking more closely at Swisslog automation. I found the video below on YouTube that does a pretty decent job of showing off the nuts and bolts of the system. And I’m excited to report that I will be going to UCSF for a tour of the pharmacy. Very exciting stuff.

Talyst and Sparton Corporation announced a partnership agreement this week. We all know that Talyst builds pharmacy automation solutions, but what does Sparton do? According to the press release they empower “customers vision as a provider of complex and sophisticated electromechanical devices with capabilities that include concept development, industrial design, design and manufacturing engineering, production, distribution, and field service to technology-driven companies in the medical device, defense & security systems, and electronic manufacturing services markets.” Apparently Sparton was part of the Talyst AutoCool product back in the day.

Mashable: “Adobe has finally released Flash Player 10.2 for Android. Its release marks the availability of Flash for Android 3.0.1 Honeycomb, Google’s OS for tablets. While Flash 10.2 for Android boasts performance enhancements that improve the experience on mobile, the thrust of this update is to bring Flash to tablet devices like the Motorola Xoom.” – I’ve been following the Android tablet market closely for quite some time. Anyone that reads this site knows, I’m a fan of the Android platform. Unfortunately the Android tablet market remains quite immature at the moment. Even though I’m eagerly waiting for an Android tablet worthy of my hard earned mula, I’m starting to think more and more that a Windows slate would make more sense.

I really like what I see out of the Lenovo Hybrid U1. I love the hybrid design with Windows while in the dock and Android when in slate mode. I’ve talked to people about this before, but didn’t think anyone would actually have the foresight to make it happen. Bravo Lenovo. Note to demo guy – practice docking tablet prior to next demo. See video below

Here’s a news flash for you, “Removing menthol from cigarettes would improve public health, according to a report from the FDA’s Tobacco Products Scientific Advisory Committee (TPSAC).” Wow, there’s some insightful information from the FDA.

Fast Company: “CoolPlanet claims that it can develop “carbon-negative fuels” that can replace gasoline found in cars in the road today. The company’s secret sauce is a thermal/mechanical processor that extracts hydrocarbons from biomass, leaving behind excess carbon in solid form. That biochar can be sequestered and used as a soil conditioner or burned as a coal substitute.” – Google just dumped a truck load of money on CoolPlanet to develop their biofuel. Good luck boys, I’m pulling for you.

mobihealthnews : “This week during a panel focused on mobile health apps at the South By South West (SXSW) event in Austin, Texas, the four panelists offered up a handful of “landmines” that are currently embedded in the way developers and service providers are approaching mobile health.” – The landmines included: sloppy behavior change strategies, ignoring the data silo problem, the real market is not “patients” and the assumption that people are logical about health. Interesting read.

I love the idea of the Chrome Cr-48 laptop. The idea of a cloud based computing platform makes me feel all warm and fuzzy inside. A recent post by Louis Gray gives me hope that we’ll see more of it in the future. Speaking about his recent experience at the SXSW conference in Austin, TX Louis says “I expect to leave Austin on Monday with the same number of devices I came here with – three. Between the CR-48, my Samsung Galaxy Tab and my Android-based Samsung Epic, I can do everything I need to, including schedule my SXSW itinerary with the show’s dedicated app.” I hold great respect for Mr. Gray’s opinion as I find him to be one of the few unbiased tech reporters on the net.

Do you know what value-based purchasing (VBA) is? Well, VBA “is a payment methodology that holds health care providers accountable for the quality and cost of the services they provide by a system of rewards and consequences, conditional upon achieving pre-specified performance measures.” In other words, if you do good work you’ll get paid, otherwise you won’t. Hmm, sounds a lot like the same standard that most working class people are held to. If you want to learn more you can stop by the Deloitte website. More detailed information provided by Deloitte can be found here (PDF).

PharmTech.com: “Pharma’s manufacturing and supply chain needs a “radical overhaul” because it is underused, inefficient, and ill-equipped to cope with new types of products that will be coming to market in the near future, according to a report from PricewaterhouseCoopers (PwC).” – As an acute care pharmacist I tend to think inside the confined space of the pharmacy I’m working in; after all a pharmacy has to deal with supply chain problems all the time. Well, it makes sense that supply chains extend far beyond my little world. Unfortunately the problems run downhill and will directly impact patient care in the future if something isn’t done to straighten them out.

And to leave you with something on the lighter side:

I stumbled across a website called High Performance Pharmacy. The site is “based on a landmark study by The Health Systems Pharmacy Executive Alliance. The study identifies proven best practices for achieving high performance across 8 dimensions of hospital pharmacy practice. Read on to learn how your pharmacy can become a High Performance Pharmacy — delivering the best clinical outcomes for your patients and financial results for your entire health system.” It appears to be tied to McKesson somehow, which makes me look at the information with a bit of skepticism. With that said, I found the information on the site valuable. There’s a lot of material there so make sure you have a little time on your hands before you get started.

I spent a little time this week looking at unit-dose distribution systems. Most of the articles I read on the topic kept referring back to Chapter 10 Unit-Dose Distribution Systems in Making Health Care Safer: A Critical Analysis of Patient Safety Practices from AHRQ. The information on the site is good, but a little out of date. Actually I should say the information is old (2001), however it’s still applicable. How disappointing is that.

I’ve been rummaging around in the Chrome Web Store recently. The web store is growing rapidly and there are a lot of great applications to be found. Unfortunately, like all online app stores, there’s also a lot of garbage out there. Anyway, as I was trying out various applications this week I came across an interesting service called Diigo. Diigo is another in a long line of web-based applications designed to capture notes, bookmarks, images, etc, and help you organize and share that information in a somewhat coherent manner. It reminds me of Springpad. I’ll let you know more as I figure out how to use Diigo better.

Lifehacker: “The iPad is easily the best tablet you can buy right now, but that’s changing. Google showed off their upcoming tablets today, casting a spotlight on the iPad’s shortcomings.” – The Android OS vs. iOS war is as brutal as ever. Just read the comments following the post and you’ll see what I mean. Honestly I don’t think either the iOS or Android OS is the best platform for a tablet. The best possible platform for a tablet is one that seamlessly works across all devices and applications. Believe it or not, Microsoft currently has the best opportunity to make it happen. Notice I said opportunity, not chance. Don’t count Google out of the equation as they continue to dabble in just about everything these days.

Annals of Internal Medicine (Ann Intern Med. 2011;154:174-180): “High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions – Conclusion: To preserve quality, we recommend careful assessment of both benefits and costs of interventions rather than focusing on either aspect alone. Evaluation of the effectiveness of interventions should include an analysis of both benefits and harms and use the best available evidence for each.” – This is an important distinction as I think many of us fail to see the long term implications of many of our decisions in healthcare. While this article is specifically addressing the clinical side of healthcare it could just as easily be applied to other areas as well such as automation, technology, safety, etc.

Annals of Internal Medicine (Ann Interm Med. 2011:154;160-167): “For each of 6 diagnoses at admission—acute myocardial infarction, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia—patient admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality. Predicted inpatient deaths would increase by 1831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest. The association between hospital spending and inpatient mortality did not vary by region or hospital size.” – Hmm, and people think money doesn’t matter. So find the hospitals that like to spend money and avoid the ones that are trying to cut costs; easier said than done.

Agile Product and Project Management Blog: “Denial is incredibly dangerous because it enables a person to postpone facing reality and therefore delays the process of either identifying a different, feasible solution or recognizing that a company is currently on a fundamentally bad course and must change course. If you’re driving a car towards the edge of the Grand Canyon but are acknowledging the data provided by your eyes, you’ll realize you must stop or turn. But if you deny the data your eyes are providing, you can drive straight over the edge of the cliff to your doom.” – More than half the people I’ve worked with would simply drive off the edge and deny that it was a problem all the way to the bottom. Unless you talking about the people I’ve worked with in healthcare, then it’s more like 90%.

EMR Daily News: “Dr. David Blumenthal announced his resignation as health IT coordinator and will return to Harvard University where he had previously served as a professor.” – Now for the litmus test: will it make any difference? Probably not. People leave jobs everyday and the sun continues to come up.

ESPN: “The University of Iowa Hospitals and Clinics will fire three employees and suspend two others after an investigation confirmed they inappropriately breached the electronic medical records of hospitalized football players.” – Can you say HIPAA? When will people learn? Sorry, that was a rhetorical question. People will never learn.

Speaking of HIPAA, last weekend while I was at a cheer competition with my girls their was a gentleman in front of me was using an iPad. I’m always curious to see what people do with their tablets so I looked at the screen. He was flipping through a patient’s medical record looking for something. When he found what he was looking for he wrote out a prescription. I am all about mobile technology and think it’s clearly the future of medicine, but I could see everything – the patient’s name, age, conditions, and medication list. The guy made no attempt to shield the screen from prying eyes. I assume he was a physician handling a call, but what a breech in patient privacy. Healthcare systems will never be able to secure medical records when healthcare professionals behave in such a reckless manner.

There’s an interesting editorial in the February 2, 2011 edition of the New England Journal of Medicine. The editorial has a lot to say, but in a nutshell it says that academic medical centers are going to have trouble with the idea of an accountable care organization (ACO) model secondary to costs and reimbursement structure. “The effectiveness of ACOs will depend on the centralization of the administration of medical care, whereas clinical departments in medical schools operate on a decentralized model.” Looks like it’s time for a change.

Does anyone else think the ACO model is simply a rehash of the old “managed care” model that morphed into an “HMO” model? Feels strangely familiar to me.

For those of you that have had your head in the sand for the last couple of weeks, The Super Bowl is this weekend. We’ve got the Pittsburgh Steelers vs the Green Bay Packers. My wife is a huge Steelers fan so obviously the Steelers are the official pick of the Fahrni household. However, if I had to put money on the game I’d take the Packers. This should be a good one.

Have a great weekend everyone.

- True Grit was #1 at the box office last weekend. My family and I saw it a couple of weeks back. Not a great movie, but worth seeing. Let’s just say it’s worth the cost of a DVD rental. This weekend it’s all about The Green Hornet.

- I spent some time on the east coast this week; work related. It was cold and snowy pretty much the entire time I was there. Went through Virginia, West Virginia, Pennsylvania and New York. Of those places Virginia was my favorite. While I was in Virginia I had an opportunity to visit the University of Virginia Medical Center inpatient pharmacy. They’re doing some really cool stuff. I’m looking forward to a return visit a year from now to see what they’ve accomplished. I’d tell you my least favorite place during the trip, but that’s probably not Kosher.

- There was an interesting article recently in the Archives of Internal Medicine that discussed the effect of complex medication regimens on patient compliance. The article specifically looked at patients that were prescribed a statin or an angiotensin- converting enzyme inhibitor or renin angiotensin receptor blocker between June 1, 2006, and May 30, 2007. In other words they looked at patients with commonly prescribed medications. That’s a good thing. Reasons for lower compliance were discussed, and the article concluded that “Medication use and prescription filling for patients with cardiovascular disease is complex, and strategies to reduce this complexity may help improve medication adherence.” I don’t think that’s an epiphany as we’ve known this for a long time. Of course, as medication complexity goes up, adherence goes down. However, tucked deeply in the article is the mention of a “pharmacy home” where medication use is consolidated, simplified and pharmacists are involved directly with the patients. This is probably the most important takeaway from the article. One issue I have with the article is that none of the authors is a pharmacist. I find that disturbing. (Niteesh K. Choudhry, MD, PhD; Michael A. Fischer, MD, MS; Jerry Avorn, MD; Joshua N. Liberman, PhD; Sebastian Schneeweiss, MD, ScD; Juliana Pakes, MEd; Troyen A. Brennan, MD, JD, MPH; William H. Shrank, MD, MSHS. The Implications of Therapeutic Complexity on Adherence to Cardiovascular Medications Arch Intern Med. 2011;0(2011))

- HealthLeaders Media: “ The ACO model predisposes collaboration between hospitals and physicians who overall have not collaborated well with each other in the past.” – This from an article titled “5 Reasons Why ACOs Could Fail”. If you’ve ever worked in a hospital then you know that working with physicians can be, um, challenging. The hospital rarely, if ever, disciplines a rogue physician and unfortunately most physicians could easily be classified as rouge. It’s a hostile work environment to say the least. In order for healthcare reform to be successful the current relationship model between hospitals and physicians must change. No question about it.

- Journal of Advanced Nursing (PDF): “Large dose deviations or weight losses can occur while splitting tablets. This could have serious clinical consequences for medications with a narrow therapeutic-toxic range.” – I find this article interesting for a couple of reasons. First and foremost, compounding pharmacists have been saying this for years and people called them quacks. Several years ago I worked in a compounding pharmacy in San Jose, CA and the pharmacist there was adamant about the fact that tablets are not designed to be cut in half. The entire tablet contains the active ingredient, but there is no guarantee that the active ingredient is evenly distributed throughout the tablet. Chalk one up for compounding pharmacists who were well ahead of the curve on this one. The other thing I would like to point out here is the number of pharmacists listed as authors on the article. Bravo ladies and gentlemen. Why wasn’t this published in a pharmacy journal?

- The New England Journal of Medicine audio summary is available for the week of January 13, 2011. I’m telling you now that this is a fantastic way to deliver the abstracts from a particular journal. ASHP really needs to be doing this with the American Journal of Health-System Pharmacy (AJHP).

- My lovely wife bought me a Kindle DX for my birthday; that’s the big one. What an awesome device. It makes reading books and PDF articles a snap. I love this thing. I can even get journal articles downloaded directly through Whispernet, Amazon’s free 3G on the Kindle devices. This includes issues of AJHP. Unfortunately it requires anther paid subscription, which kind of pisses me off considering I’m already an ASHP member and paid subscriber to the paper copy of AJHP.

- I can’t believe I almost missed this one, but Motion Computing recently announced the release of the CL900 Tablet PC, a rugged, lightweight tablet designed for healthcare. I’ve only briefly looked at the device, but what I’ve seen so far is impressive. As you may or may not be aware, I am a fan of the Motion J3500 device and on the surface the CL900 looks like a smaller, lighter version. Cool!

- InformationWeek Healthcare: “As AT&T advances its healthcare strategy by providing technology that supports wireless, networked, and cloud-based solutions specifically for the healthcare industry, the company announced Tuesday that it will be partnering with Vitality to sell Vitality GlowCaps on Amazon.com.” – I think GlowCaps are pretty cool and even blogged about them here. With that said, I think the pricing structure is a tad bit high. According to the article “The Vitality GlowCaps will be available for $10 per cap and $15 per month for AT&T service.” Ouch!

- There’s a great on-demand webinar called “Use of Automation and Robotic Technology to Improve the Process for Preparing Compound Sterile Products” over at the ASHP Media site. The presentation is delivered by Bill Churchill of Brigham and Women’s Hospital in Boston, Massachusetts. I’ve heard Bill speak before. It’s worth an hour of your time.

- This is funny. The Borowitz Report: “Elsewhere, Verizon trumpeted its new iPhone, announcing, “For the first time, consumers will have a choice of which wireless carrier drops their calls.””

- Has everyone heard of Quora, the new social media website that has users ask and answer questions as “experts”. Can you say Wikipedia all over again? If I was going to look for information on how to change the oil in my truck I might have a look. Otherwise I’ll go to more reputable sources for my information. There’s an interesting little blurb over at hive.org by Dr. Chris Paton on Quora Health. Chris says, “There are already lots of questions and answers but, as yet, I haven’t seen many health professionals posting up replies. There are obviously lots of legal and ethical questions about giving medical or health advice through a site like this which may be deterring the professionals. This does mean, however, that many of the answers will be personal opinions and not backed by reliable evidence, and hence may end up being the wrong advice.” He makes a valid point, but who’s checking to make sure the information is reliable and evidence based? Please don’t go to sites like Wikipedia, Yahoo Answers, Twitter, Facebook or Quora for information pertaining to you or your family’s health. It’s just not a good idea.

- EHR reference in a comic strip? You bet.

- CES is over, but there’s a great article over at ReadWrite Mobile about the best new Android devices that appeared at CES 2011. I can’t tell you how excited I am to see all these new Android devices. Seriously, I am chomping at the bit to get my hands on all of them. Of course I’ll never see most of them, but that doesn’t matter. It’s the thought of seeing them and what the future holds that piques my interest.

- When do you think we’ll see the first physical Android Store? Think about it, something like an Apple Store or Microsoft Retail Store. People have a real interest and curiosity regarding Android tablets, netbooks and smartphones. With the exception of smartphones, it is nearly impossible to get your hands on any of these devices. Without playing with them for a few minutes it’s difficult to make a decision on which device to spend your hard earned money on.

- Ok people, it’s playoff time. This is the time of year that all football fans wait for. The BCS bowl disasters are over and it’s time to get down to business. On tap for this weekend in the AFC we have Pittsburgh vs. Baltimore and New York Jets vs. New England. And over in the NFC we have Green Bay vs. Atlanta and Chicago vs. Seattle. I like all the teams except New England. I hate the Patriots and hope they go down in a spectacular ball of burning white-hot flame. Otherwise I’ll just sit back and enjoy the games. Speaking of which, it’s time to go get comfortable on the couch.

Have a great weekend everyone.

Below is a list of opinions I’ve gathered over the past 12 months. Some are pharmacy related, some are technology related, some are personal, and some are just random thoughts.

And here we go…

Best idea for healthcare – An integrated healthcare solution; easier said than done

Worst idea for healthcare – An integrated healthcare solution. The current infrastructure won’t support it.

Biggest healthcare story of the year – Meaningful use and electronic health records (EHR)m

Biggest pharma story of the year - Withdrawal of propoxyphene from US market. Good riddance.

Biggest story in acute care pharmacy operations – Recalls and drug shortages; 2010 was the worst year in recent memory.

Best idea for new pharmacy practice model – PPMI from ASHP

Biggest disappointment in pharmacy practice – PPMI from ASHP

Biggest disappointment from a pharmacy organization – California Society of Health-System Pharmacists (CSHP). I reached out to CSHP regarding tech-check-tech in California and they blew me off. I received a generic response to my first email, then nothing from my follow up email back to them. It’s ok if your opinion is different than mine, but at least have an opinion. #Fail

Best idea in pharmacy that has yet to mature – Clinical Decision Support (CDS) and RFID

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

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

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)

Best customer support – Talyst – Disclaimer: I’ve been working for Talyst since the beginning of December 2010, but had this opinion log before then. That’s part of the reason I decided to go to work for them. I’m just sayin’.

Worst customer support – Integrated Informatics, makers of POMS

Best bar code scanner used this year – Code Reader 3500. Still my favorite.

Best article on bar-code technology – “Effect of Bar-Code Technology on the Safety of Medication Administration” NEJM 2010; 362: 1698-1707

Biggest bar coding challenge for me this year – Actually I had two challenges this year: 1) keeping up with bar-code changes from the manufacturers and 2) acting on analytics collected from out BCMA system.

Most valuable data collected – Data from our MAK (BCMA) system

Least useful data collected – Pharmacist intervention data. I just don’t see the value in continuing to collect data to justify our existence when no one does anything with it.

Best automated dispensing cabinet technology – Omnicell. While Pyxis is still king of the hill, Omnicell is chipping away with better R&D.

Best tablet that never was – Notion Adam Ink. The tablet looks great on video, and you can pre-order it, but I’ll believe it when I see it. You wonder why Apple is winning the tablet market; look no further than companies like Notion Ink and their year long tease.

Best eReader – Barnes & Noble Nook. Say what you will about the Kindle, but my daughter has a Nook and it’s a very nice, easy to use device.

Best eReader that no one is talking about – Barnes & Noble Nook Color. The Nook Color is an Android driven eReader with 7-inch LCD screen with touch interface, and it’s a great device.

Best information collection tool I used this year – Evernote. I couldn’t live without it. SpringPad is nice, but Evernote is still the big dog in this category.

Best file sync tool I used this year – Dropbox is simply awesome. SugarSync deserves mention. Microsoft has all the pieces in place, but has yet to deliver a coherent solution. Maybe next year boys.

Best screen capture utility – FastStone Capture. It’s light weight, easy to use and performs admirably. I use it all the time.

Best new desktop application I used this year – Skype

Best new smartphone application I used this year – Google Voice

Best convertible tablet PC I used this year –Lenovo X201 tablet PC, hands down.

Worst convertible tablet PC I used this year – Dell Latitude XT2 tablet PC. I used this tablet PC for about a year and always thought it was ok. That was until I purchased a Lenovo X201 tablet PC. Now I consider the Dell as an overpriced piece of junk.

Best slate tablet PC I used this year – Motion Computing J3400. The J3500 is the updated version of the J3400 rugged slate tablet. As far as Windows based slates go, I don’t think you’ll find a better device in the current crop of tablets.

Coolest new concept for a tablet PC – The Dell Inspiron Duo. I would love to see more tablet PC manufacturers use this design concept.

Worst marketing campaign for a tablet PC – The HP Slate 500. No wonder tablet PCs have such a hard time catching on.

Best not-a-tablet-not-an-ereader device – The Kno. Great concept, I hope it makes it.

Most popular “tablet” – Apple iPad

Most overhyped device – Apple iPad

Mobile device with the biggest impact on healthcare – Apple iPad

Biggest status symbol for physicians and executives in healthcare – Apple iPad

Most underrated “tablet” of 2010 – Samsung Galaxy Tab

Best tablet PC software – Microsoft OneNote. I use it all the time and love it.

Best PDF annotation software – PDF Annotator

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.

Most interesting blogger on the ‘net – Louis Gray. He blogs about things that interest me, and he appears to be less biased than most. I can appreciate that.

Best everything mobile site on the ‘net – GottaBeMobile

Best gadget site on the ‘net – Engadget

Coolest gaming gadget of the year – Kinect for Xbox. Bought one for my nephew for Christmas. Man, what a blast. And that doesn’t even include what you can do with it once it’s been hacked.

Best new smartphone – Samsung Galaxy S and the iPhone 4. Bought my daughter a Samsung Fascinate for Christmas and let me just say that it is one phenomenal smartphone.

Biggest surprise in the smartphone market – Windows Phone 7. I spent some time playing with one at the Microsoft Retail Store and it was really nice.

Biggest tragedy in smartphones – Basically the webOS died in 2010. I hope I’m wrong because the user interface is really something.

Most functional smartphone – Android smartphones. Take your pick.

Most exciting developments in an operating system – Android. It’s only just begun.

Best smartphone user interface – iPhone 4. HTC gets honorable mention here.

Most exciting non-hardware smartphone development – HTCSense.com. The website is a series of connected services for security, backup and remote control of your HTC device. I’m surprised Google hasn’t done something like this already. The potential is off the charts.

Best meeting/conference attended – ASHP Midyear 2010

Best advice I received in 2010 – Change jobs

Best presentation attended – There were two presentations I attended at this year that really caught my attention: 1) Alternatives to Barcoding: RFID and RTLS at the unSUMMIT and 2) Better Patient Care and Safer Staff with IV Compounding Automation at ASHP Midyear

Best presentation I gave this year – Hard to say really, but the presentation I did for Nova Southeastern University titled “Pharmacy informatics – One pharmacist’s perspective” had some pretty good informational content.

Best webinar attended – Barcoding End-to-End Solutions: From Pharmacy to Bedside. This webinar featured Dr. David W. Bates and Dr. Eric Poon from the NEJM article mentioned above.

Best vendor I worked with this year – Talyst

Worst vendor I worked with this year – Siemens

Best RSS Reader – Google Reader

Best email client – GMail

Best online collaboration tool – Google Docs

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

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

Best browser for Windows machine – Google Chrome has now overtaken Firefox as my browser of choice.

Best extensions for Google Chrome
1. Chromed Bird
2. Clip to Evernote
3. Session Buddy
4. iReader
5. Docs PDF/PoserPoint Viewer (by Google)
6. Awesome Screenshot

Best consumer cloud provider – No brainer, Google

Most impressive push into the cloud – Microsoft with Window Azure

Best Twitter client for Android – Seesmic

Best Twitter client for the iPhone – TweetDeck

Best Twitter client for the desktop – Don’t know. I no longer use a desktop client for Twitter. I now use a combination of the Twitter website and the Chromed Bird extension for Google Chrome.

Best desktop operating system – Windows 7. I don’t care what anyone says, I like it.

Most exciting new development in a desktop operating system – Google Chrome OS. I’ve only seen glimpses of it, but I’m excited about its potential.

Most frustrating computer upgrade – Mac OS X Snow Leopard. I was forced to upgrade my 21-inch iMac  secondary to the purchase of an iPad. Following the upgrade it became slow and unresponsive, basically turning it into a very expensive paperweight.

Number of movies my wife, Lori and I saw at the theater this year – 47

Best movie that I saw in the theater- This is tough for me. I think I’m going to go with:
1. Iron Man 2
2. Red
3. How to Train Your Dragon

Most overhyped movies that I saw in the theater
1. The Other Guys
2. Harry Potter and the Deathly Hallows (Part I)

Worst movie that I saw in the theater- The American with George Clooney. The Wolfman was a close second.

Worst trend in movies – 3D. Someone please knock some sense into these people. I don’t know anyone that actually likes 3D.

Biggest grossing movie of 2010 – Toy Story 3. It did over $400 Million at the box office. Avatar actually grossed more domestically in 2010, but it was released on December 18, 2009.

Most overused word of 2010 – Meaningful use. I still don’t fully understand what it means.

Most valuable lesson learned in 2010 – Don’t wait so long to make a move and let people know what you want.

Best thing I did for myself – Changed jobs

Biggest surprise about my new job – The laptop assigned to me is older and in worse shape than the one I used to complain about when I worked in the hospital. Doh!

Best thing about the new job – The people and the projects.

Worst thing about the new job – Having to wear a “jacket and tie” when visiting “customers”.

Coolest commercials on TV – Geico (Therapist Sarge and Woodchucks) and E-trade (Solitary)

Worst advertising campaign – Visa and their Never Miss a Super Bowl commercials. Meet Larry “I’ve missed weddings. I have missed babies being born. But I have no intention of ever missing a Super Bowl, ever.” Makes me want to turn off the TV and spend a little time with the family. I assume that wasn’t Visa’s intent.

Best YouTube video of 2010 – iPhone4 vs HTC Evo. If you’ve ever met an Apple cultist, errr, I mean fanboy then you know they can’t be reasoned with because their minds are sealed off from rational thought. Baa-baa!

Biggest surprise in professional football – The Kansas City Chiefs. Well done.

Biggest disappointment in professional football – The Arizona Cardinals. What a difference a year and the loss of Kurt Warner makes.

Gutsiest coaching decision in professional football – The New Orleans Saints decision to open the second half of Super Bowl XLIV with an onside kick. Wow.

Best catch in the NFL 2010 – Randy Moss one-handed TD catch against the Jets. Crazy.

Biggest what-the-heck moment in pro sports – Jets assistant coach Sal Alosi tripping a Miami Dolphins player during kick coverage

Biggest disappointment in college football – Boise state losing a game and not going undefeated

Worst system in the universe to determine a sports champion – The BCS. Unfortunately it seems to work out year after year as teams like Boise shoot themselves in the foot.

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

Best professional sport to watch on TV or in person – The NFL of course.

Most visited post on this website in 2010 – Best iPhne/iPod Touch Applications for Pharmacists originally posted September 14, 2009

Biggest blogging disappointment this year – My former employer censoring my blogging by whipping out a “social media” policy. Nice!

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

• The Chronicles of Narnia: The Voyage of the Dawn Treader was #1 at the box office last weekend. I haven’t seen it yet because my girls have no interest in it. That’s just weird. I thought for sure it would be at the top of their list. Tron Legacy is out and I’m really looking forward to seeing it this weekend.
• It’s unfortunate, but it looks like the RIM BlackBerry PlayBook won’t be making a public appearance until March 2011. RIM is doing some interesting stuff, but is it too little too late? Only time will tell. When I was in San Francisco this week I had the opportunity to interact with some Product Managers from RIM. When I asked them about the PlayBook they wouldn’t even confirm that it existed. Really? C’mon.
• I am, without question, a proponent of cloud computing. The potential of such a platform cannot be ignored. And like it or not the market is demanding that industry move in the direction of the cloud. Security is always a big issue with people and seems to be the battle cry for those that oppose it. Here’s one example at Coputerworld UK where Simon Phipps comments that cloud computing may not be the future platform of choice secondary to circumstances outside the technology, i.e. people, politics and service. He has a valid point, but all technologies suffer from problems. The cloud environment won’t be any different.
• If you’d like to see an alternate view on cloud security take a look at the Practice Fusion Blog. The authors spend a little time talking about some of the security benefits of the cloud.
• There’s a great article at GottaBeMobile that talks about the various technology failures and success of 2010. I don’t agree with everything on the lists, but I do find the list of successes interesting as Android based devices appear as four of the ten items on the list. Android is a disruptive technology that will continue to grow until something bigger comes along. And that could take a while.
• Check out the Laciefloat, a harddrive with trackpad. How cool is that? You can find more information at the Yanko Design site. The QR Code at the right will take you there.
• digitalHealth Summit: “The Digital Health Summit at the 2011 Consumer Electronics Show focuses on the booming market of consumer-based health and wellness innovations that sit at the convergence of technology and healthcare.” – The only questions I have are why haven’t I heard of the digitalHealth Summit before and how do I get it.

• What You’ll See
  • Telehealth Systems
  • Therapeutic & Diagnostic Medical Devices
  • Remote Monitoring Devices
  • Mobile Health Applications
  • Secured Wireless Communication Medical Devices
  • Medication Monitoring Equipment
  • Mobile Health Devices
  • Robotic Prosthetics
  • Personal Health Records
  • Communications Networks
  • Telemedicine Systems

• mobilehealthnews: “Worldwide about 70 percent of people are interested in having access to at least one mHealth application, according to a new research report from Pyramid Research. “ – No surprise as mHealth has become a new buzzword throughout the healthcare industry.
• I recently saw a commercial with a guy sitting on a beach using his smartphone to print a document on a printer halfway around the world. Great concept and it’s available as Web-connected printing through HP. There’s certainly a need for such functionality in a world screaming for instant gratification.
• Medscape for Pharmacists has a list of top 10 Medscape articles in 2010. Unfortunately access to the article requires registration, but the top 10 articles for 2010 were:

1. Is Hookah Harmful?
2. Abbott Withdraws Sibutramine From Market
3. Gemtuzumab Voluntarily Withdrawn From US Market
4. FDA Restricts Rosiglitazone; EMA Pulls the Plug
5. Potential Interaction Between Clopidogrel and Proton Pump Inhibitors
6. FDA Issues Second Warning Against Treating Leg Cramps With Quinine
7. Best Evidence Interview: CINODs — The NSAID Holy Grail?
8. How Can Leg Cramps Be Treated?
9. NDM-1 — Making Resistant Bugs in New Ways
10. DTaP-Tdap Mix-Ups Now Affecting Hundreds of Patients

• ASHP News: “Some pharmacists say the loss of propoxyphene will not be much of an issue for practitioners.Suzanne Nesbit, clinical pharmacy specialist in pain management at the Johns Hopkins Hospital in Baltimore, said the drug is on the formulary but now has a “special alert” about the market withdrawal.” – Propoxyphene is a terrible medication, especially in combination with acetaminophen. I’m glad to see it gone from the market.
• Medical News TODAY: “The release of the AIHW report today that shows more than 80 per cent of all premature deaths are due to chronic disease highlights the importance of a collaborative healthcare model to help deal with the growing pressures of chronic diseases. Pharmacists can play a bigger role in helping to manage chronic conditions as part of a collaborative health-care team. As medicine experts, they are often the first point of contact from patients suffering from chronic conditions.” – Hmm, where have I heard that before. That statement is 20 years old. I think we need to come up with a new one.
• The College Football season is basically over. Now I just have to sit around a wait for the bowl games to arrive. Like every other red-blooded American I will have myself plopped on the couch New Year’s Day watching football and eating myself silly. I can’t wait.
• On the other hand, the NFL season is heating up and everyone is getting ready for a playoff run. I’m in one of those precarious positions again this year as some of the teams I despise are still in the running. I loath some of those teams so much that if they get into the Super Bowl I won’t even watch it. Let’s hope that doesn’t happen.

Have a great weekend everyone.

• 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’.

On with the things that I found interesting this week.

- Megamind was #1 at the box office last weekend pulling down a respectable $29 million. I haven’t seen it yet, but would like to. As everyone already knows, the new Harry Potter movie is out and that’s all you’ll see in the number one slot for a while. I find the Potter movies entertaining, but don’t see what all the hype is about. Some have been good, and a couple of the releases have been fairly boring to be honest. Regardless, it’s on my list of movies to see. Probably as soon as tonight.

- I use a DROID for most of my mobile communication needs. I’ve come to rely on the onscreen touch keyboard because I find it a lot better than the physical keyboard on the device. Fast Company has a great post on 5 Alternative Android Keyboards. I’m really impressed with SlideIT, and being an old Palm guy, I’ve tried Graffiti for the Android. It’s pretty cool. Check out the videos at Fast Company.

- The Samsung Galaxy 7-inch tablet has made quite a splash. I’ve read many of the reviews and they’re all over the board. Take each one with a grain of salt. If you’re an Apple Fanboy, you probably won’t have much good to say. If you’re an Android lover, then you’ll have lots of good to say. I’ve had a couple of opportunities to play with the device and I like it. I like it a lot. It’s very responsive and the familiar interface – I’m a DROID user – makes getting around a breeze. I would like to see a wireless only version as I really don’t need the 3G. Regardless, it’s on my Christmas list of mush have toys.

- One of the great potential uses for the new wave of slate tablets is web conferencing. That’s one of the reasons I think the Cisco Cius may be a device for enterprise to take a good hard look at. According to TechCrunch, Fuze – a provider of web conferencing services – has announced an “Android tablet app [that] includes VoIP so users can attend a meeting via their tablet even if they don’t have a phone nearby.” Nice.

- Want to build an eReader Collection? Sounds cool doesn’t it. Take a look at the Digital Reader site. The author details how Duke University did exactly that. I thought about doing this myself as the bulk of keeping up with pharmacy literature can take up a lot of physical space.

- KevinMD (post by Jay Parkinson, MD): “We must design solutions by truly understanding how humans use tools, form communities, live, move, engage with friends, and love.” – Yep, makes sense to me.

- Interesting video at MobileBeat showing the speed of the BlackBerry PlayBook browser. See the video below. I can’t wait to lay my hands on a PlayBook. There’s something compelling about the user interface. Just a thought, but one thing I think tablet manufacturer’s should stop doing is comparing themselves to the iPad. It’s a mistake. The iPad owns the space at the moment, and it makes them look foolish in my humble opinion.

- Unofficial Google Blog: “If you have a phone or a tablet that runs Android 2.2+ or iOS 3.0+ and the Google Docs interface language is set to English, you’ll be able edit documents from your mobile device and the best thing is that you don’t need to install a new application.” – This is great news. Mobile phones, i.e. smartphones, are becoming the platform of choice for many people these days.

- Just in case you didn’t know, Wacom makes some incredible products designed with the pen interface in mind. If you have the opportunity make sure to check out the Medical & Healthcare section of their website, it’s really neat stuff. Don’t skip the case study page where you can read about the Radiation Therapy staff at Oregon Health & Science University (OHSU) in Portland, Oregon using Wacom’s interactive pen display technology. After browsing through the site I’ve decided that I need one of these. Note to self: add to Christmas list of must have toys.

- Healthcare IT Consultant Blog – “5 Reasons to Consider the Cloud for Health Data” ().

• It’s easy to access
• It’s cost-effective
• It imporves efficiency
• It puts patient information where it needs to be
• It’s user friendly

Umm, that about sums it up.

- NEJM This Week Audio – November 18, 2010. I absolutely love this format. It’s a downloadable mp3 file with this weeks article abstracts read out load. Simply awesome. AJHP should consider offering such a wonderful feature to their subscribers.

- GottaBeMobile: “10 Pounds of Apple Mobility – According to Apple’s spec sheets, the combination of my 15″ MacBook Pro, 13″ MacBook Air, iPad and iPhone 4 weigh just 10.3 pounds combined. Add in one AC adapter for both MacBooks, an iPhone/iPad charger and the weight of my backpack and the whole package is still less 13 pounds.” – A compelling reason to look at Apple products. My equivalent travel bag is well over 20 pounds. Just sayin’.

- Endgadget: “A team there led by Stephen Morgan and Michael Myrick [University of South Carolina in Columbia] have developed a so-called “blood camera” that uses a combination of infrared light and a transparent layer of the protein albumin — the latter of which acts as a filter and is able to highlight blood stains by filtering out wavelengths that aren’t characteristic of blood proteins.” - More information can be found at Analytical Chemistry, DOI: 10.1021/ac101107v.

- ASHP News: “FDA and Newport, Kentucky-based Xanodyne Pharmaceuticals announced today that the company has withdrawn its propoxyphene-containing products from the U.S. market over concerns about cardiotoxicity.” – It’s about time. What a worthless drug.

- Medscape – Ask the Experts – Is Vicodin the Right Choice for This Patient?

“The APAP [acetaminophen] dosage rules are:

* Patients should not take more than 4 g/day;
* Patients should take less than 4 g/day if taking it for a prolonged period of time;
* Elderly patients should reduce these limits to 3 g/day, or 2 g/day if taking it chronically; and
* Patients with liver insufficiency or a history of alcohol abuse should limit daily intake to 2 g and should not use APAP chronically (conflicting data exist on this point, but there are no studies of chronic use of APAP daily limits in this population).”

Vicodin is one of those drugs that is overused. Does it have a place in pharmacy practice today? Hardly. We have too many options for mild to moderate pain control. If you really need the hydrocodone consider something with more hydrocodone and less acetaminophen like Norco, Lortab 10/500, etc. Patients rarely, if ever, get themselves in to trouble with the hydrocodone in Vicodin. It’s usually the acetaminophen content that poses a challenge when several tablets are necessary to control pain. Of course mileage may vary and this is strictly my opinion. Take it for what it’s worth.

- There are some compelling games in the NFL this weekend like the Packers – Vikings, Colt – Patriots and the Giants – Eagles. Do yourself a favor and don’t miss out.

- And here’s my favorite commercial from this week. That kid makes me laugh, every time.

Have a great weekend everyone.

• Saw 3D was #1 at the box office last weekend. It’s not my kind of movie so I won’t be seeing it. My wife and I saw Due Date instead. It was good and definitely worth a laugh.
• Check out the Mirador Biomedical Compass Vascular Access pressure measurement device at medGadget. “Making sure that you are not in a carotid (or subclavian or femoral arteries, etc) is not always as simple as many think.” – Yikes! I didn’t need to know that.
• MedShare for the BlackBerry is now available in Quebec. “MedShare’s BlackBerry solution allows home care workers to access their client list, client health information and schedule on the popular BlackBerry device.” Cool. I will be getting my first BlackBerry device in a couple of weeks (new job) and I’ve been scouring the internet to see what’s out there for the device. The idea of having a BlackBerry smartphone is making the new BlackBerry Playbook look better and better every day.
• Well, it looks like IT jobs will be safe for a while longer. According to a survey by the College of Healthcare Information Management Executives “more than 60% of hospital IT executives believe tech staffing shortages, which some estimate to be a shortfall of 50,000 qualified IT professionals, will definitely or possibly affect their chances to achieve meaningful use.” And we all know what meaningful use means to hospitals; money. Now might be a good time to start thinking about outsourcing your IT department.
• There’s a great article at Healthcare IT News titled “Six best practices for EHR implementation”.  Even though the list is aimed at EHR implementation, the recommendations can be applied to nearly any healthcare technology project. Actually, you could apply to principles to nearly any type of project. The best practices include:
  • Tailor your EHR to fit within staff workflows.
  • Identify ways the EHR could potentially fail in order to prevent problems in the future
  • Don’t rush implementation, take time to train
  • In EHR implementation, practices are not extensions of the hospital
  • Eliminate duplication
  • Work with experts who have EHR implementation experience
• Speaking of EHRs, did you know that statistics show the United States is one of the slowest countries in the race to adopt electronic health records? This according to the EHR Bloggers website. In addition the site goes on to say “while the US tends to rise above other countries in other business sectors, we are severely lagging in health IT.” As odd as this may sound I’m not surprised by that statement. The coolest gadgets in the world land in the US last or are severely crippled secondary to some regulatory issue when they get here. It only makes sense that this trickles into health IT.
• If you’re looking for a unique gift idea look no further than fake product boxes. These things are funny, and what’s even funnier is that I thought the iArm Forearm Mount was a real product. It’s exactly what I would expect from an Apple Fanboy. Ha!
• Remember Dell’s Inspiron Duo? I certainly do. Sure it’s just another tablet, but the screen flips over when converted to slate mode from convertible mode. It’s just plain cool. I’ve been critical of Dell in the past, but they’ve really ramped up their game lately. Dare I say they’ve been innovative? No, let’s not get carried away just yet.

• Want the yin and the yang on whether you should buy a new tablet for Christmas? If so, then have a look at GottaBeMobile.
  • Why You Might Want To Buy a Tablet/Slate This Christmas
  • Why You Might Not Want To Buy a Tablet/Slate This Christmas
• The Motorola Defy was released this week. This little Android based smartphone sports a 3.7-inch display with Gorilla Glass, and is both water and dust resistant. Gotta’ love it.
• A recent article in The Annals of Pharacotherapy compared the “severity ranking of proprietary databases to clinician assessment” for drug-drug interactions, i.e. man versus machine. The clinicians didn’t necessarily agree with the software. Interesting. All this says is what I already knew; technology and common sense go hand in hand. Software can’t really replace a pharmacist with good deductive reasoning and lots of experience, but it can make his job easier. (Ann Pharmacother ;44:1718-1724 )
• There’s a decent article at KevinMD.com on direct-to-consumer advertising (DTC). According to the article “the pressure to prescribe an advertised medication that a patient asks for by name can be great. Physicians may feel compelled to comply with the patient’s wishes.” On the surface this can seem like a bad thing, but on occasion it could benefit the patient. For this reason I remain on the fence regarding DTC advertising. For the most part I’m opposed to it, but on the other hand it is one way to disseminate information.
• The US Food and Drug Administration (FDA) has issued another recall for Symbiq One- and Two-Channel pumps. This is the third recall for these pumps. Oops!
• Do you ever get the feeling that Apple uses a lot of smoke and mirrors to get people to buy into their singular view of the world? It appears that putting Flash on the new 11-inch MacBook Air kills about a third of the batter life. Bummer.
• Google instant is now available for mobile devices. I love the instant search feature in Google, and it’s simply awesome on a mobile device.

• The NFL Network has been doing The Top 100 Greatest Players of all time. Well, they finally made it to #1 and it’s Jerry Rice. No disrespect to Mr. Rice, but are the people at the NFL crazy? Look at the people that they put Rice in front of: Lawrence Taylor, the man that single handedly changed the way offensive lines play, particularly the left tackle position; Walter Payton. Enough said; Dick Butkus, are you kidding me? This guy defined NFL toughness at the linebacker position; Jim Thorpe at #37. Do you know what this guy did? The credibility of the list is suspect to say the least.
• It’s week 9 in the NFL people, and there are some great games on tap. Who would have thought Tampa Bay would be playing a meaningful game against a divisional opponent in November? Not me. Miami and Baltimore is going to be a slobber-knocker, as will the Pittsburgh – Cincinnati game on Monday night. Oh, so much football to watch. I can’t wait.
• Oh yeah, San Francisco won the World Series. Here’s something of interest. On Sunday night, NBC’s Steelers-Saints game drew an 11.8 national rating, while Fox’s Giants-Rangers Game 4 drew a 10.4 rating. And on Monday night Fox’s Giants-Rangers Game 5 earned a 10.6 national rating, while ESPN’s Texans-Colts game drew an 8.6. So a couple of mid-season NFL games nearly trumped the World Series. That’s worth noting. There was a time when the NFL wouldn’t dare televise a game at the same time as the World Series, but now they couldn’t care less. Baseball is a boring, slow moving sport with little of interest, while football is an action packed dynamo still building steam. Take the hint Bud and cut the baseball season back before it’s too late. I’m just sayin’.

Have a great weekend everyone.

• Paranormal Activity 2 was #1 at the box office last weekend. It’s not my kind of movie so I won’t be seeing it. I see movies to be entertained, not to be scared, grossed out or depressed. So last weekend my family and I took in Life As We Know It.
• There’s a video on YouTube showing a much longer demonstration of the BlackBerry PlayBook. In my opinion the most impressive thing about the PlayBook demonstration is the card-type application management borrowed from the webOS. You get a peek of what I’m talking about at about 1:15 into the video and again at about 3:00. I thought about this type of interface for a project I recently worked on. It would be perfect.

• A couple of weeks ago I mentioned the post “Fired for Blog Post” at RxInformatics.com. Revisiting the post I found the following user comment posted on October 28: “You’ve articulated issues with ASHP’s power structure that I’ve seen personally in the past. In 1991, I turned down a job with ASHP in Bethesda because as an employee for ASHP, I would be PROHIBITED FROM WORKING AS A HOSPITAL PHARMACIST. So, with staff that are forbidden to be in the real world, what do you think happens to the passion and advocacy for our profession by ASHP staff?” Hmm, that’s not good now is it.
• Speaking of ASHP, The Pharmacy Practice Model Initiative (PPMI) Summit 2010 is set to begin in Dallas, Texas on November 7. You can attend even if you can’t be there in person via virtual participation. This is a big step for ASHP and I hope it is successful. I’ve signed up for virtual access and hope to see you there.
• Lately I’ve been experimenting more with Springpad. It’s kind of a miniature version of Evernote. Springpad is available via the web, for the iPhone and for the Andrid OS. It offers a very nice interface and a great way to sort items that you want to remember. For a nice review of the similarities and difference between Springpad and Evernote see the excellent article by Wade Roush at Xconomy.
• KevinMD – How Apple can fix the usability problem in healthcare: “I say this [wanting Macbooks to replace PCs] because my mind was opened to a new world when I started using Apple products — usability. Usability means making tools easier-to-use so you can complete your job quicker or easier than you previously could. Windows-based PCs are notorious for their usability problems…Since we have all used a Windows-based PC they are great at exemplifying usability problems.” This is an interesting opinion. I believe the author is correct that Windows offers some usability challenges and that Microsoft needs to redesign the Windows environment to be more user friendly. However, simply converting everyone’s hardware over to Apple products isn’t the answer; it’s simply a band-aid approach to the problem. And healthcare is good at applying band-aids to problems.
• GottaBeMobile: “Now let’s define that “good Inking experience.” What’s good enough for me may not be for you. What’s not good for me, may be more than sufficient for you. As I say over and over my note taking with Digital Ink is quick, down, and dirty. In rehearsal I’m watching the stage and scribbling on a screen simultaneously. I can’t afford to watch my hand and/or the stylus. This isn’t meticulous work, it is quick and I need the medium to not get in the way. With a Tablet PC, not only could I do that, but using OneNote I could, in most cases, find what I scribbled with its excellent search. I don’t think we’ll ever see that on an iPad. Up until now the iPad App, Penultimate has come the closest to giving me what I am looking for on the iPad.” – I have great respect for Warner Crocker, the author of the article, but in my opinion the inking experience on the iPad doesn’t even come close to the tablet PC.
• I took a look at the new MacBook Air last week. What can I say; I think it’s pretty cool. Like everything Apple it’s sexy, but I have to agree with Joseph Kim at Mobile Health Computing, the MacBook Air is simply overpriced for what you get. With that said, people will eat them up because Apple’s Commander in Chief says you should.
• There are a couple of new drugs that have recently been approved:  fidaxomicin for Clostridium difficile and ceftaroline for community-acquired bacterial pneumonia and acute bacterial skin infections, including those caused by MRSA. Both approvals are significant secondary to a general lack of medications available to treat each disease states, i.e. Clostridium difficile and MRSA based skin/soft tissue infections.
• Pfizer announced that it intends to recall more Lipitor secondary to “an uncharacteristic odor related to the bottles.” More information can be found here (PDF).
• The Medicine Guy has a nice summary article on what a drug interaction is. “You should always check for an interaction if you are taking more than one substance (drug, herb, vitamin, etc.). Ask your pharmacist to explain the effects as well, and for a recommendation on how the problem should be addressed.” A sound piece of advice.
• HealthLeaders Media: “The report’s executive summary estimates that an even greater number, 6.3 million medical injuries, occurred in the U.S. in 2008. Of those, 1.5 million were associated with a medical error.” Ouch! And what  are the top 10 most expensive types of errors? Well, I’m glad you asked. According to the article they are:
  • • pressure ulcers
    • postoperative infections
    • mechanical complications of a device, implant or graft
    • postlaminectomy syndrome
    • hemorrhage complicating a procedure
    • infection following infusion, injection, transfusion, vaccination
    • pneumothorax
    • Infection due to central venous catheter
    • other complications of internal prosthetic device, implant and graft
    • ventral hernia without mention of obstruction or gangrene.
• I’ve had reason lately to move more of my document storage to the cloud. My cloud storage of choice is Dropbox. I use SugarSync as a alternative depending on my needs. Recently I decided to give Box.net a try. While it offers some advantages over Dropbox and SugarSync, like the ability to create a Web Doc directly inside the application, it is much more expensive on a gigabyte basis than Dropbox and SugarSync. For now I’ll stick with Dropbox.
• I’m still looking for a new tablet. Almost pulled the trigger on an HP Slate 500 Tablet PC today. Almost. The reviews haven’t been bad, but they haven’t been great either. I need more recon before I can make a decision.
• I saw a bunch of tweets the other night about the San Francisco Giants. It took me a few minutes to realize they’re still playing baseball. Don’t they know it’s almost November. When you have to wear a jacket and you can see your breath, it means you shouldn’t be playing baseball. The only saving grace is knowing that it will soon be over and no longer take valuable media time away from football.
• One gotta see college football game this weekend is USC vs. Oregon. The Ducks may be the best team in college football at the moment, but USC always plays tough in the Pac-10.
• Do woodchucks chuck wood? I don’t know, you tell me.

Have a great weekend everyone.
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-  The Social Network was #1 at the box office again last weekend. I haven’t seen it yet, and just can’t generate enough interest in my own mind to do so. My wife and I took in RED yesterday. It was a good movie, I would recommend it.

- I was looking for information on touch surfaces and came across this great video from the University Of Michigan Museum Of Art, UMMA, demonstrating their Dialog Table. And the most amazing part of the video is that it was shot more than a year ago. C’mon Microsoft, get this stuff to the consumer market already.

- Anyone on the lookout for a rugged Android OS smartphone? Well, look no further. The Motorola Defy is dust, water and scratch resistant. The Defy has a beautiful 3.7-inch display covered with Corning Gorilla Glass, making it virtually indestructible for the average smartphone user. This device is designed to take some abuse, which makes it ideal for the hospital environment.

- Fast Company: ““but it would also make the entire cultural heritage of the country accessible free of charge to all of our citizens.” Small community colleges without extensive libraries would stand to benefit especially. Something else that sets apart the new vision, Darnton has recently said, is that that “It’s not as if we are just issuing high-minded manifestos. We are taking concrete steps at the organizational level.”” This quote is from Robert Darnton, Harvard’s chief librarian speaking about a National Digital Library. There is no question in my mind that all literature, textbook, journals, etc should be available as digital media. With the onslaught of mobile technology in both the consumer and non-consumer world alike, it’s the only thing that makes any sense. For those of you that at some point in your career would have loved to have access to a reference at 2:00am, but had no access to it, please raise your hand. **my hand is up**

- Calleam.com has a website called Why Technology Projects Fail. A recent post gives some insight into why with a great list of classic mistakes. Anyone that’s been involved in a technology project of any kind can relate. A few that are especially applicable to healthcare inclide lack of communication, lack of oversight/poor project management, poor quality implementations and insufficient user training. Thanks to @omowizard for the link.

- This week the FDA approved onabotulinumtoxinA, aka Botox, for headache prophylaxis “in patients with adult chronic migraine who suffer headaches on 15 or more days per month, each lasting longer than 4 hours.” That’s a lot of headaches.

- Practice Fusion is holding their first ever user’s conference on Friday, November 5, 2010 in San Francisco. The conference, dubbed Practice Fusion Connect 2010, is free of charge and will include “previews of EHR feature launches, educational breakout session, training and feedback opportunity”. Practice Fusion is a free, web-based EHR. I’ve blogged about Practice before. It’s a neat application.

- Healthcare IT News: “Information technology professionals in the United States can expect starting salaries to increase an average of 3.4 percent in 2011, according to the Robert Half Technology Salary Guide 2011.” – Sweet!

- RxInformatics: “Recently I [John Poikonen] was fired from a faculty position for posting a blog entry.” This kind of thing never ceases to amaze me. I too have been stung by an employer that didn’t care for something I posted online, but I wasn’t fired. I know John and find his wit, experience and intelligence a refreshing change. He says what’s on his mind and people should listen. I tease John that he likes to poke bears with a stick, and he does, but that’s ok. We need people like John in our profession to raise concerns about issues that others may not be willing to speak out about. I’m not afraid or offended by what John has to say. He and I don’t always see eye-to-eye, but that has generated some great conversations and thought. If I can’t defend my position against opposing forces then my position is weak, and I should re-evaluate. I’m just sayin’.

- There’s a great article at The New York Times blog titled “When the Nurse Disagrees With the Doctor”. Theresa Brown, R.N. writes “I couldn’t believe that this doctor, who had always worked well with the nurses on my floor, had just suggested, at least in my mind, that a nurse’s opinion on patient care matters less because patients don’t directly make appointments with us.” Unfortunately this position from many physicians isn’t limited to nurses. I’ve played out similar scenarios with physicians many times over during my career. Sometimes the nurse, pharmacist, dietician, respiratory therapist, social worker, etc has valid concerns regarding a patient that should be taken seriously, evaluated, and addressed when appropriate. I worked for a pediatric hospital many years ago and we held interdisciplinary rounds in the pediatric ICU every week. All the stakeholders for the patient were in the room and everyone had a say. I can say without hesitation that it created an environment of caring and better care for the patient. No question about it.

- Check out Danielhooker.com. The site is dedicated to talking about “health libraries, and the impact that technology is having on information, medicine and human health.” I love medical librarians. They have so much to offer the profession of pharmacy and I find that they also have a healthy interest in technology.

- EasyMedMobile has thrown their hat in the mobile medicine ring with an iPhone app. Then again, who hasn’t?

- Submitted by @carlacorkern for our amusement, a great image of a martini glass with the caption “Just the Prescription” from a place called BARx. It’s weird to the see “Rx” attached to things other than pharmacy.

- Cardinal Health has announced that it will be expanding their integration with hospital pharmacy technologies.” Cardinal Health plans to integrate its services based on each hospital’s technology preference, but has already created partnerships and integration protocols for automated dispensing cabinets, carousels, robots, re-packaging equipment and software from pharmacy technology providers including CareFusion, Sentry Data Systems, Inc., Swisslog and Talyst. Current examples of integration capabilities include:

• CareFusion: Pyxis MedStation system;
• Sentry Data Systems, Inc.: Sentinel RCMTM and SentrexTM 340B software solutions;
• Swisslog: PillPick® system; BoxpickerTM and ATP Series;
• Talyst: AutoCarousel, AutoPack, AutoCool and AutoSplit 340B software.

Ok, I’m with you so far, but how are you planning to do it and is this really anything new? I’d love to talk with someone from Cardinal about this in more detail, and no I don’t want to speak to your marketing department; no offense.

- I found this little jewel at John Hill’s website. Sure makes life with a tablet PC easier.

- I am a fan of tablet PCs. Shocking, I know. Well, as it turns out I’m in the market for a new one. I’ve been using a Dell XT2 for the better part of 18 months now and have been satisfied with the device, but not all that impressed. I’ve excluded slate models because I really like having a keyboard. HP is out because I simply don’t like HP machines, which has me looking hard at Lenovo and Fujitsu. I really like the Levovo X201 tablet, but Fujitsu is the last vendor that I’m aware of still making a 13-inch tablet PC. Decisions. Anyone willing to share their experiences please feel free to educate me.

- Is it just me or is the NFL trying really hard to ruin the sport? I love football. I love watching football. But what I’m starting to really dislike is all the time, energy and effort the NFL is putting into making the NFL about entertainment instead of about playing football. The rules have become so complex that the NFL Network now has an entire weekly segment dedicated to explaining why something isn’t the way it should be. You can tackle people, but not by the top of the jersey in the back, or around the head, or if you accidently bump someone else’s helmet, or if the guy with the ball happens to be the quarterback, or if you’re near the boundary marker and are clearly going out of bounds; it’s a penalty for a quarterback to intentionally throw a ball away to keep from getting sacked unless he intentionally, intentionally grounds the ball, i.e. to keep from being tackled “outside the tackle box” or if he needs to stop the clock. Oh man, it gives me a headache. Unfortunately it’s starting to filter down into the college and high school ranks now. Bummer.

I’m through ranting now. Have a good weekend everyone.