- Ai, Shrek Forever After remained #1 at the boxoffice last weekend with Sex in the City 2 coming in second. The Prince of Persia, the movie my family and I decided to see last weekend, was a close third. It was good.

- For anyone that really cares, the NBA finals started this week with the Lakers putting the hurt on the Celtics. I’m not a big fan of professional basketball, but at least it’s not baseball.

- The 2010 ASHP Summer Meeting is getting underway in Tampa. The meeting will officially run from June 6-9, but there’s already quite a bit going on. I was at the Summer Meeting last year in Chicago. It’s not nearly as big as Midyear, but it’s still worth the trip if you’re able to attend. I will be sitting this one out. To make sure you don’t miss anything important be sure to follow the action on Twitter by using #ashpsm10.

- Speaking of #ashpsm10, Brent Fox Tweeted this question earlier today: how many pharmacist are aware of “meaningful use”?. My answer is not many. Besides the pharmacists that are involved in informatics, the number that know anything about meaningful use is small. None of the pharmacists I work with know anything about it.

- There is a great article on “Fanboyism” at the You Are Not So Smart website. “On the other hand, if the product is unnecessary, like an iPad, there is a great chance the customer will become a fanboy because they had to choose to spend a big chunk of money on it. It’s the choosing one thing over another which leads to narratives about why you did it.” Yep, I couldn’t agree more.

- Speaking of the iPad, here’s a useful article on tips for Keynote presentations on the iPad. I’ve been looking at Keynote for the iPad as I’ve started to enjoy doing a few presentations over the past couple of months. My other big hurdle with the iPad is viewing Microsoft Office documents on the device. Fortunately Documents To Go is now available on the iPad. Sweet.

- Have you seen the video of surgeons in Japan using an iPad during surgery? If not just take a look at the video below. I don’t know whether to be amazed or appalled.

- Just in case you missed it, AT&T announced this week that they were doing away with their unlimited data plans. Just when I thought AT&T couldn’t do anything worse they turn around and make it difficult for future iPhone and iPad users to really enjoy the capability of those devices. I’ve said it before and I’ll say it again, as long as AT&T is as pathetic as they are I will not use their service for any of my personal mobile needs. Yes I have an iPhone, but it is provided to me as an electronic leash by my hospital. My personal device of choice is the Motorola DROID running on the Verizon network.

- Lately I’ve been interested in rugged laptops and tablet PCs. The Gertac V100 definitely qualifies as the latter. The thing is pretty much indestructible. The only downside is the cost of this tough little dude, which starts at a cool $3500. Ouch!

- Yesterday I posted my thoughts on the Practice Fusion EMR. I noted a couple of concerns regarding lack of access on my mobile devices and lack of clinical checking with medications. Well, Dr. Glenn Laffel from Practice Fusion left a comment on my post letting me know that Practice Fusion will offer drug-drug and drug-allergy checking “shortly“. In addition Emily from Practice Fusion commented that Practice Fusion was “also working on a mobile strategy this year.” I guess you can scratch those concerns off my list.

- I’ve talked about using a hi-tech Bluetooth scanner with the iPad before. Well how about a low-tech scanner. Here’s an interesting setup that does the same thing as the hi-tech scanner, but costs a whole lot less. The solution consists of an iPad, a CueCat USB scanner and a camera connection kit. Pretty nifty, huh?

- CMIO: “A password-protected laptop computer containing information about 61,027 Cincinnati Children’s Hospital Medical Center patients from multiple states and several foreign countries has been stolen.” How many time do I need to say this: never, ever store patient information on a laptop or any other form of portable storage solution. Mobile devices should only be used to gain access to centrally housed, secure cloud repositories. Enough said.

- A couple of articles you might find interesting:

CPOE system design aspects and their qualitative effect on usability. Stud Health Technol Inform. 2008;136:309-14

This article looks at the configuration of alerts in a CPOE system and how poorly designed implementation strategies can leave a bad taste in the mouth of those using the system. “Published studies reported that alerts which show up too early or too late in the workflow of CPOE users ordering medication can lead to errors from which users cannot recover.” It’s not only about how robust the clinical decision support is, but how it’s strategically integrated into the system as well.

Example of a Human Factors Engineering approach to a medication administration work system: potential impact on patient safety. Int J Med Inform. 2010 Apr;79(4):e43-57. Epub 2009 Sep 8.

This article gives a very interesting overview of Human Factors Engineering (HFE) and how it was applied in the face of CPOE. Interesting stuff.

- GottaBeMobile: “The Dell Streak is going on sale this weekend in Europe and will be available in the U.S. starting next month direct from Dell for $499.” I am actually excited to see this device up close and personal. Check out the gorilla glass demonstration over at Engadget. Like I said before, anything that has the descriptor “gorilla” in it has to be cool.

- The HTC EVO has been getting a lot of press this week. What a great looking Android device. A couple of long time Apple fanboys (Scoble and Gray) have given the EVO serious consideration this week, which I find encouraging. It will be interesting to see what Apple has up its sleeve with the next iPhone release rumored to be hitting the streets next month.  I have been impressed with my DROID over the past several months and believe that the Android operating system is still very immature. I can’t wait to see what it has to offer over the next several months. I’ll be looking for a new smartphone sometime before Christmas and think the timing should be right for something new and exciting.  Unfortunately my hopes of purchasing the Notion Ink Adam Adroid tablet sometime this summer went up in flames with the announcement that the device will be delayed until November. Booooooo!

- I use WordPress to write and manage this blog. It offers an incredible array of tools that makes it easy to use and more robust than anything else I’ve toyed with. One of the things that makes WordPress so interesting is the number of plugins that allow you to do anything from collect stats to autopost to the social media of choice. Socialmediatoday has a nice list of the “18 Must Have WordPress Plugins for Your Blog.” I even use a few of them.

Have a great weekend everyone.

Following my blog post last Friday where I threatened to take a drive to San Francisco for a demo of their software, Emily from Practice Fusion left this comment:

“No need for the road trip. You can get your own free EMR account with Practice Fusion in just a few seconds online here – https://pfws.practicefusion.com/apps/ehr/main.html?signup=true
Have fun testing it out. Feel free to reach out if you want more details.“

So I followed the link. The Practice Fusion site claims that any new user can be up and running within five minutes, i.e. “Live in Five”. They weren’t kidding. It only took me couple of minutes to get my login and password, and I off to the races.

The setup was incredibly simple and I found the user interface to be intuative and easy to use. It only took me a moment to get a new patient in the system and start creating a medical history. The Practice Fusion EMR uses a tabbed interface with clearly marked headers for Home, Schedule, Charts, e-Scripts, Messages, Documents, Reports and Admin. Below the primary tabs is a secondary set of tabs that gives the user access to online help videos, the recent activity of users, a “Community” area for additional information and a Marketplace where you can access consultants. However, once you enter the patient information area the secondary tabs disappear and you’re presented with nothing but a clean, unhindered user interface with easy access to your patients.

The medication section is pretty nice as you can easily search for a drug by simply typing in a few letters of the drug name and hitting ‘Enter’. The search works for both brand and generic name. The application even offers the ability to generate and send electronic prescriptions. This is a great feature. Electronic prescribing is a much better way of doing things as paper scripts often get lost, torn or forgotten.

As a pharmacist there are a couple of things I would like to see added to the medication area in Practice Fusion. First, there appears to be no cross checking between allergies and newly entered medications. I added a penicillin allergy to my patient and had no trouble ordering amoxicillin without any warnings. Second, I would like to see some clinical decision support around medication entry. There appears to be no clinical checking against coded diagnosis or the patients active medications. I was able to enter an amiodarone prescription on top of a warfarin prescription without warning. I assume that Practice Fusion expects individual pharmacies to police patient allergies and drug-drug interactions. While that is a reasonable assumption, it would be nice to see some kind of clinical chekcing in the application. Finally, I would like to see a more robust sig area within the prescription writer. I created some cool sigs while playing around with the app. I should say cool for me, but not for the pharmacist receiving them. I would have definitely received a phone call for clarification. With all that said, it is important to remember that the Practice Fusion application is not a pharmacy order entry system, is very robust and is available completely free of charge.

There are other modules available inside the Practice Fusion application, but I didn’t play with those as they had to do with insurances, billing, etc. Just not my cup of tea.

Pharmacists should take note of applications like the Practice Fusion EMR because it is clearly in their best interest. As pharmacists move into the medical home or into clinics to manage anticoagulation, hypertension, heart failure, weight loss and diabetes they will be exposed to EHR/EMR systems like Practice Fusion. They offer several advantages over legacy software systems and paper charting. Web-based medical records are the future of healthcare, so it’s best to just get used to the idea.

Oh, one other thing of note. I couldn’t view the Practice Fusion EMR on either my DROID or my iPhone; Flash issues. The application is easy to use from a desktop computer or a laptop, but it would be nice to use a smartphone to access your patient’s information in a pinch. Froyo, a.k.a. Andorid 2.2, is supposed to rectify issues with Flash. I’m looking forward to giving it another try once I update my DROID.

Throw in all the information above along with the fact that Dell and Practice Fusion have partnered to provide a ready made hardware solution to go with their EMR, and you’ve got a nice setup.

According to the Practice Fusion site:

The 1st Edition of Keys to EMR Success, was the HIMSS Book of the Year Award winner. In this revised Edition, nationally recognized expert Ron Sterling has included new chapters on EHR and Malpractice Risk, ARRA and Meaningful Use as well as detailed coverage of conversion issues for practices that have an old EMR.

“There is no question,” says Sterling, “that the selection and implementation of an EHR is a ‘bet-the-practice’ proposition. If you fail, you end up with more costs and greater frustration. Yet, few practices will be able to avoid implementing EHRs.”

I looked for the book in the usual places, i.e. Amazon, Barnes and Noble, etc. I found the first addition, but no luck on the second. I even had hopes of finding it in electronic format for the Nook, Kindle or even the iPad. Nope. So if you want to purchase the book you’ll need to go directly to the Greenbranch Publishing website.

While contemplating purchasing this book something occured to me. With the length of time it takes to publish a book, how relative would this material be to the current state of EHR/EMR implementation? Technology is moving at lightning speed. Maybe it’s time to consider a new way of disseminating information like this. Just a thought.

The Waltham, Mass.-based IntrinsiQ’s IntelliDose calculates and tracks the administration of chemotherapy treatments and will enable Allscripts’ multi-specialty and oncology clients to manage oncology patient care workflow, according to the company.

Under the agreement, oncology practices will work with Allscripts account managers to coordinate with implementation and training specialists from the IntelliDose team. Integration of IntelliDose into Allscripts tools will enable Allscripts clients to select the add-on program to navigate patient records across both systems, IntrinsiQ stated. “

This sounds like an interesting concept. I tried looking for detailed information on IntelliDose, but really couldn’t find much. Based on information at the IntrinsiQ website it appears that IntelliDose is a clinical decision support system designed specifically for chemotherapy. Based on the description, IntelliDose does many of the same things that a pharmacy information system does, i.e. checks for “body surface area limitations, patient allergies, and exceptional lab results” in addition to reviewing “dosage variables such as ideal weight, serum creatinine, and creatinine clearance.” Sounds like a pharmacist.

- Shrek Forever After did a cool $70 million last weekend making it #1 at the boxoffice. Here’s my opinion.

- RxCalc got an upgrade this week. I’ll have more to say about that in a future.

- The Student Pharmacist is a website created by a fourth year pharmacy student at Auburn University Harrison School of Pharmacy. The site features “short , concise, daily episodes covering one drug per episode starting with the #1 prescribed drug (Hydrocodone and Acetaminophen) and working towards the #200 prescribed drug.”

Each podcast covers:

• Brand/Generic
• Mechanism of Action
• Indications
• Dosage Forms
• Doses
• Pharmacokinetics
• Black Box Warnings
• Contraindication
• Precautions
• Adverse Drug Reactions
• MAJOR Drug Interactions
• Pregnancy Category/Breast Feeding
• Safety and Efficacy Monitoring
• Major Counseling Points
• Side Notes
• References

This is a great idea. I’m glad to see a budding young pharmacist lending his talent to the profession, not to mention using technology to do it. The introductory episode can be found here.

- I’ve been playing with a new application called springpad. It’s like a miniature version of Evernote, which I use all the time and love. 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 store items that you want to remember. However, it falls short in a couple of key areas; well, for me anyway. I use Evernote as a way to store and sort journal articles, i.e. lots of PDF files. So far I haven’t been able to duplicate that functionality in springpad.

- RxInformatics: “Sorry Lexi-Comp, but I do not agree with your definition of subscription, nor your idea of digital rights management. You should review some of the more established online content distribution models, such ashttp://www.audible.com/. They charge per year, but you can put the digital content on multiple devices, and it always stays on your computer. The agrument that you are a medical information vendor and Audible is a book vendor won’t fly with me either. Last time I checked both companies sell print and digital versions of their products.” - I think Lexi-Comp provides some of the best drug information in the industry, but they should take a step back and look at their distribution and service model. Read the entire post and you’ll understand why I say that.

- The arrival of the iPad, the impending onslaught of Android and Windows based tablets on the horizon and the slow pace of e-ink development is a perfect storm for the utter demise of the stand alone e-reader. In addition, the continued failure of these devices to catch on at colleges and universities as a replacement for textbooks only makes matters worse. I hope I’m wrong, but I just don’t see it going any other way.

- There are a lot of things in the pharmacy world that interest me and one of those is drug induced rashes; don’t ask why I think it’s neat, I just do. Anyway, there’s a great review article at Medscape Pharmacists on what causes beta-lactam induced rashes (“Why Do Beta-Lactams Cause Rashes?”).  Interesting stuff.

- Gastrointestinal Endoscopy (2010 May 14 [Epub]):  It appears that endoscopy performed via wireless capsule is safe and effective in children as small as 11.5 kg. According to the article, endoscopy by capsule “may be used to identify stenotic disease beyond traditional endoscopic and radiographic reach…across the spectrum of the pediatric population, from infancy to adulthood and with a weight as low as 11.5 kg (25.3 lb).” In addition retrieval of the capsule following the procedure did not appear to pose a significant risk. An example of a wireless capsule used for endoscopy is PillCam.

- Have you ever heard of using colored IV lines to prevent infusion errors? Neither have I. Well there’s a company out there that makes color tinted infusion sets. I went to the company website, but couldn’t find a whole lot of information. You can catch a glimpse of them in this video. I’m not sure I buy into the concept; for a lot of reasons. What do you think?

- There’s an interesting article in the most recent issue of Pharmacotherapy (June 2010) that gives an overview of some of the thinking that goes into making formulary decisions in an acute care setting. “Consideration of patient care and unbiased reviews of the biomedical literature are the cornerstone principles of formulary decision-making.” Notice there’s nothing in there about how nice the drug reps are or how much free stuff they give you. The complete article is available here (PDF).

- Need an extra 7” touchscreen monitor? Well look no further than the new Mino 720-F USB-driven touchscreen. At only $199 I can see mounting one of these bad boys in my office.

- I’ve been reading about Practice Fusion’s free EHR for quite a while. The idea of a free, cloud based electronic health record piques my interest. MEDINNOVATIONBLOG has a great piece on Practice Fusion. The author makes a great point when he states that “… Practice Fusion has adopted and modified the revenue model that has made Google so successful, namely gathering revenues from online advertising and lead generation tied to “free” access by users. It does not require physicians to install new hardware and software, but to off-load what they need in an EHR to the Internet using their existing office computers.” Why can’t we design a pharmacy system like that? The Practice Fusion Corporate Office is only about three hours up the road, which makes me think I need to take a field trip and have the Practice Fusion team give me an in depth look at their application.

- WebWorkerDaily: “When it comes to mobility and collaboration, cloud computing has delivered advances that I already take for granted. Because I primarily work in the cloud, I can access my work from anywhere, using a multitude of devices. This is beneficial beyond just being able to hop between a desktop machine and a laptop. When most of one’s tools live online, switching from PC to Mac (or vice versa) is much less burdensome than it could have been in the past…… Having my work available online makes collaboration far easier than it ever was before. Rather than emailing files to my colleagues and trying (and failing) to keep track of all the different versions, using a tool like Google Docs means I can have one document that everyone can access — it’s even possible to have more than one person editing that document at any one time, if I wish.” – I couldn’t agree more. Following the fresh install of Windows 7 on my Dell tablet I’ve done everything possible to work from the cloud. Of course I still use local desktop applications for a lot of things, but that list continues to shrink.

- How’s this for a compact Bluetooth barcode scanner for the iPhone, iPad and iPod Touch: the KoamTac KDCi. Seriously, the thing is smaller than a deck of cards and only weighs 1.2 ounces. Amazing.

- I have been singing the praises of Pixel Qi LCD technology for nearly a year now and I’m finally fed up and tired of waiting for their screens to appear on the market. I promised myself I would purchase the first netbook, laptop or tablet that hit the streets using their technology, but it’s time to move on. Good-bye Pixel Qi.

Have a great weekend everyone.

- Iron Man 2 was #1 at the box office last weekend. My family and I saw it last Friday. I thought it was a great movie, not as good as the first, but definitely a great movie. If you haven’t seen it, make sure you stay until the very end when you do.

- How about a Shrek ebook for the iPad? Seems appropriate since Shrek Forever After opens this weekend. Video below.

- Software Advice: “We’re hearing more and more questions about Mac compatibility from physicians interested in electronic medical records (EMR systems). Many providers, notably smaller offices, are choosing Apple computers over PC-based systems to run their practice. Their reasons are the same reasons consumers choose Mac products: stability, simplicity and “coolness.”” - It looks like Apple is really starting to make its way into healthcare. The success of the iPad and speedy adoption among healthcare professionals is testament to it. The article above goes on to describe EMR systems available for the Mac platform.

- Earlier this week I posted on the new Motion Computing tablet PCs. One of the readers of the post pointed out that although the battery life on the new C5v was improved it was still only around four hours. While it’s true that current tablet PC battery life is poor, it’s only a matter of time before tablet PC and Android tablet makers are forced into building devices with at least eight hours of battery life. Based on the Wind U160DX netbook by MSI with a reported battery life of 15 hours, and the Toughbook C1 at 10 hours, things are looking up.

- Android 2.2, a.k.a. Froyo, looks pretty exciting. Learn more about it at Engadget.

- This is interesting. The MSI SketchBook looks like an ordinary laptop, but the keyboard flips over to reveal a pen driven graphics tablet. Neat.

- When will people learn that you should never, ever store confidential patient information on laptops. Earlier this week FierceMobileHealthcare reported that “The Department of Veterans Affairs said that a laptop stolen from an unspecified contractor’s car April 22 contained unencrypted, personally identifiable information of about 644 veterans.” – The solution: storing data in the cloud.

- GottaBeMobile: “Using what they call ITSO (Integrated Through Screen Optics) Sensing Technology, their [Evoluce ONE] surface computing system can recognize and respond to objects up to one meter from the screen. The demo video (below) shows three-dimensional manipulation of large on-screen objects. No fine manipulation shown and I’d guess the precision is less than direct touch, but adding the third dimension of depth opens some terrific possibilities.” – This is amazing technology that I can see getting some use in healthcare. I’ve decided that I not only want one of these, but I need one. I started collecting pennies last night. <smile>

- RxInformatics has an interesting post on the the recent bar-code technology article in the New England Journal of Medicine. The post includes the Podcast audio from an interview with Eric Poon, the lead author of the study. Interesting stuff. Make sure you take a few minutes to listen to it.

- In the no-duh category, results from a trial in The Annals of Pharmacotherpy May 11 issue shows that “Implicit measurement of actual inappropriate prescribing predicted ADE risk, an important clinical outcome. This finding helps confirm the validity of prior studies that have relied on explicit measures to link potentially inappropriate prescribing to adverse health outcomes. “ - The article addresses the use of drugs on the Beers list in elderly veterans.

- SciGuy’s: “New Milestone in Optic Technology Allows better Data Transmissions – Using optical-fibre-optic cables, Alfred Leitenstorfer’s group at the University of Konstanz in Germany has found a way to boost data transmission significantly.  By reducing the amount of light needed to represent a 1 or 0, binary transmissions can be sent with higher efficiency.” – Will this be the answer to bigger and faster data transfer in the future? I hope so because it would mean better access to centralized data storage.

- You sometimes forget how much information you digest on a weekly bases. Like all people in my profession I get bombarded with information at a rate that I can’t possibly handle, and the stack of articles “to read” is always larger than the stack of “read”. Anyway, below are some items I read this week that you might find interesting as well. Some are freely accessible, while others require subscription. I apologize for the ones that require a log-in or paid subscription, but I am fortunate to have access to a medical librarian. It’s like magic, I just say “Hey Karen, I need blah, blah, blah” and poof, it shows up in my inbox. Enjoy:

1. Ketelhut DJ, Nelson BC, Clarke J, Dede C. A multi-user virtual environment for building and assessing higher order inquiry skills in science. British Journal of Educational Technology. 2010;41(1):56-68.

2. Caruba T, Colombet I, Gillaizeau F, et al. Chronology of prescribing error during the hospital stay and prediction of pharmacist’s alerts overriding: a prospective analysis. BMC Health Services Research. 2010;10(1):13.

3. Poon EG, Keohane CA, Yoon CS, et al. Effect of bar-code technology on the safety of medication administration. N. Engl. J. Med. 2010;362(18):1698-1707.

4. Poon EG, Cusack CM, McGowan JJ. Evaluating Healthcare Information Technology Outside of Academia: Observations from the National Resource Center for Healthcare Information Technology at the Agency for Healthcare Research and Quality. Journal of the American Medical Informatics Association. 2009;16(5):631-636.

5. Ryzner KL. Evaluation of Aminoglycoside Clearance Using the Modification of Diet in Renal Disease Equation Versus the Cockcroft-Gault Equation as a Marker of Glomerular Filtration Rate. Ann Pharmacother. 2010;44(6):1030-1037.

6. Williams D. Medication errors. J R Coll Physicians Ednib. 2007;37:343-346. (PDF)

7. Forni A, Chu HT, Fanikos J. Technology utilization to prevent medication errors. Curr Drug Saf. 2010;5(1):13-18. (PDF http://www.omnicell.com/Resources/Reprints/Technology-Utlization-to-Prevent-Medication-Errors.pdf)

8. Leape L, Berwick D, Clancy C, et al. Transforming healthcare: a safety imperative. Qual Saf Health Care. 2009;18(6):424-428. (http://qshc.bmj.com/content/18/6/424.long)

9. Asamoah AK, Sharfstein JM. Transparency at the Food and Drug Administration. New England Journal of Medicine. 2010. Available at: http://healthcarereform.nejm.org/?p=3440&query=OF [Accessed May 19, 2010].

10. 1. Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical Information Technologies and Inpatient Outcomes: A Multiple Hospital Study. Arch Intern Med. 2009;169(2):108-114.

11. Design Guidance – Displaying Adverse Drug Reaction Risk. This is a very interesting document prepared by Microsoft. I’ve read through it before, but stubble upon it while I was looking for another article in my files. It’s worth taking the time to browse through.

While not specifically designed for pharmacy, the eDoc Telemedicine/EHR System is a cool piece of technology. For information to be useful it needs to be collected and made available at the point of care, which is exactly what this system does.

In addition to the eDoc Telemed/EHR Desktop software, the rolling workstation includes a PC running Windows XP with a wide screen monitor, stereo sound, blue tooth and video technologies.

According to information collected at the ICUcare, LLC website:

The eDoc® Telemedicine/EHR System represents the most technologically advanced Telemedicine or TeleHealth Solution on wheels. If you remove the wheels, it’s really a mobile Health Clinic. ICUcare’s development team left no stone unturned, no “i” undotted, and no “t” uncrossed in their diligent efforts to bring to you the most ergonomically friendly, technologically advanced, versatile telemedicine system ever developed.

At the heart of every eDoc® Telemedicine/EHR System is the newly developed eDoc® Telemed/EHR Desktop Telemedicine Software. ICUcare’s eDoc® Telemed/EHR was the fi rst comprehensive telemedicine/EHR software solution developed and marketed by any US owned corporation in the western hemisphere.

The eDoc® Telemed/EHR Suite of Products features include a full compliment of standard medical device interfaces and supports multiple party live streaming video conferencing as well as store and forward abilities. Additionally, the solution provides multiple features like security, scheduling, forms and fi les data entry, image view /manipulation support, offl ine data transfer within the deployment or such other deployments outside, and much more.

Standard Medical Devices/Technology Included with Standard eDoc® Telemedicine/EHR System
• Welch Allyn Spot Vitals Monitor featuring NIBP, HR, SPo2 and Nellcor Temperature
• 3M Littman Digital Electronic Stethoscope featuring Blue Tooth and (ANR) technology
• Dino-Lite Digital Video Iris Examination Scope featuring still image capturing with annotation
• Dino-Lite Digital Video Ear Examination Scope featuring still image capture with annotation
• Cosmed Digital Spirometer featuring FVC, SVC and MVV lung function screening

Features
• Consolidated and comprehensive integrated Electronic Medical/Health Record (EMR/EHR)
• Authenticated secure access to patient EMR/EHR via biometrics
• Robust security management using 128 Bit encryption
• Interfaces with a large range of off-the-shelf medical devices
• Secure Login & Content Encryption
• Ability to remotely control eDoc® Desktop (patient end) from remote location. (Permissible)
• Anywhere and anytime (24/7) access via LAN / Internet
• Referral(s) of patient through multilevel structure
• User-friendly Graphical Interface with intuitive usability options
• Supports wide range of standards for data and device interface
• Integrated Live Audio, Video Conferencing
• In-place image viewing capability
• Text and e-mail messaging and alarm notifi cation
• Immediate and scheduled Offl ine Data Transfer capability
• Recording of Consult (multiple parties) capability with local and offsite storage/recall
• Comprehensive set of Imaging operations to include enhancements and annotations
• HIPPA Compliant

More information (PDF) or ICUcare, LLC website.

The current pharmacy practice model is more than 3 decades old and is sorely in need of an overhaul. Of course the changes will represent not only the services pharmacists provide and how pharmacists participate in patient care and safety, but also how to best utilize technology to accomplish the ultimate goal; a better pharmacy practice model.

The most recent PPMI newsletter gives us a glimpse of some forward thinking pharmacy practices including the University of Kentucky Medical Center. I’ve always had great respect for the UK College of Pharmacy as they usually rank high in the list of top pharmacy schools in the U.S. Of course UCSF is usually #1, but that’s to be expected (sorry had to do it).

Anyway, the practice spotlight on UK can be found here (PDF). There are some great pearls of wisdom in the article, but my interest is mainly on the technology. “The technology that provides the most support to our practice model is an integrated electronic medical record (EMR). At our hospital, we utilize a pharmacy software program that integrates patients’ EMR with computerized physician order entry (CPOE), electronic medication administration records (eMAR), lab and diagnostic test results, and clinical documentation information. This allows our pharmacists to utilize computer system to enter orders, verify and dispense medications, as well as monitor, evaluate, and revise medication therapy. Our pharmacy also utilizes an automated dispensing machine (ADM) system in which 80% of adult medications and 60% of pediatric medications are available immediately through the profiled ADM system.” The combination of an EMR, eMAR and CPOE can only be found in a small percentage of hospitals across this great nation of ours, and UK is one of them. This is a great example of what other healthcare facilities should be doing.

If you get a chance make sure to stop by the PPMI website and take the poll on “which technologic enhancement do you feel will most advance the role of pharmacists in providing direct patient care?”

“After three months of rumors, details surrounding Epic Systems’ partnership with Apple for a mobile phone-based electronic health record (EHR) application have come to light: Just a few days ago, Epic System’s iPhone application, called Haiku, became available on Apple’s AppStore. Haiku provides authorized clinical users of Epic’s Electronic Health Record with secure access to clinic schedules, hospital patient lists, health summaries, test results and notes. Haiku also supports dictation and In Basket access. Haiku works on both the iPhone and iPod touch,” according to the app’s description on the AppStore.”

This is a very interesting turn of events as rumors regarding Apples new tablet entering the healthcare arena have been swirling around the internet. Could Haiku be the precursor to what we’ll see with the Apple tablet? I sure hope so.

Source

Most consumers don’t do a very good job of keeping track of their medications; much less the medication names, dosages, what they are used for and when they were last taken. It’s not uncommon on admission to the hospital for a patient to say things like “I take a blood pressure pill” or “a pain pill” or “a water pill”. As a pharmacist I can make gross generalizations about these medications, and can narrow the options down with aggressive questioning, but can rarely be sure without seeing the medication for myself.

The Electronic Health Record Incentive Program, a.k.a. Meaningful Use guidelines, calls for medication reconciliation to be used for at least 80 percent of “relevant encounters and transitions of care” (page 95). In addition “the capability to perform medication reconciliation is included in the certification standards for certified EHR technology.” This is easier said than done.

Most medication reconciliation begins in the Emergency Department. It is typically a manual system of information collected by nurses who in turn pass it off to the physician for approval. Unfortunately many physicians don’t take the time to scrutinize the medication list which is often inaccurate or incomplete.

The ideal list of medications currently being taken by a patient wouldn’t be generated by the patient at all. Instead the list would be downloaded from a nationally standardized e-pharmacy. Of course no such thing exists, but that doesn’t mean it shouldn’t.

In theory all medications taken by patients are filled in a pharmacy, whether that is a chain pharmacy, community pharmacy or mail order pharmacy. Modern pharmacies are computerized and connected to the internet so that insurance adjudication can take place. The same data should be transmitted to a centralized e-pharmacy where it would be stored and accessed by hospitals during patient admissions. The list would follow the patient throughout their admission and be finalized on discharge. After all, the medication use profile is never more accurate than at the time of discharge.

In the absence of a centralized e-pharmacy, several vendors offer software applications designed to help hospitals maintain a digital medication reconciliation record. Most of these applications can be integrated into the pharmacy information system, making the process a little easier. The solution is not ideal, but it is better than a manual system with pen and paper.

Some vendors that offer medication reconciliation software are listed below.

RxReconcile
MedsTracker
RcopiaAC
MediRec
Mediware’s ClosedLoop Clinical Systems
HCS Medication Reconciliation