Abstract:

This paper discusses how to share medical information between heterogeneous applications via web services. Our design theory is based on a real-options framework, performance analysis and experience building iRevive, a working web-services-enabled pre-hospital documentation application. The trade-offs between efficiency and flexibility are examined in the context of exchanging information based on emerging standards in the healthcare world. These trade-offs are quantified using a real-options approach. We illustrate the importance of uncertainty in deciding the architecture enabling an application to access medical information from Electronic Medical Records (EMRs).

The article goes into quite a bit of detail in describing the trade-offs between getting access to all the information necessary to perform your job and the need for usability and speed in a data driven system. The article centered on building an integrated hospital EMR system designed to collect data via web services instead of the “every day” desktop applications typically seen in a hospital.

Some of the key points from the article include:

• Web services are a good choice for promoting the exchange of information among various systems.
• As uncertainty in data requirements goes up, so does the need for flexibility in the system. Unfortunately the same uncertainty that requires flexibility also creates inefficiency and complexity in design, i.e. how can a developer build software to capture and use data when the end user is uncertain about what data needs to be collected and how they’re going to use it.
• Modularity in EMR data design can be good or bad depending on the needs of the end user and the money available to design the system. However, increased modularity doesn’t necessarily equal increased integration or performance. It has the potential, however to create standardization and simplification.
• There are many different architectures to consider when designing an EMR capable of sharing data, but the design must balance efficiency and flexibility with usability.

The article offers an interesting perspective on system design as the authors delve into the trade-off between flexibility and efficiency in any system. According to the authors “when the designer understands users’ needs, then a focus on efficient web services makes sense”; that about sums it up for me. Anytime someone wants to get away from the desktop I consider it a positive.

The article uses an application called iRevive to illustrate several points. iRevive is a mobile data collection system for use by healthcare professionals in the field. I don’t think the product still exists as the company website looks like it’s been neglected for quite some time.

1. Gaynor, M., Myung, D., Restuccia, J. and Moulton, S. (2010) ‘Designing infrastructure to exchange Electronic Medical Records with web services’, Int J. Biomedical Engineering and Technology, Vol. 3, Nos. ¾, pp. 393-412

- 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.

- 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.

- Shutter Island was #1 at the box office last weekend. My wife and I saw it last Friday. She liked it quite a bit while my thoughts on it were lukewarm. To me a movie is good if I would walk right back into the theater and watch it a second straight time, like I did with Star Wars back in the 70′s. Shutter Island wasn’t like that. So there you go, take it for what it’s worth.

- HIMSS 2010 was held in Atlanta this week. I wasn’t ablet to attend, but still managed to get some great information by following various FriendFeed and Twitter feeds. I’m definitely attending next year.

- There’s a great “Best and Worst of HIMSS Wrapup” at the EMR and HIPAA website. And here’s the flip side at the HISTALK website: “The emphasis was on money and business rather than patients for the most part (my low point: a session that rattled off dozens of government grant programs from ARRA right on down, which reminded me of that seedy guy with the Free Government Grants infomercial).”

- KevinMD.com has a great list of free iPhone apps aimed at physicians. There are a lot of lists like this floating around the ‘net, but it’s always nice to have another. The problem is trying to figure out which applications to use and which ones to dump. You can’t use them all, believe me I’ve tried.

- The Healthcare IT Guy has an interesting article on how the EMR industry can learn from the Customer Relationship Management (CRM) industry. According to the article the CRM industry has made great strides in developing their model based on previous failures. The parallels between the current EMR industry and the CRM industry prior to maturing are very interesting. The Healthcare IT Guy states “with the lessons learned from the CRM industry , and armed with the expert guidance, you can adopt an EMR that can probably meet your financial and healthcare objectives.” Take a minute to read the entire post, it’s worth the time.

- Rumors are surfacing again regarding Microsoft’s Courier tablet. According to electronista.com “The book-like device has had more concrete hardware details and should be powered by NVIDIA’s Tegra 250 and should be relatively portable. Despite the second touchscreen, it would be lighter than an iPad and weigh just over one pound and would still be under an inch thick; the footprint would be that of a 5-by-7-inch photo when shut.” Hmm, that’s too bad really. I was hoping for a slightly larger device with two 8-10 inch screens like the enTourage eDGe. Although the enTourage is taking some hits from GottaBeMobile where the device is reported as not being “ready for prime time yet.”

- Speaking of Microsoft, it looks like their pushing their way into the acute care healthcare system with HealthVault Community Connect. Hey, more power to them. Anything that can help improve data structure and storage is alright by me.

- The iPad is scheduled for launch on Saturday April 3rd. Pre-orders will begin March 12th. I’m trying to decide if I really want one of the first generation devices or if I should wait 6-8 months. I’ll let you know on March 12th.

- medGadget: “PEPID, one of the big names in clinical information for mobile devices, is gearing up to release an Android version of its popular software suite.” – PEPID is very popular among a certain subset of physicians. I’m sure they’ll be very excited to have it on their Android devices.

- I found it interesting that Engadget posted an article questioning the survival of the Android platform in the same week that Computerwold wrote about the growing Android market share.

- It looks like e-prescribing might actually catch on after all. Medsacape is reporting that “the number of prescriptions that were routed to pharmacies electronically increased by 181% in 2009 compared with in 2008.” Wow, that’s significant.

- Archetypical: “I first heard about openEHR nearly 10 years ago. I didn’t understand openEHR at all initially, but there was something in the commonsense of getting the foundation data defined and standardized that resonated with me. Over time I have become convinced that openEHR provides an orthogonal approach to eHealth that has a very reasonable chance of success, and more importantly, of making a difference. I no longer believe that the traditional application-driven approach to electronic health information management is effective, economic or sustainable.” – This is a great article that goes on to explain more about the openEHR movement. Check it out.

- Medical News Today: “Yuksel and her research team did a study involving 262 patients at various Alberta pharmacies. Patients in the control group were given an information brochure then asked to come back in 16 weeks for a follow-up meeting. Those in the intervention group went through a more in-depth process. They spoke with a pharmacist about osteoporosis, the risk factors of the disease and screening processes for assessment of osteoporosis. When the pharmacists met with the patients 16 weeks later, they found that those in the intervention group were two times more likely to get a bone density test or start an osteoporosis medication, meaning the pharmacist intervention was beneficial in helping more people receive further assessment and a diagnosis from their doctor.” – Pharmacists continue to make a positive impact on healthcare. I’m just sayin’.

- Isoniazid is a common therapy for the prevention of active tuberculosis in patients with latent disease. Unfortunately treatment can be accompanied by some fairly undesirable side effects, including liver injury. AHSP is reporting that the CDC is now urging increased awareness of liver injury during isoniazid therapy. To that I say, Duh!

- SiliconRepublic.com: “Google believes that in three years or so desktops will give way to mobile as the primary screen from which most people will consume information and entertainment. That’s according to Google Europe boss John Herlihy who said that smart phones enhance Google’s mission to make information universal.” – That’s a bold prediction, but one that I don’t think is too ridiculous. I really don’t think desktops will become obsolete, but I certainly think mobile computing will overtake them. 

- The Five Rights website takes a look at a common situation in every actue care pharmacy in America; been there. 

Have a great weekend everyone, I know I will because I’ll be at Universal Studios Hollywood for a cheer competition.

“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

- Avatar was #1 at the box office for a second weekend in a row. It really is a great movie.

- The New Year was ushered in this week.

- TechCrunch: “Ten Technologies That Will Rock 2010 – There are beautiful Android tablets , concept tablets, and, of course, the one tablet which could define the category, the Apple Tablet. “ – Yep, the iSlate tablet from Apple is the most yet-to-be-seen-in-the-wild device I’ve ever read about. Here’s hoping that it lives up to the hype.

- GottaBeMobile : “There’s an eerie silence amongst all the excitement, though, and it is coming from none other than Microsoft and its’ partners. This silence is very concerning and it will cause Microsoft to suddenly see something they owned get snatched from their hands if they don’t quickly change their ways.” – Unfortunately I think Rob’s words are far too true for my taste. Microsoft has been blazing a trail in tablet development for years and now they are going to sit around and watch companies like Apple snatch it away from them.

- PubMed got a face lift. I know it’s been that way for a little while, but I thought I would mention it anyway. PubMed is the premiere search engine for scientific literature.

- The New York Times: “How to Train the Aging Brain – Recently, researchers have found even more positive news. The brain, as it traverses middle age, gets better at recognizing the central idea, the big picture. If kept in good shape, the brain can continue to build pathways that help its owner recognize patterns and, as a consequence, see significance and even solutions much faster than a young person can.” – I spent a good chunk of my life playing football; spring football, passing league in the summers, conditioning in the early fall, the season in the winter, etc. This had a definite impact on my brain. To this day, the smell of freshly cut grass makes me think of football fields and certain sounds in the weight room bring back fond memories of good times with close friends. It’s a great article.

- Barcode.com: “CardBank conveniently stores all of your retailer preferred cards in your iPhone. By eliminating the need to rummage through card after card on countless keyrings, CardBank centralizes the location of your cards for easy access.” The CardBank application has remained among the Top 50 Paid Utility Applications on the iTunes Store with at least 80 loyalty card programs programmed into CardBank. Users have easy access to the programs and are able to request new programs. CardBank has the ability to display barcodes in both landscape and portrait pieces to help generate positive scanning results.” – I love this idea. Doesn’t everyone have a ton of those “rewards cards” in their wallet; Barns & Noble, Borders, UA Movie Theaters, Best Buy, Starbucks, HardRock Café, etc? You can get more information on CardBank at their website.

- Green.TMCnet.com: “Zebra Enterprise Solutions, a division of Zebra Technologies, announced American Barcode and RFID has joined its partner program. The ZES partner program enables AB&R to integrate a broader range of technology solutions with its existing offerings. American Barcode and RFID is a technology integrator of Automatic Identification and Data Collection (AIDC) solutions that help customers manage assets, track inventory, mobilize their work force, and secure their work place.” – There’s that RFID thing again.

- Health Content Advisors: “In the healthcare industry, where I focus most of my attention, the possibilities for making the world run better by exploiting research, outcomes, and administrative data are enormous. Yet, the healthcare sector lags other industries by more than a decade in data management, data access and interoperability.” – Everyone knows that the healthcare industry is more then ten years behind other industries in several key areas, but the question remains; what are we going to do about it?

- The Entourage eDGe Dual Screen eBook Reader was caught on Video. This is a very exciting little device. Check out the hands-on review at CNET News.

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- There is a must read article at Technology Review called The Year in Biomedicine. The article speaks of 2009 “as the year human genome sequencing finally became routine enough to generate useful medical information”. I don’t know whether to be excited or frightened by such a thing. Anyway, the article covers some fantastic material, be sure to check it out.

- TechCrunch: “Android Finally Gets An Official Yammer App” – Think of Yammer as Twitter for use from within your company. Yammer is advertised as “Enterprise Microblogging”. Is anyone out there using this service? I’d certainly like to give it a try at my hospital. You can get more information at the Yammer website.

- GottaBeMobile has a list of ten free apps “that will help improve your overall Droid experience.” That’s cool, considering my overall Droid experience to this point has been fantastic.

- I visit a site called MobileRead.com several times a week because I have an interest in e-readers and e-ink technology. They have a feature called “MobileRead Week in Review” that any e-reader/e-book enthusiast should check out.

- Simon Bramfitt : “But no matter how you look at it thin-clients are expensive in comparison to PCs. I’ve tried to get straight answers from thin-client vendors in the past, as to why their machines cost so much, but while they are very willing to share information about sizable cost of ownership benefits, I’ve never had a complete answer to the question I was asking.” – I completely agree with this sentiment. Thin clients offer bare-bones configurations and often times cost more than a bare-bones desktop client with better specs.

- The Electronic Health Record Incentive Program, “Meaningful Use”, program was released this week. John Poikonen points out that pharmacists are listed a total of zero times in the 556 page document. That my friend is a complete travesty.

- Speaking of John; please stop by the RxInformatics website and vote for the top 10 pharmacy/pharmacoinformatics articles of 2009. The list of related articles compiled by John is impressive, and I struggled mightily trying to select the “top” ten.

- HealthcareIT News: “The government announced Friday $60 million to support healthcare IT research projects aimed at “breakthrough” advances. David Blumenthal, MD, national coordinator for health information technology, said the money would support the development of Strategic Health IT Advanced Research Projects (SHARP). SHARP projects will conduct focused research in critical areas where breakthrough advances are needed to address existing barriers to the adoption and meaningful use of health information technology. Applications are due on Jan. 25, 2010, with awards anticipated in March 2010.” – That’s not much time to get my application in. I’d better sharpen my pencil.

- EHR Bloggers: “Meaningful Use Quick Reference Guide – The following list has been excerpted from pages 47-65 of the CMS document. EHR vendors and providers should read the original document as part of any formal planning exercise and certainly in advance of any EHR purchasing decision.” – I love quick reference guides.

- Microsoft Word always tries to change “EHR” to “HER”; interesting.

Have a great weekend everyone.