In this case it’s ASHP’s Interactive Handbook on Injectable Drugs: IV Decision Support by Lawrence A. Trissel. Every pharmacist working in a hospital pharmacy knows about this reference. And if they don’t then they have a big problem because it’s only one of the most definitive reference sources for IV compatibility. Over the course of my career it’s simply been know as “the Trissel’s”. (kind of like “the Talyst”…just sayin’ – private joke people)

There’s a link in the ASHP web store leading to a “getting started video”, but I couldn’t get the video to run. Little bit of a fail. Perhaps ASHP’s never heard of YouTube. Who knows.

Now that the iPhone is available on Verizon, the question everyone will be asking themselves is “should I dump my current Verizon device and move to the iPhone?” It’s a good question and I’m sure many, many people will do it. Then again, I assume many ex-Verizon-switched-because-of-the-iPhone-but-now-I’m-unhappy-with-AT&T customers will simply switch back.

To test the desire of the average smartphone user to switch between Android and the iPhone on Verizon, I asked my wife if she’d like to jump ship now that she has the option. You see, we’re a Mac family at home; three Mac desktops, one Mac laptop,  eight iPods of various configurations and an iPad. My wife and I have talked about this day for a long time and always assumed we would make the change when the opportunity presented itself. But to my utter surprise my wife said ‘no’. Her explanation was simple. She said she was happy with the Android platform, already had an iPod Touch and an iPad, liked the integration of Google with her Droid and simply didn’t feel it offered any advantage. Zing!

And for me? I briefly had an iPhone and really liked the device. At one time I think I would have made the switch, but now I’m happily married to Google and the Android platform. I’ll be sticking with that combination for now.

RxCalc has slowly, but steadily gained functionality mainly due to some great user feedback we’ve received since it was initially released in July 2009.

So, what’s new in the latest release? Glad you asked. The featured changes include:

1. Support for dosing adjustment using single level vancomycin kinetics.
   • The calculations are performed using both patient specific information supplied by the user as well as patient population parameters.
2. Literature supported High Dose Extended Interval (HDEI) (aka “once daily” or “pulse”) aminoglycoside dosing.
   • Calculations for gentamicin and tobramycin are based on 7mg/kg adjusted body weight.
   • Calculations for amikacin are based on 15mg/kg adjusted body weight.

I have five free download codes for RxCalc. If you’d like to download the app for free just shoot me a quick email and I will send you one of the codes. It only takes a second and I’m sure you’ll like performing pharmacokinetics on your iPhone or iPod Touch. I know I do.

The codes expire in four weeks so make sure you contact me sooner rather than later.

- The Social Network was #1 at the box office last weekend. I haven’t seen it and am not sure that I want to. My family and I took in Easy A instead. It wasn’t at the top of my list, but I was outvoted. Fortunately for me it was better than I expected.

- I found this great article on “What’s Wrong With Writing Down Your Password?” over at How-To Geek. Good stuff and worth a look.

- Years ago I worked in a compounding pharmacy. I really liked the job and continue to have an interest in the subject, albeit a global interest at best. Anyway I receive a weekly newsletter from CompoundingToday that always includes a Letter from the Editor section written by Loyd Allen. This week he had a rant about the power instilled in government agencies. I don’t agree with everything he has to say, but it was a good read nonetheless. One interesting paragraph includes the following: “the bill is being “implemented” by governmental “agencies” and the implementation documentation is already double in size compared to the “passed” bill, and, the bureaucrats, they are just beginning! It is also interesting that a lot of “new” things are coming out that have not been previously discussed. Why is it that in the “interpretation and implementation” of a new law, many new things seem to be introduced?” That’s a good questions.

- I found a great little article at The Angry Pharmacist that talks about problems with different dosage forms and inconsistency among providers in how the information is communicated to pharmacies. Retail pharmacy really is a thankless job. I still don’t know why pharmacists subject themselves to it. I tried it for a while early on in my career and again a few years ago. I didn’t last long. The retail pharmacy environment wasn’t for me.

- Speaking of how retail pharmacists get abused, make sure to check out this article at KevinMD. A guest blogger takes a few unwarranted shots at the industry in general. It’s unfortunate, but the majority of consumers have no idea what goes on behind the scene in a retail pharmacy. It’s chaos on the best day, and many times the brunt of the consumer outrage is aimed at the wrong people. Be sure to read all the comments as well as the article. It’s pretty enlightening, and a bit entertaining.

- Anyone have any doubt that the iPad is impacting healthcare? EMR Daily News has a short blog post showing the growth of EMR/EHR applications in the iTunes App Store since the device landed on earth.

- How cool is this! medGadget : “Imec, an electronics research institute out of Leuven, Belgium, has teamed up with the R&D Holst Centre and TASS, a software company out of Augusta, Kansas, to create a mobile and wearable ECG system based around an Android smartphone.”

- RxInformatics.com: ““A ground-breaking system for predicting how individual patients with HIV and AIDS will respond to different drugs is launched today”. After signing up and logging in I was humbled by my complete lack of HIV therapy and genomic knowledge. The user interface and idea is compelling. It is not hard to imagine a Diabetes/CV/Stroke/DVT/ Treatment Response Prediction System, integrated into an EHR that feed a data repository that had real time updates based on population outcomes” – The potential uses for such as system are staggering.

- Ah, those radiologists and their love of sharing information. CMIO.net : “GE Healthcare has completed a digital imaging repository (DI-r) that connects hospitals and medical centers throughout southwestern Ontario, Canada, enabling the sharing of patient health data across the region”. It’s a good start.

- RxCalc 1.2 was approved in the App Store this week. A lot of work went into this version as we added some much needed functionality like extended interval aminoglycoside dosing and single level vancomycin kinetics. We also enlisted the help of an outside beta tester for the first time ever, and I’m grateful. The insight and feedback we received was very valuable. You can get more information on the latest release of RxCalc at the App Store or at the Apple Core Labs Weblog.

- An interesting thing happened on Twitter this week as some pharmacists got on the subject of powder papers. Powder papers are a long forgotten method of dispensing medications that have to be mixed from raw ingredients and for one reason or another can’t be encapsulated or packaged any other way. I haven’t made a powder paper in years, but I think it’s important to keep the history of pharmacy alive so I’ve included a video and a couple of links below that will give you a better idea of what I’m talking about. Thanks to @psweetman for the video and links.
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Also look here and here for additional information.

- According to The Digital Reader, Augen is going to be releasing six new Android based tablets in the near future. This is very exciting news if the company can pull it off. I’m especially interested in the Expresso doppio model depicted on the site. The design is a dual boot system, Android/Ubuntu, a clamshell case with keyboard and a 10.2” multi-touch screen. Almost sounds too good to be true. I have my fingers crossed that’s it’s real. The tablet market is humming along with activity and I can’t wait to see what hits the market over the next six months.

- Check out the giant touchscreen vending machine at the Engadget site. Oh boy, I can see so many applications for something like this in pharmacy; drug information, patient access, dispensing kiosks, and so on and so forth. How do I get my hands on one of these bad boys?

- HTC introduced a new concept this week, HTCSense.com. There’s a lot going on here, but the nuts and bolts of it is that you can now use the cloud to backup and archive important information directly from your Android mobile device. The service includes contacts, text messages, call history, etc. You can get more information here. This is only the beginning.

- Meridia (sibutramine) was voluntarily removed from the market this week secondary to clinical data suggesting an increased risk of heart attack and stroke. Sibutramine is used to treat obesity by blocking the reuptake of norepinephrine, serotonin and dopamine. It has a laundry list of side effects, precautions and warning.

- Worst quote ever by a pharmacist: “I liked it when I could learn everything I needed to know about a drug from a professionally prepared advertisement. Ads like that are much easier to read than clinical articles, because Big Pharma really wants me to read them.” What! I had to read it twice myself. I won’t provide the link to the article, but suffice it to say that I’m disappointed by that statement. When you start using Big Pharma propaganda  to build your pharmacy drug knowledgebase, then it’s time to call it quits. Pharmacists are the drug experts. We know things about medications that can only be found in the primary literature after careful reading and evaluation. Advertisements in “magazines” are designed to drive consumers to ask for medications and get physicians to prescribe the latest and greatest. It’s like selling cars. In the same article the pharmacist also makes an interesting comment about “Vancocin” that would cause any self respecting pharmacist reading the article to raise their eyebrow and throw up a red flag. Pharmacy journals, even the “throw aways”, should be more careful with the information they allow to grace their pages. Physicians and pharmaceutical companies use information like this as a sword when it’s actually about as sharp as a doorknob. I’m just sayin’.

- The Unofficial Apple Weblog has a nice compilation of iPhone 5 rumors. I love the rate at which smartphones are being developed, but it sure makes it hard to keep up. Do you think we’re headed for a time when you’ll lease a smartphone instead of purchasing one? With the development of cloud storage it may be time to consider the model; mobile-as-a-service, MaaS anyone?

- KevinMD : “What if you could improve patient safety, cut costs, broaden your medical knowledge and find 20% more time in your workday? On October 1, 2010, that is just what we can expect when clinical pharmacists move from the back room to the bedside in ten general medical units at the Hospital of the University of Pennsylvania.” – Seems like they’re a little late to the party, but I suppose better late than never. Like several thousand other pharmacists, I’ve been preaching this for years: get the pharmacist out of the physical pharmacy and to the bedside. How do you accomplish such a goal? Easy, liberal use of technology and by expanding the role of pharmacy technicians. C’mon ASHP, help me out here. Let’s hope your PPMI Summit does the trick.

- On a similar note I sent CSHP (California Society of Health-System Pharmacists) an email asking them for their position on tech-check-tech in the acute care setting. Their response was, how shall we say, weak. I shot them another email asking for clarification, but haven’t received a response. When I do I’ll update everyone on the progress.

- Fast Company: “Patents are re-injecting some intrigue into the thoughts about touchscreen iMacs, and potential MagSafe connectors for the iPad could hint that Apple plans wireless syncing at last.” – Let’s hope so. Mac is seriously lacking in their cloud development as well as the use of touchscreens on their laptops. I’m hoping the new MacBook Air will include a touchscreen. I still say it would make an awesome tablet.

- Football season is in full swing and I couldn’t be more thrilled. Well, I could if my Cardinals weren’t so bad. Anyway, some intriguing games in the NFL this week include:

• Kansas City at Indianapolis – I know it’s early in the season, but who would have thought the Chiefs would be the last unbeaten team in the NFL.
• Green Bay at Washington
• Chicago at Carolina – Carolina is just plain bad, but the Bears don’t exactly look like champions either. I’m curious to see if the Bears defense can keep them in the game with a backup quarterback filling in for Cutler.
• Minnesota at NY Jets – The Jets look good. I want to see if the Vikings are any better on offense with the addition of Randy Moss. I’m not a big fan of Moss, but he can still light-up a defense when he wants to. Farve looks old, which is funny because he and I are the same age. Funny.

- College football is more exciting than the NFL at the moment and there are some great games today. I’m a PAC-10 guy at heart so I’ll be watching UCLA at Cal, Oregon State at Arizona and USC at Stanford. I wanted to attend college at Stanford, but didn’t have the brain power for it. My application never made it past the initial screening process. My daughter says she wants to attend Stanford, and as a high school junior it’s about time to start applying. She’s a lot smarter than her dad so I think I may get an opportunity to live vicariously through her.

- Would someone please stop Major League Baseball already, it’s taking up valuable air time that should be dedicated to the NFL. Look, I loved playing baseball as a kid, but as a adult I find it about as fun as watching grass grow. There may be ten minutes of action in a three hour game, maybe. It’s the only sport where the best game you can play is one in which two guys play catch for three hours while everyone else watches, i.e. a perfect game. Football, hockey and basketball are sports that involve constant action. Extend the football season and limit baseball to the summer months. Please, I’m begging you.

Have a great weekend everyone.

My brother and I were talking about doing something like this on the iPhone a couple of years ago. An electronic prescription pad on the iPhone makes perfect sense as the iPhone is so prevalent among healthcare professionals. Even though ScriptPad is promoted for both the iPhone and iPad I’m convinced the iPhone is a better option. Most people carry their iPhones with them at all times. I don’t think you can say that about most iPad users.

SciptPad is looking for beta testers. Check the website for more information.

ScriptPad e-Prescribing Demo from ScriptPad on Vimeo.

- KevinMD: “I still think that drug ads should be banned on television and in newspapers and magazines, but there’s good evidence that the $1.2 billion spent on consumer marketing is simply wasted. That, perhaps, may be enough impetus for the pharmaceutical industry to rein in advertising on their own.” – I’d like to see the drug companies put that money to use somewhere else.

- I saw this tweet from John Poikonen this morning: “Duty to warn in the age of Social Media podcast by @kevinclauson – via iTunes ASHP podcast series.” If you’ve never heard Kevin Clausen speak on Social Media, then you’re missing out. He has great insight on the issue.

- Earlier this week I talked about what I believe to be unsubstantiated fears of data security in the cloud. To further illustrate my point I would like to share a few tidbits I found on the web this week. Please note that none of the stories below are the result of a cloud based approach.

• From the Fresno Bee: ”A California-based health insurance company has agreed to pay Connecticut $250,000 for losing a disk drive containing private information of 1.5 million customers, including nearly 450,000 state residents.”
• From the University of Maine Information Center: “Two University of Maine servers have been compromised, potentially exposing personal information related to some 4,585 individuals who accessed UMaine Counseling Center services between Aug. 8, 2002 and June 21, 2010″ – People will try to point out that this is the result of a server being compromised. That is true, but remember that the servers are local and maintained by the university.
• From iT News: “New York City Lincoln Hospital has suspended sending CDs via courier after a package containing seven containing detailed patient data was lost en route from its bill processing supplier Siemens Medical Solutions to the hospital. The US Department of Health and Human Services´ (HHS) public record of data breaches revealed that 130,495 patients were lost. It was the second largest loss this year on the HHS list.” - Sending information via CD just seems like a bad idea all around. Why haven’t we moved past this?

- It’s no secret that I’m a tablet PC fan. They’re just too cool not to use. Anyway, here’s a great video of an artist running an iPad and tablet PC side by side. I thought it was interesting because the artist had a pragmatic approach to her decision. The entire post can be found at Best Tablet PC News.

- The Lancet (doi:10.1016/S0140-6736(10)60964-6) has an article reporting the results from the ‘Telemonitoring and self-management in the control of hypertension’, or TASMINH2, trial. The article basically says that patients with hypertension can effectively use telemonitoring and self-management to reduce systolic blood pressure. The study is small and doesn’t deal with the effect on patient morbidity and mortality, but it is promising nonetheless. I think we’re going to see more and more use of telemonitoring and telemedicine as devices like the new iPhone 4 and HTC EVO become ubiquitous. The ability to use a smartphone for video chat will make consultation with physicians and pharmacists much easier in the future. Sounds like it’s time for another study. Who’s ready to use smartphone video chat to deliver real-time consultation? Anyone? Poision control? Emergency medicine? Paramedics?

- Have you ever heard of a Digital Object Identifier Link? Me neither until very recently. A digital object identifier (DOI) can be used to cite and link to an electronic document. The DOI for a document is permanent, which is a big plus for document storage and retrieval. The correct format for citing a DOI looks like this: doi:10.1016/S0140-6736(10)60964-6 (see Lancet blurb above). To find out what the DOI represents simply go to http://dx.doi.org, place the number in the box and hit “Go”. The DOI resolution website has a very “Google like” interface. I like it.

- The Witstech A81-E tablet is an interesting little machine. It will dual boot Android 2.1 or Windows CE 6.0. I’m not sure who would want to boot into Windows CE 6.0, but it’s nice to know you have the option.  In addition the tablet offers a 600MHz ARM processor and a seven-inch 800×480 touchscreen. It’s not going to win any technology contests, but for $200 it’s worth a look.

- CMIO: “Careless use of adjectives and adverbs comprises the first bias sin, Brenner noted. Words like “unequivocally” and “undoubtedly” espouse a single view, leaving no room for interpretation, he explained, adding that terms like “compelling” and “persuasive” lack objectivity yet nudge the reader toward a conclusion.” – This comes from an editorial in the July edition of the Journal of the American College of Radiology (full text is free). I took a “Scientific Writing” course in college. I’ll never forget the professor saying that you’re either pregnant or you’re not, you can’t be very pregnant. Some people may disagree with that statement, but you get the point.

- Daily Mail: “Scientists develop ‘fake’ genetically-engineered blood for use on the battlefield – The genetically-engineered blood is created by  taking cells from umbilical cords and using a machine to mimic the way bone marrow works to produce mass quantities of usable units of red blood cells. Blood cells produced using this method are ‘functionally indistinguishable from red blood cells in healthy circulation’, the company claims.” – Amazing stuff.

- Did you know that ASHP offers a service for their members called the “AHSP Daily Briefing“? I knew about it because I was a memeber, but haven’t given it much thought. There really is quite a bit of valuable information in each briefing. An example of today’s information includes information on the Johnson & Johnson OTC drug recalls, the FDA caution on using quinine for leg cramps, information on the rosiglitazone disaster, links to information on proposed changes to HIPAA by HHS, and so on and so forth.

- Just in case you missed it, LeBron James decided to play for the Miami Heat starting next season. Everything that’s wrong with professional sports can pretty much be summed up by the events leading up to this announcement. Will all the things going on in the world this press conference put a choke hold on the web, social media outlets, sports talk radio and various other media. Incredible in a bad way.

- I’ve had quite a few people ask me how I generate some of the screen shots that I use. The application responsible is a relatively simple and inexpensive tool called FastStone Capture. I like it because it’s small, unobtrusive and does what I need.

- My iPad has been getting a lot of use lately as I try to determine where it fits in my workflow. I spent the better part of a weekend trying to figure out a good way to take notes, mark up PDFs, move files back and forth, etc. I finally gave up and went back to my tablet PC for those activities. The iPad cannot replace what I do with Microsoft OneNote on my tablet. I am aware that the iPad was never designed to replace a tablet PC, but I thought it was worth a shot as the iPad does have several redeeming qualities like instant on, long battery life and integration with my existing Mac infrastructure at home. Trying to use the iPad as a tablet PC replacement reminds me a lot of what I tried to do with my Palm Pilot many years ago, which struck me as a giant step backward. So for now I see the iPad as a supplement to my tablet PC and desktop computer.

- A couple of things I do enjoy doing on my iPad are reading and exploring all the cool applications that are available for it. Some of the apps that I’ve found valuable include Evernote, Dropbox, GoodReader, Penultimate and Memeo Connect Reader, which I use to access Google Docs.  With that said, here are a couple of applications that I think are simply cool: Uzu, which offers no value other than it’s cool and Vuvuzela for the iPad. The Vuvuzela is good for annoying my daughters. I hit the horn continuously until I hear “Daaaaad!”. Ah, music to my ears.

- Anyone know which schools of pharmacy in the United States offer the most progressive approach to pharmacy automation and informatics? I get this question on occasion and have no good opinion on the matter. The only thing I know for sure is that my alma mater, UCSF School of Pharmacy, is certainly not on the list of pharmacy schools with a progressive informatics approach. A couple of hours on the phone made that abundantly clear. Anyway, let me know if you know of a pharmacy school that has a great informatics presence. I’d love to hear about it.

Have a great weekend everyone.

Most read posts over the past 7 days:

1. An almost disastrous bar-coding mishap
2. Cool Technology for Pharmacy – Post from before I started putting the name of the cool technology in the blog title. This particular post was from September 10, 2009 and covered the capsule machine.
3. Cool Technology for Pharmacy – Another post from before I started putting the name of the cool technology in the blog title. This particular post was from June 18, 2009 and covered Alaris Smartpumps.
4. Best iPhone / iPod Touch Applications for Pharmacists
5. Quick Hit – Mobile devices in our pharmacy – This post elicited a couple of interesting comments.
6. Curriculum Vitae
7. “What’d I miss?” – Week of June 27
8. Cool Technology for Pharmacy –NDC Translator
9. About -People checking up on me.
10. Motion J3500 gets a wicked update – People are still interested in tablet PCs, even with that other device grabbing all the press.

Top searchterm phrases used over the past 7 days:

1. “ feton capsule filling machine ”
2. “ alaris pumps ”
3. “ cerner and pandora data systems ”
4. “ dell xt2 ”
5. “ alaris pump ”
6. “ capsule machine ”
7. “ alaris infusion pump ”
8. “ pharmacokinetics iphone ”
9. “ free lexi-drugs windows mobile free ”
10. “cloud computing”

The application allows you to locate your iPhone, send an audible and/or text message to your iPhone, remotely lock your iPhone or remotely “Wipe” your iPhone via the comforts of your iPad. Pretty slick.

The only downside to Find My iPhone is the required MobileMe subscription needed to set it up. I’ve had a MobileMe account for a while, but never had a use for it. I’m a Google man myself. Now that I’m packing around both an iPhone and iPad most of the time I finally have a reason to keep it.

My initial thoughts on using Find My iPhone were lukewarm. Nonetheless I decided to play with it a bit today, and now I’m convinced that it fills a void and serves a real purpose. It’s even given me a reason to keep my MobileMe account. With that said, I think this application should be offered as a free service by Apple. It’s a shame to offer a free application only to require a fee for the service.

The images below include screenshots of the iPad application as I sent a message to my iPhone and locked it. There is also a couple of screenshots of my iPhone after the fact and the confirmation email I received telling me what I already knew.

Shown are an iPhone, an iPad, a Dell Latitude XT2 tablet PC and a Motion J3400 Tablet PC . Each device has its own set of pros and cons. Like the iPhone which is ultra-portable, but a real pain to work on secondary to the small screen. The Dell offers incredible flexibility, but the battery life is ho-hum and it doesn’t take abuse well. The J3400 is actually a solid machine and works well in our environment. It’s tough and offers darned good battery life when both batteries are installed. I haven’t rendered an opinion on the iPad yet. The coolness factor is through the roof, but after that I’m not sure where it fits.

I have plans to make a video at some point demonstrating how we use the iPad in pharmacy practice, but time seems to be against me.

iPhone version

Created with consumers in mind, the iPhone application delivers information about OTC products using the barcode located on the medication package. Users simply type in the numbers on the barcode and receive a picture of the medication along with important drug facts.

By simply touching the picture of the medication, a screen will appear where users can view the medicine’s active ingredients, warning, dosage information, and comparable generic products.

To compare multiple medications users can touch “Check Interaction” located on the main screen. A green check means the OTC medications are ok to take at the same time; a red stop sign means you should not take the medications together and consult with a pharmacist.

Android OS version

The Medilyzer Android Application is very intuitive and easily navigated. To enter anOTC medication, simply touch the “Scan Medication” button. This button activates the camera and the barcode is captured using an easy point and shoot method.

When the product barcode correctly appears in the window, the phone will blink green then display the name of the scanned medication. Users can view information such as product warnings and comparable generic products.

To check OTC drug interactions simply touch “Scan Medication” once more to learn if two OTC can be taken at the same time.

I find it interesting that you can scan the bar code image on the Android version of the software, but have to manually enter the UPC code on the iPhone. I wonder if it has anything to do with the quality of the cameras on the devices or if it is an issue with actual operating system? Anyway, I loaded both my DROID and iPhone with Medilyzer and took it for a test run.

The Android version had difficulty scanning bar codes on any surface other than the flat side of a box. In other words I couldn’t get it to scan bar codes on bottles. When it did pick up the bar code image the software worked as advertised. On the iPhone everything went smoothly. The only issue I have with the iPhone version is the need to manually enter the UPC.

In theory Medilyzer is a great application and has tremendous potential for consumer safety, but I can’t recommend it for Android devices because of the extreme difficulty I had getting a clean scan off surfaces that weren’t completely smooth and flat. The iPhone version works fine if you don’t mind entering the UPC code by hand.