The future of 340B, my perspective

The snippets below are taken from a recent article in Pharmacy Times: The Future of 340B: It’s All About Perspective

“Established more than 20 years ago [the 340B Drug Discount Program], this legislation was enacted to assist different health care settings in providing excellent care for indigent and vulnerable patients. To allow this to happen, safety net providers have access to discounted outpatient drugs from manufacturers. By being able to purchase the discounted medications, these qualifying organizations are able to utilize the savings to provide care for those uninsured and underinsured patients. “ – The 340B Drug Discount Program can be a great thing for healthcare systems that care for a lot of ‘uninsured’ or ‘underinsured’ patients. These are often time indigent patients.
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Saturday morning coffee [January 26 2013]

Amsterdam Coffee MugSo much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug to the right comes straight from Amsterdam. I stopped there back in November 2011 on my way to Germany on a work trip. It’s a dirty city with a weird vibe to it. Everyone smokes and you better watch your butt or you’re likely to get run down by a bicycle, which appears to be a popular form of transportation. I walked through the Red Light District just to say that I’ve seen it. It was disturbing and depressing. It’s sad to see that kind of thing in my opinion.  Overall I didn’t like Amsterdam. You can have it. By the way, that’s a pretty big coffee mug. It hold a lot of coffee.
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FMEA and BCMA, two acronyms that work well together

During my time as an IT pharmacist I was fortunate enough to be part of two Failure Modes and Effects Analysis (FMEA) groups; one for CPOE and another for BCMA. The FMEA process is labor intensive and time consuming, but well worth the effort in my opinion. In both the CPOE and BCMA instances several important pieces of information were discovered that may have otherwise gone unnoticed.

I don’t often see articles that talk about using FMEAs, which is a real shame secondary to their value. So it was a pleasant surprise to see a recent article in Pharmacy Purchasing & Products on the use of an FMEA post BCMA implementation. I’m not familiar with using an FMEA after the fact, but it makes more sense to me now after reading the article.

According to the author, they “had conducted an FMEA prior to initially employing BCMA; however, we never performed any post implementation follow-up on the system.” An all too common occurrence in healthcare, i.e. implement and forget. We did something similar at Kaweah Delta when I worked there, but we referred to the process as a gap analysis rather than calling it an FMEA. Regardless of the verbiage, the results were similar.

The reason cited for the second FMEA was an increase in errors associated with the BCMA system. “Errors were primarily due to unscannable bar codes, mislabeled medications, the wrong medications being dispensed, and most commonly, nursing staff’s failure to scan.” This sounds familiar. The errors cited are simply side effects of the implement-and-forget mentality. Regardless of the system in place, humans inevitably develop bad habits and workarounds. We need to be constantly reminded to do the right thing. Implementation is only a small part of the work involved with any new system. Follow-up, maintenance and optimization is when the real work begins.

And the results of the second FMEA? “Three months after completing the FMEA, the team compared the before and after scan rates. We found significant improvements in the scanning of both the patients and the medications throughout the system. In addition, we have witnessed a culture change: nurses now become anxious if they cannot scan a product.” Not bad.

Read the article, it contains some good information.

Sad, but all too common experiences with healthcare

I read Warner Crocker’s musings at GottaBeMobile as well as his Tweets via the @LPH/tablet-pc-enthusiasts list on Twitter. Warner also has a second blog called Life On the Wicked Stage: Act 2, which I do not read with any regularity. I was, however, driven toward his personal blog secondary to a Twitter post. The post, titled Rush and My Mom: Two Different Care Experiences, talks a little about his experiences with his mothers medical care. She is apparently very ill with lung cancer. I sympathize with Warner as my mother-in-law, Mary Lou, succumbed to lung cancer in December of 2008. I also understand much of what he is talking about as my wife and I experienced similar problems during Mary Lou’s chemotherapy, pain management and surgeries.
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Physician’s stolen laptop contains patient information

EMR and HIPPA: “This story made me think of two things:
1. Why is PHI being stored on the laptop in the first place? I wish I could find out if there was an EMR involved. If there was, then the EMR should be storing all of the patient information on the server and none of that data should be stored on the laptop. So, if it gets stolen there’s no breach. That’s the beauty of an EMR these days. There should be no need for this to happen.
2. There’s some really cool technology that’s been coming out in recent laptops that will allow you to remotely wipe out the laptop if it ever gets connected to a network. Basically, once your laptop is stolen you report it stolen and they start tracking it down kind of like they do with stolen cars (same people from what I understand).”
– The story associated with this blog goes on to say that “Patient names, treatment dates, short medical treatment summaries and medical record numbers were stored on the computer.“  This wouldn’t have been an issue if all the patient information was stored in the “cloud” and viewed and updated via a secure connection when necessary. Security aside, data stored on a local hard drive increases the chance for lost or duplicate data. Anyway you slice it, this was a bonehead move.