In a previous blog I discussed the need for a uniformed data structure in healthcare. The concept got me thinking about how to accomplish such a monumental task, and make no mistake, it would be a monumental task. There aren’t many “people” out there that could develop the hardware and software infrastructure solid enough to handle the needs of the complex data stream coming out of the healthcare industry.
Then I noticed a trend at a lot of the web sites that I frequent: Microsoft has slowly, and quietly, been positioning itself to jump into the healthcare market.
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There was a time when I thought all a pharmacist needed to do his job was a pen and a calculator. It was just so cumbersome to carry anything else. If you wanted to have mobile drug information it meant carrying a drug reference book with you everywhere. Who can forget being in pharmacy school where every self respecting pharmacy student had a Drug Information Handbook stuffed in their lab coat pocket along with all the other stuff they carried like a homemade peripheral brain scribbled on the pages of a notebook or on those neat little 3×5 cards.
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Unless you’ve been comatose for a while, you’ve certainly heard about the Apple iPad. The device has already been crowned the de facto device for everything from e-reading to creating a new wave in healthcare unlike anything we’ve ever seen. Of course this is all speculation as the device hasn’t been officially released yet.
Many people have speculated that the iPad will be a great device for healthcare. Whether or not that will be the case remains to be seen. One thing is for certain: everyone is banking on the iPad being a big hit in healthcare. Based on the success of the iPhone as a favorite among physicians and nurses, this certainly isn’t a wild prediction. Will this success translate to the pharmacy? Good question.
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Over the weekend I spent a little time looking at trends in pharmacy and technology. As expected the healthcare technology market is expanding rapidly and this expansion is creating a need for pharmacists with technology know-how. To prove my point I created a job trends graph from indeed.com using the following search criteria: “pharmacy informatics”, “clinical pharmacist” and “director of pharmacy”. As expected the search trends for “clinical pharmacist” and “director of pharmacy” are relatively flat, but the trend line for “pharmacy informatics” is striking. It looks like a new pharmacy career path is born.
The National Library of Medicine has a website know as Pillbox beta that allows anyone to use various identifiers on a tablet or capsule, i.e. imprint, shape, color, size and/or scoring, to quickly identify a medication. I’ve used systems like this many times for the emergency department when a patient would roll in the door with ten different medications all thrown together in a plastic baggie. The nurse would bring them to the pharmacy and say “I need you to tell me what these are”. I tried holding the baggie to my head like the Great Carnac on Carson, but most of the time I had to use other references to help me out.
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I spent some time yesterday talking with some good people over at Pharmacy OneSource about pharmacy technology, clinical decision support, data mining, and a whole bunch of other interesting items. During one point of a conversations the history of Pharmacy OneSource came up. Part of that history includes the merger of Pharmacy OneSource with HealthProLink (HPL) sometime in late 2005.
The mention of HealthProLink (HPL) brought back fond memories of a time when pharmacy informatics was really starting to take off and I was infatuated with the Palm Pilot <insert flashback sequence here>. HPL was a set of software tools for collecting and quantifying pharmacist intervention data as well as ADR/ADE information. In addition, the application offered access to several clinical calculators and a fairly robust reporting system. I was part of the implementation team for HPL when I worked at Community Medical Centers – Fresno and used it daily for a couple of years.
This was also a time when Palm Pilots were all the rage and every pharmacist I knew carried one in their lab coat pocket. The Palm OS was a stroke of genius because of its minimalistic approach to the user interface. Anyone could pick up a device using the Palm OS and figure out how to use it in a matter of minutes. They were a model of simplicity and functionality. In addition, several development environments were available for application development as well as several “readers” and database applications. This led to the development of hundreds of medical references, medical calculators, free and commercial peripheral brains and countless ways to track patients, labs, and medications available for devices running the Palm OS. It is the only time in my career as a pharmacist that the entire profession embraced a new technology and used it to their advantage. The literature was full of “studies” using handheld devices for documenting clinical interventions1-4, carrying individually created documents and “peripheral brains”5,6 performing pharmacokinetic calculations, accessing drug information and performing drug interaction checking.7-12 The entire handheld movement was quite impressive to watch.
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The Palmdoc Chronicles:” I’ve had a Palm Pre for about 2 months now and I can declare that the device has seen tremendous improvement with firmware updates (pushed OTA) and a steadily increasing amount of useful applications in the Palm App Catalog and the unofficial Homebrew scene.
How usable is it as an smartphone for doctors? Well I can say it pretty much does replace your old PalmOS device as it is. One of the cool features of the old Palm PDAs is the ability to keep snippets of information in the Memos (Notes) in various categories for instant recall. These notes may be protocols, clinical pearls or practically any bits of information which you want to look up while rounding for instance.
WebOS’ builtin “post-it” type Memos is ok if you are keeping about 10-20 notes but pretty useless if you are talking about 300-500 notes or more. There are several solutions at hand which overcome this limitation.”
The blog goes on to describe a few applications that can be used to create a peripheral brain out of the Palm Pre smartphone. One of these applications is the ever popular Evernote, which I use daily on my tablet PC as well as my Droid.
The information presented at the Palmdoc Chronicles isn’t restricted to the Palm WebOS. The iPhone, Motorola DROID, RIM BlackBerry devices, and a host of other smartphones are capable of storing memos, notes, PDFs and numerous other forms of information documentation.
The idea of using a PDA as a peripheral brain isn’t new. Felkey and Fox 1 were talking about it back in 2002 when the precursor to the Palm WebOS was popular among healthcare professionals. It’s interesting how the idea is as good today as it was nearly a decade ago.
1. Felkey BG, Fox BI. PDA interface: Creating the Digital Peripheral Brain. Hosp Pharm. 2002; 37:1222-1224
Every pharmacist that has worked in an acute care environment is familiar with documenting interventions. Information from captured interventions is often assigned a dollar value and used by pharmacy and hospital administration to justify pharmacy services or additional pharmacist FTEs.
Interventions captured can range from secondary issues like illegible handwriting and incomplete orders, to pharmacokinetic consults, renal dosage adjustment and prevention of adverse drug events caused by allergies, drug-drug interactions, disease-drug interactions, etc.
Several methods have been used over the years to capture pharmacist initiated interventions, and no two have been the same. I’ve worked at several facilities over the years, and the systems used have included a paper method, a Microsoft Access database, a PDA system built with Pendragon Forms for the Palm Pilot, a third party software system and of course the pharmacy information system (PhIS) itself. Each had advantages as well as disadvantages. The two things they had in common were that they cumbersome and lacked standardization.
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The practice of informatics: Application of information technology: MedEx: a medication information extraction system for clinical narratives
Hua Xu, Shane P Stenner, Son Doan, Kevin B Johnson, Lemuel R Waitman, Joshua C Denny
Abstract
Medication information is one of the most important types of clinical data in electronic medical records. It is critical for healthcare safety and quality, as well as for clinical research that uses electronic medical record data. However, medication data are often recorded in clinical notes as free-text. As such, they are not accessible to other computerized applications that rely on coded data. We describe a new natural language processing system (MedEx), which extracts medication information from clinical notes. MedEx was initially developed using discharge summaries. An evaluation using a data set of 50 discharge summaries showed it performed well on identifying not only drug names (F-measure 93.2%), but also signature information, such as strength, route, and frequency, with F-measures of 94.5%, 93.9%, and 96.0% respectively. We then applied MedEx unchanged to outpatient clinic visit notes. It performed similarly with F-measures over 90% on a set of 25 clinic visit notes.
Xu H, Stenner SP, Doan S, et al. MedEx: a medication information extraction system for clinical narratives. Journal of the American Medical Informatics Association. 2010;17(1):19-24.
As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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