After seeing the Grabit handle on the Yanko Design website I started looking into other ideas for refrigerators, and what better place to look for pharmacy refrigerators than Sears. All joking aside, I figured it would be better to look at consumer refrigerators because let’s face it; pharmacy refrigerators don’t exactly have a great track record for being cutting-edge technology.

One of the refrigerators that I thought was pretty cool was the Kenmore Elite Gran-N-Go French-Door Refrigerator. This refrigerator has a small door within a door. The Grab-N-Go door keeps often-used items in a small compartment accessible via a simple push button on the handle. The design lends itself to the Grabit door handle design. The outer door with the push button could easily be fitted with a fingerprint scanner on the button to limit access when appropriate, while giving everyone access to the rest of the refrigerator.

Who wants to help me build it? I really need to learn how to use some type of software like Photoshop. These ideas would look so much cooler if I had a snappy image to go along with ‘em.

Phocus Rx is camera system used in pharmacy clean rooms to document and validate the IV compounding process. It consists of two compact 5 megapixel cameras mounted outside the hood in the clean room ceiling or on articulated arm and workflow management software. That’s quite a departure from the other systems I’ve seen where the camera sits in the hood. In addition Phocus Rx includes the obligatory image capture that allows pharmacists to remotely review the compounding process. Pretty cool stuff.

By my count we now have four of these systems on the market, including PHOCUS Rx. Getting pretty crowded in there. Although I have to say that DoseEdge is far and away the most talked about of the IV workflow management systems on the market today. I’d love to play with them side by side to compare features and functionality.

The other systems that I’m aware of include:

• DoseEdge by Baxa (previously mentioned by me here in February 2010)
• Pharm-Q In The Hood (ITH) System by Envision Telepharmacy
• ScriptPro SP Central Telepharmacy System

From the PHOCUS Rx website:

PHOCUS Rx is a powerful camera verification system combining hardware and software. It enables pharmacists and technicians to remotely document and validate the preparation of IV drugs. Two ultra compact 5 megapixel cameras are located outside the hood in the clean room ceiling or on articulated arm. Bi-directional communication software enables pharmacists to review high resolution images and validate or send a warning message.

FEATURES

• scalable and modular system
• non invasive – no wires or devices in hood
• server located outside compounding area
• validate and store images
• barcode recognition
• based on client/server structure
• simple workflow screens
• historical and activity reports

One thing that occurred to us during the conversation was that we always seem to ask the same questions, which always results in the same answers.

• How do make a process faster [to free up pharmacist's time]?
• How do we make a process more efficient [to free up pharmacist's time]?
• How do we make a process better [to free up pharmacist's time]?
• Etcetera

As we sat around talking through these questions for the umpteenth time he said something that I thought was very telling. He said that “no one in pharmacy has any vision”. He’s right. Lots of people talk about being innovative, but no one talks about having vision. True innovation is rare, extremely rare. People toss the word around all the time, but most of the “innovation” I see is little more than an incremental improvement on something that already existed. Basically the changes come from answers to the questions above. Vision allows you to see into the future and begin pulling pieces of the puzzle together in a way that will allow you to get there. People with vision are rare. I’ve only met a couple of pharmacy visionaries during my entire career of 15 years.

So what questions should we be asking? Well sit back and I’ll tell you.

• Question 1: Why do we do things this way? – I bet the answers to this question will surprise people. Most processes in pharmacies are rooted in ancient dogma or regularly CYA. I’ve asked this question many, many times during my career, and the most common response is “I’m not sure, we’ve always done it that way.” That’s a terrible answer! Anyone giving that answer should be placed in the corner and forced to wear a pharmacy dunce cap, or a T-shirt that says “Don’t ask me, I have no idea. I just work here”
• Question 2: What should this process look like to keep us out of the loop? – Something truly innovative will ultimately take you, the human, out of the equation. Example: BCMA requires pharmacy personnel to scan medications before reaching the floor where nurses scan the medication prior to giving it to the patient. Makes sense to me for several reasons, but ultimately a drug may be scanned two or three times before reaching a patient. In an ideal situation you would never scan a medication because some system would know what you have in your hand during both the dispensing and administration phase. Only incorrect attempts would be acknowledged. Scanning 100 items 300 times looking for a single error is silly, but that’s how we’ve developed the system. Crud, I think an IV hood should analyze everything you do inside the sterile area and let you know when you’ve done something wrong. Look at all the work being done to make the IV room safer. They’re all wrong. Here’s another thought for you: how many humans do you think touch and/or move a drug before it ultimately reaches the patient? Three? Four? Five? Again, that’s just silly.
• Question 3: How do we get there? –  We’ll have to work backward toward a solution that will ultimately change how we do things. Moving forward with the same process only improves the process, and the process you’re working so diligently to improve may be the wrong one. Chew on that.

Many times I’ve heard people tell me something “will never work” for one reason or another. I hate it when people say that. Reinventing the wheel over and over again does nothing more than give you a better wheel. I want my own personalized transporter sitting in my garage. Star Trek had the right idea, and they thought of the idea in 1966. Pharmacy has yet to have that revolutionary vision we so desperately need, and until we have it we’re stuck in neutral. Just sayin’.

The ZiuZ Inspector:

• Verifies the contents of each unit dose bag by analyzing the size, shape and color of each item
• Takes a photo of each side of the package and saves it for future reference. The images can be viewed with the ZiuZ Viewer pictured below.
• Can handle up to 3600 unit dose bags per hour

Just think, you don’t even have to be at the packaging site to verify the contents of each bag. All you would have to do is use some type of telepharmacy setup. Tech-check-tech anyone?

That’s pretty simple. Sure beats the heck out of counting the tablets by hand. 5…10…15…20….

More information on the Eyecon Pill Counter can be found here.

Pharmacy IV rooms are no longer overlooked when implementing innovative technologies. As pharmacy operations continue to evolve it is becoming clear that IV rooms are starting to receive their due respect. A certain percentage of healthcare systems already utilize some form of technology in the IV room, however the numbers are small. A 2007 ASHP national survey on informatics found that, depending on number of beds, between 9% and 27% of facilities were utilizing some form of device in sterile product preparation¹ (small-volume and large-volume parenterals). It is unknown what technologies these facilities were utilizing at the time of the survey.

Based on information from the 2011 Pharmacy Purchasing & Products survey on the State of Pharmacy Automation, adoption of automation and technology in the IV room remains low. Only 4% of those pharmacies surveyed were using a robotic IV device.² Of those 4% most implementations were in large hospitals. Furthermore, the survey shows that the overall use of robotics in acute care pharmacies is declining. However, that same survey showed increased interest in IV room automation, specifically “workflow management” systems. Approximately 20% of all survey respondents indicated interest in implementing one of these systems, 10% within the next two years.

This was the focus of another recent Pharmacy Purchasing & Products article.³ The article discusses the implementation of IV workflow management tools at two sites within Indiana University Health: Riley Hospital for Children and Bloomington Hospital. According to the article “Prior to adopting IV management tools, [they] employed [a] rather unsophisticated method for processing IV orders common in many hospitals. Labels were printed for individual IV doses or batches three or four times a day and a pharmacist would hand off the labels at the cleanroom pass-through window for a technician to sort by time.” This is common practice in many acute care pharmacy operations.

Indiana University Health determined that their system was outdated and basically unsafe, which led them to search for a viable alternative. Their review resulted in the selection of an IV workflow management system because “such technology could provide the solution [they] needed to bridge the gap between [their] overall bar code scanning protocol and [their]IV dose preparation process.”

Implementation provided Indiana University Health with several advantages over their previously utilized system for IV preparation. Items specifically mentioned in the article include:

• Improved safety through the use of bar code scanning
• Reduced waste
• Expiration tracking for compounded medications
• Standardized method of training and preparation
• ncreased accountability
• Improved data and reporting for medications compounded in the IV room

Overall the technology has been well received and successful at Indiana University Health. The article concludes with “this type of scanning should become the standard of care for all facilities with compounding processes in place.” I agree.

References:
1. Am J Health-Syst Pharm. 2008; 65:2244-64
2. State of Pharmacy Automation, Pharm Purch Prod. 2011
3. Pharm Purch Prod. Nov. 2011, Vol. 8, No. 11

Afterthought: DoseEdge is dominating the workflow management category inside the IV room at the moment. I’ve talked with a lot of pharmacy directors over the past 6 months and they’re either using DoseEdge or evaluating it as an option. I wrote about DoseEdge nearly two years ago here.

Baxa Corporation webinar on “DoseEdge®: Changing Pharmacy Practice Through Workflow Management.” Presented by Dennis Tribble, PharmD, FASHP. Original air date: March 25, 2010

From HealthOneMed’s website (the interactive display of the DAP’s capabilities is cool):

Dispense-a-Pill
HealthOneMed’s Dispense-A-Pill (DAP) Personal Medication Manager addresses the issue of medication non-compliance by integrating the disparate approaches of pill boxes, reminders, pill dispensers and medication alert devices into a single comprehensive device enabled by new technology developed and patented by HealthOneMed.

Click here to download the DAP brochure.

Safety & Security
DAP is unparalleled in its safety capabilities, including its “No-touch” pill organizing, loading and dispensing, advanced medication on demand capability (e.g. for “take as needed” medications), password protection (e.g. caregiver medication instructions not overridden by individual), childproof setting and battery back-up in case of power loss.

Personalization & Connectivity
HealthOneMed is unique in its approach to integrating personalization into the DAP.  Enabling the DAP to record personalized medication reminders (e.g. a granddaughter recording a reminder message, “Grandpa, time to take your medicine”) helps an individual adhere to his medication protocol. FunMinderstm are personalized reminders that can be set for life’s other important activities, errands or appointments. In addition, caregivers can view medication compliance history and be alerted if an individual misses his medication.

Capacity
The DAP is unique as it can manage up to 16 pill and non-pill medications.  The DAP can store and dispense 90+ days of up to 8 different pill medications as well as manage up to 8 additional pill and non-pill medications, including topical creams, liquids, eye drops, inhalers or insulin injections.

Click here to view an interactive display of the DAP’s capabilities.

Click here to view the DAP’s FAQs.

MedVantx, Inc., has announced the deployment of its patent pending Patient Profile™ patient medication and adherence reporting engine across its network of 3,600 high prescribing primary care providers participating in the Company’s integrated program of initial free medication therapy, adherence management and home delivery program. This new program utilizes the Company’s proprietary automated ATM like sample management system (“MedStart™“) and an integrated secure web reporting portal to provide physicians visibility to their patients’ adherence to chronic medication therapy…

The MedStart™ system automates the traditional sampling process for the physician; captures physician sampling data for inclusion in the patients’ claims history medical record and provides consumers access to highly relevant drug and disease state educational materials. Since patients don’t always get prescriptions filled, physicians can enhance adherence by providing their patients with initial therapy and better informational tools to manage their conditions right from the office…

 

Now with the availability of the MedVantx Patient Profile™, physicians are able to view data about how patients, on an individual basis, are complying with their prescribed medication treatments.  By showing exactly when a patient fills prescriptions, physicians can detect late refills, gaps in medication fulfillment, discontinued treatments and more to accurately access and improve patient compliance.

Interesting concept. I often wonder if simply getting rid of chain and grocery store pharmacies, and going back to neighborhood community practices would be the best way to improve patient medication compliance. I’ve worked in chain, grocery store and community pharmacies and have always felt that the small community practice knows their patients best and provides the best patient care when it comes to medication management. Something to think about anyway.

More on the system mentioned above can be found at the MedVantx website.

Abstract
Medication adherence tends to affect the recovery of patients. Patients having poor medication adherence show a worsening of their condition and/or increased complications. Unfortunately, between 20% and 50% of chronic patients are unable to manage their medications. This study proposes a model to improve the patients’ medication compliance by reducing medication frequency.

Published studies have shown that, based on the patients’ lifestyle, simplification of the medication frequency and remodeling of the medication schedule is able to help improve medication adherence. Therefore, this study tried to simplify medication frequency by combining therapies. Moreover, by adjusting according to lifestyle, the study also tries to remodel medication timing in relation to mealtimes to create personal medication schedules.

In this study, we used 19,393,452 outpatient prescriptions from the National Health Insurance Research Database to verify our system (algorithm optimized). At the same time, we examined the differences between the frequency summarized by general public and experts’ advice medication behavior. Compared with the experts’ advice method, this system has reduced the medication frequency in about 49% of prescriptions.

Using combined medication to simplify medication frequency is able to reduce the medication frequency significantly and improve medication adherence. Furthermore, this should also improve patient recovery, reduce drug hazards and result in less drug wastage.

Pharmacies can use PharmASSIST OPTIx in stand-alone mode or integrated with Innovation’s PharmASSIST Symphony® workflow systems, which enables end-to-end prescription tracking, problem management, and reporting. In addition to processing a pharmacy’s countable medications, PharmASSIST OPTIx handles all non-countable products (e.g., ointments/creams, liquids, syringes, inhalers, etc.) for prescription filling and remote verification. The system can also assist pharmacies with physical inventory control.”

It reminds me of a non-cleanroom version of DoseEdge.

Additional automation is needed for it to be a real game changer, but it’s still pretty cool technology. It would be slick if the person filling the prescription never had to touch the product and the end result could be remotely verified.

Product website here.

OPTIx brochure (PDF).