- Shrek Forever After did a cool $70 million last weekend making it #1 at the boxoffice. Here’s my opinion.

- RxCalc got an upgrade this week. I’ll have more to say about that in a future.

- The Student Pharmacist is a website created by a fourth year pharmacy student at Auburn University Harrison School of Pharmacy. The site features “short , concise, daily episodes covering one drug per episode starting with the #1 prescribed drug (Hydrocodone and Acetaminophen) and working towards the #200 prescribed drug.”

Each podcast covers:

• Brand/Generic
• Mechanism of Action
• Indications
• Dosage Forms
• Doses
• Pharmacokinetics
• Black Box Warnings
• Contraindication
• Precautions
• Adverse Drug Reactions
• MAJOR Drug Interactions
• Pregnancy Category/Breast Feeding
• Safety and Efficacy Monitoring
• Major Counseling Points
• Side Notes
• References

This is a great idea. I’m glad to see a budding young pharmacist lending his talent to the profession, not to mention using technology to do it. The introductory episode can be found here.

- I’ve been playing with a new application called springpad. It’s like a miniature version of Evernote, which I use all the time and love. Springpad is available via the web, for the iPhone and for the Andrid OS. It offers a very nice interface and a great way to store items that you want to remember. However, it falls short in a couple of key areas; well, for me anyway. I use Evernote as a way to store and sort journal articles, i.e. lots of PDF files. So far I haven’t been able to duplicate that functionality in springpad.

- RxInformatics: “Sorry Lexi-Comp, but I do not agree with your definition of subscription, nor your idea of digital rights management. You should review some of the more established online content distribution models, such ashttp://www.audible.com/. They charge per year, but you can put the digital content on multiple devices, and it always stays on your computer. The agrument that you are a medical information vendor and Audible is a book vendor won’t fly with me either. Last time I checked both companies sell print and digital versions of their products.” - I think Lexi-Comp provides some of the best drug information in the industry, but they should take a step back and look at their distribution and service model. Read the entire post and you’ll understand why I say that.

- The arrival of the iPad, the impending onslaught of Android and Windows based tablets on the horizon and the slow pace of e-ink development is a perfect storm for the utter demise of the stand alone e-reader. In addition, the continued failure of these devices to catch on at colleges and universities as a replacement for textbooks only makes matters worse. I hope I’m wrong, but I just don’t see it going any other way.

- There are a lot of things in the pharmacy world that interest me and one of those is drug induced rashes; don’t ask why I think it’s neat, I just do. Anyway, there’s a great review article at Medscape Pharmacists on what causes beta-lactam induced rashes (“Why Do Beta-Lactams Cause Rashes?”).  Interesting stuff.

- Gastrointestinal Endoscopy (2010 May 14 [Epub]):  It appears that endoscopy performed via wireless capsule is safe and effective in children as small as 11.5 kg. According to the article, endoscopy by capsule “may be used to identify stenotic disease beyond traditional endoscopic and radiographic reach…across the spectrum of the pediatric population, from infancy to adulthood and with a weight as low as 11.5 kg (25.3 lb).” In addition retrieval of the capsule following the procedure did not appear to pose a significant risk. An example of a wireless capsule used for endoscopy is PillCam.

- Have you ever heard of using colored IV lines to prevent infusion errors? Neither have I. Well there’s a company out there that makes color tinted infusion sets. I went to the company website, but couldn’t find a whole lot of information. You can catch a glimpse of them in this video. I’m not sure I buy into the concept; for a lot of reasons. What do you think?

- There’s an interesting article in the most recent issue of Pharmacotherapy (June 2010) that gives an overview of some of the thinking that goes into making formulary decisions in an acute care setting. “Consideration of patient care and unbiased reviews of the biomedical literature are the cornerstone principles of formulary decision-making.” Notice there’s nothing in there about how nice the drug reps are or how much free stuff they give you. The complete article is available here (PDF).

- Need an extra 7” touchscreen monitor? Well look no further than the new Mino 720-F USB-driven touchscreen. At only $199 I can see mounting one of these bad boys in my office.

- I’ve been reading about Practice Fusion’s free EHR for quite a while. The idea of a free, cloud based electronic health record piques my interest. MEDINNOVATIONBLOG has a great piece on Practice Fusion. The author makes a great point when he states that “… Practice Fusion has adopted and modified the revenue model that has made Google so successful, namely gathering revenues from online advertising and lead generation tied to “free” access by users. It does not require physicians to install new hardware and software, but to off-load what they need in an EHR to the Internet using their existing office computers.” Why can’t we design a pharmacy system like that? The Practice Fusion Corporate Office is only about three hours up the road, which makes me think I need to take a field trip and have the Practice Fusion team give me an in depth look at their application.

- WebWorkerDaily: “When it comes to mobility and collaboration, cloud computing has delivered advances that I already take for granted. Because I primarily work in the cloud, I can access my work from anywhere, using a multitude of devices. This is beneficial beyond just being able to hop between a desktop machine and a laptop. When most of one’s tools live online, switching from PC to Mac (or vice versa) is much less burdensome than it could have been in the past…… Having my work available online makes collaboration far easier than it ever was before. Rather than emailing files to my colleagues and trying (and failing) to keep track of all the different versions, using a tool like Google Docs means I can have one document that everyone can access — it’s even possible to have more than one person editing that document at any one time, if I wish.” – I couldn’t agree more. Following the fresh install of Windows 7 on my Dell tablet I’ve done everything possible to work from the cloud. Of course I still use local desktop applications for a lot of things, but that list continues to shrink.

- How’s this for a compact Bluetooth barcode scanner for the iPhone, iPad and iPod Touch: the KoamTac KDCi. Seriously, the thing is smaller than a deck of cards and only weighs 1.2 ounces. Amazing.

- I have been singing the praises of Pixel Qi LCD technology for nearly a year now and I’m finally fed up and tired of waiting for their screens to appear on the market. I promised myself I would purchase the first netbook, laptop or tablet that hit the streets using their technology, but it’s time to move on. Good-bye Pixel Qi.

Have a great weekend everyone.

The unSUMMIT is billed as a place to get information on barcode point-of-care technology (BPOC), also known as barcode medication administration (BCMA). The promotional material for the unSUMMIT states that “attendees are outfitted with practical tools, insight, and inspiration for leading their institutions to carefully select, implement, and harness the quality-improvement power of BPOC systems.”. I could benefit from that.

Our facility uses barcoding technology in the pharmacy and recently went live on the floor with BCMA. Some of my thoughts on the implementation can be found here. However, the work doesn’t stop after implementation; in fact the workload has increased since going live.

Barcoding technology has been around for a couple of decades, but its use in healthcare is still in its infancy. The scope of barcoding goes beyond patient safety, which has been called into question by some, to encompass inventory tracking and management, medication usage and real-time medication administration data for pharmacists. It’s hard to say whether the technology will ever be the magic bullet everyone wants it to be, but it deserves the same attention we give all technologies that have potential to impact patient care, positively or negatively.

I’m looking forward to hearing the closing keynote by Barbara Olson; Twitterer (@SafetyNurse) , blogger and director of patient safety at HCA. Some other items of interest include the following sessions:

- “Alert, Alert, Alert! Effective Layering of Clinical Decision Support Tools of a Hospital’s Medication Delivery System”

- “Alternatives to Barcodes in Medication Administration – RFID and RTLS”

- “Optimizing Patient Safety Utilizing BPOC Metrics”

- “Intravenous Interoperability: Combining Intelligent Infusion, BPOC, and eMAR”

- “Observation-Based Medication-Error Detection”

- “It’s Not “Sophie’s Choice”: Creating and Sustaining Work Processes That Enhance Medication Safety at the Point of Care.”

The entire list of  unSUMMIT conference sessions can be found here.

To keep everyone up to date on what’s going on I will be using the 140 character gorilla of social media, i.e. Twitter, while at the unSUMMIT along with Susan Carr and Barbara Olson. I’ll be there all week so feel free to follow the action using #unSUM10. Should be a real hoot.

Once you get past the name, the technology is impressive. The most interesting thing about the Swisslog BoxPicker however, is that it is available in dual-temperature and refrigerated models. The “dual-temperature ™ option for BoxPicker allows automated storage and picking of temperature-sensitive drugs requiring refrigeration and room temperature storage within one automated compact unit.” And the “BoxPicker refrigerated option eliminates the need for pharmacy refrigerators and increases security with automated storage and dispensing of refrigerated medications.”

In addition, the BoxPicker is clean room compatible with positive pressure. The pass-through capability is a very nice feature for an automated storage unit featuring refrigeration. It prevents staff from moving in and out of the clean room environment to retrieve equipment or medications necessary for compounding.

According to Swisslog:

BoxPicker, Swisslog’s pharmacy storage and retrieval system, is a cost-effective alternative to vertical carousel storage and retrieval in the hospital pharmacy. BoxPicker provides higher speeds than vertical carousels, averaging 5 picks per minute and up to 200 transactions an hour. A two-workstation configuration allows for simultaneous production. Drug access is secured in the BoxPicker by limiting user access to one medication bin at a time with a single-box access port. The software adds security by tracking inventory and user access. View our BoxPicker Component document for further information and specifications.

A unique single-opening loading feature provides added security by limiting access to the specific items requested using controlled access drawers. Medication and supplies are stored in individual bins on an internal racking system. To load or dispense, an authorized user enters the order using the keypad or barcode; or via interface messages with wholesalers, health information systems, or cabinet replenishment systems.

Features and Benefits
1. Secure and limited access to medications
2. Limits access to one medicine at a time
3. Picks more than 3 bins to 1 when compared to carousels
4. Software tracks inventory, access and interfaces directly with hospital information systems
5. Unique single-opening loading feature reduces wrong location placement

That’s some cool technology for pharmacy.

Having both devices in my possession has given me the perfect opportunity to test them head-to-head to see which setup I prefer. My original plan was to carry the iPhone exclusively for a month or so to see if I could completely replace my DROID. Unfortunately number forwarding only works with calls. Text messages would continue going to my DROID which would create a problem for me as I receive text messages several fold more than I do direct calls. So I have been carrying both devices for the past few weeks.

One thing I’ve realized during this brief experiment is that these devices are primarily ultra-mobile computers first, and a phone second. Apple and Motorola, willing or not, have extended the reach of desktops far and wide. Some people might cringe at the idea, but I find it exciting to be able to do almost anything I want from the comforts of my couch, the coffee shop or while standing in line to get popcorn at the movie theater. These devices don’t force you to work 24/7, but they give you the option to do it if that’s what you chose. I’m like most people, if something interests me I’m likely to spend time on it regardless of where I am. On the other hand if I find something boring or useless I’m much more likely to work on it from the confines of my office. There are only so many hours in the day and why spend them working on stuff you don’t like when you can spend them working on things that are cool.

Speaking of cool, the iPhone is a very slick device. It’s hard not to like it when you pick it up. Regardless of where you are in your technology maturity, infant or aging pro, you can figure out how to use an iPhone in a mater of minutes. Simple things like having the same row of four icons at the bottom of the device regardless of what screen you’re on, or the switch on the side of the device that can be used to quickly silence it, are nice touches. Apple has done a remarkable job with the simplicity of the iPhone. It reminds me of the original Palm Pilot many years ago. The interface just begs to be touched by the end-user. One thing I’ve found to be both a blessing and a curse is the physical design of the iPhone. Its shape and symmetry make it difficult to pick up and start using in the dark. I can’t tell you the times I’ve reached for the device on my dresser in the middle of the night and had to fumble around a bit to find the top of the device. You certainly won’t have that problem with the DROID, it’s a brick with a large, protruding lip at the bottom.

The iPhone integration with Mac computers in stellar; I expected nothing less. It took only a couple of minutes to configure the phone once I plugged it into our main iMac at home. In short order I had moved all my iTunes music, movies, videos, contacts, calendar appointments, and applications onto the device. I forgot how much I enjoyed my iPod Touch, which has been sitting dormant on my dresser since purchasing the DROID. The iPhone is a great entertainment device for listening to music or watching movies. The gaming on the iPhone blows the DROID out of the water, so there’s really no comparison there. Unfortunately all this comes at the expense of battery life.

The DROID is relatively easy to set-up and start using as well, but not quite as easy as the iPhone. The DROID offers more flexibility for customization giving it a leg up on the iPhone for people that like to add a little “flair” their devices. I miss having widgets available on the iPhone. I use a full screen calendar widget on my DROID to keep track of my families activities, and believe me I need it. The DROID also allows one to place shortcuts to almost anything right on the desktop, such as contact phone numbers. I’ve found this very useful for people that I frequently call. There’s no need for me to go into my contacts to find a number. The DROID offers a “favorites” list similar to the iPhone, but even that can take a second to look through. Putting a phone, or text, number right on the main screen offers quick and easy access.

The DROID integration with Google applications is superb. I use Gmail, Google Docs, Google Voice and Google Calendar, as does the rest of my immediate family. Because the device offers such great integration I have access to everyone’s calendar right from the screen of my DROID. And Google Voice is just plain awesome. I really miss these feature when using the iPhone.

The app store for the iPhone is much better than the app store for Android, although the Android market is getting better. All the important pharmacy applications, like Lexi-Comp, a Twitter client, a Facebook client, etc are available in the Android market so that’s all I really care about. I’ve really come to like the Seesmic Twitter client for the DROID. I never thought I would replace the TweetDeck experience I had on my iPod touch, but I’ve come to prefer Seesmic. The one missing app that I would love to have on my DROID is RxCalc, but I suppose that’s my own fault since the developer is my brother. Maybe I can get him to port it to the Android OS.

One thing to note about the Android market versus the Apple app store is that there are several Android based devices and only one iPhone OS. This does make a difference as my DROID runs Android 2.0 which doesn’t always play nice with an application developed for a device running Android 1.5 or 1.6. Once again Apple’s control over their hardware and software is paying dividends.

The iPhone has turned out to be a good device for accessing the pharmacy system via our hospital’s virtual network. The Citrix client for the iPhone is much better than its counterpart for the DROID. I’ve only used Citrix Receiver on the iPhone twice to access the pharmacy system, but it worked and it was certainly better than firing up my laptop.

The screens on the devices are both very good, although the DROID’s indoor viewing is better. However, the iPhone is easily readable in direct sunlight while the DROID screen is not. I spend a fair amount of time walking from building to building at work and never noticed the DROID’s poor screen viewing in direct sunlight until I started using the iPhone. It’s a small thing, but I’ve found myself reaching for the iPhone over the DROID when I’m outside during the day.

Video playback and sound quality are better on the DROID, no question. This includes the earpiece, which I’ve found to be less than stellar on the iPhone. When I have to make a call I prefer using the DROID. This is especially true when you throw in the number of dropped calls I’ve had on the iPhone since I started carrying it. I’ve been with Verizon since February 2000, I called them to check, and I cannot recall dropping as many calls in that ten year span as I’ve dropped in only four weeks of carrying the iPhone. That’s no joke people. I’ve become so frustrated with the dropped calls that’s I’ve stopped using the iPhone as a phone. It has become a way to check email, read tweets, follow-up on text messages, etc, but when I have a choice of device for making a phone call it’s the DROID. Of course this may vary in your area as coverage is different for everyone, but for me it’s been pretty spotty.

The iPhone’s onscreen keyboard is much better than the DROID. I can type pretty well on it. I don’t have particularly large hands, but they’re certainly not small either. The onscreen keyboard for the DROID feels sluggish to me now that I’ve been using the iPhone. The best onscreen keyboard I’ve used, however, belongs to the BlackBerry Storm 2. I love that keyboard. I wish I could put the Android OS on the Storm 2. One thing I found extremely frustrating on the iPhone is that not all applications allow use of the large horizontal keyboard. I hate the small vertical keyboard on the iPhone. On the DROID the screen turns horizontal as soon as you open the slider, making it much more user friendly.

The physical keyboard on the DROID is much better than the iPhone. Ok, that’s not really fair because the iPhone doesn’t have a physical keyboard. Anyway, the physical keyboard on the DROID is serviceable, but I’ve found other physical keyboards to be much better. My daughter carries an enV Touch and I’ve found that I prefer that physical keyboard on that device over the one on the DROID. The navigation pad on the DROID’s physical keyboard is a nice feature that I wish the iPhone had.

Once I got used to it I found the copy and paste function on the iPhone to be better than that of the DROID. The DROID offers more copy and paste functionality, but the iPhone offers better onscreen precision when selecting text. Placing the cursor at the proper location is much better with the iPhone secondary to the magnifying glass that pops up. The DROID isn’t as user friendly while using the onscreen keyboard, but sliding the physical keyboard out makes cursor placement on the DROID comparable to the iPhone.

I really thought I would like the multi-touch functionality of the iPhone because I’ve complained about its absence on the DROID. However, I’ve found that being able to double tap the DROID screen to zoom in has turned out to be far better for me than the multi-touch on the iPhone. This is especially true when I’m in applications outside the web browser.

The camera on the DROID generates better images than the camera on the iPhone. The GPS functionality on the DROID is also better than that of the iPhone. The DROID’s integration with Google Maps has been very useful to me. I’ve purchased the Multimedia Station and GPS car mount for my DROID which has added significant value to the device. To my disappointment the iPhone is not compatible with some of the docking stations I use with my iPod nano. This was very frustrating for me as I have a lot of clocks, speakers and stereo adapters for my nano.

Battery life on both devices is average. I can’t get more than a day out of either without a charge. With that said, the DROID is head and shoulders about the iPhone in battery life because it has a swappable battery while the iPhone does not. When the DROID battery is dead simply pop a freshly charge one in it and you’re up and running in 30 seconds. If you let the iPhone battery get away from you then you’ll have to find an outlet. I’ve found this to be an issue while traveling. As an extension of my desktop these devices get heavy use and the poor battery life can certainly be an issue. This becomes an even bigger issue if you start using the iPhone for entertainment, which is too bad because the iPhone is particularly good for passing the time during quiet moments. Don’t even try watching a full length movie on the iPhone and expect to use it for anything else.

The voice search feature on the DROID works great and I wish it was available on the iPhone. Tap the button, speak into the DROID and get a list of everything you’re looking for including literature searches. The other thing I really like about the DROID is the “multi-tasking”. Holding down the home button on the DROID brings up a list of the last six applications you had open. This works great for me as I frequently bounce back and forth between emails, text messages and websites. I’m sure I’m not the only one that’s forgotten what they were trying to reference and had to go back for a second look. This lack of functionality on the iPhone cost me a few times during the first week of use because I kept trying to do the same thing with disastrous results.

The DROID offers much better email, twitter and text notification than the iPhone. The notification bar at the top of the DROID and the little light in the upper right hand corner of the device is awesome; blinking blue for @JFahrni mention in Twitter, solid blue for text message, blinking green for email, etc. It’s a small feature, but very useful. Depending on where you have your application icons on the iPhone you may have to move around a little bit to find what you’re looking for.

Final thoughts
I’ve really enjoyed using both these devices over the past four weeks. They both offer incredible flexibility and functionality, but they are not interchangeable. My initial impression was that you could use either device without missing a beat. Not true. I’ve found that I prefer the iPhone for certain things and the DROID for others. The iPhone is certainly more user friendly and polished, while the DROID’s Android 2.0 operating system feels a little immature and clunky next to the iPhone. The DROID offers more customizable options, while the iPhone offers a better gaming experience and far more applications.

The big thing for me has been the poor coverage offered by AT&T in my area and the DROID’s better ear piece quality. I mean, really, when you want to make a call on your mobile smartphone shouldn’t you be able to. In addition, the integration with Google makes the DROID ideal for me and my family.

If the iPhone ever makes its way to the Verizon network I’ll give it another look. For now I’ll stick with the DROID and make due with the iPad that I have on order.

The current pharmacy practice model is more than 3 decades old and is sorely in need of an overhaul. Of course the changes will represent not only the services pharmacists provide and how pharmacists participate in patient care and safety, but also how to best utilize technology to accomplish the ultimate goal; a better pharmacy practice model.

The most recent PPMI newsletter gives us a glimpse of some forward thinking pharmacy practices including the University of Kentucky Medical Center. I’ve always had great respect for the UK College of Pharmacy as they usually rank high in the list of top pharmacy schools in the U.S. Of course UCSF is usually #1, but that’s to be expected (sorry had to do it).

Anyway, the practice spotlight on UK can be found here (PDF). There are some great pearls of wisdom in the article, but my interest is mainly on the technology. “The technology that provides the most support to our practice model is an integrated electronic medical record (EMR). At our hospital, we utilize a pharmacy software program that integrates patients’ EMR with computerized physician order entry (CPOE), electronic medication administration records (eMAR), lab and diagnostic test results, and clinical documentation information. This allows our pharmacists to utilize computer system to enter orders, verify and dispense medications, as well as monitor, evaluate, and revise medication therapy. Our pharmacy also utilizes an automated dispensing machine (ADM) system in which 80% of adult medications and 60% of pediatric medications are available immediately through the profiled ADM system.” The combination of an EMR, eMAR and CPOE can only be found in a small percentage of hospitals across this great nation of ours, and UK is one of them. This is a great example of what other healthcare facilities should be doing.

If you get a chance make sure to stop by the PPMI website and take the poll on “which technologic enhancement do you feel will most advance the role of pharmacists in providing direct patient care?”

Rule #1: “That’s what the computer told me to do” simply isn’t justification for doing something that makes no sense. Computers are dumb. They do what we tell them, albeit very well, but they don’t think independently from the human operating them. It’s ok to question the decision made by technology if it doesn’t make sense clinically or logically. Drug errors occur for many reasons. And as humans we make mistakes and healthcare professionals are not exempt. Technology can be used as an additional barrier between a potential mistake and the patient; however pharmacists and nurses should not decrease their vigilance at any point in the medication distribution and administration process secondary to new technology.

Rule #2: technology implementation should not complicate your process. A complicated process is one that is destined to lead to frustration and create opportunities for mistake. Take advantage of technology to streamline a process. Create a better workflow, not a more cumbersome one.

I think the two things mentioned above are simple common sense, but somehow they get overlooked all the time. Just a thought.

Based on the video of PASS Rx in action, the entire process looks quick and easy. Information on the medication, including the NDC number, is scanned into the system via bar code. The medication is then loaded into the device, the user presses the start button and the results are returned in just a few seconds. Positive identification results in a green ribbon at the top of the PASS Rx screen that reads “Verified”. Failure to verify the medication results in a flashing red screen and audible alert; pretty simple.

I don’t know what the process is when the drug you want to verify is not available for cross reference, nor do I know how many drug entities are stored in the Centice database. The company website only states that “Centice’s robust proprietary database consists of the most commonly dispensed drugs and is updated frequently with the most current drug information which includes new branded drugs, generics and customer initiated requests in the PASS Rx system.”

Overall I think the PASS Rx system is some pretty cool pharmacy technology.

Features

Proven technology offers efficient analysis, peace of mind and an efficient workflow

The PASS Rx system enhances patient safety by offering full molecular analyses of the majority of tablets and capsules (brand and generic) in your everyday workflow – rapidly and accurately. This advanced pharmaceutical verification system can be easily implemented to enhance pharmacists’ resources and their current quality control processes.

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• SMALL TABLETOP INSTRUMENT
  • Uses minimal space in a cramped pharmacy
• EASY TO IMPLEMENT
  • 3 easy steps
  • Measures through the capped vial
  • Fits seamlessly into workflow
  • Complements existing technology
  • Accepts most vial types and sizes
  • Rapid time to result
  • Can be used with technician, RPh or both
• PRODUCT SPECS
  • Majority of tablets and capsules analyzed with spectroscopy and machine vision
  • All drugs in your workflow are covered
  • Valuable information provided with each scan
  • Rapid response time
  • 17.12L x 8.5W x 17.25H

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Ask any pharmacist that’s been around for a while and they’ll tell you about the headaches associated with faxed medication orders. I can’t tell you how inefficient a fax machine can be for order retrieval, storage and sorting. In fact, fax machines really can’t do any of that. Well, you no longer have to deal with fax machines in the pharmacy if you chose not to.

Pharmacy, or physician, order management systems like OmniLinkRx offer a software only solution designed to reduce the influx of faxed orders to the pharmacy. Not only do systems like this reduce confusion, they also reduce paper waste. I suppose that makes OmniLinkRx “green”. Consider OmniLinkRx a digital fax machine that sends the order to your computer monitor instead of a fax machine.

According to the OmniLinkRx datasheet (PDF):

“OmniLinkRx runs on a standard server with user access via workstations using Microsoft Windows Internet Explorer. Orders may be sent via analog fax and/or digital sending devices. Nurses simply place the physician order into the sending device and indicate STAT or routine. The scanned document image is sent to the OmniLinkRx server where it is immediately viewable by pharmacy for order entry. The orders can be viewed remotely.

Nurses may view the orders sent to pharmacy at any internet enabled PC and/or at Omnicell Color Touch cabinets. Nurses are able to view the status of the order to allow them to know when to expect new medications. “

Some of the features that I like about OmniLinkRx are that it is web-based, it creates an audit trail based on user annotation, it offers pre-defined and customer generated stamps, it creates bar code association of the order to the patient and it can automatically associate the patient’s name to the order based on an OmniLinkRx to ADT system interface.

The one thing I don’t like is that the OnmiLinkRx technical specifications state “Web-based application, requiring Microsoft Windows Internet Explorer 7.0 Web browser.” While I appreciate the web-based part, I would like the option to use other browsers. It may still work in other browsers like Firefox and Google Chrome, then again it might not. If you’re savvy enough you can use one of the plugins for Firefox or Google Chrome that allows you to run a native IE window inside the browser, but most IT departments frown on this type of freedom.

Overall pharmacy order management systems like OmniLinkRx offer a great advantage to acute care pharmacies. They’re especially useful with a dual monitor set-up with the pharmacy information system up on one monitor and the order management system up on the other.

With proper use this technology can decrease turn-around time, allow easier order management and create a easy method to search for and locate orders already processed. Believe me, it’s much easier to search through electronic document files than it is to rummage through 400 paper faxes.

Other pharmacy order management systems:

• POMS from Integrated Informatics
• Pyxis Connect from Care Fusion
• Siemens EDM
• InterChange from AmerisourceBergen

The portal is well designed, relatively easy to navigate and was well received by the user group meeting at ASHP Midyear. Areas of the portal include access to technical support, general product information, ordering consumable products, a blog from the company’s CEO, and probable one of the more useful things, a customer community where users can get together and bounce ideas off each other and talk about how to best use Talyst automation.

Communities of similar minded people are always helpful; look no further than the explosion of social media use among healthcare professionals as testimony to the fact. I’ve found the Siemens Listserv to be much more beneficial than the actual documentation for our Siemens Pharmacy System so I’m looking forward to diving into the Talyst Customer Portal as a way to get ideas on how to improve the use of our systems. Remember, there’s always someone smarter, more experienced and better prepared than you, and those are the people you want to hang around with.

The system is designed to flow something like this:

- IV medication orders entered by the pharmacist, or other healthcare professional, are sent to the DoseEdge system where they appear on the DoseEdge touchscreen.
- When the technician, or pharmacist in some cases, accesses the order via the touchscreen instructions for preparation of the product are displayed.
- The product label is generated.
- The barcode on each injectable ingredient used for the preparation of the IV product is scanned to ensure the correct medications have been selected. Items identified as incorrect result in an audible message of “product not allowed for this dose.”
- The barcode on the IV product label generated by the pharmacy is scanned to ensure that ingredients are appropriately matched.
- Each ingredient is drawn into a syringe.
- An image of the syringe with appropriately drawn medication is taken for review by the pharmacist, or technician, whichever the case may be. This is a nice feature as it allows one to see the actual amount of drug drawn into the syringe prior to shooting it into the fluid bag.
- Ingredients are injected into the fluid bag and an image of the final product is taken.
- A final scan of the product barcode is done to complete the fill.

While not as advanced as a system like Robotic IV Automatoin (RIVA) DoseEdge offers some nice features. When followed as designed, the chances of making a mistake are limited by the barcode scanning and the photo image of the medications drawn to the appropriate dose. A syringe drawn to the inappropriate dose could easily get rejected during review of the image taken during compounding.

An additional benefit of a system like this would be the possibility to perform remote checking, via tele-pharmacy, for hospitals with limited pharmacy presence such as critical access hospitals. In addition a system such as this could potentially be used when pharmacists are unable to reach a location for unforeseen circumstances such as inclement weather or natural disaster.

Overall I like the idea behind the process and look forward to seeing the system in person sometime.

The DoseEdge website offers an interesting video of system and information on a DoseEdge road show and webinar can be found here.

Update:

The following is a comment regarding DoseEdge left at RxInformatics where this blog was cross posted:

There’s more…

Submitted by DATdoc on Fri, 02/12/2010 – 05:26.

I must first disclose that I work for the company that makes Dose Edge and am credited with being its inventor. The following is offered solely to round out the description of the product (in no particular order):

1) Transactions within the system are logged in detail making it practical to assess performance metrics on an ongoing basis, as well as to log actual fluctuations in work flow.

2) The software offers a feature called “scan events” that allow a site to create markers for events of interest in the life cycle of a dose and then track the progress of doses through those events using bar code scanning. While the value here is most obvious for the tracking of delivery of doses to patient care areas, consider other applications such as tracking returns, or creating destruction manifests (required in some states for hazardous materials).

3) Since bar code scanning is required to verify the ingredients in each dose, the NDC code of the actual drug used for each dose is recorded and available for reporting and billing.

4) The software automatically performs volume calculations based on the product scanned in by the user.

5) If the volume needed is below a site-defined threshold, and a more dilute product is available, the software prompts the user to use the more dilute product.

6) The software supports a function called “kitting” that permits a pharmacy that keeps everything outside of the clean room to assemble everything needed for a group of doses (including all the labels) into a kit (with bar code scanning of the component drug containers) that can then be passed into the clean room (or into a barrier isolator).

7) The product is offered on an SaaS model at a per-dose price; the data are ultimately kept at a hosting site that is SAS70 compliant, but are stored locally on a database cache as well to ensure continued operation even if internet connectivity is lost or bandwidth drops.

8) The procedures associated with preparation of specific drug products as well as the dose preparation procedures can be customized per drug.

9) Pharmacist checking is performed on-line using the pictures taken during preparation.

10) Doses reach the system through a print capture process that is field configurable.

11) Data are stored perpetually; pictures and original label capture images are purged after 90 days, but additional retention can be arranged at an additional per-dose price.

12) The formulary comes with information not ordinarily found in a commercial database, including the amount of diluent required for reconstitution (where applicable) and the concentration of the product, the permitted diluents, and a table of known stabilities at various concentrations, various storage conditions, and in various diluents.

13) There is a formulary update process that permits a user to download changes, select the changes to implement in their system, and then implement them at their leisure.