Sterile compounding optimization during COVID-19

From January 2020 until March of 2022, I was one of two inpatient pharmacy supervisors at Community Regional Medical Center (CRMC) in Fresno, California. CRMC is a big level one trauma center. They have about every imaginable service, minus only bone marrow and solid-organ transplants. The pharmacy is large and busy. The size and complexity of the place generated plenty of opportunities to make changes, test out new processes, and work through complicated patient care issues. 

Thinking back, you will note that COVID-19 was in full swing during my time at CRMC, especially during late 2020 and throughout 2021. The fallout from the virus created some interesting problems for pharmacy, namely supply chain issues and increased patient acuity, resulting in increased workload. One particularly troublesome issue was the strain that COVID-19 put on CRMC’s sterile compounding service. The inability to get product, combined with increased demand for certain types of infusions, wreaked havoc on the department.

In response, our team did some interesting things to simplify, streamline, and improve IV production during this time. The work was some of the best I had ever done. I felt so good about it that I thought others might like to review the process. I thought someone might be able to learn from our successes and failures. So, along with a couple of colleagues, I decided to write what I thought would be a publishable article. Turns out there’s a reason I started a blog more than a decade ago instead of trying to push information through mainstream publications.  

The article manuscript was uploaded to the AJHP portal and sat for quite some time. Once the review process began, it wasn’t long before it was summarily rejected. Not “hey, fix these things and we’ll publish it”. Nope, a straightforward “we regret to inform you…”. Apparently, the information wasn’t worth publishing. Some of the comments received from reviewers were valid, and worth consideration, but others were quite silly. Someday, I might post the reviewer comments here just to see what others think. However, right now I’m irritated, so it doesn’t seem like a great idea.  

Overall, I found the reviewers comments lacking in basic understanding of what goes on day-to-day in a large inpatient pharmacy. Some of the comments — “What type of inventory adjustment occurred when usage patterns changed?” – had me scratching my head. Had these folks ever worked in a real pharmacy? I mean, adjusting inventory isn’t rocket science. Ask yourself what happens when your family starts going through two gallons of milk every week instead of one. You buy more milk. Or, for empty nesters like me and my wife, when you hardly ever need milk anymore, you only buy it when you need it. Common sense, people. Common sense.

Anyway, my original intent for the article was to disseminate information to those that might find it useful. So, for those people, I’m including it here in its entirety, warts and all. With that said, the article is written in a more formal tone than my normal writing, which honestly makes it more difficult to fully understand. All told, the necessary information is probably a 1-page weblog. Regardless, I hope you get something out of it. Happy reading.  

Oh, one thing that I think is important but got left out of the article is how manual the processes were that we used to improve our sterile compounding. Shocking, really. My love of technology and automation offered no benefit here. Healthcare – and by association pharmacy – is so disjointed and fragmented that I quickly abandoned any attempt to automate this project. Simple, manual tasks continue to rule the day.

Sterile product optimization during the SARS-CoV-2 pandemic at a large academic medical center pharmacy

Remdesivir, the pharmacy budget buster

I saw the discussion below in one of the pharmacy forums. Fact check true on this one.

Gilead would have everyone believe that remdesivir is a magic bullet for COVID-19 infection. Not true. Helpful? Useful tool? Maybe.

Remdesivir, while potentially beneficial, has limitations. For one, it should only be used on hospitalized patients that have falling oxygen saturation and chest infiltrates. Second, while it has been shown to potentially shorten the course of the disease, it has not been shown to reduce mortality.(1)

On the flipside, the drug is relatively expensive, has been overused, and contrary to data showing that it may shorten the course of the disease, may inadvertently lengthen hospital stays.

Based on the “Solidarity” trial, a WHO guideline committee went as far as to recommend against the use of remdesivir.(2)

“The Solidarity Trial published interim results on 15 October 2020. It found that all 4 treatments evaluated (remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon) had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalized patients… So far, only corticosteroids have been proven effective against severe and critical COVID-19. [see RECOVERY trial (3)]… The researchers determined the evidence quality to be low for remdesivir in regard to improving time to clinical improvement, hospitalization duration and mechanical ventilation duration.”

However, you won’t find physicians touting this particular WHO recommendation. Why not? Simply put, it doesn’t fit the narrative put forward by Gilead and the media. Nor does the WHO recommendation give practitioners access to this new therapeutic toy. A combination of marketing and fear has led to remdesivir rapidly evolving into “best practice”. It is basically spreading through hospitals unchecked.

But Jerry, no hospital could have predicted the pandemic and therefor the cost of remdesivir. True. However, if remdesivir truly cut hospital stays by a couple of days and reduced time on mechanical ventilation, the cost of the drug would be a wash. I have not seen any large-scale data to support this notion. As of today, hospitals have spent millions upon millions of dollars on remdesivir. Not to mention that there are reports of providers prolonging patient stays to complete remdesivir treatment courses even when patients have met criteria for discharge. Such practice spits in the face of common sense.

But Jerry, even if it saves one life it will have been worth it. Ah yes, the battle cry of people who want something done, regardless of the consequences. Such sentiment seems reasonable on the surface, but quickly fades with analysis and thought. A philosophical debate for another time. Suffice it to say that real life doesn’t work that way.  

Overall, the unfettered use of remdesivir, combined with failure of healthcare to provide clear, concise, science-based use criteria, has created a budget pitfall that will take years to climb out of, if at all. It’s this type of fiscal irresponsibility that makes the U.S. healthcare system so special.

———-

  1. Healio.com. 2021. Remdesivir shortens time to improvement, but has no significant mortality effect. [online] Available at: <https://www.healio.com/news/primary-care/20210331/remdesivir-shortens-time-to-improvement-but-has-no-significant-mortality-effect> [Accessed 29 April 2021].
  2. Who.int. 2021. “Solidarity” clinical trial for COVID-19 treatments. [online] Available at: <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments> [Accessed 30 April 2021].
  3. New England Journal of Medicine, 2021. Dexamethasone in Hospitalized Patients with Covid-19. 384(8), pp.693-704.

Chapter 8: First things first

Several years ago, shortly after I was let go from Talyst, I found myself with some free time on my hands. I started writing a book. The book was titled ‘Making the right choice: Helping pharmacies make smart decisions about automation and technology’. Like many books I’ve started, it remains unfinished. I don’t think I’ve touched it since 2016. At least that’s the date I have listed as the last time I edited it. However, I recently had reason to go back and review some things I included in the book. Kind of a retrospective review of advice to myself.

Specifically, I was interested in my thoughts on putting together a project team and managing a project. And there, in Chapter 8: First things first, I found what I was looking for. Some of the information is outdated, specifically the final page called Cautionary Tale**, but overall the information still rings true. 

Here it is, Chapter 8 in it’s draft form. Maybe one day I’ll get around to finishing the book. One never can tell.

Chapter 8: First things first

“You can do anything…but before you can do anything, you have to do something.” — Clifford Cohen

You can’t get to the end of a project if you never start, and getting started can often seem like the most difficult part of any project. I can’t pinpoint why it’s so hard to get started, but it is. Perhaps it’s fear of the unknown, or unwillingness to move away from comfort zones. Or maybe it’s because we don’t want to do the work. Who knows? The only thing I know for sure is that once the ball gets rolling, no matter how slowly, it always seems to roll forward. The key is to stop putting it off and get started.

With that said, it’s important that one is truly ready to move forward. Understanding the reason(s) for doing something is key. Seems simple, but it might surprise you to learn how often people do things without understanding why. Begin the process with eyes wide open. Never do anything simply for the sake of doing something.

One must be able to justify all projects, regardless of their purpose. Simply put, the project must worthwhile, viable and affordable, bring a reasonable return on investment (ROI), and be within acceptable tolerances and risks.

Ask yourself these three questions:

  • What do I hope to accomplish?
  • Does the technology make sense?
  • Does the technology fit my operations

If you’ve answered the above questions to everyone’s satisfaction, it’s time to get busy. 

Below are the things that I think are important to ensuring a successful technology implementation in a pharmacy. While it may seem like a lot of work, the end result will be worth the time and energy.

Gauge user beliefs and feeling. Is it going to be an uphill battle? Are the pharmacists and technicians open to the idea of implementing new technology? Is the pharmacy morale where it should be? Does your department fear change? The success of your implementation will rely heavily on how well you and your department are prepared. The implementation of new technology can often pose a threat of reduced control over one’s work. This can create pushback from the staff. Helping them understand what it is you hope to accomplish, how it will help them, and offering opportunities for staff to become involved and have a vested interest in the project can go a long way to ensuring a successful implementation.

Get support / buy-in for the project. The need for support for any project is a must, and this is especially true for pharmacy projects. Success depends on support from the top of the organization to the bottom. Lack of support will result in a failure to launch. If and when possible, it is best to start with an executive sponsor, or someone from the Hospital Board of Directors, if you have one. This person, or persons, will be your champion during high-level meetings within the organization.

Once you have executive level support, it’s time to consider support from other areas. If the project will impact nurses, find a nurse. If a physician, find a physician. And, so on. You don’t want to launch a project that will impact a group of people without getting their support. Trust me, it’s not a good idea. Call it politics if you must, but peer-to-peer communication works wonders. Having support from a variety of areas and disciplines will improve communication and go a long way in generating support for a project.

Create a buzz. Create some excitement. Don’t act like the project is required, but rather a choice that’s going to make things better.

Give everyone fair warning of what you plan to do. People fear change. Give them plenty of time to get used to the idea. This will go a long way in gaining support for a project. Being aware of what’s coming is always preferable to being surprised by what has already been done.

Involvement and participation. When individuals believe that a project is relevant, they are much more likely to have a positive attitude toward it. And the best way to get individuals to believe is to get them involved. Allow them to participate in all phases of the project. “Increasing user participation … enhances post-development user involvement and attitude” (Vaughan PJ. System implementation success factors; it’s not just the technology. Internal Report of Information Technology Services. University of Colorado at Boulder. 2000), which is what you want. 

Involve as many as you can as often as often as you can. When people are involved, it gives them a sense of ownership and a vested interest in making a project successful. It also helps deal with negative vibes from others. Include multiple disciplines, depending on the technology and departments affected.

It is also important that all participants be volunteers. Mandated participation has been shown to be ineffective and potentially detrimental to the success of this type of project.  (Hunton, James E., and Jesse D. Beeler. “Effects of User Participation In Systems Development: A Longitudinal Field Experiment”. MIS Quarterly 21.4 (1997): 359. Web. 8 Apr. 2016.)

Champions. Champions are those people that go above and beyond the general participant. Champions believe in the project and the benefits it will provide. They can often have a contagious zeal about the project, and are sometimes referred to as “evangelists”, or in extreme cases “zealots”. Whatever you call them, when it comes to implementing new technology in the pharmacy, Champions can be your best source of support. They can be useful in putting a spotlight on the project in a positive way and swaying the negative feelings of others.  

Finding Champions shouldn’t be too difficult. They’re usually early adopters and will take the initiative to learn more about a project without being asked. 

Develop rules for participation. This is really quite simple. It is important that the rules for participation be laid out well in advance, and that each member of the team sign off on them. There should be no surprises for what’s expected from participants once the project is underway. The following rules are examples:

  • Be willing and able to engage in the project
  • Be willing to be positive about the project
  • Be willing to work with others to advance the project toward accomplishing the goal
  • Be willing to commit to attending meetings
  • Be willing to commit to handling extra work, even if it means staying late or doing some reading at home in the evenings or on weekends. I understand that no one wants to put in a bunch of unpaid overtime on these projects. However, on occasion, a little extra work may need to be done to keep things moving forward. One should enter into participation with the understanding that this could happen.
  • Be willing be engage in every aspect of the project, not only the items that are assigned. It is vitally important that each participant have at least a basic understanding of the overall scope of the project and what each member of the team is assigned. Things happen. People get sick, quit their jobs, move to another state, and so on. Unforeseen events should not completely derail the project timeline or goals.

Find naysayers and sway them over to your side. Every project has its opposition. As the saying goes, you can’t please everyone all the time. Unfortunately, naysayers tend to have vocal personalities. They’re not afraid to say what’s on their mind. These two things – being negative and outspoken – tend to go hand-in-hand. The downside to naysayers is that outwardly negative comments about a project have a way of spreading like wildfire. They can be caustic, seeping into the minds of even the staunchest supporter. And once there, negative thoughts can grow like a cancer. With that said, naysayers and their negative comments have their place. Because they’re not afraid to speak up, they can sometimes point out things that others fail to see, helping avoid potential pitfalls. The trick is to use the information to your advantage. Allow naysayers to offer up their thoughts in a controlled environment where their comments can be contained. Give them space to vent. Listen to what they have to say. Use what you can and toss the rest. Showing naysayers that you’re willing to listen and take their concerns seriously can go a long way. In rare cases, you might even make a convert out of one, which would be a huge victory for the project. However, never try to force change on a naysayer. Forcing change, or mandating them to join your side, rarely works. It’s like dealing with a donkey, the harder you pull, the harder they resist.

Build your team. According to Harvard Business Review’s (HBR’s) 10 Must Reads On Emotional Intelligence[(HBR’s 10 Must Reads On Emotional Intelligence. Print.), a source of great team success lies with teams that can achieve high levels of participation, cooperation, and collaboration among members. Sounds logical, but oh so difficult to do.

Note: HBR’s 10 Must Reads On Emotional Intelligence is a great collection of previously written articles pulled together into a single book. Each article is informative and interesting in its own right. However, when combined, they create a great collection that any person involved in a project should read. I highly recommend it. It’s a short book and an easy read.

Team members must be chosen carefully and meet three basic conditions:

  1. Mutual trust of one another
  2. Have a sense of group identity: a feeling that they belong and the project is worthwhile
  3. Have a sense of group efficiency: belief that the team can perform well and that the group is better than the individual members.

Collectively, HBR refers to this as the groups “emotional intelligence” (EI). While intelligence and experience among group members is important, EI may be more important still. Keep that in mind when you begin building your project team.

Chose a project leader. Ah, the leader. The captain. Thy person in charge. It’s a burden that many well qualified individuals shy away from. Someone has to be in charge. Someone has to be given authority over the group and be willing to make the tough decisions and hold people accountable.

Not everyone is cut out to be a leader. Everyone reading this has worked for both great and terrible leaders. While I cannot tell you exactly how to identify a great leader, I know one when I see one.

According to HBR’s 10 Must Reads On Emotional Intelligence what distinguishes good leaders from great ones is their EI. For individuals, EI is “a group of five skills that enable the best leaders to maximize their own and their followers’ performance”.

The EI skills are:

  • Empathy
  • Motivation
  • Self-regulation: controlling negative impulses [side note: this is really hard to do, especially during high-stress times]
  • Self-awareness: knowing strengths and weaknesses
  • Social skill: being able to build a rapport with others to get desired results {side note: especially tough if you’re a natural introvert]

Find yourself a project manager. As ridiculous as this may sound, the project manager is an often overlooked position when discussing project teams. Let me go on record now as saying that a good project manager is absolutely vital to the success of any project, and could arguably be considered the linchpin to the success of the entire project.

It is the job of the project manager to manage all aspects of the project, including the scope, timeline, cost, quality, and people. They apply their knowledge, skills, tools, and techniques to help projects be successful.

“The role of the project manager is that of an enabler. Her job is to help the team get the work completed, to “run interference” for them, to get scare resources that they need, and to buffer them from outside forces that would disrupt the work.” (Lewis, James P. Fundamentals Of Project Management. New York: American Management Association, 2007. Print.)

Things to consider when selecting a project manager:

  1. The person must have leadership qualities, have good self-management and time management skills, and be a taskmaster.
  2. The project manager cannot serve two masters. Individuals that serve as a project manager must not be required to do any of the actual work in the project. According to James Lewis, “as team sizes increase, it becomes impossible to work and manage both [the work and the team], because you are constantly being pulled away from the work by the needs of your team members”. Having project managers attempt to manage the project and perform work in the project is a recipe for disaster.
  3. The person must have a proven track record. We all know people that can’t manage the paper piles in their office much less a multi-faceted project requiring meticulous attention to detail.

I encourage everyone involved in a large project to read a book or two on project management. Being a project manager is not as easy as it sounds and should be given the respect it deserves.


**Cautionary Tale. Since drafting this section of the book, I have been involved in another amazing project. One that had me working with large teams to remodel or construct new pharmacy cleanrooms for several hospitals. The project spanned well over a year and was simply incredible.


Saturday morning coffee [September 23 2017]

“It is better to be hated for what you are than to be loved for what you are not.” ― André Gide

So much happens each and every week, and 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…

It’ reigned supreme at the box office for a second week in a row, bringing its total domestic gross to nearly $220 million. Not bad for a movie I will never see. I’ve never understood the human psyche that drives people to want to be scared. The world is scary enough already, and it’s free.

Speaking of movies, earlier this week my wife and I threw our hard-earned money at American Assassin. It wasn’t a bad movie, but it’s probably not something you’d want to pay full price for either. Michael Keaton is one of the co-stars. He plays an ex-Navy Seal that’s now used by the CIA to train covert spies, i.e. assassins. I swear there was one point in the movie where his character was going off the deep end a bit and all I could think was Beetlejuice.

Los Angeles Times: “A state pharmacy inspector made a surprising discovery last year while conducting a routine records review at a Westside facility that compounded drugs for patients at UCLA medical centers…More than 1,000 IV bags of sterile medications for heart patients and others with serious health issues had been made with expired and potentially dangerous ingredients, according to state Board of Pharmacy records.” Oops. The list of expired items included monosodium glutamate monohydrate (MSG) and monosodium aspartate monohydrate (MSA), clopidogrel, mexiletine, and estradiol. The dates on those drugs ranged from November 2015 to September 2016, a month before the inspection. While there is no excuse for using expired medications, it’s likely that no harm would come from it. In fact, the FDA has recently started to question the expiration date practice of drug manufacturers.

Looks like a theme park ride, although I doubt the people on the station platform were having much fun:

I was in San Diego last weekend to celebrate my daughter’s birthday. While there, we visited a local mall where Amazon was showcasing the Smart Life Roadshow. Basically a trailer with all kinds of smart appliances connected to the Amazon Alexa. It was pretty cool. I have both an Amazon Alexa and a Google Home. The Alexa resides in my living room and the Google Home in my kitchen. They are similar in many ways, but I prefer the Google Home. My wife, on the other hand, seems to use Alexa more. Just goes to show that there’s a place for all these smart devices. The only thing I find creepy is that they are always listening.

My wife drives a 2017 Dodge Charger. Nice car. During our trip to San Diego, I had an opportunity to spend a lot of time behind the wheel using Android Auto, which is built into the Charger. Super nice setup. With my phone connected to the car, I was able to do all the things I normally do on my phone via voice control: navigation, look for places to eat or get gas, ask questions, play music via Google Music or Spotify, and so on. Not to mention I was able to use the giant touchscreen in the middle of the dash to do the same. It was cool. Something I’ll definitely look for when I finally decide to replace my truck.

I found myself using the term eutectic at work this week. “A eutectic mixture is defined as a mixture of two or more components which usually do not interact to form a new chemical compound but, which at certain ratios, inhibit the crystallization process of one another resulting in a system having a lower melting point than either of the components [1]. Eutectic mixtures, can be formed between Active Pharmaceutical Ingredients (APIs), between APIs and excipient or between excipient; thereby providing a vast scope for its applications in pharmaceutical industry. Eutectic mixture formation is usually, governed by following factors: (a) the components must be miscible in liquid state and mostly immiscible in solid state [1], (b) Intimate contact between eutectic forming materials is necessary for contact induced melting point depression [2], (c) the components should have chemical groups that can interact to form physical bonds such has intermolecular hydrogen bonding etc., (d) the molecules which are in accordance to modified VantHoff’s equation can form eutectic mixtures [3].” (source: Journal of Developing Drugs)

Anyone remember Hostess Zingers? I was having a conversation with one of my colleagues this week, and she told me that she had never heard of a Zinger. Those little raspberry cakes of gold are a solid childhood memory for me. Are they no longer a thing? Does that mean I’ve outlived my usefulness because I’m out of touch? Heck no! It means I need to buy her a box of Zingers.

Engadget: “Researchers at BYU have introduced a non-interfering solution: A nanofoam cushioning that measures impacts in real-time… The foam can be inserted in helmets and padding to track collisions via electrical signals and wirelessly send the data to tablets and devices held by coaching staff on the sidelines. It’s designed to operate quickly, too, informing coaches how hard a player has been hit — and whether they’re at risk of a concussion and should be pulled off the field.” – Pretty cool.

And just for the heck of it, let us all watch how balls of steel are made….

Have a great weekend, everyone.

Saturday morning coffee [September 2 2017]

Why do you look at the speck of sawdust in your brother’s eye and pay no attention to the plank in your own eye?” — Matthew 7:3 (NIV)

So much happens each and every week, and 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 Hitman’s Bodyguard was #1 at the box office last weekend, making it two in a row. It’s a decent movie. Not as funny as one might think, or hope. My wife and I both thought the same thing, Ryan Reynolds playing Deadpool without the costume.

Speaking of movies, this Summer hasn’t been kind to the Hollywood bottom line. From the New York Post: “Heading into the next-to-last weekend of the summer movie season, the US box office was running 13.4 percent below last summer, according to comScore.” Take it from someone that likes watching movies on the big screen, this summer has indeed been lackluster. The Mummy wasn’t very good. Transformers 5 was bad. Planet of the Apes was too dark and depressing. Atomic Blonde had some awesome fight scenes, but was otherwise meh. Dark Tower made me look at my watch and wonder “how long is this thing”. And the above mentioned Hitman’s Bodyguard was just ok. Wonder Woman was the cream of the crop, leaps and bounds better than any other movie this summer. It makes me desperate for Justice League.

Lest we forget just how powerful Mother Nature can be, Houston, Tx is literally under water following Hurricane Harvey.

Alabama is sitting pretty at #1 in this year’s first preseason Top 25. And there they will sit until someone knocks them off. I think it’s going to be a great year for college football. As for the NFL, not so much. I’ve lost almost all interest in the NFL. I haven’t watched a single pre-season quarter.

The NSAS Flickr site has some pretty cool images from the eclipse.

It appears that “banana bags” are no longer the treatment of choice for management of alcohol-associated vitamin and electrolyte deficiencies. Go figure. The practice of using banana bags has been called into question secondary to time to infuse, cost:benefit, etc. “Based on the published literature, for patients with a chronic alcohol use disorder admitted to the ICU with symptoms that may mimic or mask Wernicke’s encephalopathy, we suggest abandoning the banana bag [in favor of different therapy].” — Flannery A, Adkins D, Cook A. Unpeeling the Evidence for the Banana Bag. Critical Care Medicine. 2016;44(8):1545-1552. doi:10.1097/ccm.0000000000001659.

Calcium Gluconate is the calcium salt of gluconic acid, an oxidation product of glucose. It’s commonly used in healthcare, even more so now that Calcium Chloride is hard to get. The 10% solution, pictured below, is supersaturated and stabilized by the addition of calcium saccharate tetrahydrate. The problem is that supersaturated solutions are prone to precipitation. I was basically unaware of the problem until I found this bottle. I Tweeted about it and received multiple responses indicating that “it happens all the time”. In my 20 years, I don’t recall ever seeing this before. Some propose that it’s the warm California weather that prevents it from happening. Maybe.

In the wake of what went down in Charlottesville, some groups were kicked off the internet. For example, Cloudflare Inc., an internet security service, cut ties with the neo-Nazi website the Daily Stormer. While everyone seems to agree that these people are aholes, I think we’re getting into some pretty dangerous territory. Even Cloudflare’s CEO, Matthew Prince thinks so, and he’s the one who pulled the plug on Daily Stormer. According to Prince he “Literally… woke up in a bad mood and decided someone shouldn’t be allowed on the internet. No one should have that power”. He’s right, no one should have that power. Everyone believes in the right to free speech and having their own opinion until someone else’s opinion doesn’t agree with their own. At that point rational thought goes right out the window. Whether I disagree with Daily Stormer’s views is irrelevant. I have no idea what their views are. I’ve never been to their site. I am not a neo-Nazi nor do I believe in their cause, at all. Until the Charlottesville incident I had never even heard of them. However, that’s not the point. What if someone woke up one day and decided I shouldn’t be allowed on the internet because of my views? That’s some scary stuff right there. Think about it.

There’s an interesting article at Ars Technica about the slippery slope we’re on with internet censorship.  

Android Authority: “The official Android 8.0 release is here: Android Oreo officially arrived Monday August 21 during the solar eclipse. The over-the-air (OTA) update began rolling out immediately to supported Pixel and Nexus devices and factory images were posted on the Android Developers’ site the same day.” – Android 8.0 – Orea – will include the following new features: Picture-in-picture, Notification dots, simplified autofill framework to simplify how users set up a new device and synchronize passwords, system optimizations and background limits, auto-sizing textview, adaptive icons, shortcut pinning, and a few things under the hood that are over my head. My wife’s Pixel XL received the update a couple of days ago. I’m jealous. 

The Essential Phone is finally available, sort of.  While I appreciate the engineering that went into the device — and it is beautiful — the reviews have all said the same thing, it’s a beautiful phone that’s not quite up to par in certain key areas.  Not to mention, the company has suffered from shipping problems and at least one email slip up. As much as I link new toys, there’s just nothing there to entice me.

IFA 2017 is going on in Berlin as we speak. I love reading about all the cool stuff that shows up at IFA each and every year. In years where I’m thinking about buying a new laptop — like this year — I typically wait to see what drops at IFA before making a decision.

The Samsung Note 8 was recently announced. My Note 5 was the best smartphone on the market when I bought it, and it still kicks butt. From what I’ve seen and read, the Note 8 is better in almost every way, with a couple of minor exceptions. It looks like Samsung has the best smartphone on the planet, again. For your reading pleasure: 10 Reasons you’ll love the Note 8. 

Chrome Unboxed: Chrome Tip To Help Those Who Use Lots Of Tabs: “Take your files app, for instance: you can hold CTRL and select multiple items or hold SHIFT and select a range of items with just a couple clicks….That’s right, you can hold CTRL and select multiple tabs. After this, you can grab any of the selected tabs and move them around as a group. Likewise, if you click one tab, hold SHIFT, and then click another tab, all the tabs between are selected and can be moved as a group.” – I’m a longtime user of Chrome and had never heard of this tip before. Very useful. 

Speaking of Chromebooks, I’m thinking about giving them another try. Even after my recent failure, I’m still drawn to them. This time around it’ll be either a Samsung Chromebook Plus or Asus Chromebook Flip C302, I think.The Samsung Chromebook Plus has the edge, but the stupid thing doesn’t have a backlit keyboard. Then again, I’ll wait until IFA is over before making any decisions. 

I continue to be amazed by the quality of images captured by smartphones. The image below was taken with my two-year old Samsung Galaxy Note 5 while out walking my dogs. 

Have a great weekend, everyone.

The Future of Pharmacy: Using Technology to Drive Practice Change [presentation]

Below is the presentation that I gave at Health Connect Partners 2016 in Chicago, IL. I’ve had a few requests to publish the slides so I uploaded them to SlideShare. With that said, I have issues with SlideShare like the loss of animations, timed transitions, and a couple of minor formatting problems.

If you would like to view the presentation as it was meant to be viewed, you may do so here at the Microsoft Mix site. However, there is a log-in wall. I would have preferred that it not be there, but it is. The choice was to require a log-in to view or allow the presentation to be listed as Creative Commons. I am not prepared to do that. So, if you happen to have a Microsoft account – Hotmail, outlook, Office 365, etc – or you prefer to sign in with Google of Facebook, you will be able to view the presentation as it was intended, including the two embedded videos. However, if that’s not your thing, feel free to view it below or directly on the SlideShare site realizing that it’s missing some of its pizzazz.

Enjoy!

Saturday morning coffee [August 8 2015]

Power is like being a lady… if you have to tell people you are, you aren’t.” – Margaret Thatcher

The mug below comes from Six Flags Magic Mountain down in Valencia, California. If you like roller coasters, then this is the place for you. They have some of the best in the business, and my kids love to ride them. We used to go down there a few times a year, but haven’t had the opportunity in a while. It was nice to have a little reckless fun for a change. One of the longtime landmark rides at Magic Mountain was the Colossus, billed as the tallest and fastest wooden roller coaster in the world. Something happened in 2014 and Six Flags did some major work on the coaster. It’s no longer the wooden beast it was, but rather a hybrid wood and steel roller coaster called Twisted Colossus. The new ride features barrel roll inversions, and a near-vertical drop. And when I say near-vertical drop, I mean near vertical. It got my heat racing. Should have brought the GoPro.

Twisted Colossus MUG
Continue reading Saturday morning coffee [August 8 2015]

FDA approves first 3D printed drug

This was all over the web yesterday, so I’m not telling you anything you don’t already know, but this is huge. 3D printing is one of those technologies that has the potential to disrupt just about every industry it touches. It’s not often that you can say that. The most recent technologies that I can think of that had that kind of impact was the explosion of smartphones and tablets, which are now ubiquitous across every industry you can imagine.

SPRITAM

Continue reading FDA approves first 3D printed drug

JerryFahrni.com Podcast #3: Semi-automated IV Workflow Management Systems

Show Notes:
Host: Jerry Fahnri

New Equipment:
Blue Microphones Yeti USB Microphone – Blackout Edition
Dragonpad Pop Filter

IVWFM systems discussed:
APOTECAps1
BD Cato
DoseEdge
EPIC Dispense Prep2
i.v.SOFT
IVTrac1
Meditech1,2
PharmQ-ITH – No longer available. IP sold to BD
Phocus Rx
PyxisPrep – No longer available. Killed following acquisition by BD
RxADMIX1
ScriptPro
Verification

  1. I have not reviewed these systems in a live environment, i.e. non-beta customer site. I have had a live demo of IVTrac.
  2. These systems are part of an already existing EHR platform, i.e. they are not standalone

Saturday morning coffee [August 1 2015]

“True humility is not thinking less of yourself; it is thinking of yourself less.” ― C.S. Lewis,

So much happens each and every week, and 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…

MUG_SMC
Continue reading Saturday morning coffee [August 1 2015]