I recommended that we use the pharmacy specific lingo, but I was told no because it wasn’t the industry standard. I found that quite interesting because we build products for pharmacy, i.e. that is the industry we’re in. However, the terminology used for this particular process is different outside the pharmacy world. Still with me? Good.

So, the question becomes does one conform to the terminology in the market segment you’re in, i.e. pharmacy, or do you ignore the pharmacy terminology and go with the “standard”? My gut reaction would be to go with the standard – after all I preach standardization all the time – however, if one does that you end up talking to pharmacy people that have no idea what you mean. You know, everyone has that deer in the headlights look with everyone standing around wondering what the heck is going on. And to top it off, no one asks for clarification because they’re afraid it might make them look stupid. We’ve all been there. I know I have.

So, based on what I just said above I think you have to conform to the industry you’re in. In other words, use the pharmacy terminology, standard or not.

One thing is for certain, if you’re waiting for the right moment, the moment will never come. Decisions don’t need to be right or wrong, they simply need to be made. Heaven forbid you make a bad call on something. I seriously doubt anyone has gone through life mistake free. If you never make a mistake you’re not trying hard enough in my opinion. Heck, I’d go as far as to say that some of the most valuable lessons I’ve learned have been from my failures. Sure, the failures sting a little, but that’s what helps one learn from the process.

I believe fear is the cornerstone of indecisiveness; fear of making the wrong decision. Choosing to not make a decision is, in itself, a decision. Unfortunately it’s a decision that people repeat time and time again without learning from the mistake of not choosing. The only way to learn to make good decisions is through the experience gained from making bad decisions. Kind of a circular argument, I know. Go figure.

According to Albert  Camus “life is the sum of all your choices.” So what does that say about your life if you don’t make any decisions? Not much.

As Staff Sergeant Nantz so eloquently put it in the movie Battle Los Angeles, “You can go right. You can go left. I don’t give a damn. Just make a decision”.

I Googled “epatient”, and here’s what I found: “e-Patients are health consumers who use the Internet to gather information about a medical condition of particular interest to them, and who use electronic communication tools in coping with medical conditions The term encompasses both those who seek online guidance for their own ailments and the friends and family members who go online on their behalf. e-Patients report two effects of their online health research: “better health information and services, and different (but not always better) relationships with their doctors.”” This definition comes from Wikipedia. I’m not a big fan of Wikipedia, but in this case it seems appropriate.

Here are some thoughts on the e-patient movement:

• It assumes free time – If you don’t already have a working knowledge of the heathcare system, diagnoses, use of medications, etc, then it can take you quite a bit of time to figure it out. Many families have their hands full trying to make a living and survive in this crazy world without having to worry about whether or not they’re getting proper care.
• Assumes access to information – Information on disease states and treatment options is found online, in journals and books, long discussions with your healthcare provider, etc.
• Assumes intelligence – Is it wrong to assume that the “average” person may not have the skill set necessary to keep up with their own health care? Some of this stuff gets complicated. Healthcare providers spend years in school plus years of training to do this stuff. If the average person can effectively manage their care, why the heck are we spending all this time, energy and money on training doctors, nurses and pharmacists? Shouldn’t the system be designed for the lowest common denominator? This isn’t a shot at those without PhD’s, it’s a legitimate concern. I consider myself a fairly intelligent guy, but I don’t think I’d try to build a nuclear submarine from some manuals and an internet search. Know what I mean?
• Assumes access to not only computers, but the internet – My girls go to school with kids that don’t have a computer at home, much less access to the internet. Don’t even get me started on the idea behind mHealth.
• Creates more silos; those that have the time, energy and resources to make sure they’re getting good care, and those that don’t. Many sick people simply want to be taken care of, and I think that is appropriate. We’re not fixing a car, we’re fixing people.

It’s always good to be an active participant in your care, but it shouldn’t reach a point where the care becomes substandard if you can’t. What if the e-patient becomes the “normal” patient? Will those that can’t manage their own health fall through the cracks and receive worse care? Probably. I’ve already experienced this while working closely with chronically ill family members; some with end-stage diseases. If you stay on top of things you get better care. If not, you receive worse care.

Should we really be developing a system that encourages people to provide their own care because it’s better than the care the system provides, or should we build a system that provides better care for every patient? With available resources we can’t do both. Build a better healthcare system. Think about it.

My mother has been doing well since here liver transplant earlier this year, but was recently admitted to a local emergency department with some complications. She was immediately transferred to UCSF where her liver transplant team is. I received the call telling me as much late Thursday night. I couldn’t get any information Thursday night and her life was not in danger so I waited until Friday morning to try to get more details on the situation.

I tried calling my mom’s room directly on Friday morning, but no one answered so I called the nurses station and was told I couldn’t speak with her nurse because they don’t take phone calls between 8:00 – 10:00am. I understand that. It’s prime time for medication distribution on the units and they try to minimize interruptions to prevent medication errors. I get it. Makes sense. However, all I needed to know was what was going on, what they’re doing and what I need to do on my end. I didn’t need her nurse to provide me with the information I needed. They ever so politely told me to call back after 10:00am. Needless to say I was irritated.

Fast forward to 10:00am. I got ahold of the nurse only to be told that she couldn’t tell me anything secondary to patient privacy. Hey, I get it, but I am her son and my name is all over her chart, her durable power of attorney, her medical records, her super secret list of people in the know, etc. Heck, I even set up the password for family members to get updates on her condition when she was there for her transplant. The nurse wouldn’t budge.

My mood went from irritated to pissed. I wanted to reach through the phone and slap the nurse upside the head. I’m several hours away, my mom is in the hospital and I can’t find out what’s going on. After handing up I redialed my mom’s room and eventually reached her. She was tired, in quite a bit of pain and loopy from the meds; not the right person to be giving me information over the phone. While my mom is an intelligent woman she’s not the one that should be answering my questions and being interrogated about tests and procedures. Fortunately she was doing better, but ia am still unclear about the nature of the problem.

According to the UCSF Medical Center website they “define quality as”:

• Superior care and outcomes
• Outstanding patient safety
• Excellent service and patient satisfaction

I think they nailed the first two things on their list, but failed miserably with the third. This is one time when doing the right thing took a backseat to meeting regulatory compliance. In other words, the patient wasn’t the primary focus of the care, the rules were.

And before you privacy and safety nuts start foaming at the mouth consider this: I am the primary decision maker for my mom’s medical care for the past several years; her medical records say as much, at no point did I ask them to risk her safety and all they had to do was check their records to know that they can tell me anything.

I’ve given UCSF the benefit of the doubt many times because I love the university and the medical center, but not this time. This time they get an epic fail.

2011 brought many new and exciting changes not only in my personal life, but in the world of pharmacy and technology as well. I’ve learned many new things, gained some new skills, made some new friends, explored the world of pharmacy more deeply, traveled more than ever before and discovered that I once again know nothing. I am excited to see what 2012 has to bring.

Below is a list of opinions I’ve gathered over the past 12 months. Some are pharmacy related, some are technology related, some are personal, and some are just random thoughts. If you don’t agree with my opinions that’s fine, but I don’t want to hear about it. On the other hand if you have something useful to add please feel free to leave a comment.

• 2011 was the year I took a hiatus from blogging, got bored, came back
• 2011 was the year my wife and kids bought me a Barnes & Noble Nook Color and I rooted it; makes a great Android tablet.
• 2011 was the year that I learned you have to be a jerk to be successful. I don’t need to be successful that badly. Just sayin’.
• 2011 was the year I completely divorced myself from Apple. I moved my music to the Amazon Music Player first and then to Google Music, and threw my iPod in a drawer. I haven’t missed it.
• 2011 was the year I bought my first suite, and it was about as fun as a prostate exam.
• 2011 was the year the online tech pundits became little more than sounding boards for Apple. Even my favorite tech bloggers in 2010 have become little more than sheep.
  2011 was the year I realized that people basically don’t want to think for themselves anymore.
• 2011 was the year Christina Aguilera screwed up the National Anthem at the Super Bowl. Nothing could have been more disgraceful.

• 2011 was the year that Android took a giant leap forward.
• 2011 was the year of patent trolling.
• 2011 was the year that form overcame function and that’s a real shame.
• 2011 was a year in which mobile became more than a smartphone.
• 2011 was the year of infographics. Still not sure what value they hold, but they’re everywhere, and they’re pretty cool.
• 2011 was the year in which healthcare may have become the most regulated industry in the world. Don’t believe me? Spend some time in a hospital chasing down all the departments, people and forms needed to keep up with all the regulatory garbage.
• 2011 was the year when everyone finally realized a unified EHR wasn’t going to be easy.
• 2011 was the year that my family and I saw 49 50 movies in the theater.
• 2011 was the year that RIM and BlackBerry died (just you wait and see)
• Best idea in healthcare in 2011 – An integrated healthcare solution (same as last year)
• Worst idea for healthcare – Accountable Care Organizations (ACOs)
• Most overused words in healthcare 2011 – mHealth, ACO and meaningful use
• Best pharmacy conference/meeting attended in 2011 – ASHP Conference for Leaders in Health-System Pharmacy in Chicago, Illinois, October 17-18.
• Best ideas in pharmacy that hava yet to mature – Clinical Decision Support (CDS), PPMI and tech-check-tech
• Best drug information resource, hardcopy – Lexi-Comp Drug Information Handbook
• Best drug information resource, handheld/electronic – Lexi-Comp Lexi-Drugs
• Best pharmacokinetics calculator, handheld/electronic – RxCalc for the iPhone, of course
• Best medical reference, electronic/web based – UpToDate (includes access to Lexi-Drugs, online version)
• Best automated dispensing cabinet technology – Omnicell. With that said, Pyxis (CareFusion) appears to have noticed Omnicell’s push and is finally doing some innovative things once again.
• Most active area of pharmacy automation/technology in 2011 – IV room stuff, specifically “IV Workflow Managment”. 
• Best IV Room Workflow Management system – DoseEdge by Baxa
• Biggest story in pharmacy 2011 – Drug shortages. It goes without saying that drug shortages are a real problem that are not only frustrating, but are affecting patient care as well.
• Most underutilized thing in pharmacy in 2011 – Data. Data rules people. We need to learn how collect it, analyze it, group it and use it.
• Healthcare technology in 2011 that’s poised to leap forward – Teleprescence – telepharmacy, telemedicine, etc.
• Most over-utilized thing in pharmacy in 2011 – Warnings/alerts. When is it going to end?
• Technology with most potential for healthcare that absolutely no one is talking about – Near Field Communication (NFC)
• Coolest piece of healthcare technology I saw in 2011 – IV Check by SEA Medical
• Coolest piece of consumer technology I saw in 2011 - ReRFIDgerator. Seriously, someone needs to make one of these for use in healthcare.
• Weakest link in health information technology – Standardization and interoperability (no one wants to play with the other guy and everyone wants to do it “their way”)
• Best “throw away” pharmacy journal/magazine in 2011 – Pharmacy Purchasing & Products. This journal/magazine is the best source for pharmacy technology related information out there at the moment.
• Best pharmacy organization in 2011 – American Society of Health-System Pharmacists (ASHP)
• Best pharmacy automation and technology mind in pharmacy in 2011 – Dennis Tribble
• Best pharmacy IV room mind in pharmacy in 2011 – Eric Kastango
• Best social media mind in pharmacy in 2011 – Kevin Clauson
• Thing I missed most professionally in 2011 – Access to primary medical literature
• Things I should have done more of in 2011 – Blogged. I hope to get back to it in 2012
• “Old” technology that’s finally starting to take off – “Cloud computing”
• Most useful data gathering device in 2011 – Pen and paper, or pencil and paper; the choice is yours. The plethora of tablets hitting the market have yet to replace good old pen and paper for note taking.
• Speaking of pens. The best pen on the market – Uni-ball Jetstream RT pen. I started using these as a pharmacy student and have yet to find anything better.
• Most overused piece of mobile technology – BlueTooth headsets. You people look like morons.
• Funniest commercials I saw in 2011:
  1. GEICO Smartphone, dumb things – “Is the gentleman with the BroStache invited to this party?“
  2. Allstate Mayhem Blind Spot – “You’re good”

• Most over-hyped death of 2011 – Steve Jobs. A man died, and that is tragic and sad, but c’mon, really?
• Worst thing to happen to innovation and advancement in 2011 – Patent trolling.  Companies are doing everything in their power to slow competition via the courts instead of in the market. 
• Dumbest move by a company in 2011 – HP dumped the Touchpad….and eventually the webOS. Fools. What a shame, it was a beautiful operating system with tons of potential. However, I was able to grab a TouchPads in the fire sale, so good for me. I like the tablet hardware and OS, but the lack of applications for it is rough.
• Best movie I saw in 2011 in the theater – This is a tough one for me because we saw so many movies, but I’m going to go with Battle Las Angeles.
• Best movie I saw in 2011 honorable mention – Harry Potter and the Deathly Hallows Part 2. For those of you that know me you know that I am not a Harry Potter fan, but the movie was well done, exciting and most of all it entertained me. I would see it again.
• Worst movie I saw in 2011 in the theater – Season of the Witch. Nick Cage just keeps getting worse.
• Weirdest movie I saw in 2011 in the theater – Drive
• #1 Movie at the box office in 2011 – Harry Potter and the Deathly Hallows Part 2. Interesting that the #1 grossing movie in 2011 made less than the #1 grossing movie in 2010 and 2009. In addition it sold fewer tickets than any of the #1 box office hits in the last decade. What does that tell us? Probably nothing, but it is interesting nonetheless.
• Best online movie service – Still Netflix
• Best place to get a pizza – Pizzeria Uno, Chicago, Illinois. “Real” Chicago pizza according to my friend. It’s nothing like California pizza to be sure. Regardless it’s incredible. Now I know where the phrase “pizza pie” came from.
• Best place to kill time while on the road – Microsoft Retail Store, Bellevue, WA. I enjoy being able to lay my hands on all the different Windows 7 laptops and tablet PCs. It makes me smile :-)
• Best new thing in social media in 2011 - Google+ (pronounced “Google Plus”)
• Worst thing in social media in 2011 – Checking in everywhere you go and applications that post photos like Instagram. Well, I suppose it’s not Instagram itself rather it’s how people use it. Do you really need to post 500 pictures of your cat or dog napping, or the food you’re about ready to consume, or the beer bottles you’ve collected during your drinking binge? Seriously people, get a life. 
• Best social media platform in 2011 – Twitter. Sorry Facebook, but I just don’t like you that much.
• Best desktop Twitter Client – no idea, don’t use one
• Best Web-based Twitter Client – Silver Bird (Google Chrome extension)
• Best Google Chrome extensions, from left to right:

1. Silver Bird – My favorite Twitter Client when working on my laptop(s)
2. Tweet Button – Self explanatory.
3. SGPlus – Allows me to post to Twitter and Facebook from within a Google+ post. It’s not perfect, but it’s the best I’ve found so far.
4. Session Buddy – Saves my current Google Chrome Session so if anything happens I can easily re-open all my previously open tabs
5. Readability Redux – Gets rid of a lot of the fluff on a web page, making it easier to read.
6. Diigo Web Highlighter – Allows me to bookmark a web page, annotate it, highlight it, share it, etc. It’s pretty handy
7. Evernote Web Clipper – The most valuable Chrome extension ever made. Allows me to clip part or all of any web page I’m on, tag it and send it to Evernote.
8. TabCloud – Similar to Session Buddy, but the info is saved in the cloud. I can retrieve my session from any machine. Why even use Session Buddy? I like the UI better and I’ve been using it longer.
9. Awesome Screenshot – Allows me to capture all or part of a webpage and turn it into a JPG, along with some other cool features.
10. ScribeFire – A full-featured blog editor from within Google Chrome. It works with all my existing blog platforms: Windows Live, Tumblr, Posterous, Blogger, etc.
11. XMarks – Cloud-based bookmark extension. I had to find an alternative after Google decided to scrap Google Bookmarks.

• Best mobile Twitter Client for Android – Official Twitter app for Android
• Best email client – GMail
• Best decision(s) by Google this year – Google+ and the Samsung Galaxy Nexus
• Worst decision by Google this year – Getting rid of Google Bookmarks. That really pissed me off.
• Best thing that happened in the NFL in 2011 – They settled the holdout before it impacted the season.
• Worst thing in the NFL in 2011 – The holdout because it makes them all look like greedy bastards, and the new rules. The NFL continues to dilute the game. I can barely recognize the game I played and loved as a boy. It’s more about entertainment now than anything else, and that’s sad.
• Lamest penalty in the NFL – Pass interference. It’s the only penalty in the world that has the potential to be worth the entire length of the field; it’s a spot foul.
• Dumbest penalties in the NFL – The ridiculously stringent rules surrounding hits on quarterbacks and wide receivers. Dear Comissioner Goddell, please consider putting flags on them, it would make things a whole lot less confusing for the rest of us.
• Most amazing play I saw in the NFL in 2011 – Jerome Simpson Front Flip Touchdown against my beloved Arizona Cardinals

• Best rookie in the NFL 2011 – A.J. Green, WR, Cincinnati Bengals. This kid is a game changer. Honorable mention: Andy Dalton, QB, Cincinnati Bengals and DeMarco Murray, RB, Dallas Cowboys. I know, I know, where’s Cam Newton? I’m not talking about fantasy football here. The numbers don’t mean anything to me. It’s all about the “W’s”.
• Most polarizing figure in the NFL in 2011 – Tim Tebow. I will admit here and now that I’ve flopped on Tebow. I didn’t like him in collage. I said he was overrated and would fail miserably in the NFL. I was wrong, and somewhere along the way, despite my best efforts, I started pulling for the guy. Perhaps it’s the fact that “the experts” say he can’t succeed in the NFL because he’s not a prototypical QD. Well, we all know that “the experts” are pretty much a bunch of sheep; they all say the same thing. Maybe it’s time for someone to shake up the NFL.
• Biggest surprise team in the NFL in 2011 – The SF 49ers. Who would have thought a coaching change would have made that big a difference.
• Biggest disappointment in the NFL in 2011 – The Indianapolis Colts. Yikes!
• Biggest scandal in college football in 2011 – Take your pick: Ohio state, Syracuse, University of Miami? With that said the worst thing to hit college football in the history of the sport had to be the Penn State scandal, hands down.
• Worst thing in professional sports 2011 – The NBA lockout.  The NBA already has a bad reputation of catering to a bunch of spoiled, rich thugs. All the lockout did was reinforce that idea. I’m not a big fan of the NBA, and all this did was make me go from a casual fan to no fan at all. I won’t be watching an NBA game anytime soon.
• Biggest surprise in pro sports – The World Series. First time in recent memory that it I felt any interest at all in watching MLB. The sport was almost dead. Perhaps this was enough to resurrect it.
• Best in sports talk radio – The Herd with Colin Cowherd (ESPN). I think Cowherd rambles on at times, but at least he rambles on about sports.
• Worst in sports talk radio – The Dan Patrick Show. Honorable mention Mike and Mike.
• Best new TV series – Suits
• TV series that used to be good, but turned to crap in 2011 – Burn Notice and The Closer. It’s the beginning of the end for both. The storyline for Burn Notice is getting old and I find myself rooting for the bad guys in The Closer because the main character has become such a self-righteous witch.
• Best traveling companion other than my wife and family in 2011 – SiriusXM Satellite Radio. Why? Because the stations are always the same, no matter where I go: 84-ESPN Radio, 85-ESPN Xtra, 86-Mad Dog Radio, 88-SiriusXM NFL Radio.
• Coolest thing I did at work in 2011 – AutoPharm Mobile (it’s my first product)
• Best trip for work – Europe: Amsterdam; Paris, France; Düsseldorf and Cologne Germany
• Worst trip for work – Overnight trip to Las Vegas
• Best thing about being a PM – Visiting “customers”, i.e. getting paid to talk with other pharmacists
• Worst thing about being a PM – Tons of useless paperwork. Honorable mentions: 1) having to prove that an idea can make money before it’s deemed a “good idea”. 2) having to put on a suite and tie.
• Best mobile operating system – Android. Honorable mention, Windows Phone 7 (Mango)
• Best Android Tablet – Asus Transformer. I suspect the Transformer Prime will be better, but I haven’t actually seen one to be sure. The original Transformer tablet is a great device, and the keyboard docking station only makes it that much better.
• Best new Windows 7 Slate – Samsung Series 7 11.6-inch Slate.
• Best new rugged tablet – Panasonic Toughpad. I would really like to get my hands on one of these. I like the idea of being able to use a slate tablet on the road without worrying about pampering it.
• Biggest impact from a new tablet device – The Kindle Fire. It made waves.
• Best new Windows 7 convertible tablet – Nothing here to report. 2011 will go down in history as the year of the slate tablet to be sure. I miss the keyboard revolution. To all you great computer makers – Lenovo, Dell, Samsung, HP – please bring the keyboard back to tablets, whether as a convertible machine or as a docking station similar to the Asus Transformer.
• Best not-exactly-computer-related technology of the year - Wacom Inkling
• Best e-reader – Amazon Kindle DX. E-Ink is still the best screen type for reading.
• Most amazing piece of technology that no one is talking about – Microsoft Kinect for the Xbox 360. Some of the things that have been done with this technology is amazing, but all-in-all you don’t really hear that much about it. 
• Best synching solution across multiple computers – Sugarsync
• Best “cloud” based back up solution – Sugarsync
• Most indispensable piece of software on a tablet PC – Microsoft OneNote
• Best PDF editor – PDF Annotator
• Best screen capture utility – FastStone capture. I believe Version 5 is still freeware and is absolutely indispensable. I use it multiple times everyday
• Best information collection tool I used in 2011 – Evernote. I couldn’t live without it. It’s so valuable, and I use it so often, that I pay for the premium version
• Best application used to temporarily-park-content-you-intend-to-read-later in 2011 –  Read it Later. Read it Later works better on my smartphone than Evernote. I can’t clip an entire webpage to Evernote on my smartphone, but I can send it to Read it Later.
• Best new smartphone – Samsung Galaxy Nexus. I have one. It’s my first new smartphone in almost three years. Suffice it to say that it is simply spectacular.
• Technology I’d like to see manufacturers work on the most in 2012 – Battery technology. The functionality, processors, screen technology, etc has outpaced smartphone batteries. It’s an issue.
• Favorite family trip 2011 – There were two trips that stick out in my mind this year: 1) My family and I drove to Oregon in July to attend my niece’s wedding. We spend five days near Eugene. We had a great time. 2) In early August my family and I spent two weeks running around Washington State. During that time we ventured into Idaho and Montana and took the kids into Northern Washington to visit Forks and La Push (of course we had to do this because of the Twilight books and movies). Both trips were awesome. They each generated enough good memories for a lifetime.
• Favorite family trip 2011 honorable mention – Disney World. My daughter’s competitive cheer team qualified for “Worlds“, a world-wide cheerleading championship, and it was held at Disney World in April 2011. 
• Coolest barcode scanner I used in 2011 – KoamTac KDC300
• Best RSS reader – Google reader. With that said, the idea of an RSS reader is beginning to fade as social media platforms like Twitter and Google+ take shape.
• Best mobile news reader – Google Currents and Pulse. I like Google Currents better on my smartphone and Pulse on my tablet.
• Worst “improvement” to web-based system – What Google did to Google Reader and GMail. I don’t like the “new look”
• Best desktop OS – Windows 7. Looking forward to Windows 8
• Best desktop office suite – Still MS Office
• Best cloud-based office suite – Google Docs
• Best “desktop” browser – Google Chrome. I don’t even have Firefox on my machine anymore
• Best cloud music storage/player – Google Music. Honorable mention goes to Amazon Music Player.
• Favorite technology blog/website 2011 – Engadget
• Favorite medical technology blog/website 2011 – Medgadget. I love this site. 
• Honorable mention for healthcare technology blog/website 2011 – DirkMD – Free CMIO Perspective
• Favorite mobile technology blog/website 2011 – GottaBeMobile
• Favorite medical mobile technology blog/website 2011 – FierceMobileHealthcare
• Favorite website for videos and short presentations about cool stuff 2011 – TED
• Favorite website for great science stuff 2011 – sciencebase. David Bradley has created a great site that I enjoy immensely. I loved chemistry and other science long before I became a pharmacist and this site satisfies my ever present curiosity. 
• Best new pharmacy informatics blog/website 2011 – rxINFORMATICA
• Most interesting pharmacy blog/website 2011 – The Cynical Pharmacist
• Best place to order technology not available in the US – Dynamism.com
• Best online retailer – Amazon.com
• Best airline I used in 2011 – Icelandair. I flew to Europe on Icelandair for work and they were great.
• Worst airline – Oie! That’s a bit more difficult than the best airline. They’re all pretty bad, but I think American takes the cake.
• Worst idea by and airline – In flight advertisement, especially this one.
• Best travel experience in 2011 – Received a free upgrade to first class on two occasions. Both were short flights – Denver to Fresno – but it was really cool.
• Worst travel experience in 2011 – Flight was cancelled and I got stranded at SFO; literally stuck in the airport overnight. The experience was pretty lousy as the airline customer support and our company travel agent were about as helpful as a bag full of rocks to a drowning man.   

2011 was an amazing year. I wonder what 2012 will bring? Only time will tell. Happy New Year everyone.

Luke 2:8-11

I have enjoyed compounding throughout various stages of my career. One of the best jobs I ever had was as a compounding pharmacist at a small community pharmacy in San Jose, California. The job was challenging, fun and centered on patient care. For many years I dreamed of having my own compounding pharmacy, but I was never able to make it a reality for numerous reasons. And because of this I was disheartened to read a recent editorial by Dr. Loyd V. Allen, Jr. writing about the lack of compounding content at the recent ASHP Midyear in New Orleans.

In the editorial Dr. Allen writes:

Having just returned from the 2011 ASHP Clinical Midyear Meeting in New Orleans, promoted as the largest gathering of pharmacists in the world, one wonders what the programming committee considers as important topics.

In a year where the number of drugs in short supply exceeds 250, and profiteering rampant among those greedy companies that can purchase and then resell at up to 4000% profit, one wonders why there was no dedicated programming on compounding of drugs in short supply or criteria involved in selecting a compounding pharmacy for outsourcing, both nonsterile and sterile.

Actually, there appeared to be only about 3 posters related to compounding and only one podium presentation. There were untold numbers of sessions on therapeutics, automation, administration and other topics that are covered in detail every year.

With hospitals implementing USP <797> and many actually outsourcing compounding to those pharmacies that can service them, one wonders what is the reason for the lack of programming related to pharmacy compounding. Is it that many pharmacists have not been trained in compounding and realize its importance? Or, they are so busy with distributive, administrative and clinical duties they don’t have time to worry about the drugs that are required for their patients? After all, without the drugs, there is not much need for pharmacists. Or, is it that many consider the highly technical and scientifically based compounding practice can be done by technicians; some of which are good but they do not have the background necessary for formulation, quality assurance, etc. And none have the knowledge base or the responsibility of final approval that a pharmacist has.

It was a very disappointing meeting from the standpoint of educational sessions. There were a significant number of compounding support companies in the exhibit hall and their presence was quite significant. However, to me it seems that there is a disconnect between ASHP programming and the critical needs of patients for their pharmaceuticals.

The profession, she’s a changin’.

The ASHP Midyear 2011 Conference basically concluded for me today. I’d like to evaluate the meeting, but honestly have very little to say. This was my first year working in the role of Product Manager for a vendor, and not acting as an “attendee”, i.e I was here for work. The conference took on an entirely different feel this year as I wasn’t able to attend any of the sessions. For the most part I was stuck in the company booth playing the role of demo jockey. It was a strange feeling to say the least. I tried to follow the Twitter stream (#ashpmidyear) a bit, but finally relented and gave up.

I ran into a few old friends that came by the booth to mock me. It was good to talk pharmacy for a while here and there, but it was far and few between. I would have liked to seen and talked with more colleagues and friends, but it wasn’t meant to be. I wonder why I didn’t see more familiar faces in the exhibit area? Hmm.

Anyway, I found a few minutes here and there to wonder the exhibitor area and check things out, but nothing like previous years. The exhibitor area used to be one of my favorite places to be as it’s typically full of all kinds of cool automation, technology and new ideas.

Some vendors were worth visiting such as Omnicell, CareFusion, Baxa and Healthcare Logistics (HCL). Those were really the only booths I took time to peak at in any detail. Both Omnicell and Carefusion are doing some cool new stuff. Looks like both companies see a change in the future and are making moves to get ahead of the curve. Baxa had some great IV room stuff. Simply put, they’re kicking the crap out of everyone else. And HCL always has a great booth with a cool design. This year was no exception; Scottish theme complete with castle, kilts and Loch Ness Monster. Sorry, but I didn’t think to snap a picture.

I was thrown out of a vendor booth for the first time ever. That was pretty exciting. Apparently they didn’t think another vendor should be snooping around. The most interesting thing about the whole ordeal is that this particular vendor and my company aren’t doing any of the same things. Weird.

One of the most innovative things I’ve seen in a long time had to be IV Check by SEA Medical Systems. I’ll blog more about that later. Needless to say, I was impressed.

On the upside, New Orleans was an interesting place to visit. The city certainly has its share of night life activity and there’s no shortage of good food. The highlight of my entire visit, however, had to be my trip to the Superdome to watch the Saints take on the Lions on Sunday Night Football. What a great experience.

The CDC has additional information on NIVW here, and a whole lot more information on seasonal influenza (Flu) as well. Need to know more about types of influenza viruses? No problem, you can find that at the CDC site too. The most common form of influenza is Type A. For most healthy people the flu is self-limiting. Sure you feel like crap for a few days, but you get over it and truck on. With that said, influenza can be quite dangerous to elderly and those with compromised immune systems. Get vaccinated.

If you do happen to get the flu it’s probably too late to use an antiviral, but if you and your physician feel compelled to do so you can find more information on this handy-dandy Influenza Antiviral Medication Summary sheet from the CDC (PDF). And no, you can’t treat the flu with antibiotics like amoxicillin, SMX/TMP, cirprofloxacin, azithromycin, etc. So don’t use them if you have the flu. If you do you’re just contributing to a bigger problem.

The best treatment for the flu? TV remote, a comfortable couch and rest.

www.YouCanStopTheFlu.com

Next week is National Influenza Vaccination Week. As experts and educators in safe and effective medication use, pharmacists are uniquely qualified to lead efforts within health systems to encourage influenza immunization of health care workers. Encourage your co-workers to get vaccinated. Public health campaigns such as these are the first line of defense against a potentially deadly illness.

Recognizing that influenza infection in health care workers can lead to outbreaks with serious consequences for patients, the American Society of Health-System Pharmacists (ASHP) launched an initiative for pharmacists to improve influenza immunization rates among health care workers. Health care workers can acquire influenza and unwittingly transmit the virus to patients, other health care workers, and members of their household and the community a day or two before symptoms appear.
The resource center includes the following features:

• Essential influenza immunization resources and helpful links
• Practical toolkit to advocate immunization to your co-workers
• Success stories from other pharmacists
• Downloadable widget to track your facility’s progress toward 100% influenza immunization
• Test your Influenza IQ

So, was the move worth it? Simply put, yes.

I can tell you that my eyes have been opened. My world as a pharmacist was small. My ability to impact change was non existent. As a pharmacist, my thought process was limited by my own lack of experience in the real world. As a pharmacist I thought I’d reached the pinnacle of success. I mean, I had a good job, making good money. I was respected by my peers. I was pretty good at what I did. That’s what we all strive for, right? Like many pharmacists I figured I’d work for 40 years, retire and enjoy some time at home. After all, that’s how it’s done.

I was naïve. I lived a sheltered life as a pharmacist and now that I’m out in the real world things are a bit more interesting. People outside my once sheltered reality are brutal. They don’t really care about the credentials after my name; I’m just another schmuck. The really smart people don’t all work in a hospital (I have a theory about that, but won’t share it for several reasons). As a pharmacist I was allowed to make decisions on my own, now it’s decision by committee.

Overall the past year has been eye opening for me. I’ve been humbled on several occasions and had my ego bruised a few times. On the other hand I’ve had some minor victories and grown a bit in the process. I’ve just now started to learn my boundaries and what I can and can’t do. For the past 15 years I’ve learned how to hold my temper, play well with others, hold my tongue and live off favors. Basically I’ve been learning how to be “a nice guy”. Turns out that this is the equivalent of an anchor around my neck in the world outside of healthcare. I no longer have to be a nice guy. I need to learn to be direct, to the point and straightforward regardless of peoples feelings. Interesting change in philosophy don’t you think? And guess what, as long as you’re getting your job done that’s ok.

Someone once told me I was too old to be an effective Product Manger (I’m in my 40’s), and now I know why. At my age I have certain beliefs that have been cemented in place by years and years of exposure to the world around me. And to put it in simple terms, the world around me has changed. With that said, I don’t think age has anything to do with being a good Product Manger. My mind is still sharp, and I have experiences that the 20 something crowd lack. Getting older, yes. Toothless, no. I can hold my own.

With all that said, it may seem to you that my move was a bad thing. Nothing could be further from the truth. For the first time in many years I’ve been challenged. Challenged to compete with people who are smarter than me. People that work harder than me. And people who have more experience and know more about the job than me. Being a Product Manger is a good job, and I like it.

Thoughts on being a Product Manger. I can’t say whether these are unique to the company I work for or can be applied across the board because, hey, I’ve never been a Product Manager anywhere else.

The Good

The company – Salary and benefits? It’s all about the same, but the company treats me well; very well. From the little things like free snacks and drinks at the corporate office, to letting me run around the country on the corporate dime. It’s all good. Hands down the best company I’ve ever worked for.

The job – Seriously, can you believe people pay me to think up new things to build? I can’t. I love pharmacy automation and technology, and the fact that I get to do this for a living is still hard to believe.

Autonomy – I suppose this goes along with the job, but people pretty much leave me to my work. Pharmacy was never like this.

The people I work with – The people I work with are all intelligent, hardworking people. They have the same goal in mind that I do: build a successful product. I haven’t met anyone yet that I’d like to punch in the face or drive out in the middle of nowhere and leave for dead. I can’t say the same for any of my previous jobs.

The people I visit, i.e. “the customer” – As a Product Manger I spend a fair amount of time talking to “customers”. It just so happens that those people are pharmacists. Seriously, someone pays me to run around the country and talk to other pharmacists. I’ve learned a great many things by speaking with pharmacists from different parts of the country, and the one thing that sticks out the most is that the profession is completely fragmented. Every pharmacy has the same set of problems and they all approach them with a different strategy. Some good. Some bad. They could all learn from one another, but they don’t have the luxury of spending time with each other. Too bad really because there are some really great pharmacies out there. Perhaps I’ll write a book someday on all the different things I’ve seen.

Education – As I said above, I was naïve. I’ve been schooled on more than one occasion. My business knowledge sucks and I’m struggling to understand it now. I’ve learned things that I would have never learned as a pharmacists.

Never bored – I was pretty bored as a pharmacists. I don’t have to worry about that now. I get to do a lot of things that I’ve never done before.

Authority/Power – I’m just now starting to probe the limits of my authority as a Product Manger. Apparently they have a lot of power inside a company. However, I haven’t figured out how to wield it yet. As I said above, I need to learn how to be a more direct and to the point. No fluff needed. 

The travel – This has been a blessing and a curse. I’ve seen places that I would have never seen in my lifetime. I used to fear getting on a plane. Yep, I was scarred of flying. Well, nothing’s changed. I’m still afraid of flying, but now I take it like a man. No more crying during takeoff and landing ;-)

Conferences – I’ve been to more conferences in the past 12 months than the previous 3 years combined. I believe conferences are a necessary part of one’s development as a pharmacists and I’ve been fortunate enough to enjoy several this year. What an awesome bonus to being a Product Manager in a company that deals in pharmacy automation and technology.

The Bad

The job – I used to scour the internet looking for pharmacy automation and technology to escape from my real job. Now it is my real job which makes it less appealing. Now I look for ways to escape from it.

I used to love to blog, but some of the luster has been tarnished now that it’s part of “my job”. Not to say that I find things less interesting, I just don’t feel compelled to write them down. I used to look forward to getting off work so I could get home and blog about something interesting. Not anymore. Now I read about something interesting, make a note about it and truck on.

Definition – No one can really tell me what a Product Manager does. I’ve had multiple people, from top to bottom, give me different opinions on what I’m supposed to be doing. So, what’s a Product Manger do? Crud, I don’t know.

The travel – A blessing and a curse., remember? I feel like I travel quite a bit, but I’ve been told that it’s not really that bad. I’m away from home about two, sometimes three weeks a month. Not bad I suppose, but compare that to my previous 15 years on the job; gone zero. For the first time ever as a dad I’ve missed both my girls birthdays (the actual date, not the celebration),  I’ve missed sporting events and school functions. Fortunately my girls are 14 and 17, and they not only understand, but are so busy that I’m not sure they even notice when I’m not in the house. I couldn’t have done this job 10 years ago.

On wearing a suit and tie – Not my style.

The people – I work with some pretty strong personalities. I haven’t really learned how to deal with that part of the job yet, but I’m working on it. Some people think they’re always right. Sometimes it feels like I’m working with physicians again. 

Opinions – I just can’t get used to having people tell me my opinion is wrong. Yep, my opinion. Someone will ask me my opinion and then spend a half hour lecturing me on why opinion is wrong. I took that at face value for a while, but not anymore. My opinion is my opinion, and they aren’t wrong. You want to know why? Because they’re my opinion, nimrod. If you don’t want my opinion, don’t ask. And just for the record, who’s to say your opinion isn’t wrong and mine right? Chew on that.

More opinions – The other nasty thing I’ve run into on several occasions is someone telling me I don’t know what pharmacists want. Really? Last time I checked I was a pharmacist long before I was a Product Manger. I’d argue that I still know pharmacy a heck of a lot better than I know being a Product Manger. I’m not saying I’m always right, but I find that some “business” people don’t have a clue how a pharmacy operates.

Paperwork – These people like their documentation: battle card, ROI, business case, concept document, MRD, technical specs, spec sheets, etc. One could get lost in the mountain of paperwork. “Did you write up an MRD?” “Did you fill out a battle card?” “What’s the business case?” “I didn’t see a spec sheet on that?” Half my time is spent creating some type of documentation. And I thought healthcare was full of red tape and an over abundance of documentation.

The Ugly

It’s a business, bro – Ah, the heart of the matter. Never forget, this is a business. It doesn’t matter how great the idea, if you can’t prove it will make money then you can forget about it. This is a frustrating concept for me because I personally believe there are some ideas that can’t be proven before they’re done. How can you prove something will make money if it’s never been done? It’s a problem to be sure. Nature of the beast boys and girls.

Some ideas that I thought were quite brilliant were conceived years ago by the company I work for, but shelved because they were perceived as low profit potential. Every once in a while I’ll trot out something I think is totally awesome only to have one of my colleagues show me documentation on the same idea they had four years earlier.

Final Thoughts

I’m enjoying my time as a product manager. In fact I don’t see myself going back to being a practicing pharmacist any time soon. Pharmacy as a profession is a dead end, and I’m just not ready to sit in the proverbial professional rocking chair.

I’m still a rookie as a product manager, and I have a lot to learn, but that’s okay. I’m looking forward to the challenge. For now I’m just along for the ride.