Saturday morning coffee [December 28 2013]: Year End Edition

Let our New Year’s resolution be this: we will be there for one another as fellow members of humanity, in the finest sense of the word.” – Goran Persson

So much happens over the course of a year that it’s often hard to remember what you did, where you went, who you met and what you read, watched and ate. Here are some thoughts and reflections on 2013…

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Saturday morning coffee [December 21 2013]

“Great people talk about ideas, average people talk about things, and small people talk about wine.” - Fran Lebowitz

So much happens each and every week that 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….


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Back in the saddle again

“I`m back in the saddle again, out where a friend is a friend” – Gene Autry

It was 49 days between the time I was unceremoniously released from duty as a product manager by my previous employer until I finally went back to work. You can see my thoughts on my search for a job here.

On Thursday, September 12, 2013 I found myself in familiar territory as I reported for duty as a per diem IT Pharmacist at Kaweah Delta Medical Center. The position calls for two shifts a week. It’s a start.

For those of you that don’t know, Kaweah Delta is where I got my start as an IT Pharmacist back in November 2007. the idea of an IT Pharmacist was new and it was an exciting time. I spent about three years at Kaweah Delta implementing technology and automation left and right. I was fortunate to have been involved with a pharmacy remodel, smart pump implementation, BCMA implementation, the first stages of CPOE implementation, the early stages of mobile technology, among other things. It was also during that time that I started experimenting with this blog and social media. I learned a lot during my time at Kaweah Delta. They were good to me, but I left in 2010 to explore other opportunities.

When I left Kaweah Delta in 2010 the IT Pharmacy department was one person, me. Since that time they’ve grown the service to include 2.5 full-time pharmacists and a full-time pharmacy technician. They’ve done a lot of good things since 2010, and thankfully they’re doing a lot more. They are currently preparing to implement the NEPS Labeling Solution for their labeling needs as well as implementing DoseEdge in their IV room. Fortunately for me they ran out of bodies to do all the work and were contemplating hiring another pharmacist when I made contact in search of employment. Timing is everything they say.

I won’t lie, the first two days in the “new” position were a bit humbling. I felt like the kid that went away to college at the big university only to find out that he couldn’t make it and had to return home and start over at the local junior college. I am now at the bottom of the very ladder of which I used to sit atop. My excursion into the world outside the pharmacy walls has literally cost me six years of career path time, i.e. I’m right where I was in November of 2007. Actually, that’s not true. In the strictest sense I’m in a position lower than I was in November 2007.  So in reality it’s more like ten years of career path time, unless pharmacy career time is like dog years. In that case I should be ok unless I have the dog years thing backward, at which point I’m screwed.

Everyone at Kaweah Delta has been great. I’ve had to explain my situation to several people, but no one has openly mocked me yet, which I believe the pharmacist code allows. Regardless of all that, it feels good to be back in the saddle again.

The job market for pharmacists has taken an ugly turn

There was a time when I could have found half a dozen pharmacist job openings in one afternoon. Now I find myself in a position where I can’t even find one.

It’s no secret that I was laid off several weeks ago; July 25th to be exact. I don’t know why I was laid off, only that my position was eliminated. I didn’t really think to ask any questions at the time as I was in a state of disbelief. I’ve been a pharmacist for just over 16 years and during that time I had never been laid off, fired, or “let go”. This is officially uncharted territory. I’m told that this kind of thing “happens in business”. Sucks anyway.
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What’s the single most important technology introduced into pharmacy operations in last 10 years?

I asked this question on Twitter today looking for opinions from the countless number of people roaming the internet. Alas, I received not a single response. Not one. I’m starting to think that Twitter, and most other social media, is worthless as a way of gathering information from people. Oh sure, my Twitter feed is great for consuming an endless string of articles and links, but the few times I’ve actually reached out to the Twittersphere with a question I’ve ended up with bupkis.
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Pharmacists should learn to write code

You know what’s missing in healthcare? Pharmacists that write code and work on application development, that’s what’s missing. It’s the only way to ensure that applications have the right look, feel and functionality. Who knows better than a pharmacist, or pharmacy technician, how a pharmacy application should behave? No one, that’s who. Trying to explain healthcare workflow to a non-healthcare person is like trying to explain calculus to a dog; not that I think people outside healthcare are dogs. It’s just a metaphor.

Anyone can learn to code the basics, much the same way anyone can learn the basics of being a pharmacist. I could teach an average sixth grader how to perform the basic functions of a pharmacist; no lie. Of course things get a lot more complicated once you get past the basics, and that’s when you need people with more experience, expertise and wisdom.

I’ve dabbled in “programming” here and there, mostly out of necessity. At one time or another I’ve taught myself to code with visual basic, C# and some scripting languages like Javascript, PERL, and HTML. I also spent a couple years learning the ins and outs of database design and writing queries. But I was never all that good at it. I could do the basics, but it was neither my profession nor passion.

I wrote a couple of small apps to help me do my job – desktop and web-based – and built some databases to handle pharmacokinetic tracking and pharmacist interventions. Everything worked, but they were nothing that would have wowed anyone. What I needed was someone with a lot more experience to take those applications and turn them into something spectacular. That’s where having a real “programmer” would come in handy; someone with years of experience, expertise and wisdom.

However, back to my original point. Healthcare needs pharmacists that know how to write code to jump start the development process and drive things forward when things stall. Sometimes pictures and words simply don’t work.

Just an opinion. Take it for what it worth.

The loss of Google Reader will be tough and here’s why

The news that Google Reader is going to be sunset in July of this year has created somewhat of a panic among many, including myself.  The internet has been abuzz with articles on potential replacements. I’m sure people will look at many of these and find something to meet their needs, but what I’ve found thus far has been disappointing. I assume that’s because Google Reader was truly more than just a RSS aggregation tool for me.  A lot of the functionality that I used was the result of many third party developers that wrote plugins and scripts to do everything from rearranging the information on the page to removing ads. Google Reader was popular and mature, and it showed.



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Computers, bags and TSA screening


Mobile Health Computing: “Electronic devices that are smaller than a standard laptop can stay in your bag. There is no need to pull them out. The TSA told us this back in 2010.” Good to know.

I was told by TSA that anything with an SSD (vs. a standard HD) can remain in your bag; iPad, Android tablet, eReader, etc. I tried to apply this logic to my laptop, but it didn’t work. The TSA is inconsistent with how they apply the rules. I only travel about 20 times a year, but it can be different from one airport to another. Most handle things the same way, but it’s not 100% across the board.
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Crowdsourcing pharmacy: automation, technology, informatics

redlegoI travel for work a couple of weeks a month, sometimes more, sometimes less. Most of the time I travel by myself, but recently I found myself traveling, albeit briefly, with another pharmacist. He and I ended up in a little pub one night talking about work; products, strategy, gripes, likes, and so on. Typical stuff when two guys get together and talk about work. After a while the conversation turned away from work and toward pharmacy in general. Just two guys talking about stuff that’s interesting.

A few drinks and several bowls of popcorn later we had covered a lot of interesting pharmacy topics including acute care pharmacy operations, telepharmacy, medication therapy management, insurance company billing, specialty pharmacy practice and so on. There were several interesting ideas figurative sketched out on the back of a napkin that night. This type of comradery is good for the creative process as I’ve mentioned before.

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fMRI study uncovers mechanism for drug cravings

This article at Medical Xpress caught my interest because I’ve been reading Physics of the Future: How Science Will Shape Human Destiny and Our Daily Lives by the Year 2100 by Michio Kaku, which spends a fair amount of time talking about fMRI.

“An fMRI machine uses “echoes” created by radio waves to peer inside living tissue. This allows us to pinpoint the location of the various signals, giving us spectacular 3-D images of inside the brain…

The fMRI scans allows scientists to locate the presence of oxygen contained within hemoglobin in the blood. Since oxygenated hemoglobin contains the energy that fuels cell activity, detecting the flow of this oxygen allows one to trace the flow of thoughts in the brain.

…fMRI scans can even detect the motion of thoughts in the living brain to a resolution of .1 millimeter, or smaller than the head of a pin, which corresponds to perhaps a few thousand neurons. An fMRI can thus give three-dimensional pictures of the energy flow inside the thinking brain to astonishing accuracy…”

According to the Medical Xpress article:

“Cues such as the sight of drugs can induce cravings and lead to drug-seeking behaviors and drug use. But cravings are also influenced by other factors, such as drug availability and self-control. To investigate the neural mechanisms involved in cue-induced cravings the researchers studied the brain activity of a group of 10 smokers, following exposure to cigarette cues under two different conditions of cigarette availability. In one experiment cigarettes were available immediately and in the other they were not. The researchers combined a technique called transcranial magnetic stimulation (TMS) with functional magnetic resonance imaging (fMRI).

The results demonstrate that in smokers the orbitofrontal cortex (OFC) tracks the level of craving while the dorsolateral prefrontal cortex (DPFC) is responsible for integrating drug cues and drug availability. Moreover, the DPFC has the ability to suppress activity in the OFC when the cigarette is unavailable. When the DPFC was inactivated using TMS, both craving and craving-related signals in the OFC became independent of drug availability.”

Cool stuff.

Article referenced: Takuya Hayashi, Ji Hyun Ko, Antonio P. Strafella, Alain Dagher; “Dorsolateral prefrontal and orbitofrontal cortex interactions during self-control of cigarette craving.” PNAS, January 2013, DOI:10.1073/pnas.1212185110