Well, it turns out that long plane rides and airport delays are a good time to get your thoughts together, toss around some ideas and make some decisions. While I have a long list of Siemens specific items to look over when I get back to work tomorrow, I won’t bore you with those here. Instead I thought I would share some general thoughts about my Innovations 2010 experience.

• The smartphone is definitely more popular this year than last. A technology is officially ubiquitous when you see pharmacists using it regularly. The BlackBerry appears to be at the top of the heap as I saw lots of BlackBerry Storms as well as other high end BlackBerry devices with physical keyboards. Android devices were also more prevalent this year than last as I spied several Droids as well as a few of the newer devices like the EVO and Droid X. The iPhone remains popular, but they were less prevalent than in previous years. Is this a sign that there is a changing of the guard? Not likely, but a it’s clearly a sign that there are finally some players in the game.
• I saw more laptops sitting on tables this year along with a fair number of iPads. Of course these devices were more common in the “technology” sessions than they were in the “medication safety” tracks, but I take it as a good sign nonetheless. Other than my trusty Dell Latitude XT2 tablet, I did not see a single tablet PC in the group.
• Screen brightness appears to be the number one enemy to the battery on my tablet, and small changes seem to make a big difference; 45 minutes difference in some cases. As much as I’ve enjoyed the Dell tablet I think it’s time to look at something with at least six hours of battery life. I carried an extra battery with me at all times while at Innovations. The strategy worked for all day use, but it was a big of a hassle.
• There was no free wireless available at the conference. I think this is a huge oversight when you consider that Innovations 2010 was promoted as a conference “for Healthcare IT“.  This isn’t unique as I ran into the same issue at ASHP Midyear 2009 in Vegas during the pharmacy informatics sessions. Wireless access should be part of all conferences that include HIT as part of the venue. Heck, it should be included for all conferences regardless of venue, in my opinion.
• Last year it was all about BCMA. This year it was all about CPOE. I wonder what next year will bring? I have to believe that many facilities chasing the meaningful use dollars will get themselves into trouble secondary to rushing to do something they aren’t prepared to take on. In that case we’ll be talking about the same things next year. All we can do is wait and see.
• Virtualization is popular, again. I’m not sure if this is really newer technology or simply an attempt to resurrect an old one. I don’t know enough about virtualization to make an informed decision. One thing I can tell you for certain is that I’m not a big fan of the virtualized desktop. The whole thing still feels a little fuzz to me. It could be that I haven’t seen a solid implementation yet, but I wouldn’t know one way or the other because it’s not really my area of expertise. One of my goals for the upcoming year is to gain more knowledge on the topic. I’ll just add it to the list of “need-to-do”.
• We aren’t the only facility experimenting with the iPad. I ran into several pharmacists and IT folks from other facilities that were doing the same thing. Most have reported poor results both from the IT side and the user experience side. People desperately want to push the iPad into areas it doesn’t belong. I’m don’t have an answer for this behavior, but it’s going to be a costly lesson in the long run. The right tool for the job people. No matter how cool the device is, it just may be the wrong fit for certain applications. Hey, a Lamborghini is cool, but you wouldn’t use it to haul rocks. On the flip side, the iPad performed admirably for reading, watching movies and playing games on the long flight to and from Orlando.
• Siemens has been doing a pretty good job of updating their pharmacy system. Their current development cycle is much faster than it was when I first came work for Kaweah. According to some of the Siemens programmers I spoke with the company took on an “agile” approach about three years ago complete with scrums, a bullpen, customer involvment, etc. Whatever the case it appears to be working. I think they still have some work to do, but recent changes to the system have been positive. With all that said I think they should abandon the current platform and begin developing the pharmacy system on top of their Soarian system (see below).
• Siemens flagship application for healthcare is clearly their Soarian product. The company has built their enterprise financial solution on top of Soarian, their clinical nursing and physician solution on top of Soarian, their documentation on top of Soarian, their CPOE system on top of Soarian, and so on. The Soarian platform is very flexible and powerful as was demonstrated several times over at the conference. I even managed to crash a private demo of the Soarian Critical Care module, which offers some pretty exciting functionality including customized views, integration with Draeger monitors, data capture from various pieces of hardware like ventilators and blood glucose monitors, and even integration with smartpumps (future release). Soarian is built on an open architecture and provides flexibility and possibilities not available in Siemens Pharmacy and current the BCMA system. So why doesn’t Siemens build the pharmacy and BCMA systems on top of Soarian like everything else? I mean the CPOE component is already there, which seems like it would only be a hop, skip, and a jump to a full blown pharmacy order entry system. It makes sense to me as all the lab, micro, radiology, nursing documentation, physician notes, etc are all housed in Soarian. Huh, imagine that, a centralized location for everything. I asked several programmers and Siemens folks about it while at Innovations. Most had no real response, while a couple told me that the company was working on this approach at one time, but has since abandoned the idea. Why?

Overall Innovations was a successful conference for me. I picked up quite a bit of information and had the opportunity to speak with some cool people. Now it’s time to head back to work and see if I can put some of this information to good use. Wish me luck. You can never tell how people will react when you bring something new to the table. Most people really don’t like change. I’m just sayin’.

This years Innovations conference was heavy with sessions on ARRA, meaningful use and CPOE. I’m not surprised as this is where all the money will be for vendors involved in HIT over the next several years.

Anyway, I feel there are a couple of presentations I attended yesterday that are worth mentioning.

CPOE Lessions Learned: A Pharmacy Perspective
Franklin Crownover, RPh - Pharmacy Computer Coordinator, Tufts Medical Center, Boston, MA

Tufts Medical Center is a well known teaching hospital affiliated with Tufts University. The hospital is 451 licensed beds and offers all the normal patient services that y0u would expect to find in a facility that size, i.e. critical care, ED, pediatrics, a NICU, etc. In addition I’ve known Franklin for a couple of years now and have had some great conversations with the man during that time. He is quite brilliant and I frequently use him as my personal consultant for all things Siemens.

Apparently CPOE implementation is quite difficult and Tufts ended up running approximately one year behind their original implementation schedule. Franklin had some very interesting things to say about why their CPOE implementation fell behind, but the best reason he gave was that “it was hard“. That about sums it up.

Other reasons for the difficulties included the complex nature of the CPOE build, lack of resources dedicated to the project, unfamiliarity with the product and it’s functionality and lack of physician involvement. Franklin said it was a miracle that the project ever got off the ground. Not encouraging words.

The project team consisted of nursing, pharmacy, information technology, a Siemens consultant and a Dell-Perot consultant. This is consistent with other facilities I’ve spoken with. However, the lack of a physician on the team is disturbing.

Some of the things I took away from the presentation include:

• Identify available pharmcy resources and get them involved early.
• Pharmacy needs to understand the system by attending appropriate education provided by Siemens or other third party.
• Don’t underestimate the resources needed, and when you think you have enough, push for more.
• Don’t try to copy the paper process. Figure out new ways to do it in the electronic system.
• Develop a painstakingly thourough test plan.
• Clean up your order set process before starting CPOE project.
• Invest in an evidence based order set system like Provation or Zynx (Tufts uses Provation)
• Don’t try to build, track and maintain the order sets yourself; they tried and failed. (One of the slides from the presentation was a great flowchart for their process of authoring and approving order sets)
• Standardize whenever possible, i.e. G, GM, or GRAM; CAP, CAPS, or CAPSULE; etc.
• Serval Siemens specific items that I won’t bore you with here.
• “Make it idiot proof”. I love this line. Who do you think he was talking about?
• Finetune the alerts for physicians whenever possible, i.e. don’t burden them with useless garbage.

Overall Franklin had a lot of negative things to say about the CPOE project in general, and even took a couple of shots directly at Siemens. But he did it in a humorous way while offering some sound advice.

Are You Ready for CPOE? Do You Have What it Takes with Pharmacy to Prepare and Implement CPOE Successfully?
Brian George, PharmD, Assistant Director of Pharmacy and Judy Miller, Clinical Analyst for phamrayc systems, MedCentral, Mansfield, OH

The MedCentral system consists of a couple of hospitals totalling 351 licensed beds, and is one of the 2010 ‘Most Wired Hospitals’ so I was very interested in what they had to say. This presentation took a slightly different approach than Franklins, but provided a lot of the same details, i.e. resources are important, evidence based order set development (Zynx), standardization, etc.

The one thing the MedCentral presentation did that the Tufts presentation didn’t was break down the number of pharmacy hours necessary to complete various phases of the project. Needless to say it’s a lot of hours.

My impression

Both presentation were helpful in my quest to secure informatin for our upcoming CPOE build and implementaiton. Unfortunately much of what I suspected regarding the difficulties involved have been confirmed. I believe we have fallen into the same trap as Tufts with a lack of resources and physician involvement, but only time will tell. I’m really not looking forward to banging my head against the wall for the next 8 months.

“Working the spreadsheet” was mentioned several times throughout both presentations, and each time I cringed in my seat. It’s strange to hear pharmacists talk about sitting in front of a computer hour after hour doing nothing but changing the word ‘CAP’ to ‘CAPSULE’. It just seems to be an odd use of resources. I don’t know, maybe I’m just overly sensitive. With that said I have a sneaking suspicion that I’m in for a long year. I’m just sayin’.

One unplanned event that I have to mention was the pleasure of eating breakfast next to Johnathan Paul, a senior engineer in enterprise R & D at Siemens. He casually sat down next to me this morning and asked me what sessions I was planning on attending. I promptly gave him my spiel about attending the various pharmacy sessions, but in addition I lamented the fact that I was going to miss the presentation on “Virtualization, Cloud Computing, SOA, Elasticity, De-Duplication…What Do These Technical Terms Really Mean and How Do We Apply Them?” because it was at the same time as the pharmacy update. I didn’t know at the time, but he was the presenter for that session. After I got past my initial embarrassment we had a great conversation about many of the topics he planned to cover. I came away with some great information and knowledge that Siemens is doing things behind the scenes that makes me downright giddy.

Session Attended

Medication Safety Track
Siemens Pharmacy / Medication Administration Check Solutions Update [Medication Administration Check, a.k.a. MAK, is Siemens BCMA system]

This is one of my favorite sessions to attend at Innovations because I like to see what I can expect out of Siemens Pharmacy in the near future. As I’ve mentioned previously our facility uses both Siemens Pharmacy and MAK and we’ve made it priority to always be up to date with the latest version of the software. Even though I was already aware of most of the information that was presented it was still good to get an official listing of enhancements coming down the pike.

Some of the new features presented include:

• Lot number, expiration and manufacturer tracking for vaccines in both the pharmacy system and MAK. In addition, the service pack due out later this year will also allow transmission of that information to the California vaccine registry. This is huge for our facility as it’s been a real point of contention over the past several months.
• The ability to attach a “reminder” to a medication in pharmacy at the formulary level or manually by the nurse. We currently use fake medication orders in the pharmacy system like “remove patch” to remind the nurses to do something. It’s not a good solution, but it works. With the upgrade these reminders can be built into the drug definition and will not require a separate entry by the pharmacists. This solves some issues and is a big positive in my opinion.
• The option to add a barcode to a medication at the order level. This is the one I’ve been waiting for. This will allow us to place patient/drug specific barcodes on items like pediatric syringes and compounded medications that were previously problematic.
• A completely redesigned pharmacy monitor. The pharmacy monitor is where incoming CPOE orders arrive in pharmacy. We don’t use the pharmacy monitor yet, but will as soon as we go live with CPOE later next year. The current pharmacy monitor has limited functionality and was in desperate need of an overhaul. The version shown today is a big improvement with expanded display, significantly more options for customization and better segregation of orders coming from various locations throughout the hospital. I think it sill needs some work and it won’t replace our current order management system, but it is a big improvement nonetheless.
• And a couple little things like customized options for user maintenance, improved reporting for ARRA and an improved area for “pharmacy instructions”, i.e. comments not seen by everyone.

I’ve been fairly critical of Siemens Pharmacy in the past and still think they have a lot of work to do, but I am excited to see some of the changes taking place. They appear to have the right people in place and the right attitude toward advancing their system to make it better in the future. I will reserve further comment until I see Siemens Pharmacy v24.2 in action at my facility. We’re scheduled to be upgraded sometime in October of this year.

Technology Solutions Track
Use of Desktop Virtualization with Soarian Clinicals

This session presented the experience of Alegent Health in Omaha, NE as they implemented thin-client technology in several of their patient care areas. Most of the information was generic, but several great questions from the audience and a general discussion following the presentation added to the overall value of the session. I came away with a better understanding of several components of the virtualized desktop. I’m especially interested in their “smooth-roam” feature, their smart card technology for logging in and out of systems, and their use of Wallaroo Medical Stations in patient access areas.

One thing I thought was odd was the presenters opinion of various non-thin client solutions. He bashed the use tablet PCs based on reasons that I did not agree with. It gave me the impression that the presenters motives were a little skewed toward his opinion rather than presenting the facts. It could have been presented a little more objectively, but overall it was great information.

Medication Safety Track
Implementation of a Closed Loop Medication Solution

This presentation basically covered several projects at HealthAlliance Hospital designed to close the medication loop between the physician order and administration of medication at the bedside. I’ve seen presentations like this before. In fact, one of the best closed loop medication presentation I’ve ever seen was at ASHP Midyear in December 2009.

Solutions implemented at HealthAlliance Hospital included CPOE, pharmacy barcoding and unit-dose distribution, BCMA and eMAR. The presentation was a little dry, but made some important points. Several slides were presented showing changes in prescribing habits and recorded medication errors following each system implementation. No mention was given as to how the data was collected however, which lessons the impact of the information just a little bit.

Overall, the first day was a success. Tomorrows focus will be on CPOE in the morning, followed by my presentation at 11:00 am and a small group demonstration of Siemens newest version of Soarian Clinicals. I’ll let you know how it goes.

I’m sitting in the airport waiting for my flight. I’m on my way to Orlando for Innovations ’10 for Healthcare IT. Innovations is an annual conference put on by Siemens, who promote themselves as “ a global powerhouse in electronics and electrical engineering, and operates in the industry, energy and healthcare sectors.” The hospital where I work uses several products from Siemens including Siemens Pharmacy, Siemens Medication Administration Check (MKA) and Soarian, which is their clinical information system for physicians and nurses, and the foundation for their CPOE system.

Like many conferences, Innovations offers an opportunity for like-minded professionals to gather and get the latest scoop on cutting edge practices. And for me it’s all about finding the people and facilities that do things better than us and trying to put that information to work for me when I get back to the hospital. Although it doesn’t always work out the way I planned, attending is still a good idea.

This will be my third Innovations meeting and the two tracks that are of most interest to me are usually the Medication Safety and Pharmacy tracks; shocking, right? This year however, I’ve decided to expand my scope a little and investigate a couple of other tracks, including Soarian Analytics/Decision Support Solutions and Interfacing & Integration. The titles for the breakout sessions in these tracks look intriguing and I’m hoping to find a diamond in the rough.

In addition to deviating from my normal track routine I am presenting at Innovations for the first time ever. My presentation, “How Rounds Reports and Mobile Computing Support the Roles of the Clinical Pharmacist”, covers a fairly broad range of topics. I actually submitted two separate presentations for consideration, one on creating reports for rounds (UDA in Siemens speak) and one on mobile computing, but Siemens didn’t have room for both, so rather than scrap one they asked me to consolidate them into a single presentation. I think that worked out better anyway. My presentation is on Tuesday, August 10 from 11:00 a.m. til noon. Wish me luck as I haven’t had much presentation practice over the past several years. I will post the slides on slideshare following the presentation.

As an FYI, my traveling gear of choice for this conference:

1. Dell Latitude XT2 tablet (lesson learned from the Nashville trip) – will be used to get a little work done, mark-up presentation slides during various sessions, and of course blogging during Innovations.
2. iPad – will be used for entertainment, i.e. movies, music and games, reading PDFs of which I downloaded last night and as a prop for my presentation that includes several slides featuring the iPad and Citrix accessing our pharmacy system.
3. iPhone – used mostly as an MP3 player and backup to the DROID.
4. DROID – used primarily for social media and email. Oh and to make calls on. Go figure.

Imprivata OneSign Platform:”Imprivata helps organizations secure employee, contractor and temporary hire access to desktops, networks, applications, and transactions – - enforcing who gets access; providing visibility into what was accessed; and ultimately, terminating all of a user’s network and application access, instantly. Imprivata OneSign® is an identity and access management platform that strengthens user authentication to networks; streamlines application access; and simplifies the process of compliance reporting–all delivered through a secure, self-contained appliance that requires zero modifications to existing IT infrastructure, and is centrally managed from a single administrative console. “ – The Imprivata OneSign Platform offers single sign-on to all enterprise applications. This is something I’ve been interested in as pharmacists have to log into no less than five different systems to do their job; at our facility anyway. It makes sense to me to use information from a single location to create single sign-on access for employees. The OneSign Platform is pretty flexible, allowing users to choose from password validation, proximity cards, RFID, biometric scan, and flash drives among other options for user authentication.

Toughbook T8: “Lightweight, yet Durable – Weighing in at 3.3 lbs., the Toughbook® T8 business-rugged laptop combines light weight and durability, with a built-in a magnesium alloy case, sanitizable rubber hand strap, embedded wireless, and added security and remote management with Intel® Centrino® 2 with vPro™ technology. Built with legendary Toughbook reliability and unparalleled portability, the drop- and spill-resistant Toughbook T8 keeps up with today’s busy mobile professionals.” – I had an opportunity to play with this tough little dude and I have to say I was impressed. The T8 is light enough to hold securely in one hand via the strap located on the underside. It’s not a full blown tablet PC, but does offer a nice touchscreen interface, which allows you to move around the screen with only your finger. And it’s tough. The T8 is designed to survive a fall of 2.5-3 feet. The only thing missing, in my opinion, was a swivel screen.

As I wrap up my time here at Innovations ’09 a few thoughts come to mind:

I should have stayed an extra day or two. There are two hospitals near here that I would love to visit: Pinnacle Health in Harrisburg and Main Line Health. When I grow up, I want to be like them.

Overall Innovations was a good experience, but I am looking forward to the ASHP Midyear in December of this year. I hope to see you all there.

Where did My Mumps Job Scheduler (MJS) Go? – This was a pretty basic “how-to” session covering the new job scheduler, Cache, used in the latest version of the pharmacy system. Boring, but helpful.

Integrating Siemens Pharmacy to Maximize the Pharmacist Role – This was the most interesting presentation of the day, by far. Yakima Valley Memorial hospital is located in Yakima, Washington. Their pharmacy department is clinically solid and technologically advanced. They make extensive use of various custom pharmacy system reports to monitor antibiotic therapy, follow patients with poor glycemic control, and follow-up on patients with questionable orders. In addition, Yakima is in the process of writing advanced rules against their pharmacy system to track patients receiving warfarin therapy with no INR within the previous 24 hours. The warfarin monitoring is necessary to meet National Patient Safety Goal 3E. Much of the information is practical and can be reproduced at my facility.

Hitting the Mark with MAK! – Everyone wants to learn more about MAK, Siemens BCMA solution, and there have been presentations on just about every aspect of the system. This was no exception as the entire presentation was on how to develop a project plan for MAK implementation. This one nearly put me to sleep.

Leveraging MAK/MAR Integration to Achieve Increased Operational Efficiency – Centra State Healthcare System has done some pretty amazing things with their MAK data and the electronic medication administration record (MAR) found in Soarian. Soarian is Siemens system for collecting and displaying clinical information such as labs, allergies, patient assessments, physician notes, etc. Centra managed to create an integrated solution that offers physicians a one-stop-shop for clinical information as well as previous, current, and future medication administration. I was impressed. It appears I have a little reading to do when I get home.

I spent most of the afternoon talking with other pharmacists about computerized provider order entry (CPOE) and pharmacy automation. One pharmacist from CaroMont Health in Gastonia, NC was particularly interesting as his facility uses almost the exact same setup as ours; Siemens Pharmacy, Pyxis, and Talyst automation. He and I shared quite a bit of information. The time spent talking with other pharmacists was very valuable, possibley more valuable than all the presentations combined. 

Tomorrow is the final day of Innovations ’09 with more of the same on my agenda. Sessions on my radar for tomorrow include: Extending Patient Safety with MAK Beyond the Acute Inpatient Setting, Building the Bridge between MAK and Soarian, and Raising the Bar for Patient Safety. After that, it will be time to pack up and head for the airport; until then.

My first session today was an update on various future enhancements to both the Siemens Pharmacy System and their barcode medication administration system (BCMA), fondly referred to as MAK. The future enhancements bring much needed functionality to a system that, in my opinion, wasn’t ready for prime time.

Enhancements presented include:

The rest of my day was spent listening to presentations on BCMA. While the information was good, there wasn’t anything that I hadn’t heard before.

Best quotes of the day:

“It’s a great system, but you can’t get away from the human factor.” I believe this down to my core, but I also believe you can limit the human factor by making the system so easy and intuitive that the user would have to go out of their way not to use it. In other words, make it easy to do the right thing and hard to do the wrong thing.

“People still have accountability and responsibility.” If you hold people accountable for their actions, they’re more likely to think before they leap.

Some items of interest to me were:

Sessions I’m attending today include: Siemens Pharmacy/Med Administration Check Solutions Update, A Detailed Approach to Workflow Data Collection and MAK Design, and Barcoded Medication Administration: Is It a Luxury or Standard of Care?.

More to follow…..