I’ve mentioned before the importance of attending healthcare conferences, and while this wasn’t nearly as good as being there in person, it was certainly better than not being involved at all. User groups offer the chance to hear about new company products long before the information is released to the general public and give you the opportunity to commune with people in the same situation as you.

The main focus of this particular user group meeting was to discuss the Talyst Software Only Workstation (SOW) pilot that I’ve blogged about here, and here; introduce and review the new AutoPharm3 patient safety release; and discuss the new barcode scanning hardware that Talyst is planning on rolling out in the near future. In addition there were discussions on various issues ranging from customer best practices to utilizing the Talyst customer portal.

The SOW pilot presentation and discussion was led by Brian Peters, Pharm.D., Director of pharmacy, Community Hospital North in Indianapolis, IN. He described the use of the SOW system in a cardiovascular specialty hospital using CPOE, eMAR and digital imaging technology. His experiences with SOW were mostly positive and similar in many ways to what I’ve experienced with the system myself. He too felt that a solution that offered visual feedback when scanning items while out of sight of the AutoPharm workstation would be beneficial. Overall, the presentation went well and provided some good information.

The show stopper, however, was the presentation on the upcoming AutoPharm3 release. Talyst has been talking about this “patient safety release” for quite some time and based on what I saw today there are some great new features. In a nutshell the AutoPharm3 will offer:

• Lot number and expiration tracking. For many facilities this won’t make much of an impact because they already utilize the expiration tracking function in their automated dispensing cabinets (ADC). On the other hand, the ability to track lot numbers is becoming increasingly important as recalls are giving everyone a giant headache. One could easily skip the expiration tracking in their ADCs in favor of using the lot and expiration tracking in AutoPharm. The benefit of using the AutoPharm system would be the reporting capabilities and the in-your-face way the system presents the information on the main dispensing screen.
• High alert medications. AutoPharm will now allow facilities to control messages for high alert medications at the formulary level. The functionality forces additional steps prior to dispensing a high-alert item and provides the end user with informational text on the label in the form of a watermark.
• Pediatric auxiliary labels for pediatric syringes. This is an interesting addition and one that I have discussed with various Talyst representatives in the past. I’m not sure where it fits in, but like many adult facilities pediatric medications can be challenging. Wait and see on this one.
• New role based permissions. This feature will be a welcome addition as it is a glaring hole in the current AutoPharm release. The current permissions structure in the AutoPharm system offers little flexibility and creates some workflow issues. This new feature will offer additional flexibility to users of the system. Looking forward to this.
• New reporting. This is something that I’ve been waiting on for a while. Quite frankly it has been a weakness of the system until very recently. New reports include high alert medication tracking, expired drug reports, lot number tracking, inventory adjustment report, i.e. discrepencies, and improper scan reports. That last one is the one I’ve been after for a while. I call them bad scans, but it’s the same idea. The report basically tells you how many times the system intercepted someone pulling the wrong drug. It’s a basic concept, but one that you can drill into to find out quite a bit about workflow.
• The new Code 3500 scanner. Tony North from Talyst spent quite a bit of time going over the new Code Corp 3500 scanner. He presented the advantages that the 3500 offers over the older CR3. In addition, he dissected the technology and presented some of the new features offered by the scanner. I’ve talked about the Code Corp 3500 scanner before. It is significantly better than the current CR3 scanner used by most Talyst customers. I’m fortunate that I’ve been using the 3500 for several months. End users will appreciate the upgrade.

Overall I picked up quite a bit by “attending” the 2010 Talyst user group meeting at the ASHP summer session. It was a little weird watching everyone on the monitor and I had trouble hearing at times, but as I said before it was better than missing the whole thing. There were a couple of times when the screen was filled with a slide and I continued to hear everyone, but couldn’t see them. It actually felt strange not being able to see everyone during those periods. I felt like I was more engaged when I could see what was going on at the table. Anyone else ever experience anything like that?

Below are several screen shots I took during the user group. There isn’t anything spectacular about them, but I thought I would include them for anyone that was interested. Enjoy.

We currently utilize software and hardware from Talyst to manage a sizable chunk of our inventory by running it through two automated carousels. If you’re interested you can see photos of the installation back in 2008 here. As we use a decentralized pharmacy model and dispense a majority of medications directly from automated dispensing cabinets, i.e. Pyxis, our entire pharmacy workflow revolves around these two carousels. However, there are still some areas of the pharmacy inventory that are not easily managed with the carousels, including the refrigerators, the freezers, items in the IV room and some of our large volume products that require a significant storage area. Talyst offers a solution for the refrigerated areas called AutoCool that we chose not to use, but the other areas remain a challenge. With the availability of the AutoPharm software only solution we’re able to place a workstation strategically in the pharmacy to cover some of these areas by creating static “carousel” shelving where there are no physical carousels; same idea as the carousels, they just don’t move.

Two areas that were of particular interest to me were an area in the main pharmacy affectionately called “the wall“, and our two offsite satellite locations, especially the sub-acute facility which is just down the road from the main campus. The pharmacy on the main campus and the sub-acute pharmacy couldn’t be more different. The pharmacy at the main campus is a busy acute care pharmacy that processes over a thousand orders and dispenses several thousand unit-doses each day for a census of nearly 400, while the sub-acute pharmacy processes less than 50 orders per day for a census of less than 30. The main campus pharmacy is open 24/7, while the sub-acute pharmacy is open Monday through Friday 8:00am-12:30pm. The main campus pharmacy is responsible for nearly 100 Pyxis med stations throughout the hospital, while the sub-acute pharmacy maintains only a handful. And so on.

The installation at the main campus was a breeze as we were simply adding to the existing system. Once installed, the technicians quickly integrated the new area into their workflow. There was no confusion and it took less than a day for the technicians to become comfortable with the location of the new workstation. With the addition of the workstation we’ve been able to shave about 30 minutes off our a.m. Pyxis fill, which is our largest fill of the day. In addition the number of items that are pulled from the wall on a daily basis without going through the AutoPharm system has decreased. I attribute this to the new workstation being in line-of-sight of the pick area. In addition, during the installation of the new AutoPharm workstation we uncovered an interface problem that may have never been discovered; can you say serendipitous. The HL7 message for several of our  premixed piggyback medications was arriving at the AutoPharm system with a quantity of zero. It had something to with custom programming in the HL7 within Siemens Pharmacy that was erased when we upgraded in late 2009. I wonder how something like that could have gone on for several months without being noticed. Since discovery, the item has been added to the test plan for future upgrades. I’ve found no appreciable difference in Pyxis fill errors, although there were very few to begin with. I’ll probably have to collect 6-12 months worth of data just to make a realistic comparison.

The sub-acute facility has been a different story altogether as the installation completely changed their workflow. The sub-acute pharmacy consists of a single pharmacist and a single technician that had their workflow ironed out prior to installing the AutoPharm system. Over the past several weeks, and with a little bit of hand-holding, they’ve integrated the new system into their operations pretty well. It took a little getting used to, but they’ve adapted. The ordering appears to be slightly smoother than before secondary to the tight inventory control offered by the combination of limited personal, AutoPharm’s inventory tracking and integration with the wholesaler. In addition I’ve turned on the Pyxis PARx feature at the sub-acute facility to close the loop between the pharmacy and the Pyxis. No problems so far. In my opinion the PARx system works quite nicely when combined with liberal use of Cubies in the Pyxis med drawers.

The only thing that appears to be less efficient for the sub-acute pharmacy is the re-stocking process. At the main campus the orders arrive in various totes that are separated on to carts and taken to their prospective areas to be put away. The system works well as the AutoPharm workstations are in close proximity to the storage areas so the technicians can see the computer screen while putting the order away. However, the sub-acute facility is slightly different as the screen on the AutoPharm workstation is either too far away or obscured as the technician moves around the pharmacy while restocking.

I’ve had several calls with Talyst since the pilot project started and one of the possible solutions to the line-of-sight issue at the sub-acute facility is to use a handheld computer with a small screen that the technician can view in place of the larger monitor while putting the order away. There are no immediate plans for testing, but the idea seems plausible. The technology appears to favor this solution as I’ve found a few scanners that might fit our needs. Examples of scanners with this functionality include the Motorola MC3100 series mobile computer and the Intermec CK31ex. The other option would be to mount the AutoPharm workstation on a mobile cart, a.k.a. COW. The workstation already has a small enough footprint we would just have to ensure wireless connectivity for it to work.

Other than that things have been going quite smoothly. The AutoPharm software has several potential uses throughout the facility. In addition to implementing in several other areas of the main pharmacy, I see the system being beneficial in a satellite setting. Considering the addition of our new tower and the probable addition of at least one pharmacy satellite in the next 12 months, that’s a good thing.

The day started with me giving a brief presentation at their quarterly meeting about Kaweah Delta’s experience installing Talyst equipment, and ended with a tour of their warehouse facility in Preston that included a peak at their process for managing and testing canisters for their AutoPack Oral Solid Packaging System; very interesting stuff.

Talyst was a wonderful host and I had a great time visiting their facilities and speaking with a bunch of very intelligent and interesting people. I learned a lot and had fun at the same time. You can’t ask for more than that.

About 60% of our medication inventory is stored in the AutoCarousel system. Not unlike most acute care pharmacies the remaining inventory is scattered throughout various areas in the pharmacy: refrigerators, freezers, large shelving areas, etc. Items not stored in the carousels aren’t necessarily routed through the AutoPharm system, and thus don’t benefit from the software’s functionality.

Talyst is currently piloting a system that makes use of their AutoPharm software without the need for their AutoCarousel system. The pilot is designed to take advantage of the AutoPharm software in an area with static shelving. I prefer using the automated carousels for storage, but this new idea is ideal for smaller facilities with limited capital resources that might not be able to afford the AutoCarousel system. They get the benefits of AutoPharm at a greatly reduced cost.

Our facility is fortunate enough to be involved in the pilot. For the last several days I’ve been installing AutoPharm workstations at both our sub-acute facility and an additional AutoPharm workstation in our main pharmacy. The installation was quite painless and went amazingly smooth. The process consisted of getting the hardware peripherals connected to the PC, configuring the network connections and entering the inventory into the system; piece of cake.

The stand alone AutoPharm system consists of a POS-X PC117 workstation, a Code CR3 scanner and a Zebra ZM400 printer, and of course Talyst’s AutoPharm software.

According to the Talyst website:

AutoPharm

Inventory and Workflow Manager
The Talyst connected pharmacy uses powerful AutoPharm® software and a suite of hardware components to enable greater patient safety, improved efficiency, and control of your inventory. The unique AutoPharm software platform allows you to manage your complete pharmacy inventory from arrival to delivery. It works throughout your facility, even with multiple locations and multiple hospitals.

Patient Safety
• AutoPharm allows multiple bar code checks to receive, restock, and dispense medications Works with your current bedside verification system and unit-based equipment.
• Supports automated packaging and labeling to bar code virtually 100% of your doses
• Supports Automatic Canister Recognition Systems for accurate pharmacy packaging

Inventory Control
• Enables the creation of a real-time, perpetual inventory system
• Supports your current hospital information system and wholesale relationships
• Enables password-protected security to limit access to medication and data
• Enables centralized ordering and management
• Supports multiple pharmacy inventory locations

Workflow Efficiency
• Automates receiving, stocking, picking, and returns
• Synchronizes user tasks and system components
• Automates wholesale orders driven by actual usage
• Works with centralized or decentralized pharmacy distribution models
• Supports web-based ordering from remote departments or hospitals

The POS-X workstation is a big improvement over the traditional use of a monitor and standard PC tower. It’s not exactly petite, weighing in at 24 pounds, but it’s still a real space saver.

According to literature on the Talyst customer portal “the versatile, all-in-one workstation features powerful hardware components built into an easy-to-use 17″ monitor. It delivers premium computer performance in a minimum of space. The space-saving workstation also includes a keyboard and mouse, and the compact, all-in-one monitor can be placed on a desk, a mobile cart, or easily mounted to a wall.”

The unit includes a 2 GHz Celeron processor, 160 GB HD, 1 GB RAM, a 1280 x 1024 display and runs Windows XP Pro. The specs aren’t exactly cutting edge computing technology, but the workstation has more than enough horsepower to take care of the operations it was designed to handle. Heck, it has better specs than the machine I use at work day in and day out; except I have 4 GB RAM.

I spent some time on the POS-X website, but couldn’t find the PC117 model. Of the workstations listed on the POS-X site the one with the closest technical specs was the XPC517. The XPC517 includes a splash-resistant touchscreen. I couldn’t find anything on the Talyst specsheet that mentions a touchscreen, so I’m assuming that accounts for the difference in model numbers.

Regardless, I really like the all-in-one PC design and think the POS-X PC117 is a pretty cool piece of pharmacy technology.

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

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

The Code Reader 3500 uses newer technology over the CR3 and performs much better with our carousel. The reader is easier to use due to its wider target area and “reflection and glare reducing illumination”. It’s also quite a bit faster. The technicians love it.

We had some initial problems with the scanner. It read the barcodes fine, but our AutoPharm system had trouble interpreting the information. Needless to say we were a bit disappointed. However, while at ASHP Midyear I had a chance run in with some folks from Code Corp. The two minute conversation I had with them resulted in Code Corp sending a representative to Kaweah Delta to help me resolve the issue with the scanner.

The representative provided us with a new Code Reader 3500, programmed it, and tested it. Unfortunately we continued to have issues with the scanner at which time Code Corp sent out a second product specialist that eventually hooked me up with one of the company’s product engineers. After tossing around some ideas the engineer figured out the problem, sent me a new programming barcode, and like magic our issue was resolved.

In a time when I experience poor customer service and support from some of our vendors, it’s refreshing to see a company go out of their way to support their products. Kudos to Code Corp.

What brought all this up? Over the weekend one of the technicians dropped the 3500 scanner and broke the trigger on the battery handle. They ended up going back to the old CR3 that I keep as a backup for just such an emergency. Needless to say, they weren’t happy about having to give up the 3500 scanner. If they would have called me I could have told them that the battery handle on the CR3 can be used on the 3500. It took me about 30 seconds to switch the handles and everyone was happy once again. I guess it really is about the simple things in life. Go figure.

The User Group was made up of representatives from several hospitals across the country: California, Nevada, Arizona, Washington, New York, North Carolina and Pennsylvania among others. There were IT pharmacists, operation managers, pharmacy directors and one medication safety pharmacist. A good mix.

Topics covered included how to manage multiple NDC numbers for products stored in an automated carousel, an introduction to the new Talyst customer portal, an introduction to the new Talyst report writing service and an update on patient safety. Most of these items were hot topics at the June meeting, and it’s nice to see Talyst taking note of the customer feedback they received.

The new customer portal is a good thing for Talyst customers. If used properly it will become a place for customers to connect to discuss issues and best practices. In addition the new portal gives users access to customer support as well as ordering consumables.

Like many other hospital pharmacies, Kaweah Delta relies heavily of various reports to analyze dispensing trends, inventory control, clinical activity, etc. Even though our AutoPharm and AutoPack systems offer several model reports, they don’t cover all areas we like to look at. The new Talyst report writing service offers customers the opportunity to ask for custom reports to fit their individualized practice. In addition, reports created for customers will be placed in a library where other customers can access them.

Patient safety is always a big topic when a group of pharmacists get together to discuss automation. Talyst is working on several new safety features, including lot number and expiration tracking, high alert medication information, and multi-part labels for special needs medications.

Overall the User Group was a positive experience and certainly a good use of time. I picked up quite a bit of information and made contact with some really smart people; always a good thing.

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.