“What’d I miss?” – Week of January 30, 2011

As usual there were a lot of things that happened over the past week, and not all of it was related to pharmacy automation and technology. Here are some of the things I found interesting.

The Rite was #1 at the box office last weekend; definitely not my kind of movie. I watch movies to be entertained, not creeped out. My wife and I saw The Mechanic instead. It was exactly what you’d expect from a Jason Statham move, and that was fine by me.

I stumbled across a website called High Performance Pharmacy. The site is “based on a landmark study by The Health Systems Pharmacy Executive Alliance. The study identifies proven best practices for achieving high performance across 8 dimensions of hospital pharmacy practice. Read on to learn how your pharmacy can become a High Performance Pharmacy — delivering the best clinical outcomes for your patients and financial results for your entire health system.” It appears to be tied to McKesson somehow, which makes me look at the information with a bit of skepticism. With that said, I found the information on the site valuable. There’s a lot of material there so make sure you have a little time on your hands before you get started.

I spent a little time this week looking at unit-dose distribution systems. Most of the articles I read on the topic kept referring back to Chapter 10 Unit-Dose Distribution Systems in Making Health Care Safer: A Critical Analysis of Patient Safety Practices from AHRQ. The information on the site is good, but a little out of date. Actually I should say the information is old (2001), however it’s still applicable. How disappointing is that.

I’ve been rummaging around in the Chrome Web Store recently. The web store is growing rapidly and there are a lot of great applications to be found. Unfortunately, like all online app stores, there’s also a lot of garbage out there. Anyway, as I was trying out various applications this week I came across an interesting service called Diigo. Diigo is another in a long line of web-based applications designed to capture notes, bookmarks, images, etc, and help you organize and share that information in a somewhat coherent manner. It reminds me of Springpad. I’ll let you know more as I figure out how to use Diigo better.

Lifehacker: “The iPad is easily the best tablet you can buy right now, but that’s changing. Google showed off their upcoming tablets today, casting a spotlight on the iPad’s shortcomings.” – The Android OS vs. iOS war is as brutal as ever. Just read the comments following the post and you’ll see what I mean. Honestly I don’t think either the iOS or Android OS is the best platform for a tablet. The best possible platform for a tablet is one that seamlessly works across all devices and applications. Believe it or not, Microsoft currently has the best opportunity to make it happen. Notice I said opportunity, not chance. Don’t count Google out of the equation as they continue to dabble in just about everything these days.

Annals of Internal Medicine (Ann Intern Med. 2011;154:174-180): “High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions – Conclusion: To preserve quality, we recommend careful assessment of both benefits and costs of interventions rather than focusing on either aspect alone. Evaluation of the effectiveness of interventions should include an analysis of both benefits and harms and use the best available evidence for each.” – This is an important distinction as I think many of us fail to see the long term implications of many of our decisions in healthcare. While this article is specifically addressing the clinical side of healthcare it could just as easily be applied to other areas as well such as automation, technology, safety, etc.

Annals of Internal Medicine (Ann Interm Med. 2011:154;160-167): “For each of 6 diagnoses at admission—acute myocardial infarction, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia—patient admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality. Predicted inpatient deaths would increase by 1831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest. The association between hospital spending and inpatient mortality did not vary by region or hospital size.” – Hmm, and people think money doesn’t matter. So find the hospitals that like to spend money and avoid the ones that are trying to cut costs; easier said than done.

Agile Product and Project Management Blog: “Denial is incredibly dangerous because it enables a person to postpone facing reality and therefore delays the process of either identifying a different, feasible solution or recognizing that a company is currently on a fundamentally bad course and must change course. If you’re driving a car towards the edge of the Grand Canyon but are acknowledging the data provided by your eyes, you’ll realize you must stop or turn. But if you deny the data your eyes are providing, you can drive straight over the edge of the cliff to your doom.” – More than half the people I’ve worked with would simply drive off the edge and deny that it was a problem all the way to the bottom. Unless you talking about the people I’ve worked with in healthcare, then it’s more like 90%.

EMR Daily News: “Dr. David Blumenthal announced his resignation as health IT coordinator and will return to Harvard University where he had previously served as a professor.” – Now for the litmus test: will it make any difference? Probably not. People leave jobs everyday and the sun continues to come up.

ESPN: “The University of Iowa Hospitals and Clinics will fire three employees and suspend two others after an investigation confirmed they inappropriately breached the electronic medical records of hospitalized football players.” – Can you say HIPAA? When will people learn? Sorry, that was a rhetorical question. People will never learn.

Speaking of HIPAA, last weekend while I was at a cheer competition with my girls their was a gentleman in front of me was using an iPad. I’m always curious to see what people do with their tablets so I looked at the screen. He was flipping through a patient’s medical record looking for something. When he found what he was looking for he wrote out a prescription. I am all about mobile technology and think it’s clearly the future of medicine, but I could see everything – the patient’s name, age, conditions, and medication list. The guy made no attempt to shield the screen from prying eyes. I assume he was a physician handling a call, but what a breech in patient privacy. Healthcare systems will never be able to secure medical records when healthcare professionals behave in such a reckless manner.

There’s an interesting editorial in the February 2, 2011 edition of the New England Journal of Medicine. The editorial has a lot to say, but in a nutshell it says that academic medical centers are going to have trouble with the idea of an accountable care organization (ACO) model secondary to costs and reimbursement structure. “The effectiveness of ACOs will depend on the centralization of the administration of medical care, whereas clinical departments in medical schools operate on a decentralized model.” Looks like it’s time for a change.

Does anyone else think the ACO model is simply a rehash of the old “managed care” model that morphed into an “HMO” model? Feels strangely familiar to me.

For those of you that have had your head in the sand for the last couple of weeks, The Super Bowl is this weekend. We’ve got the Pittsburgh Steelers vs the Green Bay Packers. My wife is a huge Steelers fan so obviously the Steelers are the official pick of the Fahrni household. However, if I had to put money on the game I’d take the Packers. This should be a good one.

Have a great weekend everyone.

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