Jerry Fahrni

Month: February 2011

  • “What’s in it for me?”

    I spent some time this week in Las Vegas attending some NCPDP work groups on standards, e-prescribing and pedigree/track and trace. Because I’m relatively naïve in these areas I learned a lot. The NCPDP is an interesting organization that appears to be doing a lot of the right things in driving standards and improving e-prescribing in the outpatient setting. Unfortunately acute care hasn’t been as aggressive in adopting these standards or implementing e-prescribing. That’s for another blog post.

    Following the scheduled meetings I found myself sitting in on a few impromptu after hours sessions where I got my first glimpse of the political side of the pharmacy underbelly. Let’s just say that there are a lot of special interest groups involved in the process and much of what they want has little to do with better healthcare or improved patient care. Instead it’s a what’s-in-it-for-me mentality. It was disturbing to see the good work that NCPDP was doing overshadowed by groups looking to make a buck or make sure that their competitors didn’t get the upper hand.

    Even though I was enlightened by the work done by NCPDP, I was troubled by the behavior of “industry leaders” and large healthcare providers. I believe we have forgotten the reason we’re in healthcare in the first place. I’m just sayin’.

  • First Impressions – Lenovo T410s Laptop

    There’s a new Lenovo T410s laptop in the house. It’s technically not mine because it has a giant company asset tag on it, but it’s mine for the duration of my employment and it’s one incredible machine.

    The configuration is as follows:

    • Windows 7 Professional (64-bit)
    • Intel Core i5-M560 Processor
    • 160GB Intel Solid State Drive
    • 8GB RAM
    • 14.1-inch WXGA touchscreen…yes, that’s right, it is a touchscreen
    • 6 Cell Li-ion battery
    • 3-cell ultrabay battery that fits in the DVD slot when I need additional battery
    • And all the typical stuff that goes with most laptops, i.e. camera, Bluetooth, wireless (no 3G), etc

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  • Quick hit: approaches for standardized healthcare data

    When my brother, Rob and I get together it often brings our wives to tears with boredom as we often get deeply engrossed in long conversations about computers, software and technology in general. Super Bowl weekend was no different. Rob and I started talking about strategies for connecting various pharmacy systems to other hospital systems and the issue of a lack of standardized information in healthcare came up. I mean we have standards, right? Of course we do. There’s SNOMED-CT, RxNorm, ICD-9, ICD-10, LOINC, GLNs, GTINs, NDC, bar-code “standards”, HL7, NCPDP SCRIPT standards and so on and so forth ad infinitum. I realize the list above includes a hodge-podge of standards that don’t really belong in the same category, but I did it to illustrate my point. And that point is that we have too many stinking standards. Trying to figure out which standard to use is an exercise in futility. Standards typically make sense to the people that invent them or study them, few others. And someone always has an idea for a better standard, hence the plethora of standards.

    As healthcare inches forward interoperability of systems will hold a key role in the success of the government’s plan for electronic health records. So as Rob and I discussed how to integrate various services and products we pondered how one goes about creating a standard that everyone can live with. Well, how does one create a standard that everyone will use? Heck if I know, but we decided that there are basically two approaches. The first is to create a standard and try to cram that standard down everyone’s throat. Microsoft has been fairly successful with this approach. With that said, few people have the resources that Microsoft has to throw at a problem. The second approach is to offer the standard as part of a free solution that comes with your product; this way people can use your product and use your free, open-source solution to tie the systems together. I assume this is the smart approach for companies that have limited resources; kind of a grassroots approach. Of course it would be wise to build this free, open-source solution on top of an existing standard that’s prominent in the market, otherwise you’re trying to re-invent the wheel. And we all know what happens when someone re-invents the wheel. Uh, you get a wheel. We don’t really need any more of those. Both approaches have pros and cons.

    Now the question becomes which standard makes sense as you design your solution. If only I had a crystal ball. We’re at least a decade away from having a truly inter-operable healthcare system; optimistic, I know.  Ultimately, the standard of choice won’t be driven by what makes sense, but rather will be driven by adoption rates. Things often become a standard without even trying.

  • Monday evening quarterback

    What a great weekend. The Super Bowl wasn’t a blowout and turned out to be quite exciting in the end. The commercials weren’t extravagant, but were surprisingly entertaining. The one downside was the absolutely embarrassing rendition of the National Anthem sung by Christina Aguilera. For all those would be National Anthem singers out there, please don’t add to or take away from the National Anthem. When you do, you’re doing nothing more than punching this great country of ours in the face.

    Anyway, here’s some other stuff I’ve found interesting over the weekend:
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  • “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.
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  • Do smaller hospitals get the shaft when it comes to automation and technology?

    I’ve worked in several acute care hospitals during my career, from the small one horse operation that did little more than care for minor inconveniences, to larger, multi-pharmacy facilities that handled everything from pneumonia to severe trauma. As I’ve mentioned elsewhere on this blog each one of those pharmacies offered a slightly different way of doing things. Granted, some were variations on a similar approach, but they were all different.

    However, one trend I’ve discovered across the range of facilities is that the smaller the hospital, the less automation and technology the pharmacy has. Why? It’s quite simple. Automation and technology is expensive. It’s also time consuming to plan for, implement and maintain. Of course another argument is that smaller hospitals - and therefore smaller pharmacies – need fewer technological advances. That doesn’t make much sense to me. I agree that a small 50 bed hospital pharmacy may not need a giant robot to fill their med carts, but they can certainly benefit from clinical decision support, pharmacy surveillance software, bar code medication administration (BCMA), computerized provider order entry (CPOE), automated dispensing cabinets (ADCs), smartpumps, mobile devices, so on and so forth. The problem is that much of this technology is expensive and takes a sizable chunk out of smaller budgets.
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