Reviewing an #archetype

I’ve been meaning to write this for a while, but you know how things go.

While at HIMSS12 in Las Vegas last month I was asked to do a little review work. That’s not all that uncommon. People ask me to do things on occasion; review a blog post, review an app, give my opinion on something and so on. But this was completely different as Dr. Heather Leslie (@omowizzrd), Director of Clinical Modeling for Ocean Informatics and Editor for the openEHR Clinical Knowledge Manager asked me to review an archetype. A what? Yeah, that was my response when Heather and I first spoke about the topic nearly two years ago.

According to good ol’ Merriam-Webster an archetype is “the original pattern or model of which all things of the same type are representations or copies: also : a perfect example“. Simple enough, but still too vague for my brain so I went in search of a better explanation which I found at Heather’s blog – Archetypical.
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Cool Pharmacy Tech – Phocus Rx

Ever heard of Phocus Rx? Neither had I until a couple of days ago when my boss sent me a link to this story about Children’s Hospital Los Angeles receiving Phocus Rx as a charitable donation.

Phocus Rx is camera system used in pharmacy clean rooms to document and validate the IV compounding process. It consists of two compact 5 megapixel cameras mounted outside the hood in the clean room ceiling or on articulated arm and workflow management software. That’s quite a departure from the other systems I’ve seen where the camera sits in the hood. In addition Phocus Rx includes the obligatory image capture that allows pharmacists to remotely review the compounding process. Pretty cool stuff.

By my count we now have four of these systems on the market, including PHOCUS Rx. Getting pretty crowded in there. Although I have to say that DoseEdge is far and away the most talked about of the IV workflow management systems on the market today. I’d love to play with them side by side to compare features and functionality.

The other systems that I’m aware of include:

From the PHOCUS Rx website:

PHOCUS Rx is a powerful camera verification system combining hardware and software. It enables pharmacists and technicians to remotely document and validate the preparation of IV drugs. Two ultra compact 5 megapixel cameras are located outside the hood in the clean room ceiling or on articulated arm. Bi-directional communication software enables pharmacists to review high resolution images and validate or send a warning message.


  • scalable and modular system
  • non invasive – no wires or devices in hood
  • server located outside compounding area
  • validate and store images
  • barcode recognition
  • based on client/server structure
  • simple workflow screens
  • historical and activity reports

Medscape application now available for the Kindle Fire

I’m sure by now everyone has heard of the Kindle Fire. If not just know that it is the 7-inch color media device from Amazon based on the Android operating system. The device has been uber popular to this point. It’s difficult to tell how popular exactly, but one thing is for sure, you know a device has gained some ground by the applications that get developed for it.
Continue reading Medscape application now available for the Kindle Fire

AJHP optimized for mobile access

Looks like the little elves over at AJHP have been busy making their journal easier to access from mobile devices. That’s pretty cool. I spent a few minutes playing around with the site on my Nexus and it worked well. I was able to pull up Implementing smart pumps for epidural infusions in an academic medical center and read through it without any major obstacles. The only recommendation I have for AJHP would be to make the process of logging in easier. The optimized site bounces you to the full blown web page for login. Overall, well done.


Technology still can’t beat pen and paper

I am a tablet PC guy, no question. My tablet of choice is the Levnovo x201t, but I’ve tried several and enjoy the constant hunt for a new one. I don’t travel with it much these days as I’ve grown tired of carrying multiple machines, dealing with security, etc. But when I’m at home my tablet PC is a workhorse. Between Microsoft OneNote and Evernote I’ve basically eliminated my need for a notebook. Or so I thought.

For whatever reason I decided to take a long hard look at my note taking needs this week. I’ve been rather irritable lately and found myself nitpicking many of the cons associated with using a tablet PC for taking notes that I previously overlooked. The shortcoming of using a tablet PC are obvious: battery life, “boot time”, size and the mother of all….you can’t take notes on a tablet of any kind when it’s turned off, which has been a real issue for me while traveling.
Continue reading Technology still can’t beat pen and paper

Effect of med reconciliation on med cost after hospital D/C [article]

The Annals of Pharmacotherapy March 20121

BACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs.

OBJECTIVE: To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.

METHODS: A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included.

RESULTS: Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10).

CONCLUSIONS: Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.

Based on the exchange rate mentioned in the study (EUR 1 = USD 1.3443) the six month savings associated with medication reconciliation was about $75 U.S. per patient after factoring in labor. Not exactly earth shattering, but nothing to turn your back on either. At least there’s a positive ROI.

I would have liked to have seen the authors take the study one step further by linking the medication reconciliation savings back to hospitalization readmission and/or effect on the patient’s lifestyle/activity. Once in a while optimizing a patient’s therapy might mean trading a more expensive drug for ease of use or improved patient compliance.


  1. Karapinar-Çarkit F, Borgsteede SD, Zoer J, Egberts TC, van den Bemt PM, van Tulder M.Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. Ann Pharmacother. 2012 Mar;46(3):329-38. Epub 2012 Mar 6. PubMed PMID: 22395255.

Physician dispensing, that’s some bad mojo right there

Physician dispensing is a hot topic for several reasons. And while I’m not opposed to the use of medication kiosks to dispense medications to patients, I believe that their use must be carefully defined and continuously monitored. As I said in a post in September 2010Under the right set of circumstances, and with thoughtful implementation, kiosks could free up pharmacists to spend more time with patients in emergency departments and urgent care clinics across the country. After all, don’t pharmacists argue for more clinical face time with patients and less association with the physical medication dispensing process? That’s what I’ve been hearing from pharmacists for years.” The key part of that quote is “under the right set of circumstances”. You cannot remove the pharmacist form the medication use process. It would be a mistake to do so, and I believe ultimately would lead to increased patient risk. I’ve worked in retail, long-term care, home infusion and acute care pharmacy, and let’s face it, physicians struggle at times to get things right. That’s why God made pharmacists. While I’m not naive enough to think that a pharmacist has to speak to each and every patient about every medication they use each time they receive it, I do think there should be some oversight of the process; regardless of the method of distribution.
Continue reading Physician dispensing, that’s some bad mojo right there

Physician shares thoughts on using tablet PC in the field

Mobile Healthc “Dr. R. Dale Walker, from the Cherokee Tribe of Oklahoma, is a professor of Psychiatry, Public Health and Preventive Medicine as well as the director of the Center for American Indian Education and Research at Oregon Health and Science University and director of the One Sky Center.

… “When out in the field, you want to eliminate as many things that could go wrong as possible, and the J3500 Tablet PC does just that with its battery life, ruggedness, power and performance,” said Dr. Walker. “Consumer tablets just can’t compute like the Windows®-based Motion Tablet PCs, and who wants to carry around multiple systems when you have everything you need in one device?”

According to Dr. Walker, using the J3500 Tablet PC is just like taking notes on paper, but much more efficient. An hour’s worth of notes can be converted to text and emailed out in just minutes. “The ability to capture information, report back on my findings and share knowledge in near real time is an invaluable capability,” said Dr. Walker.

The tablet serves as a desktop replacement or portable library, helping Dr. Walker look up, verify or access educational tools on the fly, which proves extremely valuable considering the often remote locations of the communities. The access to information also reduces the amount of time spent on each subject, meaning more time to cover more topics. “It’s giving them the gift of information,” said Dr. Walker.”

The article reads a bit like a propaganda piece from Motion Computing, but I agree with pretty much all the highlights. I’ve been a fan of the Motion J3500 for a while. I’ve written about it before and stand by my opion. The only negative to the device is the price tag. In this day of inexpensive consumer tablets it’s difficult to swallow the price tag, which is a staggering $2-3K. You get a lot for your money, but it’s still hard to swallow.

Cool Pharmacy Tech – T-Haler

The T-Haler is a training device developed by Cambridge Consultants to help asthma patients learn how to use their inhalers. Why is this such a cool piece of technology? Because patients invariably do a crapy job using their inhalers.

I used to ask asthma patients to demonstrate how they used their inhalers, and I was almost always disappointed by what I saw. Most patients don’t understand how to properly use these simple little devices, which ultimately leads to treatment problems, and in worst case scenarios poor control of their asthma.  This is especially true in pediatric patients. Asthma education was a big part of the pharmacist’s job when I worked in a pediatric hospital.

From the Cambridge Consultants site:

Cambridge Consultants developed the T-Haler concept, a simple training device. Interactive software, linked to a wireless training inhaler, monitors how a patient uses their device and provides real-time feedback via an interactive video ‘game’. T-Haler provides visual feedback to the user on their performance and the areas that need improvement. These tools could help the estimated 235 million asthma sufferers worldwide to get the most from their inhaler, and potentially reduce the millions spent annually on asthma-related emergency room admissions.

More than 50 healthy participants, aged 18-60, took part in a recent study conducted by Cambridge Consultants to test the efficacy of T-Haler. Before using the training system, the average success rate of the group in using an inhaler correctly was in the low 20% range – in line with numerous other studies carried out. The participants had no prior experience with asthma or inhalers and were given no human instruction beyond being handed the T-Haler and told to begin. The on-screen interface walked the group through the process, which takes just three minutes to complete.

The T-Haler measures three key factors for proper inhaler use. First, whether the patient has shaken the inhaler prior to breathing in; second, the force with which they breathed in; third, when they pressed down on the canister (the step which releases the drug). These three variables can determine the efficacy with which drugs are delivered in a real metered dose inhaler (MDI) device.

As healthcare trends toward a focus on preventive care and devices which offer greater consumer appeal and compliance, innovations such as the T-Haler may soon become the norm in doctors’ offices, pharmacies and clinics.

RFID technology to monitor football players to prevent overheating on the field

This is simply cool. There’s no other way to put it. “On the football field, for example, heat prostration has led to several fatalities over the past few years. The problem starts during pre-season practices that take place under the intense summer sun. Identec has already developed a headband with an embedded heat-sensing chip. The RFID chips embedded in helmets developed by HotHead Technologies, combine RFID with a heat-sensing thermistor, offering plenty of range.”

From the hotheads technology website:

The H.O.T. System is a patent-pending, two-component package that embeds a heat sensing unit inside the helmet of an individual and collects and relays periodic temperature readings from that person’s skin to a portable data collector (A ruggedized PDA or Laptop Computer). The portable device is used to alert the individual or an observer that the person has exceeded an allowable temperature while the subject’s helmet is on.

If skin temperature ranges outside of the set parameters then the data collector will alert the sensor unit in the helmet to take temperature readings at a faster rate. The alert will be displayed on the data collector so the operator of the data collector can make a decision on whether to stop the current activity and seek to receive further observation from a professional and take measures to cool their temperature down. The alert will be automatically removed from the data collector as soon as the skin temperature falls back into the normal parameters.

There’s also a short video that shows the basic idea here.