My initial impression of Microsoft’s Surface RT Tablet

First and foremost I haven’t purchased a Surface RT tablet. While traveling this week for work I found an opportunity to stop by a Microsoft Retail store in the area and finally get my hands on one for about half an hour. There is no question about  it, Microsoft has done themselves proud with the Surface hardware. The tablet is beautiful from the kickstand to the angular features and even the touch cover, which is surprisingly nice to type with and gives the tablet a finished look when closed. The UI works great on the tablet and everything operates smoothly. I put it through its paces by opening as many programs as I could and just bouncing around from a Word document and SkyDrive to taking photos and video. I even spent time browsing the web from within the new IE. Everything worked as advertised.

Continue reading My initial impression of Microsoft’s Surface RT Tablet

Saturday morning coffee [October 27 2012]

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug to the right is from Galveston, TX. Galveston is an interesting place. It’s a beach town, but unlike any beach town here in California. Galveston has the warmest ocean water I’ve ever been in. Almost like bath water. That may sound like a negative, but it’s really not. Instead of having to inch my way into the water I was able to jump right in and spend some time with the kids without freezing half to death. It was a nice change of pace from the California coastline. The other distinct feature of the beach is that it has a gradual slope into the water from the shoreline. I was able to walk more than 100 yards from shore without getting into water over my head. It made for some great fun as my wife and daughters joined me and we played in the water for quite some time. I hadn’t been in ocean water for a long time. It felt good. By the time we were finished at the beach I was sticky with salt, worn out and slightly burnt. In other words, perfect.

Paranormal Activity 4 was #1 at the box office last weekend. It’s that time of year again. Because we’re nearing Halloween we’re seeing a whole slew of scary movies hitting the box office. Not my thing.  I’m not a big fan of Halloween in general. Give me Thanksgiving or Christmas every time. You can keep Halloween and the movies that go along with it.
Continue reading Saturday morning coffee [October 27 2012]

Clinical documentation: composition or synthesis? [article]

A recent article in the Journal of American Informatics Association (JAMIA) takes a look at note-writing practices of medical residents while using an electronic health record (EHR) system. Through the use of time-and-motion studies the authors concluded that there was “a high level of fragmentation of documentation activities and frequent task transitions [when using an EHR].” Not really surprising when you consider that most EHR systems simply aren’t designed with the needs of the end user in mind. In addition it is difficult to use an electronic system in an attempt to mimic the act of taking notes using pen and paper. I’ve struggled with that for years. The thought process is different.

Clinical documentation: composition or synthesis?
Mamykina L, Vawdrey DK, Stetson PD, Zheng K, Hripcsak G.

Department of Biomedical Informatics, Columbia University, New York, USA.

OBJECTIVE: To understand the nature of emerging electronic documentation practices, disconnects  between documentation workflows and computing systems designed to support them, and ways to improve the design of electronic documentation systems.
MATERIALS AND METHODS: Time-and-motion study of resident physicians’ note-writing practices using a commercial electronic health record system that includes an electronic documentation module. The study was conducted in the general medicine unit of a large academic hospital.
RESULTS: During the study, 96 note-writing sessions by 11 resident physicians, resulting in close to 100 h of observations were seen. Seven of the 10 most common transitions between activities during note composition were between documenting, and gathering and reviewing patient data, and updating the plan of care.
DISCUSSION: The high frequency of transitions seen in the study suggested that clinical documentation is fundamentally a synthesis activity, in which clinicians review available patient data and summarize their impressions and judgments. At the same time, most electronic health record systems are optimized to support documentation as uninterrupted composition. This mismatch leads to fragmentation in clinical work, and results in inefficiencies and workarounds. In contrast, we propose that documentation can be best supported with tools that facilitate data exploration and search for relevant information, selective reading and annotation, and composition of a note as a temporal structure.
CONCLUSIONS: Time-and-motion study of clinicians’ electronic documentation practices revealed a high level of fragmentation of documentation activities and frequent task transitions. Treating documentation as synthesis rather than composition suggests new possibilities for supporting it more effectively with electronic systems.

J Am Med Inform Assoc. 2012 Nov 1;19(6):1025-31

Combination lock to prevent blood transfusion errors? Why not

medGadget: “Typenex Medical, a Chicago, Illinois company, has created a solution that pretty much eliminates the possibility for errors. The system utilizes a combination lock on the blood bag that will only open using a code printed on the patient’s armband. If a clinician accidentally attempts to open the bag using another patient’s code, it will stay closed and the transfusion will not happen.” – Simple, yet effective. Interesting concept, no?

The product is called FinalCheck.

Cool Pharmacy Technology – RxMedic ADS

The RxMedic ADS robot is kind of cool. I’m not a big fan of robotics because I think they’re basically slow and I don’t believe the technology is mature enough yet; in healthcare that is.

The thing that makes this interesting to me is the checkout process, which can be found at about 1:30 into the video. The process includes photo verification. Lends itself to remote checking and tech-check-tech, don’t you think?

As technology like this becomes available it is becoming increasingly clear that the traditional role of a pharmacist is obsolete. Not sure if the new role is a completely “clinical” one, but it certainly isn’t what it is now.

From the RxMedic website:

The only retail robotic dispensing system with photo verification. The RxMedic ADS packs high speed processing into a very small footprint. Its 256 cells enable you to fill as much as 80 percent of your daily processing, complete with verification, labeling and capping.

  • Interfaces with any pharmacy management system
  • Save 50% – 80% of time spent preparing orders
  • Can pay for itself in pharmacies with as few as 150 prescriptions per day
  • Fill up to 80% of your daily prescription volume
  • Special HEPA filtration combined with vacuum technology helps reduce dust and cross-contamination
  • Nationwide on-site service

Microsoft Surface RT is a great looking tablet, but I’ll be holding off for now

The difference between men and boys is the price of their toys” – unknown

I had a Microsoft Surface RT tablet in the shopping cart. I was this close – holding my thumb and index finger very close to each other – to pulling the trigger. Had the trusty credit card out and permission from the spousal unit.

What’s not to like about Surface RT? I believe it’s a more sophisticated option than either an iPad or Android tablet. The starting price is $499 for a 32 GB model with 10.6-inch ClearType HD screen, five-point multi-touch, resolution of 1366 x 768, a NVIDIA T30 chip paired with 2 GB of system memory, MicroSD card slot, USB 2.0 port, HD video out port, has a kickstand and so on. It even includes Microsoft Office 2013 Student Edition for crying out loud! And if you’re willing to drop a bit more cash you have options for a keyboard cover. It’s truly a bargain.

So what’s the problem? There’s really no problem. I want one. I really want one. The issue is that I made a deal with myself a month or so ago that I wouldn’t purchase another piece of technology unless it could replace something I currently have. I have a lot of toys.  And unfortunately the Microsoft Surface RT won’t replace any of the bigger ones because it runs an ARM-based chip that typically powers smartphones and consumer tablets. It could easily replace an iPad or Android tablet, but not my laptop or tablet PC. I suppose it could in theory, but not practically.

Being the logical guy that I am I’ve decided to wait for Surface Pro and shell out the $1K plus in the hope of replacing at least one of my bigger machines. That’s the plan anyway. You never know though. I’ll be in up in Bellevue, WA next week, which means that I’ll end up at the Microsoft Store at least once. I wouldn’t be at all surprised if I ended up walking away with a Surface RT tablet. Just sayin’.


Cool Pharmacy Technology – Kirby Lester KL1Plus

The Kirby Lester KL1Plus is a piece of technology designed to count medications in a retail/outpatient pharmacy setting. The device was introduced at the recent National Community Pharmacists Association (NCPA) and Department of Defense Joint Forces Pharmacy Services annual conventions in San Diego, CA.

The KL1Plus is based on Kirby Lester’s KL1 tablet counter combined with new verification software. It’s small enough to fit in your hand and uses barcode technology to provide medication verification during the counting and filling process.

The is pharmacy technician scans the barcode on the patient label, then scans the corresponding stock bottle or package when counting.

What I really like about this technology is that it’s simple, it’s small, it fills a niche, it uses barcode scanning for verification, and uses touch screen technology. It’s a smartly designed product. I like it.
Continue reading Cool Pharmacy Technology – Kirby Lester KL1Plus

KoamTac adds scanner cases for Samsung Galaxy SIII and Samsung Note 2

KoamTac makes some pretty cool BlueTooth barcode scanners. I’ve used their KDC300i imager with an iPod touch. It’s small, light and fast.

Historically KoamTac has been almost exclusively aimed at Apple equipment, i.e. iPhones, iPod touches and iPads. It’s nice to see that they’re including other popular smartphones as well. I’m particularly excited to see that they have a case for the Samsung Note 2. The Note 2 would make an interesting device if paired with one of the KoamTac BlueTooth scanners, especially when you consider the additional functionality of the S Pen. Pretty cool.

Saturday morning coffee [October 13 2012]

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug to the right is from The Sixth Floor Museum at Dealey Plaza in Dallas, Tx. My family and I spent some time there during our summer vacation in Texas. One of the things I really wanted to do in Dallas was visit Dealey Plaza and the site where JFK was assassinated. Well, I finally got that chance as my family and I spent some time walking around the plaza area, visiting the location of the assassination and spending a little time at the book repository and museum. JFK is one of the few men in history that I would have liked to have met in person.

Taken 2 was #1 at the box office last weekend. My wife and I saw it last Saturday. Not bad. If you decide to go see it make sure you don’t want a good story line or incredible acting range. Just enjoy the senseless violence and be entertained. Hotel Transylvania was #2 at the box office. I saw that last night with my wife and youngest daughter. Good, clean humor. Worth seeing especially if you have little ones.

Continue reading Saturday morning coffee [October 13 2012]

More on the meningitis outbreak caused by contaminated steroid injection

Things just keep getting worse: death toll rose to 14 and people affected was up to 172 in 11 states as of this afternoon. It’s difficult to find accurate information on the exact cause of the meningitis, but it appears that most of the cases are related to either Aspergillus or Exserohilum.

Fungal infections are notoriously difficult to treat, especially when they’re in the central nervous system (CNS). The CNS is designed like a fortress to keep things out, like fungus and bacteria, thus keeping you safe and healthy. Unfortunately it doesn’t discriminate and does a great job of keeping medications out as well. That’s why it’s hard to treat infections in the CNS.

I’ve been involved with several meningitis cases over the years, but rarely those involving a fungus. The outcome generally depends on several variables including how quickly the infection is discovered, how soon treatment is started, how aggressive the treatment is – you can never be too aggressive when treating meningitis – and the general health of the person you’re treating. A little divine intervention is always desirable as well. However, as I mentioned above, meningitis is difficult to treat and the outcomes associated with fungal meningitis aren’t great.

The CDC has released treatment recommendations. You can find them at the ASHP Pharmacy News site here.

“The Centers for Disease Control and Prevention (CDC) recommends i.v. voriconazole and liposomal amphotericin B as initial therapy for patients who meet the current case definition for fungal meningitis.

According to CDC, the antifungal therapy for patients with meningitis should be administered in addition to routine empirical treatment for potential bacterial pathogens.

CDC Medical Epidemiologist Tom Chiller said during an October 10 conference call that broad-spectrum antifungal therapy is advisable because it is “unclear as to how many potential fungal pathogens could be involved” in the outbreak.

For patients who meet CDC’s current case definition for fungal meningitis, the recommended dosage of voriconazole is 6 mg/kg administered every 12 hours. Chiller said the dosage should be maintained “for as long as the patients tolerate it.”

Liposomal amphotericin B should be administered intravenously at a dosage of 7.5 mg/kg/day, according to CDC. The agency stated that liposomal amphotericin B is preferred over other lipid formulations of the drug.

The optimal duration of therapy is unknown but is presumed to be lengthy.”

Emphasis above is mine.