Jerry Fahrni

Year: 2012

  • Domain expertise in healthcare can go a long way

    mobilehealthnews: “[John] Sculley said [while speaking at the Digital Health Summit, CES 2012] that some companies have put too much emphasis on style over substance.

    “The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,””

    I think these comments ring true for many of us that realize the disconnect between the people designing and building products for healthcare, and those actually using them. I can attest to the fact that it exists in many aspects of pharmacy automation and technology where things have a way of being forced down your throat. It becomes a game of which product is the “least bad”. It’s called settling for something, and it never really makes anyone happy. That’s why we’ve seen so many homegrown systems in pharmacies over the years.

    There once was time when terrible usability at least meant great functionality. Unfortunately many companies have chosen to improve the usability at the expense of the functionality, which ultimately leads to a crappy product. I’ve experienced this many times during my career, especially with pharmacy information systems where improved UI’s have often resulted in poor performance, more mouse clicks and frustration.

    Do the industry a favor and ask the end users what they need, instead of giving them what you think they want.

  • Contact lenses loaded with anesthetic medication

    When I think of technological advances these are the things that come to mind.

    medGadget “…researchers at University of Florida are reporting that they developed a way to load topical anesthetics into contact lenses to provide extended delivery of pain relief in a uniform fashion.  And since many of the patients that undergo eye procedures have been wearing contacts prior, they’re already used to putting them on. From the study abstract in Langmuir:

    Here we focus on creating dispersion of highly hydrophobic vitamin E aggregates in the lenses as barriers for drug diffusion for increasing the release durations. This approach has been shown previously to be successful in extending the release durations for some common hydrophilic ophthalmic drugs. The topical anesthetic drugs considered here (lidocaine, bupivacaine, and tetracaine) are hydrophilic at physiologic pH due to the charge, and so these cannot partition into the vitamin E barriers. However, these surface active drug molecules adsorb on the surface of the vitamin E barriers and diffuse along the surface, leading to only a small decrease in the effective diffusivity compared to non-surface-active hydrophilic drugs. The drug adsorption can be described by the Langmuir isotherm, and measurements of surface coverage of the drugs on the vitamin E provide an estimate of the available surface area of vitamin E, which can then be utilized to estimate the size of the aggregates. A diffusion controlled transport model that includes surface diffusion along the vitamin E aggregates and diffusion in the gel fit the transport data well. In conclusion, the vitamin E loaded silicone contact lens can provide continuous anesthetics release for about 1–7 days, depending on the method of drug loading in the lenses, and thus could be very useful for postoperative pain control after corneal surgery such as the photorefractive keratectomy (PRK) procedure for vision correction.

    Cool, simply cool.

    Check out the image and rest of the article “Transport of Topical Anesthetics in Vitamin E Loaded Silicone Hydrogel Contact Lenses” at the Langmuir site.

  • VGo telepresence robot has Verizon LTE

    Engadget: “the VGo ‘bot — a chest-high roving device that has a display and camera built-in and allows patients and others to interact with a remote operator — is at CES this year to show off its inclusion of Verizon LTE, instead of the WiFi-only model we’ve seen in times past.” – So? So this means you’re no longer confined to locations with Wi-Fi. It means you can have telepresence (telemedicine, telepharmacy) anywhere. Need a specialist’s opinion in the middle of nowhere? Ok, just fire up the VGo robot with Verizon LTE.

    For those of you that haven’t experience “4G” you’re missing out. It’s quite snappy. I frequently use my Galaxy Nexus to watch movies on Netflix while waiting for my daughter at Volleyball practice. No lag. No buffering. Just a smooth movie watching experience.

     

  • If I were to buy a tablet today…

    imageI’m always on the lookout for a new tablet, and never more so then I am at this moment. My trusty Lenovo X201T is getting old. At more than a year, it’s downright ancient in computer technology years. It’s a dilemma to be sure.

    Fortunately for me there’s no shortage of tablets on the market: Windows OS, Android OS, iOS. Crud, based on reports from CES 2012 I’ll have a much bigger selection within another 6 months or so.

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  • Expanding the role of pharmacy technicians

    If you know me then you know that I’m a proponent of expanding the role of pharmacy technicians in the acute care pharmacy setting. I believe pharmacy technicians are underutilized and are capable of doing many functions within a healthcare system to improve patient care, both directly and indirectly, as well as free up pharmacists to do the things they should be doing.

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  • Quick hit: Confusion over industry terminology

    I had an interesting conversation with a colleague earlier today. We were talking about a feature set for a new product that we have due out later this year. Some of the language being used to describe a certain feature, and how it would be used, was causing quite a bit of confusion for me. So I tried to clarify things a bit. After a brief email exchange it turned out that I knew exactly what he was talking about; healthcare and especially pharmacy simply use different words to describe the process.

    I recommended that we use the pharmacy specific lingo, but I was told no because it wasn’t the industry standard. I found that quite interesting because we build products for pharmacy, i.e. that is the industry we’re in. However, the terminology used for this particular process is different outside the pharmacy world. Still with me? Good.

    So, the question becomes does one conform to the terminology in the market segment you’re in, i.e. pharmacy, or do you ignore the pharmacy terminology and go with the “standard”? My gut reaction would be to go with the standard – after all I preach standardization all the time – however, if one does that you end up talking to pharmacy people that have no idea what you mean. You know, everyone has that deer in the headlights look with everyone standing around wondering what the heck is going on. And to top it off, no one asks for clarification because they’re afraid it might make them look stupid. We’ve all been there. I know I have.

    So, based on what I just said above I think you have to conform to the industry you’re in. In other words, use the pharmacy terminology, standard or not.

  • Robots better than human surgeons? Maybe…maybe not.

    MedPage Today: “Robotic prostatectomy has spread all over the U.S., despite the fact that we don’t have clinical trial data to show that it’s better than traditional open surgery. 

    The company marketing the robotic surgery systems boasts on its website about news coverage from ABC’s “Good Morning America” and from CNN’s Dr. Sanjay Gupta.  And, under a picture of a couple dancing, the manufacturer claims:

    “Studies show patients who undergo a da Vinci Prostatectomy may experience a faster return of urinary continence following surgery … Several studies also show that patients who are potent prior to surgery have experienced a high level of recovery of sexual function (defined as an erection for intercourse) within a year following da Vinci Surgery.”

    But a paper published by the Journal of Clinical Oncology concludes that:

    Risks of problems with continence and sexual function are high after both (robotic and open prostatectomy). Medicare-age men should not expect fewer adverse effects following robotic prostatectomy.”

    The article gives examples of complications following open (“normal”) surgery versus robotic surgery using Medicare claims data from 406 men that had robotic surgery and 220 that had open surgery. The data from the two groups looks surprisingly similar. In fact, the open surgery group had a larger percentage of respondents reporting no complications than did the robotic surgery group; although the difference may not be significant.

    Ultimately the authors of the Journal of Clinical Oncology suggest that the reason for the popularity of robotic surgery may be “gizmo idolatry” is at play. The authors go one step further by calling out Medicare’s reimbursement for robotic prostatectomy, “The apparent lack of better outcomes associated with (robotic prostatectomy) also calls into question whether Medicare should pay more for this procedure until prospective large-scale outcome studies from the typical sites performing these procedures demonstrate better results in terms of side effects and cancer control.”

    It makes one wonder where the line for reimbursement should be drawn. Should reimbursement be tied to evidence based outcomes? It’s a good question when you think about all the treatments we use everyday that may not have sufficient data to back them up. Does that mean we should only use evidence based treatment? No, that would limit our ability to try new therapies when others fail. Interesting debate nonetheless.

  • Cool Pharmacy Technology–KitCheck

    Anyone that’s ever worked in an acute care pharmacy knows about med trays, code trays, transport boxes, intubation kits, etc. They’re a bit of a headache because all the medications inside each kit has to be manually manipulated and tracked, including the dreaded lot number and expiration date of everything in the trays.

    Well, KitCheck is a system that uses RFID technology to track the medications found in all those different med trays, code boxes, etc. I thought it was pretty cool. It’s a great idea. Wish I would have thought of it.

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  • Telemedicine in rural areas [video]

    Seems like a reasonable platform for clinical pharmacy services.

  • Eliminating Barriers To Care Using Technology [Video]

    Interesting video that talks about the use of telepharmacy for Medication Therapy Management (MTM).

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