Jerry Fahrni

Year: 2012

  • Mobile computing at its finest, the Golden-i Headset

    Not to be confused with the Golden-Showers Headset (post for another time), the Golden-i Headset is a mobile computer worn by paramedics made by Ikanos Consulting, a Nottinghamshire, UK firm. The headset itself is butt ugly, but the functionality is cool. The headset can be controlled by both voice and head gestures.

    How many use cases can you think of for something like this in pharmacy? Several, I’m sure.

    Medgadget: “The headset has a camera and microphone for interacting with applications and to communicate with hospital physicians. The Paramedic Pro software performs voice recognition and allows patient data lookup and entry through voice alone. Remote physicians can see and hear through the headset, allowing them to guide paramedics in stabilizing their patients and starting treatment in difficult cases.”

  • Saturday morning coffee [November 10 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 Chicago, Illinois, obviously. The first time I was in Chicago was in October 2011, so about a year ago. I’ve been in and around Chicago three times since. I find Chicago and the surrounding area fascinating. It is one of the few places that I would consider spending an extended amount of time. I’ve really enjoyed my time there. I say all of this with one giant caveat, and that is that I’ve never been there in the dead of winter. Based on what I know about the winters in Chicago that could be enough to quickly change my mind about staying. One thing that I really need to do before I die is attend a Bears game at Soldier Field. I’ve wanted to do that for a long time now, at least since the days of Walter Payton.

    I have been systematically going through all the coffee mugs in my cupboard to generate these posts. All my mugs used to reside on a single shelf in one of our cupboards. After using a mug for one of these poses, and using it for the weekend, I move it to another shelf; simple way to remember which mugs I’ve used. Well, this morning when I went to retrieve the next mug in line, the cupboard was looking a little bare. It looks like I’ll be out of mugs by the end of the year, which means I need to either get more mugs or find something else to do on Saturday mornings.
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  • EMR software optimized for Windows 8

    EMR & HIPAA: “Yesterday at the Digital Health Conference I had the chance to catch up with George Cuthbert from Medent. He’d emailed me a few months back about the potential benefit of Windows 8 in the EHR world and the deep integration of Win 8 that they’d been working on to leverage the unique abilities of Windows 8 for their EHR users.

    I admit that since I’ve become more of a health IT blogger and less of a techguy, I haven’t kept close track of all that was happening with Windows 8. I knew that it was designed to incorporate touch as a major focal point of the new Operating System and I knew that it was Microsoft’s attempt to integrate the best of touch together with the advantages of data input using a keyboard and mouse.

    Based on the short demo that George did for me of Win 8 and the Medent EHR, it has some real promise. In fact, as the title suggests, I think that if an EHR vendor does it right this could solve the issues that so many EHR vendors have of trying to create an iPad EHR application.”

    I’ve always thought that the Windows OS would be ideally suited over iOS and Android for EMR/EHR use because it is the native platform used by a majority of healthcare systems in the United States. Why continually reinvent the wheel when all you do is delay innovation? That’s what’s been going on in healthcare for the last several years when it comes to using tablet technology. Everyone has fallen in love with products that offers less functionality today than my tablet PC did nearly a decade ago. It’s odd when things turn out like that. People tend to get easily distracted by shiny objects. It happens.

    The EHR software described at the EMR & HIPAA site can be found in the Microsoft Store. It’s called EMR Surface. More information can be found at the Pariscribe website. It looks interesting, but one can never tell whether or not something is usable by simply looking at it. I’d be interested to hear whether or not anyone has used it and what their opinion is of the system.

  • Cool Pharmacy Technology – NFC-enabled medication compliance

    Thanks to Timothy Aungst for the tip. His Tweet led me to this Quand Medical page where I found a little bit of information about their medication compliance software. Their solution utilizes NFC technology to aid patients with tracking and taking their medication as well as potentially reducing errors.

    The Tweet from Timothy was timely as I’ve been musing about using NFC technology in the medication use process. With the popularity of smartphones and the slow, but steady adoption of things like Google Wallet, it makes sense to take a deeper dive and give the technology a long hard look.

    I would have liked to have seen a video of the product in action, but I couldn’t find one. Who knows whether or not this is the solution for medication compliance, but it’s certainly a tool worth investigation.
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  • 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.


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  • 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.
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  • 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’.