Monitoring Pharmaceutical Products in Twitter [article]

Pharmacovigilance of TwitterThere’s an interesting article in the April 2014 edition of Drug Safety that looks at English Twitter posts from November 2012 through May 2013 to see if there is any correlation between adverse event (AEs) reporting via Twitter and more “official” channels.

The authors collected public Tweets, which were subsequently stored for analysis using Amazon Web Services. See how they did that? Nothing magical about it. They used readily available information and a commercially available storage source.

Through the use of some human ingenuity, a “tree-based dictionary-matching algorithm”, and some manual labor, the authors collected 6.9 million Tweets, of which 61,402 were examined, ultimately leading to 4,401 AEs identified; referred to as Proto-AEs by the authors. During the same period 1,400 events were reported by consumers to the FDA.

While not perfect, and most certainly limited, I think the results were surprising, encouraging, and disappointing all at once.

Surprising because of the number of Proto-AEs found in the Twitter stream. People are savvy. “There was evidence that patients intend to passively report AEs in social media, as evidenced by hashtags and mentions such as #accutaneprobz and @EssureProblems. Even within 140 characters, some tweets demonstrate an understanding of basic concepts of causation in drug safety, such as alleviation of the AE after discontinuation of the drug.”

Encouraging because being able to mine social media streams like Twitter could open up an entirely new avenue of real-time AE tracking; we all know that AEs are under reported, which leads to a lack of information for pharmacists and other healthcare professionals.

Disappointing because of the limited number of AEs reported to the FDA. I used to see AEs in the hospital that were never reported. I’m as guilty as many for not reporting AEs.

More work needs to be done in this area before we can begin to rely on data mined from social media, but they again it’s probably as reliable as information collected elsewhere.

The article is open access and the full version is online for free, so there’s no excuse not to read it.

New Questions for Pharmacists in the Health Care System [article]

Am J Pharm Educ. 2014;78(2)1: “The pharmacy profession is determining how it will become a vital part of new health care models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). Pharmacists must be prepared to demonstrate their value in these emerging health care models by improving the quality of care, reducing health care costs, and enhancing patient access and satisfaction. The health care decision makers will require demonstration of value, framed in business language, using new measures of outcomes quite different from what have been used in the past for pharmacy services. Colleges and schools of pharmacy should take on the task of developing these new measures demonstrating pharmacist value in collaborative care delivery, and instruct students in how they will need to demonstrate their value in new health care models.”

Interesting view from the authors. I’m not opposed to calling for colleges of pharmacy to develop measures to determine the value of pharmacists, but I would caution those developing these measures to learn from others. Physicians defined their measures and outcomes long ago and are paying for it dearly now. Pharmacists should not seek to mimic such a model, i.e. valued on the number of interactions, patients seen, and billable events.

The time for proving that pharmacists can actively participate in patient care is past. The data is there, but the profession continues to think that providing even more data will flip a switch that will instantly make pharmacists a valued member of the healthcare team. That’s not likely to happen, even in the data-driven healthcare environment of today. Pharmacists are viewed quite differently from physicians and other direct patient care providers like nurse practitioners, and rightly so. As pharmacists continue to fight for “provider status” they should consider carefully the end goal of such a fight.

Let’s not forget what pharmacy is all about. Pharmacy is about providing the safest, most effective, cost conscious therapy possible. That doesn’t necessarily equate to “provider status”.  What happens when the primary concern of our profession is no longer pharmaceutical care? Who will provide such expertise when pharmacists no longer concern themselves with such things? I do not recommend living in the past, but I do recommend thinking long and hard about the future of the profession.

Go read the entire article, it’s only a few paragraphs long. I’d love to hear your thoughts.

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  1. Joseph T. DiPiro and Robert E. Davis (2014). New Questions for Pharmacists in the Health Care System. American Journal of Pharmaceutical Education: Volume 78, Issue 2, Article 26. doi: 10.5688/ajpe78226

Is pharmacy informatics defined well enough to be a specialty?

Pharmacy informatics remains in its infancy as a profession. What started out as a job for tech-savvy pharmacists with working knowledge of pharmacy has turned into an ever expanding career field.

I’m looking through the ASHP Summer Meeting Informatics Institute schedule and the topics are varied. I see something on human factors, information management, clinical decision support, and e-prescribing. And that’s only on first glance.

If you look at job descriptions for healthcare systems seeking informatics pharmacists you’ll see everything from involvement in strategic development of services to data entry by monkeys, and everything in between. There’s little consistency in what one facility is looking for versus another. That point alone is telling.

This reminds me of pharmacy practice in acute care facilities 20 years ago. Outside of academic medical centers pharmacists were largely involved in operations, and only slightly involved in other care activities. That’s all changed as pharmacists practice in many different areas today and can specialize in a variety of disciplines, i.e. infectious disease, cardiology, etc.

I think we’re heading in that direction with informatics as well. The field is so vast that being a informatics generalist will soon be impossible because the information will be more than one person can reasonably be expected to handle. The influx of consumer technology and the need for better interoperability between systems will ultimately drive informatics pharmacists to specialize in one, or perhaps a few, specialized areas.

I consider myself an informatics generalist, but wonder how long before I won’t be able to keep up with new developments in the field. I’m already seeing signs of specialties within pharmacy automation and technology, it won’t be long now until we see it in other informatics areas.

Ultimately pharmacy informatics cannot be a specialty as the subject area by definition requires generalist knowledge. Eventually I think we’ll see practice specialties like we do in pharmacy practice today. Until then creating a pharmacy informatics specialty makes little sense.

SCiO – a molecular scanner for your pocket

medGadget: “A new device launching on Kickstarter today aims to simplify the process by utilizing spectrometry to analyze and provide real-time information on any food that you aim it at. Dubbed SCiO, this molecular scanner from Tel Aviv-based company Consumer Physics takes spectrometry technology found commonly in laboratories and industrial environments and places it in a consumer device not much larger than a common USB drive….. SCiO can also scan medication. During a live demonstration we attended last week, Consumer Physics’ co-founder Dror Sharon scanned two brands of ibuprofen, and SCiO was able to identify which pill was a generic brand.”
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IV hood sensors [idea]

I saw a commercial for the Honeywell Wi-Fi Smart Thermostat the other day. It’s a neat little gadget that reminded me of something that I’ve been thinking about for years.

The requirements for monitoring, cleaning, and analyzing conditions in an IV clean room are enormous. To get a feel for what I’m talking about I would encourage you to take some time to read through the list of surface testing, air sampling, and end product testing required by USP <797> for pharmacies that compound sterile preparations (CSPs). It’s fairly extensive and complex.
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Proposed USP Chapter <800> for Hazardous Drugs

The rules and regulations swirling around acute care pharmacy clean rooms continues to grow. Recently I became aware of the United States Pharmacopeia and The National Formulary (USP–NF) General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings, or simply USP <800>. I attended a webinar put on by Pharmacy Advisor that specifically addressed USP <797>, but briefly mentioned USP <800>. Then a colleague and friend mentioned it so I decided I better learn a little bit more about the proposed chapter.
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Still searching for that perfect tablet PC replacement

After years of using a Lenovo x201t tablet PC as my primary machine I finally moved on and replaced it with a Lenovo Yoga 2 Pro. I thought about upgrading the x201t, but decided against it for several reasons. Unfortunately none of the current line of pen-enabled Lenovo Windows 8 machines caught my eye. The Helix was close, but Lenovo needs to upgrade to the newest generation of Core processor before I’d be willing to part with my hard earned money; I want that extra battery life. The Thinkpad Yoga might seem like a perfect solution, but I had my reasons for not choosing it, the biggest being the folding mechanism for putting the machine into tablet mode. I much prefer the twist-style mechanism for folding a machine from laptop to tablet mode when I want to write with a pen. There’s a rant there that I’m not willing to put in writing.

The Yoga 2 Pro has been a good machine, but I really miss having an active digitizer. I hadn’t realized how often I used the pen until now.
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Cool Pharmacy Technology – WillCall Rx from SencorpWhite

I had an interesting call with an account executive from SencorpWhite last week. He and I talked about several things, but one thing I found particularly interesting is something the company is doing in the outpatient pharmacy space with horizontal carousels. Carousels are neat technology for those that have a need for automated storage space, i.e. you’re “space challenged” in your pharmacy. When coupled with bar-code scanning technology carousels are a good way to manage all kinds of inventory in a pharmacy.

The system from SencorpWhite is referred to as WillCall Rx and consists of several components designed to store and retrieve prescription items that have been filled and are ready for patient pickup. I’m familiar with the WillCall Rx system and have had the pleasure of seeing it up close and personal in two large outpatient pharmacies attached to large medical centers. It’s a neat concept.
Continue reading Cool Pharmacy Technology – WillCall Rx from SencorpWhite