Cool Pharmacy Technology – Vaccine Smart-Fridge

The Vaccine Smart-Fridge is an interesting concept for ambulatory care. It appears to be a consignment vaccine distribution system. Reminds me of a refrigerated single-point automated dispensing cabinet (ADC).

There’s a lot to like here.

By using a consignment model, the vendor offers an ambulatory care clinic low cost, low risk access to vaccines. It also decreases the chance of something sitting in the cabinet beyond it expiration date, or going bad because the temperature is out of range. The company supplying the items has a vested interested in making sure that everything inside those refrigerators is ready for use, and that waste is kept to a minimum.

I believe that the consignment model for pharmaceuticals will only continue to grow. The largest budget item in many pharmacy is inventory, by a wide margin. Refrigerated medications seem to be the main target for consignment, but it’s possible that the model could creep into other spaces as well, especially with the introduction of biosimilars.

The system provides real-time alerts on inventory shortages and temperature. Automated temperature monitoring ensures that things stay within their appropriate temperature range. Heat is bad for lots of medications, especially vaccines. This information can be viewed from a computer or mobile device. I like that it’s proactive.

Single-item access is a great concept for an ADC. This style of distribution is frequently used for controlled substances – morphine, fentanyl, etc. It provides better security than open access trays, drawers, and bays, thus minimizing opportunity for diversion. Does it make sense for everything? No, not really, but in this case it fits.

The system provides access to real time analytics and historical dispensing data. This information could be linked to other systems for easy access to vaccination records.

Pharmaceutical refrigeration is in need of a little disruption, so when I see something like this I’m encouraged that someone is thinking about it. There’s nothing new about this technology, but it does provide a new paradigm to think about.

ASHP Section of Pharmacy Practice Managers has a new strategic plan

A little more than a week ago the most recent ASHP Section of Pharmacy Practice Managers Chair’s Message(1) landed in my inbox. I don’t typically read these messages carefully as they’re mostly full of the same old rhetoric. However, this particular message caught my attention because it included information on the ASHP Section of Pharmacy Practice Managers new strategic plan for 2015-2016.

According to the email:

“…the Executive Committee recently completed an extensive update to the Section’s strategic plan, which is now available on the Section webpage.  Our intent was to set a structure that would help us continually remain focused on the most important needs of practice managers. We have worked to carefully align the Sections plan with the overall ASHP Strategic Plan. This alignment eliminated the need for separate Section goals, which greatly streamlined the plan.  We also identified critical areas for practice managers.  The critical areas identified for 2015-16 are:

  • Leadership Development
  • Innovation Management
  • Management of the Pharmacy Enterprise
  • Patient Care Quality
  • Multi-Hospital Health System Pharmacy Executives”

These are all great areas of focus.

Much more detail can be found the actual strategic plan document, which can be found here. I read through the document, much of which is what you’d expect, but there are some interesting items in the strategic priorities and goals section. Three bullet points caught my attention: 1) Expand pharmacy practice in ambulatory clinics and other primary pharmacy care settings, 2) Produce an Innovative and Timely Professional Journal, Website, Drug Information Compendium, and Other Publications that Meet the Needs of Members and Other Customers, 3) Improve the Discoverability of ASHP Digital Content Assets.

Expand pharmacy practice in ambulatory clinics – There was a time when I thought all pharmacists should practice in a hospital setting, but my views on that have slowly changed over the years. The most appropriate time for pharmacists to have a meaningful impact on patient care is before they’re hospitalized, i.e. in the ambulatory care environment. We are the medication experts, and nowhere is there more inappropriate medication use than in the outpatient setting. I think it is wise for pharmacy managers to spend more time focused on this practice area.

Produce innovative and timely information – Times have changed. The amount of readily available information is growing at an exponential pace. Unfortunately not all information is reliable. ASHP has made only small strides in the past several years in improving speed and access to information. Information affecting practice areas like operations, management, and technology should be made available at breakneck speed as it does not require the same rigorous vetting that clinical information does. It is no longer acceptable to wait a year for someone to present their findings at ASHP Midyear, or for AJHP to take months to publish something that is relevant now.

Improve discoverability of ASHP digital content – This would be a welcome change. ASHP has created a mountain of valuable information, but it’s scattered and difficult to find, cross reference, etc. I could go on and on about this, but suffice it to say I would love to see an improved content management style.

Let’s hope that Dr. Hoffman is able to make good on his promises. I’m going to hold him to his word.


  1. The ASHP Section of Pharmacy Practice Managers new chair is James M. Hoffman, Pharm.D., M.S., BCPS, FASHP. With all those initials after his name he must be good.

Choosing the right computer for the job

“Jack of all trades – master of none”

I recently read a great article by Paul Thurrott [PC vs. Tablet: Use the Right Tool for the Job]. The article concisely articulates how I feel about the non-Windows tablet space these days. I was a little surprised to discover that the article was posted in December of 2013.

Paul brings up some interesting points about the use of tablets versus PC’s.(1) I’ve been pursuing the perfect machine for many years. Like Paul, I tried using a Palm Pilot with a folding keyboard. And later a slew of tablets – iOS, Android, BlackBerry, webOS – in a jaded attempt to find a single, perfect device. To date I haven’t found a device that meets all my requirements for both home and travel. The Surface Pro 3 (SP3) was nearly perfect, but not quite. I believe Microsoft has finally figured “it” out.

I’ve had reason to think about the singular-device theory again due to the large number of articles covering the new Apple iPad Pro. I’ve seen many articles comparing it to the SP3. I don’t read those articles because they’re nothing more than clickbait. I really don’t think anyone believes that a mobile OS can compete side-by-side with a desktop OS. I’ve seen many try, and they’ve all failed. The iPad Pro is quite literally the Samsung Galaxy Note Pro 12.2 from January 2014, which is simply another attempt at creating a “real computer” out of a mobile OS. The SP3 is so much more.

I went down the iPad path a few years ago. I realized after several months that my three-year old tablet PC was much more capable. Unfortunately, I did the same thing with Samsung Galaxy tablets as well. Remember what Albert Einstein had to say about insanity, “doing something over and over again and expecting a different result“. It seems that that is applicable for those trying to use a mobile OS for “real work”. Anything I can do on a non-Windows tablet I can do on my phone. Why do I need a tablet running a mobile OS with mobile processors and mobile limitations? I don’t.

Thurrott states it perfectly: “Now, it’s certainly true that some people — many, in fact — can get what for them is “real” work done on a tablet or even a smartphone, phablet, or mini-tablet. That is, these devices provide access to email, calendar, contacts, the web, social media networks, various Microsoft and third-party services, and even remote desktop capabilities for the truly dedicated. They are simple and easily manageable…Of course, in our world—what we might call IT, or that of knowledge workers, but what I prefer to think of as the world of the “doers”—PCs aren’t going anywhere. And I think that many reading this, like me, have had that moment when we’ve sat with our hands hovered uncertainly over some other device—tablet, phone, whatever—and have simply gotten up, fished the laptop out of whatever bag it’s stored in, and gotten back to work. That is, we’d perhaps like to be able to get it all done on such a simple device. But our jobs are a bit more demanding.”

It’s strange, but after many years in search of a single mobile device to meet all my needs, I find myself slowly migrating back toward larger, more capable machine when I have work to do. I’ve even considered going back to a desktop machine for a host of reasons.(2) And like Paul, I believe that “I’m on the vanguard of something that will eventually occur to others…I’m not going to compromise my work or personal experiences for the other. I’m going to use the right tool for the job”.

Do I still want an ultrabook? Absolutely, but it won’t be my workhorse machine. Do I still want a non-Windows tablet? Sure, I like to tinker, but I won’t use it for anything more than surfing the net and playing games.

I’m really looking forward to the next round of Surface Pro devices because as I said above, Microsoft gets it.

1) Generic use of terms “tablet” and “PC”.
2) Bang for your buck. A Core i7 desktop with 8GB or RAM and 1TB hard drive can be had for around $500.

Will healthcare disruption come easy and fast?

Healthcare is so massively broken, that its disruption will come easy and happen fast

The quote comes from part of a weekly newsletter that I receive from Peter Diamandis. Peter was the keynote speaker at the ASHP Summer Meeting in Minnesota a few years ago. Truly inspirational. To date it is perhaps the only keynote address that I haven’t regretted sitting through.

Here’s a bit more from the newsletter:

Healthcare is so massively broken, that its disruption will come easy and happen fast. Hundreds of startups are working to make you the ‘CEO of your own health’ — to augment (or replace) doctors and hospitals.

I expect new AI-enabled healthcare options to be free or near-free, and so much better, that people will forgo traditional medical care in favor of these superior options. This will cause today’s healthcare system to crater.

Think libraries in an age of Google… Think traditional wired landlines in an age of mobile telephony… Think taxis in an age of Uber… Think long-distance in an age of Skype… the list goes on.”

I defer to Peter’s wisdom and incredible insight into the future, but I don’t think disruption in healthcare will come easy or happen fast. No industry needs disruption more than healthcare. However, healthcare appears resistant to the normal rules of the cosmos. The healthcare industry thinks that EHRs and bar code scanning technology is cutting edge. Their idea of mobile is using a smartphone as a drug reference.

There are many things being developed to improve healthcare, but the innovation is coming from outside sources. People are literally leaving healthcare to innovate things for healthcare. It’s a bit wonky, but true. The real test will come when innovators try to integrate their solutions back into healthcare. Good luck, ladies and gentlemen.

Healthcare is years behind other industries when it comes to innovation and cutting edge advances. As an example, I’ve been waiting for the use of pharmacogenomics for nearly 20 years. The concept has been around for a long time, but its integration into mainstream medicine remains elusive.

Peter has much more to say on the issue and I highly encourage you to read the rest. I also encourage you to subscribe to his newsletters. I find their content quite interesting.

Pros and cons of IV workflow management systems

Pondering the need for an IV workflow management system (IVWMS)? You’re not alone if you are. According the most recent PP&P State of Pharmacy Automation Survey, 15% of facilities have already implemented something and another 29% plan to do so in the next few years. The only surprise is the relatively low percentage of facilities planning on implementation in the near future.
Continue reading Pros and cons of IV workflow management systems Podcast | Episode 5: RFID Technology in Pharmacy

Jerry talks about the use of RFID technology in pharmacies, specifically the use of RFID in refrigerated consignment programs and medication tray management.

Show Notes:
Host: Jerry Fahnri

Current setup:
Blue Microphones Yeti USB Microphone – Blackout Edition
Dragonpad Pop Filter
Sony MDR-V150 Headphones

RFID-enabled refrigeration [4:25]:
Cardinal consignment programs [PDF]
FFF Enterprises

RFID-enabled medication tray management systems [7:00]
Intelliguard Kit and Tray Management System by MEPS
KitCheck by KitCheck

Is multi-dose packaging really a solution to medication adherence?

Multi-dose packaging has been a part of pharmacy for longer than I’ve been a pharmacist. It’s mostly been limited to long term care (LTC), such as nursing homes, rehab facilities, etc. It’s not something that’s commonly used in acute care hospitals for a host of reasons, most notably medication regimens frequently change in acute care settings. Multi-dose packaging works best when the patient is stable and medications can be dispensed for multiple days, hence the popularity in LTC.

Recently articles have been cropping up for companies attempting to use multi-dose packing technology in the ambulatory care setting, i.e. outpatient pharmacy. The most recent of which is an article in the Tampa Bay Times, describing the M5000 robot (1) by MTS Medication Technologies, an Omnicell company. Check the video below.

Continue reading Is multi-dose packaging really a solution to medication adherence?