Ownership of healthcare data

A couple of weeks ago my brother wrote a piece about access and ownership of medical records. My brother isn’t a healthcare professional but he is an intelligent, tech-savvy individual that has been forced to navigate the healthcare system due to his own plight as well as time spent helping with my mother’s care prior to her death following complications of a liver transplant. I have also written about this myself, albeit from a slightly different perspective.

“Seriously though, why should our medical records be locked in a system we cannot access? We can learn something from Twitter, Facebook, and Google. We should own our medical records — via an open standard — and allow doctors and hospitals to ask our permission to see them. Much like friending someone on a social network. The doctor looks me up, asks if they can see my records, I get a message saying the doctor would like access to my records, and I choose to let them or not. My choice, my records.”

Robert brings up an interesting concept. How one would go about creating such an open standard, and where that data would be stored are two things that have to be addressed. To be absolutely “neutral”, I suppose the U.S. government would have to handle both. That’s not comforting. Remember, the government created the DMV and IRS. Yikes!

Allowing people to keep, store, and manage their own healthcare data is clearly not an option. There are those that would be quite good at it and those that would suck at it.

I often consider banking when I think about healthcare data. Many of us (all?) use credit and ATM cards, ATM machines, banks, mobile pay, and so on daily. We never really think about our data, i.e. who has it, where it’s stored, how to access it, etc. However, when I need to look at something, the information is nearly always readily available and retrievable. Also, when I go to buy a car or home, finance something, etc. it always seems easy for those that need access to the information to get it. I don’t “own” my financial data, per se, but it’s always there for me and whoever else needs it.

“Case in point. I have a problem with one of my knees. In 2004 I had surgery to remove cartilage, a bone spur, and some arthritis from that knee…Fast forward to 2017 and that knee has become an issue…I made an appointment with my family doctor to discuss the problem. Before going I tried to locate the doctor that did the surgery back in 2004, but she’s moved on. I contacted her old group to see if they had my records. Nope…I visit my doctor last week [and] explain there is a history here but I cannot tell her exactly what was done. My only explanation is I had surgery in 2004 to do X, Y, and Z. But I don’t know the exact terms nor do I know where the cartilage was removed or how much…She orders and x-ray and while she’s doing this she explains she’d like to do an MRI but the Insurance company requires she order an x-ray and order physical therapy before doing the MRI.”

I had a similar experience a couple of years ago. I fell down my stairs at home — seriously, that happened — and ruptured my quadriceps tendon. I’ve never felt pain like that in my life. I thought I broke my leg. Anyway, I ended up in a local ED where I got x-rays, an ultrasound, and an MRI. Diagnosis: ruptured quadriceps tendon. Solution: surgery.

Fast forward a couple of days later in the surgeon’s office. I had a copy of all my records from the ED visit on a CD. I thought I was being proactive. Not so. The surgeon’s computer and EHR system were not compatible with the data stored on the CD from the ED. The surgeon re-ordered two separate MRI’s. No kidding.

My leg about a week after surgery.

“This [the system] is broken”. Yep, there is no question that the system is broken. Just ask anyone that’s navigating it for the first time. Even my mother, who spent years in and out of hospitals secondary to her liver condition struggled to navigate the system at times.

“…I know the EHR is only a tiny fraction of our dated system but I’d like to have a complete medical history. It’s my history…To fix this will take eons. Medicine is so far behind when it comes to technology. Look at systems like Epic. It is seen as a leader in its field, but it’s a closed system. How does that benefit anyone but Epic? It doesn’t….We need an Open API with services offered by many providers that are patient driven. Allow data to move between systems. Don’t make your money by holding patient data hostage. Make your money by building the better service.”

My brother echos the sentiment of Ralph Waldo Emerson, “Make a better mousetrap, and the world will beat a path to your door.” I wish it worked that way in healthcare. But for some reason we continue to accept garbage. I am certainly not familiar with all EHR’s, but I have worked with several. They’re all terribly bloated and cumbersome. Not only that, they offer little in the way of cooperative information exchange. Sure, they all claim to play well with others, but my personal experience — along with that of many others — paints a different story.

My brother and I don’t agree on much, but I think we’re on the same page here. We may not agree on which route to take, but we certainly have the same destination in mind. And that destination is better access to and sharing of healthcare data. 

Cool Technology in Pharmacy – Evolve Refrigeration

The Evolve line of compressor-free, medical grade refrigerators* are quite impressive. Powered by SilverCore™ Technology, they have no compressor. And because they have no compressor, they have no mechanical parts, run quiet, use less electricity, and generate less heat.

The system “absorbs heat energy from the storage cabinet using a non-toxic, non-hazardous refrigerant embedded in the walls. Heat energy is channeled up to a high-performance thermoelectric heat pump that cools the refrigerant and transfers the heat into the ambient environment“. Science!

Evolve refrigerators meet CDC vaccine storage guidelines as well as requirements for use in a clean room. In addition, the units provide alerts for temperature, door, battery, memory, loss of WiFi, and loss of power via local and remote monitoring options.

Because the refrigerators utilize solid-state technology, the company is able to squeeze more storage capacity into a unit compared to a similar sized non-solid state refrigerator. Up to 25% more storage capacity according to the company.

I’m not sure if you’re aware of how much noise refrigerators can add to a pharmacy, but it’s lot. This is especially true in the IV room where PEC’s (hoods) already make the environment less than friendly to one’s ears.

Not only does the Evolve line of refrigerators look pretty cool — no pun intended — their ability to reduce noise pollution in the pharmacy is a welcome bonus.


* I first wrote about Evolve back in December 2015 after seeing the product at ASHP Midyear.


Quick thoughts on Swisslog acquisition of Talyst

I’m a little slow getting to my thoughts on this deal.

A couple of weeks ago it was announced that Talyst had been acquired by Swisslog Healthcare. I’ve known about this acquisition for a while so I wasn’t surprised when it finally went through. Since the announcement, I’ve reached out to some friends and colleagues on both sides of the fence to get their thoughts and opinions on what’s in store for the future.

My contacts at Talyst have been quite helpful and informative. Swisslog, not so much. In fact, they’ve provided me with no additional information or insight. All they’ve done is sic their marketing department on me, who in turn sent me a bunch of marketing hype that I can find online. Useless. I hope this isn’t a primer on what we can expect from the “new Talyst” moving forward. That would be unfortunate. I suppose this is the difference between a small company and a large company. I’ve always had trouble getting good information from large companies. There are simply too many layers to get through. With small companies, I can often go directly to the CEO. In large companies, I’m met by an army of people designed to keep people like me away from the CEO.

Trying to figure out what Swisslog wants with Talyst has given me much to think about. Talyst is a market leader in certain acute care areas of pharmacy, such as carousels and inventory management software. They aren’t particularly creative or innovative, but rather steady. Talyst knows carousels but that market has kind of run its course unless you’re building a new pharmacy. The high-speed packaging market in acute care pharmacies is basically dead. The company doesn’t offer a competitive controlled-substance management system. They have a solid refrigeration strategy, but it’s not as innovative as something like Evolve. Talyst doesn’t do anything with RFID technology nor do they have a mobile strategy. Their software has good functionality but is antiquated in many ways. So what it is that Swisslog wants? Customer base? Name recognition?

Swisslog doesn’t have much of a footprint in acute care pharmacies except for their tube system, which is basically everywhere. However, Swisslog is creative and innovative. They have some robotic systems like BoxPicker, PillPick, and RoboCourier. They make use of RFID technologies. They have pretty decent integration within their systems and they’re really good at logistics. Honestly, I don’t know as much about Swisslog as I do Talyst. 

In general, I like products from both companies. However, it’s hard for me to imagine where Talyst products will fit into the Swisslog scheme. The items I think Swisslog needs from Talyst will likely be the most difficult to use, i.e. think square peg and round hole. I suppose the existing Talyst customer base is something that Swisslog can take advantage of. Customers using Talyst products could benefit from Swisslog products and better integration across the two platforms. That goes vice versa as well.

Only time will tell, but I’m betting that we won’t see anything significant from this deal for quite some time.

Books in medicine, out of date and out of touch

Nature Microbiology: “… I know it is a big deal in some fields to publish books and careers get decided by books. But for those of us working in medicine or public health, are books and book chapters worth the effort? Is the juice worth the squeeze?? … Based on my experience of contributing over a dozen book chapters, and serving as an Associate Editor of one textbook, my answer is no. I can give you half a dozen good reasons.”

The author goes onto describe three specific concerns he has with book publishing in medicine:

  • Timeliness, or lack thereof. “A delay of 2 – 5 years might not matter in some fields (e.g. anthropology or history or statistical methods), but it matters in medicine and science!” You don’t say.
  • Affordability. Anyone that’s every purchased a science or healthcare related textbooks of any kind can attest to this. Some of my pharmacy school textbooks came with staggering price tags. Same thing applies to medical literature/journals. The subscription cost of some journals is criminal.
  • Access. No doubt a huge problem. “I also worry that those who really need my book can never get hold of it.” I find that this is also a huge issue with medical literature/journals. Getting ahold of articles isn’t easy. You can always get the information, as long as you’re willing to cough up the dough.

The author is spot on with his assessment. This is especially true in my area of expertise, i.e. pharmacy automation and technology.  I’ve read the so-called pharmacy informatics textbooks. They’re out of date and expensive. I regret purchasing both of them.

I suppose the big question after reading the piece in Nature Microbiology is how to solve the problem. I don’t have an answer. Going completely digital isn’t the solution, at least not with current technology. Hundreds (thousands?) of hours in front of a computer monitor has convinced me of that. It’s like gazing into a flashlight. Headaches and eyes that feel like sandpaper at the end of the day have led me to re-embrace paper. I know, I know, it feels antiquated to me as well. But I haven’t found a technology yet that completely replaces the ease and utility of using pen and paper for some things; reading literature and taking notes, for example.

With that said, there are certain things that publishers can do to speed things up, improve access, and cut cost. The open-source literature movement has taught me that.

Universities should also take a more active role in pushing publishers to do the right thing. It never ceases to amaze me when customers refuse to push back. I see this in hospitals with automation and technology vendors. Hospitals will purchase and continue to use technology that they are unhappy with. Why? Something akin to Stockholm Syndrome, perhaps.

It will be interesting to see what publishers do moving forward. The current system is stuck in time, and as long as the end-user continues to accept the model, it will continue.

Ramping back up…

Hello, old friend, it’s been a while.

I have neglected this weblog. The reasons are not important. I continue to write, explore ideas, and think about technology. However, for the past several months I’ve been using a more traditional method to record my thoughts, i.e. pen and paper. There’s something cathartic about writing in a notebook, and I’ve filled a few.

The world of pharmacy technology has, at least in my mind, become a bit stale. I’ve been exploring other technologies that I don’t routinely see in pharmacies, such as artificial intelligence and neural networks, augmented reality, nanotechnology, 3D printing (see some of this in healthcare), autonomous vehicles, and so on. This has allowed me to keep my sanity while continuing to work as a practicing pharmacist.

I continue to explore pharmacy topics but in a more philosophical way. I’ve had many long discussions with pharmacists both young and old about the profession, past, present, and future. Some of the discussions have been enlightening and encouraging. Others have been disturbing and gut-wrenching. Overall, the profession is heading in a direction I don’t want to go. I’ve seen and heard things that lead me to believe that the profession as a whole is on life support.  If one were to gaze into the future and be truly honest with themselves, they would realize that pharmacy exists out of nostalgia more than necessity. But that’s of no importance here, at this moment.

This weblog is a personal space, where I can write about pharmacy and other topics of interest to me. It was never intended to be used for business. I have to remember that. With that said, I think it might be time to revive my digital presence here. I have a lot of things to talk about. Some pharmacy related, some not. Some technology related, some not. Some uplifting, some discouraging. All interesting, at least to me.

I’m thinking about a career move that would free up my weekends again. If that happens, perhaps we can even enjoy some Saturday Morning Coffee together. I miss my Saturday Morning Coffee.

Calling all students and professionals with an entrepreneurial spirit!

Here’s something special happening in the local Fresno area….

Calling all students and professionals with an entrepreneurial spirit! We’d like to invite you to join our new FREE HealthTech Initiative course. Find out more about this exciting class that will help develop healthcare products and services here: CHSU.ORG/HEALTHTECH-INITIATIVE

We are looking for individuals to join teams with people from all types of disciplines including:

  • Health (Medical, Vet, Dental, Nursing, Pharmacy, …)
  • Computer Sci (Web/PC/Mobile app development, …)
  • Business (Entrepreneurship, marketing, pricing, …)
  • any individual interested in health care

Class meets on Wednesday evenings from 5:30 pm to 7:30 pm at the California Health Sciences University (CHSU) in Clovis CA.

  • The class is FREE
  • The first class is August 23rd
  • The 15-week course ends on December 6th
  • Dinner is included

Participants work in teams, and we will help you join a good team. You will not sit around for long-winded lectures. This course will provide participants with a “hands-on” introduction to leading an entrepreneurial enterprise by building a business model and constructing a prototype product or service. Participants work in teams, and all good ideas are acceptable.

Teams will meet once a week to report progress. Teams demonstrate their prototype and business models to people or organization who are potential customers. Teams revise their prototypes and business models based on feedback. The step-by-step “Lean Startup” process is based on the National Institutes of Health (NIH) program to train medical scientists/entrepreneurs.



Dr. Charles Douglas at cdouglas@chsu.org or 559.573.8026.