Jerry Fahrni

Author: Jerry Fahrni

  • “What’d I miss?” – Week of September 20th

    As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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  • Cool Technology for Pharmacy

    chipinpillProteus Biomedical: “Proteus ingestible event markers (IEMs) are tiny, digestible sensors made from food ingredients, which are activated by stomach fluids after swallowing. Once activated, the IEM sends an ultra low-power, private, digital signal through the body to a microelectronic receiver that is either a small bandage style skin patch or a tiny device insert under the skin. The receiver date- and time-stamps, decodes, and records information such as the type of drug, the dose, and the place of manufacture, as well as measures and reports physiologic measures such as heart rate, activity, and respiratory rate. The IEM is the cornerstone of the company’s Raisin™ System, which is currently in clinical development. The Raisin™ System measures the body’s response to medications and is intended to improve the management of chronic diseases like heart failure, infectious disease and psychiatric disorders.”

    The Financial Times is reporting that the pharmaceutical company Novartis is partnering with Proteus Biomedical to implant these IEMs into oral blood pressure medications. The IEMs are designed to send reminders to patients, in the form of a text message, when non-compliant with their medication regimens.

    No word on what blood pressure medication they’re using, but Novartis is the maker of Lotrel, Tekturna and Diovan.

    Remember, Big Brother is watching.

  • To touch or not touch….a computer screen

    GottaBeMobile: “I am firmly of the belief that touch and multitouch make no real, practical sense on the desktop monitor. As we’ve stated on GBM before, the main problem for touch interfaces on the desktop is “gorilla arm”, that heavy, painful feeling you get in your arm after having it outstretched for an extended period, trying to touch a monitor 20-24 inches away from your body. Sure there are times when touch on the desktop monitor would be handy to just scratch out a quickie OneNote drawing, but for 99% of the time, for 99% of the people, touch on the desktop monitor space just doesn’t make a whole lot of sense even if it came for free. Now on the smaller form factors, Apple has really done the space a lot of service. Users and fanboys alike have been shown how touch and multitouch work on an iPhone. Apple’s advertising for the touch features of iPhone are direct, to the point, and show the audience what is going on without a lot of flash or distraction. Much like the HP ads for their newer IQ-series TouchSmart kitchen PC, the advertising is creative and effective.” – While I agree in theory to what Mr. Locke is saying, there are times when a touch screen is simply the best way to go. Desktop computers may not be the right application for such devices, but a desk surface may be the perfect area for a touch screen. We have several monitors scattered throughout our pharmacy that I would love to see as touch screens. For some reason I feel compelled to touch a computer monitor when I’m standing instead of seated in front of it. Touch screens also make excellent tools for surfing the internet while kicking back on the couch watching football. Now there’s a practical use for touch screen technology.

  • BCMA vs. CPOE, Which Comes First? Webinar Results

    argumentPharmacy OneSource hosted a webinar “debate” today that had two excellent speakers presenting their cases for which technology should implement first; Computerized Physician Order Entry (CPOE) or Bar Code Medication Administration (BCMA). The webinar was well worth the time.

    The case for CPOE was presented by John Poikonen, Pharm.D. John is the Clinical Informatics Director at UMass Memorial Health Care, an Academic Medical Center and health system in central Massachusetts. John is an interesting informaticist as he has repeatedly spoken out against the lack of evidence supporting BCMA. It was a good fit for him to argue for CPOE implementation ahead of BCMA. He brought up some great points and presented a fair amount of literature to back them up. You can read more of John’s musings at RxInformatics.com.

    The case for BCMA was presented by Steve Rough, the Director of Pharmacy at the University of Wisconsin Hospital and Clinics, and Clinical Assistant Professor at the UW-Madison School of Pharmacy. Steve has done quite a bit of work with bar code medication scanning technology and presented an excellent case for BCMA.

    Both presenters had valid reasons and good arguments for their positions. I for one am in favor of both CPOE and BCMA, but would personally push for BCMA ahead of CPOE for several reasons. CPOE requires a much larger investment in resources, both human and financial, when compared to BCMA. There is also a reasonable expectation that BCMA will stop errors at their most vulnerable point, the administration phase. I’ve mentioned this before and Steve brought up some of the very same points in his presentation. Finally, CPOE requires buy-in from physicians in order to be completely successful. And if there is one thing you can count on it’s that physicians will fight you tooth and nail when it comes to technology and change.

    You can grab a copy of the presentation slides here.

  • The American Recovery and Reinvestment Act is not without risk

    The American Recovery and Reinvestment Act (ARRA) has created quite a flutter of activity in healthcare during the past several months. I can’t remember a time when something was such a popular topic. Everywhere you look, Twitter, Facebook, personal blogs, professional blogs, and so on are talking about how to demonstrate “meaningful use” and get their hot little hands on some cash.

    While the idea is sound, the implementation has something to be desired. The overwhelming attention to the definition of “meaningful use” and the looming 2011 timeline has created some unwanted side effects to the ARRA. Hospitals have started throwing project plans in reverse for significant revision or throwing them out the window and starting over all together. Projects that may have been in the pipeline for months, or years, are now taking a back seat to the ARRA requirements. Project development and timelines are involved processes that are designed to work around several variables such as capital budgets, current software and hardware specs, and available human resources.

    Many healthcare systems have yet to develop a plan to implement many of the requirements necessary to meet the ARRA “meaningful use” criteria. If a healthcare systems wasn’t ready to begin the process at any time over the past several years what makes the US government think they’ll be ready just because they say so? Is the infrastructure in place? Do they have the resources to not only implement, but support the new systems as well? These are all questions that people should be asking. I for one am disappointed in our facility as we have decided to immediately move forward with projects that weren’t slated for another 18-24 months. To make this happen other projects have been placed lower in the priority queue, creating a lack of resources that risk jeopardizing the quality of both implementations.

    Healthcare systems should not be directed down a path that they feel unprepared to face. Doing so will only invite failure.

  • Librarians and patient safety

    PSQH: “In order to learn whether librarians and information professionals have expanded their involvement in patient safety, the 2007 survey again asked respondents to choose from a list all of the activities in which they participate. In the 2003 survey, only four persons (of 174 total respondents) indicated they had no role in patient safety activities. In 2007, four persons (of 318 total respondents) indicated they had no role in patient safety activities. In 2007, 82.4% of the survey population responds to ad hoc inquiries on patient safety. As in the 2003 survey, this activity ranked first of all the options offered. More than half of persons who responded are also involved in documenting best practices for patient safety from the literature (68.55%), providing targeted alerts on patient safety issues to staff (57.23%), and creating resource guides for patients and practitioners (52.52%).” – During my time as a critical care pharmacist at Community Regional Medical Centers from 2001 – 2006 I spent a fair amount of time in the library researching this and that. Frequently I had to enlist the help of the medical librarian and we soon became friends. Besides being an excellent resource for information, he and I spent quite a bit of time discussing ways to better access and present pharmacy related information. He was a big believer in centralized storage and retrieval of reference material. We didn’t know it at the time, but we were discussing a cloud model. His insight into situations pertaining not only to medical literature, but to patient care was invaluable. He and I have moved on with our careers, he to the VA and me to my current position at KDDH, but I will always remember the value he added to the overall patient care model. I therefore find it all too easy to believe that medical librarians have become an integral part of patient safety initiatives.

  • Additional thoughts on the Motion J3400 and Dell XT2 tablet PCs

    I’ve had the Motion J3400 and Dell XT2 for a few weeks now and thought I would update my opinion on these tablets.

    Motion J3400 configuration:
    Windows Vista Business
    1.4 GHz Intel Core Duo Processor
    2 GB RAM

    Dell XT2 configuration:
    Windows XP Tablet Edition –SP3
    1.6 GHz Intel Core Duo Processor
    2 GB RAM
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  • University of Missouri Health Care outsourcing IT resources?

    Columbia Tribune: “Cerner talks confirmed by officials – University of Missouri Health Care is now negotiating with the Kansas City-based Cerner Corp., administrators have confirmed. MU Health information technology workers have been worried for months that their jobs could be outsourced to Cerner, considered one of the leading health information technology providers. Several employees have said supervisors told them different Cerner-related stories, but mostly workers have been kept in the dark. Williamson and Ross said employees would be notified “promptly” if a Cerner agreement is made. The university has a longstanding relationship with Cerner. The company provides hardware products for the hospital and has an educational partnership with the MU School of Medicine.” – The University of Missouri Health Care may not be handling the situation in the most gracious way possible, but I’ve mentioned before that I think outsourcing IT resources is a good idea. It’s simply unreasonable to expect locally developed IT resources to have the same knowledgebase as the IT resources at the company providing the product. And it’s probably cheaper, too.

  • Wikipedia as a drug reference….bad idea.

    Medicine 2.0 Congress blogspot : “Readability of the Top 50 Prescribed Drugs in Wikipedia  – Devin explained that a sample of 50 most prescribed drug in United State were selected and the content related to those prescribed drugs in Wikipedia were indentified and saved as HTML files for evaluation. Each Wikipedia entry was analyzed independently by two investigators using Flesch-Kincaid Grade Level. A Health information readability analyzer was also used to integrate dimensions that other readability tools lacked such as : lexical, the most easy to read; semantic, the most difficult to read; cohesion and syntactic. Eventually, descriptive statistics was used to analyze the scores generated by these tools. Devin concluded by stating that the reading level of the 50 prescribed drug entries in Wikipedia are higher that the reading level of consumers. Therefore, there is a potential barrier of health and drug information for some Wikipedia users. To improve the Wikipedia, the vocabulary can be simplified; and in order to improve the consumers’ comprehension, the lexical and syntactic constructs need to be enhanced without compromising cohesion and structure.” – Similar to information provided by drug reps, Wikipedia is not a credible drug reference and should never be used as such. While interesting, Wikipedia may contain opinions and information presented in a biased manner. The fact that there is a study on the usability of drug information in Wikipedia is disturbing. When looking for drug information, healthcare professionals should always use credible references like Lexi-Comp, UpToDate, MD Consult, or something similar. If detailed information is needed, consult the primary literature. Consumers should consult their local pharmacist for credible drug information.

  • Epocrates in the news this week

    epocrates-screenshotEpocrates is a suit of mobile medical reference material, with their drug information application being the most popular. The applications are available for a variety of mobile devices including Palm, Windows Mobile, BlackBerry, and of course the iPhone. Despite the popularity of Epocrates I still think Lexi-Comp offers better products for mobile devices.

    FierceMobileHealthcare: “Epocrates: Nurses prefer Palm but physicians love the iPhoneA recently released survey from mobile healthcare software developer Epocrates indicates that nurses still prefer Palm PDAs and smartphones for viewing Epocrates reference tools, though the iPhone/iPod touch and BlackBerry platforms are gaining. But in an interview with FierceMobileHealthcare last week, Michelle Snyder, Epocrates’ senior VP for subscriber business, said that the iPhone is far and away the most popular device among physicians.” – The article goes on to say that Epocrates is gaining “more than 300 new docs a day on the iPhone“.No surprise there.

    Medical Smartphones: “Epocrates has announced that they will be phasing out support for older Palm OS and Windows Mobile/Pocket PC devices. Specifically, older devices, including those with Palm OS less than 5 and Pocket PC 2002 OS, will lose support. If you have a Pocket PC, go into Settings, and then click on “About” to see what version you’re running. Some older devices (like some of the HP iPaq models) run Pocket PC 2002.” – This is interesting, but pretty much irrelevant. I think most healthcare professionals using mobile technology as a reference device won’t even notice the loss of support for these older devices.