Jerry Fahrni

Author: Jerry Fahrni

  • New drug education

    Medicine And Technology: “We have seen so many new drugs and even new classes of drugs emerge over the last ten years. How do most physicians learn about new drugs? Many (certainly not all) community practitioners would say they learn what they need to know from the drug reps. Others indicate continuing medical education or CME activities as their main source of information regarding new drugs. Back in the “old days,” docs would also attend many promotional/marketing dinners and social functions to learn about new medications. Those days are ending as PhRMA code regulations get stricter. So what is the most effective way for physicians to learn about new drugs? They are so busy and easily overwhelmed by their workload that many have a difficult time keeping up with the latest science, the latest medical news, or even urgent FDA alerts and warnings.” – Any healthcare practitioner should be leery of using “drug-reps” or marketing dinners to educate themselves about new drug therapy. Remember, drug-reps are in it for the sales. In most cases they are not even healthcare professionals; pharmacist, nurse, physician. There are few truly unique breakthroughs in drug therapy each year and even fewer turn out to live up to expectations. Several years may be necessary to properly evaluate a medication’s place in therapy. I never understood the bandwagon approach to medication therapy, it’s irresponsible. Information on new drug therapy should come from primary literature or other reputable sources, such as the Pharmacist Letter, the Medical Letter, or from practice guidelines developed by professional organizations like the Infectious Disease Society of America (IDSA) and the American College of Chest Physicians (ACCP). Heck, this would be a good place to start reducing the cost of healthcare as many new “me too” medications with no proven benefit are often significantly more costly than their evidence-based counterpart. Why isn’t anyone talking about that?

  • Meditech Version 6 – Does glitz and glam equal better functionality?

    EMR Daily News: “A new KLAS report takes a closer look at the latest release of the Meditech electronic medical record (EMR) software and whether it’s a viable solution to help Meditech’s more than 2,000 clinical customers reach the meaningful use threshold. The release of Meditech 6.0 brings with it high expectations for making the software better suited for physician use, which is a key aspect of the federal government’s definition of meaningful use and a traditional weakness of Meditech systems. According to the KLAS report “Meditech Version 6: A Strong Step Forward?”, early adopters of version 6 are reporting positive results, including an improved user interface and easier navigation, but many obstacles still stand in the way of widespread adoption. “Meditech has long struggled with deep CPOE adoption, and version 6 is geared toward addressing that gap,” said Jason Hess, KLAS general manager of clinical research and author of the Meditech report. “However, several issues will likely impact how quickly version 6 is rolled out to the Meditech customer base.”
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  • A failure modes and effects analysis on bar code medication administration

    Over the past several months I’ve been involved with a committee tasked with performing a failure modes and effects analysis (FMEA) on our bedside scanning initiative. An FMEA is a procedure for analyzing potential failure modes within a system and classifying those potential failures by frequency and severity. The failure modes can be actual or potential. It’s a way to plan for holes in the system before they actually develop, and can be quite useful in creating possible solutions for future problems. Being proactive is always easier than being reactive, I think.
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  • The Future of the IT Industry

    John Suffolk: “Following on from recent blogs, publications and presentation on the Government’s IT strategy I have been asked a number of times what my thoughts are on how this will play out in the IT industry over the next ten years…I think we are all in for a shock, a big shock because IT and service provision will be dramatically different and I’m not convinced the IT industry is facing up to the new reality. Consider a world where:

    – The concept of desktop disappears as a predominant model…
    – Things like ERP become a sequence of transactions….
    – The number of data centres will be dramatically reduced….
    – Public and private clouds will be pervasive….
    – The combined cloud model and the application store opens up the IT market….

    So those operating on the IT world will need to decide what their true competences will be.  Where can they shine and get recognition for being outstanding.”

    The blog is quite insightful and I believe an accurate look at where IT is headed. In addition I think the healthcare industry will see more outsourced IT support as we move toward a cloud model. Hospitals will be tied less to software and hardware support, instead providing informatics experts responsible for developing workflow and effective use of purchased services. Some hospitals have begun adopting this model already, and expect to see greater adoption in the future.

  • “What’d I miss?” – Week of July 26th

    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

    RIVA“Robotic IV Automation (RIVA) is a medical device developed by Intelligent Hospital Systems Inc. (IH Systems). Hospital pharmacies use RIVA to automatically and accurately prepare IV syringes and bags. By automating the preparation of IV syringes and bags, RIVA addresses the issues of safety for the patient and the pharmacy technician, efficiency and effectiveness in the pharmacy and the challenges of a changing regulatory environment. RIVA allows hospital pharmacies to compound sterile preparations in a United States Pharmacopeia (USP) 797 environment while producing admixtures in either syringes or bags. The automation of repetitive and complex tasks reduces the incidence of errors and contamination.” – The RIVA system is built on .Net 2.0 written in C# running on Windows XP Embedded OS. The system costs somewhere in the neighborhood of $1.2 million and uses a robotic arm to prepare IV syringes and bags behind a glass case. There are two videos on YouTube worth watching here and here. They are very similar, but offer different views of the robotic arm in action.

    RIVA appears to be popular in Children’s hospitals as three of the four hospitals listed on the company’s website include Primary Children’s Medical Center of Salt Lake City, Children’s Hospital of Orange County, and The Children’s Hospital of Philadelphia. I’ll be in Philadelphia in about a week and only live a few hours from Orange County. I wonder if I could arrange a demo. Hmmm.

  • Interesting observation about EMR and babies

    EMR and HIPAA: “However, the thing that hit me most was that the computer was so rarely in the middle of my wife and baby’s care. At all of the most important points the computer wasn’t even really present. Other sophisticated technical devices were there, but the computer and the EMR were no where to be seen. No EMR when they measured her contractions. No EMR when they gave her a spinal tap (don’t ask me the real technical terms). No EMR when the doctor was performing the c-section. The first time I saw an EMR was actually when we took my new born baby into another room to do all the necessary weighing, immunizations, etc.” – Nursing units where babies are delivered (insert naming convention here: “OB”, “Mother-Baby”, “Post-Partum”, etc) often use some form of EMR, but it may not be the same one as the rest of the facility. One thing I’ve learned during my involvement in several projects here at the hospital is that “OB” does everything just a little bit differently. When we implemented Pyxis and eliminated floor stock, they fought us every step of the way. When we implemented Alaris pumps, they fought us every step of the way. As we move forward with barcode medication administration (BCMA), they are fighting us every step of the way. The same was true during the meeting to discuss our implementation plans for CPOE. The argument is always the same, “that just won’t work for us because we’re different”. I think every nursing unit feels that way at first, but most come around after they give the technology a fair evaluation. Every unit has little nuances; it just takes some time to work through them. Now, if I could only figure out how to make OB feel same way.{sigh}

  • Tablet PCs in pharmacy practice – The technology

    Today we continue our series on tablet PCs in pharmacy practice by looking at available technology. Enjoy the second part in the four part series.
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  • Why I wanted RxCalc

    I have a couple of passions when it comes to pharmacy. The first is a love of pharmacy technology. Very few pharmacists have an appreciation for the “operations” side of pharmacy which includes automated dispensing cabinets, automated carousels, automated TPN compounders, Pharmacy Information System, etc. These tools are absolutely necessary if we want to get pharmacists out of the physical pharmacy and at the bedside where they belong. My second passion is a little less known discipline known as pharmacokinetics. I have no idea why I like pharmacokinetics; I just do. Some kids like PB&J and some don’t. It’s just the way it is.
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  • Keeping up while on the information superhighway

    Web 2.0 has certainly created an information revolution. I used to rely solely on journal articles to keep me up to date. Now I rely on an internet connection. Unfortunately, this creates a situation where information arrives faster than I can digest it, and if you’re not careful you can drown in the excess and end up not learning a thing.
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