Author: Jerry Fahrni

  • Saturday morning coffee [August 9 2014]

    “If you think a weakness can be turned into a strength, I hate to tell you this, but that’s another weakness.” -Jack Handey

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug below is relatively new. It’s one of two that I picked up in Las Vegas at M&M World during one of my daughter’s volleyball tournaments earlier this year.

    Orange M&M's Coffee Mug
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  • Keeping up with the Joneses, or how pharmacies choose technology

    Recently a colleague sent me a link to the FierceHealthIT article below. Much of what the article had to say rang true for me.

    Hospitals covet neighboring facilities’ technology: “Facilities were more likely to acquire a new surgical robot if neighboring hospitals had done so, according to a study from a group of private and government researchers published in this month’s Healthcare journal… The authors found that a hospital whose neighbor had acquired a surgical robot was more likely to also get one….According to the authors, the results suggest that tech adoption may be driven “in part by competition among neighboring hospitals rather than solely by the mission to provide optimal patient care.”

    This is consistent with what I’ve witnessed in pharmacy technology over the past several years. In my experience pharmacies rarely choose the technology that’s right for them. It’s much more likely that pharmacies will make decisions based on usage patterns of other local hospitals, i.e. word of mouth. That’s why it’s so important for companies in the pharmacy technology sector to get people using their products. It’s not like the consumer market where new technology can often unseat an incumbent with a whiz-bang feature or some clever marketing. No, in pharmacy it’s likely that once a decision is made that decision will stick for many years.

    It’s also important for pharmacies to ensure that they’re making a wise decision when it comes to implementing new technology. They should ask themselves two questions: 1) what do I need it to do, and 2) will it fit my workflow. Answer those two questions and you’ll know if it’s right for you.

  • Cool Pharmacy Technology – TelePharm

    Telepresence has seen its ups and downs over the years. The technology is certainly nothing new, but it has been underutilized in both the inpatient and outpatient healthcare space. This is especially true when it comes to pharmacy, which is odd because one would think that telepresence technology could be used to give pharmacists the freedom they crave.

    TelePharm is a telepresence system aimed at the ambulatory pharmacy space. It’s difficult to elicit much detail from the website, but ultimately the system appears to use cameras and a web-based application to remotely monitor technicians, and provide patient consultations via video conference.

    “Pharmacists are provided captured images of all work products (hardcopy prescriptions, labeled containers, medications (tablets/capsules), stock bottle containers, and stock bottle. They compare all this information to the system information and stock images provided to verify the prescription has been filled properly.”

    It appears that patient consultations can take place on any web-enabled device. “A pharmacist needs an audio/video enabled device with internet to access the TelePharm application. Patients need to have an internet and audio/video connection through a tablet, mobile phone, or home PC.”

    The TelePharm service reminds me of what Envision Telepharmacy does with acute care pharmacies and infusion centers.

    Anyone out there used TelePharm or seen it in person? If so feel free to leave a comment below.

  • Saturday morning coffee [August 2 2014]

    “A journey of a thousand miles begins with a single step.” – Lao-tzu, Chinese philosopher (604 BC – 531 BC)

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug below is relatively new. I picked it up in Las Vegas at M&M World during one of my daughter’s volleyball tournaments earlier this year.

    Yellow M&M Mug
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  • Medical errors remain a problem despite years of effort

    I recently read an article at Senator Bernie Sanders website about preventable medication errors. The article lists preventable medical errors in hospitals as the third leading cause of death in the U.S. behind only heart disease and cancer.

    The article goes on to say that “the Journal of Patient Safety recently published a study which concluded that as many as 440,000 people die each year from preventable medical errors in hospitals. Tens of thousands also die from preventable mistakes outside hospitals, such as deaths from missed diagnoses or because of injuries from medications.” I’m not exactly sure what article they’re referencing here as they didn’t provide a link or additional information, but I assume they’re referring to the article by James in September 2013. Just a guess, I could be wrong.1 Regardless of the actual reference, the bottom line is that the number of patients that die from preventable medical errors is high.
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  • Saturday morning coffee [July 26 2014]

    “Everything happens for a reason, and sometimes that reason is you’re stupid and make bad choices” – unknown

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug below is relatively new. I received it as a gift from my brother Robert and his wife, Kim. Very cool. I’ve had a running joke about monkeys for years. Once upon a time, not too many years ago, an administrator in the pharmacy where I worked told me that a monkey could do my job. Made me pretty angry. Sad part was he was right.

    MUG_Monkey
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  • Desire to see more collaboration between pharmacies and local universities

    Bitwise Industries in Fresno is an interesting place. It’s basically a tech hub pulled together by some great local minds. Located in a nice little area in downtown Fresno, BitWise has tasked itself with taking “a burgeoning tech industry that was growing in silos in California’s heartland, add places that inspire community, collaboration, and growth, create accessible education that equips and empowers a homegrown army of technologists, deploy talent to execute technology success stories”. I visited the facility with my brother, Robert when it first opened. Impressive and inspiring.

    But this post is not about BitWise. It’s about something I’ve been thinking about for a couple of years. BitWise was simply a catalyst to remind me to revisit my idea.
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  • Moving from the Motorola Moto X to the Samsung Galaxy S5

    s5_blackA short time ago I was an unwilling participant in my Moto X being dropped on a concrete floor.

    Over the past year or so I’ve been working with a colleague on a book about the state of automation and technology in pharmacy IV rooms. During this time I’ve made several site visits to acute care pharmacies to look at the technology, workflow, etc in their IV rooms. As part of the data collection process I not only take a lot of notes, but snap lots of photos and record video of technicians working with the technology. I find the photos and video invaluable when reviewing my notes.

    Prior to entering the cleanroom at one large hospital back east, the pharmacist in charge insisted that he wipe down my Moto X with alcohol. I wasn’t thrilled with the idea, but it was either let him do it or not take it in. I opted to let him wipe it down. During the process he dropped my Moto X. It hit the concrete floor pretty hard and bounced. The back popped halfway off. Not good. Since that time my Moto X has been acting weird, freezing up, not taking voice commands, and so on. I finally decided to replace it through the insurance I carry on the device.
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  • Color labels for pharmacy – Quick Label Systems

    QuickLabel

    I was rummaging through my travel bag and found some items that I collected during the ASHP Summer Meeting back in June. Most of the information had to do with IV room systems, tablet identification, and so on. But there was one item that caught my eye that didn’t fit with the rest: color labels.

    I’ve written about the use of color on pharmacy labels before. It has its place, but in my opinion the major barriers have been cost and label quality. That’s why I was so interested when I saw the booth from Quick Label Systems at the ASHP Summer Meeting. The labels they had on display were spectacular. It’s difficult to see in my photo, but the image quality and label stock are top notch. The labels are tough –  really tough – resistant to water, and don’t smear. Very nice.

    The quality of the label and print gives users the ability to place a crazy array of information on the label, including the ability to embed audio or links to video using bar code technology. It’s pretty cool.

    The company isn’t a pharmacy solution in the traditional sense, but do provide OEM services for other companies. In other words, if you have a need for color labels Quick Label Systems will build color label printers with your name on them.

    Not every product that leaves the pharmacy needs a color label, but they could certainly be useful in the IV room. Using color to differentiate or highlight something that requires special attention like chemotherapy is always helpful to pharmacy and nursing.

    I’ll try to get the rest of my bag’s contents up over the next few days.

  • Medication Therapy Management as a tool for reduced cost of care and fewer readmissions

    A colleague asked me if I had any information on the use of Medication Therapy Management (MTM) as a way to reduce healthcare cost and prevent, or decrease, readmissions.

    I’m kind of a digital packrat and I knew that I had some stuff sitting in Evernote, so I spent the better part of a day rummaging through the information I had. The deeper I dug the more I realized that MTM is a no-brainer. There’s enough information out there to convince even the staunchest opposition.

    Some thoughts I had as I read through my Evernote notes:

    1. I find it interesting that we’ve coined the phrase Medication Therapy Management (MTM) for something that pharmacists have been doing for decades. I remember interning for a community pharmacy back in the late 90’s. Speaking to the patient about their medication, adherence, compliance, adverse effects, etc was simply part of the job. Have we forgotten about that?
    2. MTM comes in many forms. Positive intervention can be achieved over the phone, via Telepharmacy, face-to-face with a pharmacist or technician, and so on. It is not a one size fits all approach.
    3. Even the simplest interaction between provider and patient can create a positive impact.
    4. MTM should start when a patient is admitted for any condition, continue throughout their hospital stay, and follow the patient out the door to their homes. In other words it should be continuous.
    5. Not everyone will need pharmacist intervention once they leave the hospital. Healthcare systems should first target patients with chronic conditions, problems with cognition, poor history of compliance, or a heavy medication burdens. Like everything else in the world around us, some people will do better with more help while others will prefer less.
    6. mHealth and sensors should be part of MTM. Continuous glucose monitoring, heart monitors, blood pressure sensors, smart bottles, devices to monitor and record inhaler use – classic area for pharmacist intervention, wireless digital scales for weight – think heart failure, and so on . This information should be fed directly into the patients MTM record for review by the pharmacist, physician and nurse.

    Below is a summary of the MTM information I sent my colleague.
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