Jerry Fahrni

Author: Jerry Fahrni

  • Using facial recognition for medication adherence?

    While doing a routine search of Twitter I came across AiCure (@AiCureTech), which touts itself as “Computer vision and facial recognition technology to confirm medication adherence on mobile devices”. Ok, you got my attention. Unfortunately the Twitter account appears to be dead as the last Tweet listed on the account was from September 25, 2013. The AiCure website is a bit more recent, however. The last item posted to their News & Events section was from March of this year.

    There’s a video on the website that gives a basic overview of the process. I would have embedded the video here, but couldn’t figure out how to grab it, which is a real shame because it’s in their best interest to make information easy to share.

    After watching the video I’m not entirely sure that the process makes sense to me. The video shows a jogger running on a pier. The jogger receives a notification on her smartphone reminding her to take her medicine. She stops, pops the tablet in her mouth, records the transaction via facial recognition on her smartphone, and then merrily continues on her way. In my experience people that are as “with it” as the person portrayed in the video don’t have any trouble remembering to take their meds; calendar reminders, pill bottle next to the coffee pot, etc. And why is the jogger carrying her medication with her while out jogging? I assume her jogging session wouldn’t last more than an hour or two. Take the med before or after. There’s no sense of the importance of the medication to the patient’s condition, nor is their any sense of the person being so busy that they couldn’t remember to take their medication. It would have made more sense to show some teenager with a serious medication-dependent disease state going through a busy school day. Right? Having so much fun with their friends that they forget to take their medication?

    Thoughts on marketing aside, the concept of using facial recognition is intriguing.

    From the AiCure website:

    The combination of automated computer vision technology with dynamic patient feedback, offers a new gold standard in medication adherence monitoring. The computer vision platform is being extended to develop a robust identification and authentication system for medication.

    Much like a voice recognition system, which understands what the user says, AiCure’s sophisticated, patented computer vision system visually understands what the user is doing.

    The software-based technology is uploaded onto a smartphone or tablet computer. The user follows a series of pre-determined steps that are instantly recognized and confirmed through the webcam.

    Automated DOT® [Directly Observed Therapy] confirms facial identity, medication dosage, correct ingestion, and time of ingestion. In addition, built-in data tools allow for ongoing patient-provider feedback; reminders in case of nonadherence; positive feedback; self-reported data by the patient; and therapy information – all designed to ensure real-time adherence monitoring and improved patient adherence over time.

  • Additional thoughts on the use of gravimetrics for I.V. compounding

    Scale in PECSeveral months ago I wrote about my thoughts on using gravimetrics for I.V. compounding. At the time I wasn’t convinced of the utility, but my thoughts on the matter have changed. Over the past several months I’ve had the opportunity to dig deeper and mull over my thoughts on the matter.

    There was a session at ASHP Midyear back in December titled New and Emerging Strategies for Minimizing Errors in I.V. Preparation: Focus on Safety and Workflow Efficiency. The presentation covered several topics, but one thing that caught my attention was data presented on error rates for the preparation of compounded sterile products (CSPs)1 and the benefits of using gravimetrics in the process. I was skeptical about some of the numbers that were presented. Data is only as good as how it was collected, what it’s compare against, and how it’s presented. One should always question the data, especially when it runs contrary to previously held beliefs.
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  • Access to information and learning

    “Intellectual growth should commence at birth and cease only at death.” ― Albert Einstein

    I’ve recently returned from the ASHP Summer Meeting. I learned some new things, which serves as a reminder to me of the importance of continuous learning and access to information in our profession.

    As a pharmacist I’ve been involved in a lot of systems over the years designed to keep me up to date. All have been successful in their own way, but obviously some were better than others.
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  • Slingshot, getting clean water from just about anywhere

    I was sitting in a movie theater in Las Vegas waiting for X-Men Days of Future Past to start when I saw an interesting video about a product called the Slingshot, invented by Paul Lazarus.

  • New Medscape Pill Identifier Tool [reference]

    Medscape Pill IdentifierI received an email this morning from Medscape introducing me to their new Pill Identifier Tool.

    The tool is pretty simple to use. When you click on the link above you’ll be taken to the Pill Identifier Tool site where you can begin your search. Any pharmacist, nurse, or physician that’s ever used a reference to identify an oral medication will be familiar with the process.

    Across the top of the Pill Identifier you will find several fields to help narrow your search: IMPRINT, SHAPE, COLOR, FORM, SCORING. I’ve always found that if you have the imprint you’re about 80% there.

    Clicking on a medication will give you additional information. There’s even an option to view the Drug Monograph.
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  • Monitoring Pharmaceutical Products in Twitter [article]

    Pharmacovigilance of TwitterThere’s an interesting article in the April 2014 edition of Drug Safety that looks at English Twitter posts from November 2012 through May 2013 to see if there is any correlation between adverse event (AEs) reporting via Twitter and more “official” channels.

    The authors collected public Tweets, which were subsequently stored for analysis using Amazon Web Services. See how they did that? Nothing magical about it. They used readily available information and a commercially available storage source.

    Through the use of some human ingenuity, a “tree-based dictionary-matching algorithm”, and some manual labor, the authors collected 6.9 million Tweets, of which 61,402 were examined, ultimately leading to 4,401 AEs identified; referred to as Proto-AEs by the authors. During the same period 1,400 events were reported by consumers to the FDA.

    While not perfect, and most certainly limited, I think the results were surprising, encouraging, and disappointing all at once.

    Surprising because of the number of Proto-AEs found in the Twitter stream. People are savvy. “There was evidence that patients intend to passively report AEs in social media, as evidenced by hashtags and mentions such as #accutaneprobz and @EssureProblems. Even within 140 characters, some tweets demonstrate an understanding of basic concepts of causation in drug safety, such as alleviation of the AE after discontinuation of the drug.”

    Encouraging because being able to mine social media streams like Twitter could open up an entirely new avenue of real-time AE tracking; we all know that AEs are under reported, which leads to a lack of information for pharmacists and other healthcare professionals.

    Disappointing because of the limited number of AEs reported to the FDA. I used to see AEs in the hospital that were never reported. I’m as guilty as many for not reporting AEs.

    More work needs to be done in this area before we can begin to rely on data mined from social media, but they again it’s probably as reliable as information collected elsewhere.

    The article is open access and the full version is online for free, so there’s no excuse not to read it.

  • New Questions for Pharmacists in the Health Care System [article]

    Am J Pharm Educ. 2014;78(2)1: “The pharmacy profession is determining how it will become a vital part of new health care models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). Pharmacists must be prepared to demonstrate their value in these emerging health care models by improving the quality of care, reducing health care costs, and enhancing patient access and satisfaction. The health care decision makers will require demonstration of value, framed in business language, using new measures of outcomes quite different from what have been used in the past for pharmacy services. Colleges and schools of pharmacy should take on the task of developing these new measures demonstrating pharmacist value in collaborative care delivery, and instruct students in how they will need to demonstrate their value in new health care models.”

    Interesting view from the authors. I’m not opposed to calling for colleges of pharmacy to develop measures to determine the value of pharmacists, but I would caution those developing these measures to learn from others. Physicians defined their measures and outcomes long ago and are paying for it dearly now. Pharmacists should not seek to mimic such a model, i.e. valued on the number of interactions, patients seen, and billable events.

    The time for proving that pharmacists can actively participate in patient care is past. The data is there, but the profession continues to think that providing even more data will flip a switch that will instantly make pharmacists a valued member of the healthcare team. That’s not likely to happen, even in the data-driven healthcare environment of today. Pharmacists are viewed quite differently from physicians and other direct patient care providers like nurse practitioners, and rightly so. As pharmacists continue to fight for “provider status” they should consider carefully the end goal of such a fight.

    Let’s not forget what pharmacy is all about. Pharmacy is about providing the safest, most effective, cost conscious therapy possible. That doesn’t necessarily equate to “provider status”.  What happens when the primary concern of our profession is no longer pharmaceutical care? Who will provide such expertise when pharmacists no longer concern themselves with such things? I do not recommend living in the past, but I do recommend thinking long and hard about the future of the profession.

    Go read the entire article, it’s only a few paragraphs long. I’d love to hear your thoughts.

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    1. Joseph T. DiPiro and Robert E. Davis (2014). New Questions for Pharmacists in the Health Care System. American Journal of Pharmaceutical Education: Volume 78, Issue 2, Article 26. doi: 10.5688/ajpe78226

  • Is pharmacy informatics defined well enough to be a specialty?

    Pharmacy informatics remains in its infancy as a profession. What started out as a job for tech-savvy pharmacists with working knowledge of pharmacy has turned into an ever expanding career field.

    I’m looking through the ASHP Summer Meeting Informatics Institute schedule and the topics are varied. I see something on human factors, information management, clinical decision support, and e-prescribing. And that’s only on first glance.

    If you look at job descriptions for healthcare systems seeking informatics pharmacists you’ll see everything from involvement in strategic development of services to data entry by monkeys, and everything in between. There’s little consistency in what one facility is looking for versus another. That point alone is telling.

    This reminds me of pharmacy practice in acute care facilities 20 years ago. Outside of academic medical centers pharmacists were largely involved in operations, and only slightly involved in other care activities. That’s all changed as pharmacists practice in many different areas today and can specialize in a variety of disciplines, i.e. infectious disease, cardiology, etc.

    I think we’re heading in that direction with informatics as well. The field is so vast that being a informatics generalist will soon be impossible because the information will be more than one person can reasonably be expected to handle. The influx of consumer technology and the need for better interoperability between systems will ultimately drive informatics pharmacists to specialize in one, or perhaps a few, specialized areas.

    I consider myself an informatics generalist, but wonder how long before I won’t be able to keep up with new developments in the field. I’m already seeing signs of specialties within pharmacy automation and technology, it won’t be long now until we see it in other informatics areas.

    Ultimately pharmacy informatics cannot be a specialty as the subject area by definition requires generalist knowledge. Eventually I think we’ll see practice specialties like we do in pharmacy practice today. Until then creating a pharmacy informatics specialty makes little sense.

  • SCiO – a molecular scanner for your pocket

    medGadget: “A new device launching on Kickstarter today aims to simplify the process by utilizing spectrometry to analyze and provide real-time information on any food that you aim it at. Dubbed SCiO, this molecular scanner from Tel Aviv-based company Consumer Physics takes spectrometry technology found commonly in laboratories and industrial environments and places it in a consumer device not much larger than a common USB drive….. SCiO can also scan medication. During a live demonstration we attended last week, Consumer Physics’ co-founder Dror Sharon scanned two brands of ibuprofen, and SCiO was able to identify which pill was a generic brand.”
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  • IV hood sensors [idea]

    I saw a commercial for the Honeywell Wi-Fi Smart Thermostat the other day. It’s a neat little gadget that reminded me of something that I’ve been thinking about for years.

    The requirements for monitoring, cleaning, and analyzing conditions in an IV clean room are enormous. To get a feel for what I’m talking about I would encourage you to take some time to read through the list of surface testing, air sampling, and end product testing required by USP <797> for pharmacies that compound sterile preparations (CSPs). It’s fairly extensive and complex.
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