Jerry Fahrni

Author: Jerry Fahrni

  • Inhaled Corticosteroid Adherence and Emergency Department Utilization Among Medicaid-enrolled Children with Asthma [article]

    J Asthma. 2013 Jun 5. [Epub ahead of print], Rust G, Zhang S, Reynolds J.

    Abstract
    Objectives: Asthma is the most prevalent chronic disease among children enrolled in Medicaid. This study measured real-world adherence and outcomes after an initial prescription for inhaled corticosteroid therapy in a multi-state Medicaid population.

    Methods: We conducted a retrospective study among Medicaid-enrolled children aged 5-12 with asthma in 14 southern states using 2007 Medicaid Analytic Extract (MAX) file claims data to assess adherence and outcomes over the three months following an initial prescription drug claim for inhaled corticosteroids (ICS-Rx). Adherence was measured by the long-term controller to total asthma drug claims ratio.

    Results: Only one-third of children (33.4%) with an initial ICS-Rx achieved a controller to total drug ratio greater than 0.5 over the next 90-days. Children for whom long-term control drugs represented less than half of their total asthma drug claims had a 21% higher risk of emergency department visit (AOR 1.21 [95% CI 1.14, 1.27]), and a 70% higher risk of hospital admission (AOR 1.70 [95% CI 1.45, 1.98]) than those with a controller to total asthma drug ratio greater than 0.5.

    Conclusion: Real-world adherence to long-term controller medications is quite low in this racially-diverse, low-income segment of the population, despite Medicaid coverage of medications. Adherence to long-term controller therapy had a measurable impact on real-world outcomes. Medicaid programs are a potential surveillance system for both medication adherence and emergency department utilization.

    Posted online on June 5, 2013. (doi:10.3109/02770903.2013.799687)

    Two things to consider:
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  • Cool i.v. room technology – Drugcam Assist

    [Update 12/22/2013: I received an email from one of the inventors/developers of Drugcam software informing me of a new website that contains more information about the system. The site is eurekam.fr, which contains pages describing both Drugcam Assist and Drugcam Control. It’s still not a great amount of information, but at least it’s more than I had.]

    I’ve talked about technology for the i.v. room extensively on this weblog. It’s no secret that I think the i.v. room is the next frontier for pharmacy technology. The reason I think this is simple, the i.v. room is dangerous, and precious few healthcare systems are using technology to its fullest in that environment.

    I’m not the only one that thinks the i.v. room is important. As of December of 2012 I knew of basically four i.v. room workflow management systems: DoseEdg DoseEdge by Baxa, Pharm-Q In The Hood by Envision Telepharmacy, SP Central Telepharmacy System by ScriptPro, and Phocus Rx by Grifols.

    Joining the fray are at least two more systems that I saw at the ASHP Summer Meeting just last week: Cato software, which is now owned by DB, and Drugcam Assist by Getinge. Unfortunately you won’t find much about Drugcam Assist online, which is really too bad because it’s an amazing system. The website offers more information and a video demonstration for those that are willing to fill out a form and register. I was not willing.

    Drugcam Assist
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  • Saturday morning coffee [June 7 2013]: Fast & Furious 6, Peach Cobbler, PRISM, Pharmacy, MedPod

    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 headline for SMC is a bit different today in case you haven’t noticed. I’ve taken the advice of a Twitter colleague, Charles Webster, MD (@EHRworkflow). Charles has recommended a couple of times now that I make my headline more descriptive. I like the idea so I’m giving it a shot. Feedback welcome.

    My trip to Minneapolis, MN for the ASHP Summer Meeting has me waxing nostalgic. The coffee cup below was my trophy for winning the first ever ASHP Midyear Meeting Twitter contest. I’m not even sure what year it was, but I believe it was 2009; don’t hold me to that recollection though. At that time ASHP  was unable to use any of the official Twitter logos due to some time of licensing issues. So instead they generated a Wordle from my website and placed it on the mug you see below. My Twitter handle (@JFahrni) and web address (JerryFahrni.com) are displayed on the back near the handle.

    ASHP Twitter contest mug
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  • Thoughts on the ASHP Summer Meeting (#ashpsm)

    I’ve just returned from the ASHP Summer Meeting in Minneapolis, MN. I was there for work, but managed to squeeze in some sessions; just like a real pharmacist.

    For those of you that don’t know, the ASHP Summer Meeting is small, really small. It pales in comparison to the ASHP Midyear Meeting that’s held each year in December. Being small doesn’t make it bad, it just makes it small. The sessions are smaller and less grand, and the exhibitor area is quite a bit smaller than Midyear as well.

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  • Every amateur mechanics dream – AR-media 3D tracker app

    Check out the video below from AR-Media using augmented reality (AR) and digital technology blended with real world scenarios to create an app to help would-be mechanics work on their cars. What a great, and practical use for AR. Reading instruction manuals for toy assembly at 2:00 AM on Christmas morning just went right out the window; been there.

    Now pair that same technology with Google Glass, develop an application that blends AR with medication identification technology and, BOOM, something really cool.

  • Saturday morning coffee [June 1 2013]

    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….

    Is it really June 1st already? Wow, time is flying by this year.

    The coffee cup below is a simple, cheesy mug used by some place here in the Denver airport to serve coffee. I’m passing through on my way to the ASHP Summer Meeting in Minneapolis, MN. I get in later this afternoon. The festivities will start for me tonight and go through Tuesday. I plan on spending some time attending sessions as a real pharmacist. I have to admit, I’m a little excited by the idea. I’ve been unable to attend an educational session at a conference in approximately two years. I’m looking forward to having my brain cleansed by some good old fashioned pharmacy information.

    MUG_DEN
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  • Requirements for bar code scan verification set too low in meaningful use guidelines

    homer-simpson-dohOver the weekend I read an article at HealthBiz Decoded about bar code requirements and meaningful use (MU). I knew that there was some language in Stage 2, but never took the time to read through it carefully. The meaningful use documentation is exactly what you’d expect from years of bureaucrats sitting around trying to generate a document worthy of the governments typical high standard. Yeah, it’s a big ol’ pile of crap. One thing’s for sure, it’s going to create an entire generation of consulting business for a lot of people. I digress.

    According to the article, “Hospitals will be required next year to use bar codes to verify 10 percent of medication orders under government health IT rules.”  That number seems pretty low, even for our low reaching federal bureaucracy. And some people have noticed.

    The article quotes Mark Neuenschwander, a barcoding evangelist, as saying “We should be striving for a higher percentage because errors can happen in the other 90 percent as easily as they can happen in the 10 percent.” True enough. Anyone out there have a job where 10 percent accuracy, completion or participation is acceptable? If so please give me a jingle if/when you have an opening.

    It’s hard for me to imagine what someone was thinking when they pulled 10 percent out of thin air. I’m not naïve enough to think we’ll ever get to 100 percent, but c’mon man, 10 percent! Really? Fifty percent would have been low, but 10 percent is comical.

    I think bar coding technology has a place in healthcare. It offers up some real advantages when used appropriately, and I find it disturbing that the MU guidelines find 10 percent scan rates acceptable. That’s some serious weak sauce right there.

  • Is it just me or is the pharmacy presence on Twitter growing?

    My daughter had a three-day volleyball tournament over the weekend. While there’s a lot of action during these tournaments, there’s also some downtime. I usually pass the downtime by reading through my social media streams. I have a system that typically goes something like this: Twitter –> Google+ –> Facebook –> LinkedIn –> RSS-feed-reader-of-the-week –> start over.

    This weekend I found myself clicking on, and reading, a lot more pharmacy related Tweets than usual.
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  • Saturday morning coffee [May 25 2013]

    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 cup below is several years old. It’s a plastic Starbucks cup that I picked up somewhere in either Fresno or Visalia, California during my time as an IT Pharmacist at Kaweah Delat Medical Center in Visalia. The commute from my front door to Kaweah is just under an hour. There’s a Starbucks around the corner from my house and I used to swing by there on the way to work several mornings each week. Seemed like a shame to throw away all those cups, so I bought this dude. This weekend it’s sitting on the desk of a hotel room in San Mateo, California as I wait for my crew to stir so we can make our way to my daughter’s volleyball tournament.

    MUG_StarbucksPlastic

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  • Pharmacists should learn to write code

    You know what’s missing in healthcare? Pharmacists that write code and work on application development, that’s what’s missing. It’s the only way to ensure that applications have the right look, feel and functionality. Who knows better than a pharmacist, or pharmacy technician, how a pharmacy application should behave? No one, that’s who. Trying to explain healthcare workflow to a non-healthcare person is like trying to explain calculus to a dog; not that I think people outside healthcare are dogs. It’s just a metaphor.

    Anyone can learn to code the basics, much the same way anyone can learn the basics of being a pharmacist. I could teach an average sixth grader how to perform the basic functions of a pharmacist; no lie. Of course things get a lot more complicated once you get past the basics, and that’s when you need people with more experience, expertise and wisdom.

    I’ve dabbled in “programming” here and there, mostly out of necessity. At one time or another I’ve taught myself to code with visual basic, C# and some scripting languages like Javascript, PERL, and HTML. I also spent a couple years learning the ins and outs of database design and writing queries. But I was never all that good at it. I could do the basics, but it was neither my profession nor passion.

    I wrote a couple of small apps to help me do my job – desktop and web-based – and built some databases to handle pharmacokinetic tracking and pharmacist interventions. Everything worked, but they were nothing that would have wowed anyone. What I needed was someone with a lot more experience to take those applications and turn them into something spectacular. That’s where having a real “programmer” would come in handy; someone with years of experience, expertise and wisdom.

    However, back to my original point. Healthcare needs pharmacists that know how to write code to jump start the development process and drive things forward when things stall. Sometimes pictures and words simply don’t work.

    Just an opinion. Take it for what it worth.