Jerry Fahrni

Author: Jerry Fahrni

  • Top posts for week ending April 3, 2011

    Below is a list of the most read blog posts over the last week based on number of hits:

    1. Automated unit-dose packagers for acute care pharmacy
    2. Cool Technology for Pharmacy (Alaris Smartpumps June 18th, 2009) – Smartpumps seem to be picking up speed again, especially in regard to integration into BCMA systems and eMARs/EHRs.
    3. Best iPhone / iPod Touch Applications for Pharmacists – It’s interesting that this post keeps rising to the top of most viewed. I originally created the post on March 31, 2010 making it more than a year old. But as you know the iPad continues to make news.
    4. The art of the excuse
    5. Quick update: Pharmacy iPad use – See comment from #3 above
    6. Where will automation and technology make the biggest impact in pharmacy? – The more I think about outpatient pharmacy automation, the more I think outpatient pharmacists should be concerned
    7. Moving storage around in the “cloud”
    8. The evolution of tablets for pharmacy – New tablets continue to hit the market at mind-numbing speed
    9. Another opportunity for pharmacist$ – Medication adherence, just sayin’.
    10. Barcodes on patient wristbands – Another really old post, June 13, 2009. I wonder if renewed interest has anything to do with the upcoming unSUMMIT in Louisville, KY?
    11. Realistic view of medication reconciliation?
    12. Using technology to advance pharmacy practice through education
    13. What are you going to do with all that data?
    14. Is the 30-minute rule for medication administration good or bad?
    15. Pharmacists and medication adherence – See comment from #9 above

  • Different tablets for different tastes

    The Digital Reader: “Due to weight I had to pick between my a Win7 tablet convertible or (as a pair) my iPad and Viewsonic gTablet. I’m taking the Inspiron Duo.

    I can get more work done with it than the other 2 combined. I can run all the same apps on my Win7 laptop and on my Duo. I can start a project on one, email it to myself, and continue it on the other. I also know that no matter what I download I’ll be able to open it. Neither mobile OS has any real support for Office formats, not even basics like RTF, ODT, or others.

    The same goes for all my other data. Just a few minutes ago I copied 70GB of work files onto the Duo. I didn’t need more than about 100MB, but copying the files over was so easy that I went ahead and grabbed them all. I know that I will be able to open whatever I happen to need, so why not?”

    While I don’t completely agree with everything the author says I’m slowly coming to the same conclusion myself, i.e. that a Windows tablet is the way to go. I experimented with an iPad last year, but it didn’t meet my needs. I’ve been seriously considering an Android tablet, but just can’t seem to pull the trigger; can’t really say why. One thing I do know is that I use Windows 7 for a majority of my computing needs, including on my current tablet of choice, the Lenovo X201 Tablet PC.

    The Inspiron duo is an interesting machine. I’ve played with it at the Microsoft Store in Bellevue, WA and wasn’t all that impressed with it. But I must say it’s a refreshing change from the standard slate and convertible designs I’ve seen over the past couple of years.

    It just goes to show you that one size definitely doesn’t fit all. Different strokes and all that jazz.

  • Another opportunity for pharmacist$

    Reuters: “During the current study, 21 percent of the 1506 participants said they had previously not taken medications because of money concerns. Another 5 percent said they were worried they might not be able to pay for drugs.

    The researchers, who published their results in the journal Academic Emergency Medicine, considered both groups to be “at risk” of nonadherence with future prescriptions.

    Looking at the responses to other questions on the survey, Rhodes and her team found that people were more likely to be at risk of nonadherence if they had money issues – for instance, they worried about money, didn’t have enough food, reported housing problems, and had inadequate health insurance. But they were also more likely to be at risk of nonadherence if they smoked, used illegal drugs, or experienced domestic violence, as either the victim or perpetrator.”
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  • The art of the excuse

    Excuses are a great way to deflect work. And just like everyone else I’ve ever met I’m guilty of using them when they suite my needs. But it feels like I’ve run into more than my fair share of people lately that have nearly perfected the art of the excuse.
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  • Realistic view of medication reconciliation?

    Hospitals & Health Networks: “Despite progress, medication reconciliation remains a bitter pill. Un-intended changes in medications occur in one-third of all patients transferred between hospital departments, and in 14 percent of patients at hospital discharge, according to the Agency for Healthcare Research and Quality.

    Most medication inconsistencies could be avoided if reconciliation were performed at patient admission, transfer and discharge. Hospital information systems are helping some wired hospitals rdo this across the care continuum despite the lack of a universal solution.

    Medication reconciliation was designated a 2005 National Patient Safety Goal by the Joint Commission, which recommended that organizations accurately and completely reconcile medications across the continuum of care. In 2009, however, the commission announced it would no longer score medication reconciliation during on-site accreditation surveys, because of difficulties with implementation strategies. Then, in December 2010, the commission announced a new version of the NPSG (08.01.01), to be effective July 1 of this year. According to the commission, the new streamlined version focuses on critical-risk points in the medication reconciliation process.

    The Institute for Safe Medication Practices still is disappointed in the current status of medication reconciliation. “It’s not what we expected for a process that on the surface seems so simple,” says Stu Levine, an ISMP informatics specialist.”

    I received a link to this article through the Healthcare IS – Pharmacy IT/Pharmacy Informatics CPOE Group on LinkedIn. The article is titled “Medication Reconciliation Only as Good as the IT Allows”. I find the title a little strange, and a bit misleading. Consider that the medication reconciliation process is best handled by diligence among healthcare providers, not IT. The technology to provide clinicians with medication lists is only a tool to make the process easier. Reconciling a patient’s medications is at best a difficult task. The “general public” knows surprisingly little about their own medications; including the simplest of things like names and doses. Getting physicians to reconcile a medication list isn’t much better. More often than not they simply sign the “transfer med list” without really scrutinizing what’s on it.

    Unfortunately the article makes it sound like a simple process of looking at the medication list on admission, transfer and discharge. It really isn’t as simple as that. We utilized this process at my previous hospital and I can tell you that we were lucky to have a patient medication list that was accurate. Most were haphazard attempts that lead to confusion and lots of phone calls and clarification.

  • Pharmacists and medication adherence

    WSJ: “”Retail pharmacists appear to be able to play a really substantial role in encouraging patients to use their medications better,” says William Shrank, an assistant professor of medicine in the division of pharmacoepidemiology at Brigham and Women’s Hospital in Boston. “They are an underutilized resource.”

    A study by researchers at the Walter Reed Army Medical Center in Washington, D.C., published in the Journal of the American Medical Association, found that a pharmacy-care program for 200 people age 65 and older who were taking at least four medications for chronic conditions boosted adherence to 97% from 61% after six months. Patients were educated about their medications, including usage instructions; medications were dispensed in blister packs that made it easier to keep track of whether they had taken their pills for the day; and pharmacists followed up with patients every two months.

    After 12 months, those who continued to get the pharmacy care kept their adherence at about 96%, while adherence among those for whom the program was discontinued dropped to 69%.”

    This ties back in to what I was talking about on Saturday, i.e. that better use of pharmacists in the community practice setting might be a good thing. And one way to get community pharmacists to spend more time with patients is to get them out from behind the counter and away from the phones using better automation and technology. The inability of a patient to adhere to their medication regimen costs the healthcare system in the United States millions of dollars each and every year, but for some reason we continue to sit idle and allow it to continue.

  • Where will automation and technology make the biggest impact in pharmacy?

    I was planning on writing a rant this morning about lack of motivation, leadership and dumbasses – hey, I was in a fould mood when I got up – but then I opened an email from a friend. He asked me “How can retail pharmacists get involved in this [pharmacy informatics] industry?”. My first thought was to say that retail pharmacy would be the death of our profession and that they have no business getting involved in pharmacy informatics. Harsh I know, but I told you I was in a foul mood.

    Then I did something I rarely do, I thought about the question a bit more before answering. After some time I came to the conclusion that retail, or more generally outpatient, pharmacy is exactly where more automation and technology is needed. I follow a few retail pharmacists on Twitter and one generalization I can make from reading their Tweets is that they all pretty much hate their jobs. Why? Because they spend precious little time working as pharmacists, instead spending most of their time physically filling prescriptions, chasing insurance claims, etc.

    What retail pharmacy needs is a super-sized dose of pharmacy automation, technology and greater pharmacy technician involvement. Nowhere in pharmacy is there a greater need for automation and technology than outpatient services. Much of what’s done in the outpatient pharmacy setting does not require a pharmacist. This echoes the words by Chad Hardy last week on the RxInformatics website. Chad states “The longer we rely on pharmacists to run the entire supply chain, the higher our risk of obsolescence.” He’s absolutely right, although the article he references insinuates that pharmacists will become obsolete secondary to technology. Nay, I say. Technology in the outpatient arena can offer pharmacists the opportunity to break away from the mundane and do a little more hands on patient care. In addition, the drive to implement automation and technology in the retail setting creates the perfect job opportunity for pharmacists interested in informatics.

    Of course we’ll have to prove to the retail boys upstairs that they can save money by using pharmacists in a more clinical role, but that’s what business cases are for. Unfortunately I couldn’t write a business case to save my life. In fact, a colleague of mine told me that pharmacists are terrible at creating business cases. I suppose that’s true as most of us didn’t become pharmacists to practice business. Instead we became pharmacists to provide patient care. Go figure.

  • Tablet tid-bits

    This morning at breakfast I sat across the table from an older gentleman in an Air Force flight suite. He was eating his cereal, drinking his coffee and playing with his iPad. I don’t often see older men in flight suites using an iPad so I felt compelled to strike up a conversation. I simply asked him what device he was using and what he was doing with it. I find that it’s better to play dumb in situations like these as people tend to open up a little more.

    Anyway, I found his responses fascinating. He said that he uses his iPad in the cockpit of his aircraft to replace an “entire bag full of papers and books”. He was using an application to file his flight plan, check the weather, handle some flight calculations and review his “alternate” landing sites. In addition he was reading the New York Times and checking his email all while enjoying breakfast.

    We talked a bit about the features of the iPad and how he liked it. He indicated that he used to have an iPhone and thought it was similar enough that he didn’t have much of a learning curve.  Before leaving he finished up the conversation by saying “it lets me keep everything in one place” before turning back to finish his meal.

    The short conversation got me thinking about the often overlooked value of the new generation of tablet design. In this case it was an iPad, but it could have been an Android device, BlackBerry PlayBook, or HP TouchPad. Three things struck me:

    First – The importance of the tablet form factor. Everything the gentleman was doing on his iPad could have easily been done on any computer. However, during our conversation he said that he used to use a laptop in the cockpit, but found that it was awkward. He liked the form factor of the iPad much better. Slate tablets are lighter, smaller and have better battery life. It’s hard to beat that combination of features for quickly viewing information.

    Second – Standardized user interface and user experience. The fact that his learning curve for the iPad was improved by his previous use of an iPhone didn’t escape my attention. Android smartphone and tablet manufacturers should make note of this. The current trend with Android tablets is to create a customized user interface that overlays the “stock” Android UI. As cool as I think the aftermarket user interfaces are, they have the potential to create a bit of a dilemma for the end user. Keep it standard across the board boys and girls. From what I’ve seen of the TouchPad it looks like HP is trying to keep the experience similar across its line of devices.

    Finally – Availability of key pieces of software and applications. Consuming information on a mobile device certainly took center stage for this gentleman as he was using his iPad to take the place of more than one item that he previously carried in his bag. It’s hard to say if all tablet manufacturers will have enough software and applications to make their devices as compelling as the iPad. Only time will tell.

    When our conversation was over and the gentleman had finished his cereal he simply picked up his coffee cup in one hand, his iPad in the other and walked out the door. I suppose that just about sums up the value of utilizing technology in a mobile form factor.

  • “What’d I miss?” – Week of March 13, 2011

    As usual there were a lot of things that happened over the past week, and not all of it was related to pharmacy automation and technology. Here are some of the things I found interesting.
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  • How not to design an application for pharmacy

    I’ve used Pyxis PARx before, but only in combination with a carousel storage system. I recently had the opportunity to play with the standalone version of PARx and all I have to say is yikes!

    The system utilizes an older version of Windows Mobile on a clunky Motorola handheld. To get from log-in to a useful place in the application required me to go through no less than four screens. The touch screen was unresponsive and difficult to use, the device was painfully slow and the connectivity was lacking.

    So, to sum up my experience with PARx – used with carousel technology it’s great, but try to use the standalone product and you might find yourself spewing profanity.