Jerry Fahrni

Author: Jerry Fahrni

  • Efficacy of handhelds for radiologic consultation

    To continue with the radiology theme from yesterday: Toomey RJ, Ryan JT, McEntee MF, et al. Diagnostic Efficacy of Handheld Devices for Emergency Radiologic Consultation. Am. J. Roentgenol. 2010;194(2):469-474.

    Abstract: Diagnostic Efficacy of Handheld Devices for Emergency Radiologic Consultation
    OBJECTIVE. Orthopedic injury and intracranial hemorrhage are commonly encountered in emergency radiology, and accurate and timely diagnosis is important. The purpose of this study was to determine whether the diagnostic accuracy of handheld computing devices is comparable to that of monitors that might be used in emergency teleconsultation.
    SUBJECTS AND METHODS. Two handheld devices, a Dell Axim personal digital assistant (PDA) and an Apple iPod Touch device, were studied. The diagnostic efficacy of each device was tested against that of secondary-class monitors (primary class being clinical workstation display) for each of two image types—posteroanterior wrist radiographs and slices from CT of the brain—yielding four separate observer performance studies. Participants read a bank of 30 wrist or brain images searching for a specific abnormality (distal radial fracture, fresh intracranial bleed) and rated their confidence in their decisions. A total of 168 readings by examining radiologists of the American Board of Radiology were gathered, and the results were subjected to receiver operating characteristics analysis.
    RESULTS. In the PDA brain CT study, the scores of PDA readings were significantly higher than those of monitor readings for all observers (p 0.01) and for radiologists who were not neuroradiology specialists (p 0.05). No statistically significant differences between handheld device and monitor findings were found for the PDA wrist images or in the iPod Touch device studies, although some comparisons approached significance.
    CONCLUSION. Handheld devices show promise in the field of emergency teleconsultation for detection of basic orthopedic injuries and intracranial hemorrhage. Further investigation is warranted.

    I’m not as sharp as many of you so I had to actually look up the word roentenology, which means “Radiology, the science of radiation and, specifically, the use of both ionizing (like X-ray) and nonionizing (like ultrasound) modalities for the diagnosis and treatment of disease.”

    According to the article “the scores of PDA readings were significantly higher than those of monitor readings when all observers’ readings are taken into account” and “no statistically significant differences between handheld device and monitor findings were found for the PDA wrist images or in the iPod Touch devices studies, although some comparisons did approach significance.”

    An interesting follow-up to this study would be to insert an iPad into the same scenario against the iPod touch. I would be very interested to see how radiologists would react to that. The iPad would offer similar functionality to the iPod touch with the advantage of a larger screen. I can only speculate that more screen real estate would be preferred over less screen real estate for radiologists if given a choice. Just a thought.

  • SaaS and speech recognition for EHRs

    CMIO: “In the past, major barriers to EHR adoption included high upfront costs and lack of IT resources to implement and maintain the technology,” the report stated. “A SaaS model solves both of these issues and Ovum believes it is the best approach for physician offices and small hospitals. With a predictable, monthly expense, a subscription-based SaaS EHR is a much easier cost for providers to swallow.” Speech recognition tools have helped increase EHR adoption among clinicians by increasing the accuracy of the patient health record—providers don’t need to make as many corrections. Speech recognition should feed directly into the PHR without the lag time of transcription, according to the report.” – It makes sense that Software-as-a-Service (SaaS) and speech recognition could be used to increase EHR adoption rates. Together they offer several potential benefits as well as creating a better user experience. In fact, I’m a fan of both and have blogged about how I think they could be used in pharmacy; here and here.  However, in regards to speech recognition, an educational session at the 95th Annual Meeting of the Radiological Society of North America (RSNA) reports that “a study by Zoltani and colleagues conducted at their facility found that 68 percent of more than 17,000 finalized reports contained errors, 15 percent of which could potentially change the meaning of the report. A radiologist’s experience, sex and caseload were not associated with significant differences in error rates.”

  • Will hype for iPad in healthcare translate into benefits for pharmacy?

    Unless you’ve been comatose for a while, you’ve certainly heard about the Apple iPad. The device has already been crowned the de facto device for everything from e-reading to creating a new wave in healthcare unlike anything we’ve ever seen. Of course this is all speculation as the device hasn’t been officially released yet.

    Many people have speculated that the iPad will be a great device for healthcare. Whether or not that will be the case remains to be seen. One thing is for certain: everyone is banking on the iPad being a big hit in healthcare. Based on the success of the iPhone as a favorite among physicians and nurses, this certainly isn’t a wild prediction. Will this success translate to the pharmacy? Good question.
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  • Cool Technology for Pharmacy

    The DoseEdge Pharmacy Workflow Manager, formerly IntelliFlowRx Workload Management Software by Baxa, is a system designed to track and manage intravenous (IV) medication dosages prepared by pharmacy personnel in a clean room environment. The system is touted as “The world’s first and only fully integrated workflow manager for the IV room.”

    The system is designed to flow something like this:

    – IV medication orders entered by the pharmacist, or other healthcare professional, are sent to the DoseEdge system where they appear on the DoseEdge touchscreen.
    – When the technician, or pharmacist in some cases, accesses the order via the touchscreen instructions for preparation of the product are displayed.
    – The product label is generated.
    – The barcode on each injectable ingredient used for the preparation of the IV product is scanned to ensure the correct medications have been selected. Items identified as incorrect result in an audible message of “product not allowed for this dose.”
    – The barcode on the IV product label generated by the pharmacy is scanned to ensure that ingredients are appropriately matched.
    – Each ingredient is drawn into a syringe.
    – An image of the syringe with appropriately drawn medication is taken for review by the pharmacist, or technician, whichever the case may be. This is a nice feature as it allows one to see the actual amount of drug drawn into the syringe prior to shooting it into the fluid bag.
    – Ingredients are injected into the fluid bag and an image of the final product is taken.
    – A final scan of the product barcode is done to complete the fill.

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  • Quick hit – Barcode scanner consistency

    Part of the process of implementing barcode medication administration (BCMA) is evaluating hardware; mostly scanners. There are several makers of barcode scanners including Honeywell, Symbol, Metrologic, Datalogic and Code Corp. Having so many choices always makes the selection process interesting.

    One suggestion from several hospitals I spoke with that were already live with BCMA, was to use the same barcode scanner on the nursing floors that were used in the pharmacy. That sounds logical, right? Sure, if the barcode scans correctly in the pharmacy, then nursing should be able to scan the same barcode using the same scanner.

    The scanner of choice in our pharmacy department is the the Code Reader 3500 from Code Corp. So of course this is the scanner I recommended in my report to the BCMA hardware sub-committee. For whatever reason, the committee decided to go with a different brand of scanner. Unfortunately the scanners we purchased won’t scan some of the more complex barcodes coming out of pharmacy, making them virtually useless. The scanners purchased by the hospital are on their way back to the wholesaler as I patiently await for round two.

    Take away lesson: use the same barcode scanner for the nursing units that the pharmacy department uses to meet their barcoding needs.

  • What is the future of pharmacy informatics as a career choice?

    Over the weekend I spent a little time looking at trends in pharmacy and technology. As expected the healthcare technology market is expanding rapidly and this expansion is creating a need for pharmacists with technology know-how. To prove my point I created a job trends graph from indeed.com using the following search criteria: “pharmacy informatics”, “clinical pharmacist” and “director of pharmacy”. As expected the search trends for “clinical pharmacist” and “director of pharmacy” are relatively flat, but the trend line for “pharmacy informatics” is striking. It looks like a new pharmacy career path is born.

  • DynaMed – an evidence based medicine point of care tool

    Our facility is running a trial of  DynaMed, “an evidence based medicine point-of-care” database. It reminds me of UpToDate.

    From the DynaMed site:

    • According to the National Academy Press (2001) 44-98,000 American deaths per year occur due to preventable medical errors; medical errors are estimated to cost the U.S. $17 to $29 billion annually
    • Using the “best available evidence” for clinical decision-making improves health outcomes and reduces health care costs
    • Busy clinicians use “fast and easy” resources expected to answer most of their questions instead of resources designed to provide the best current evidence
    • Clinicians sometimes turn to textbooks and online resources with substantial breadth, but these resources do not use the best available evidence
    • Physicians and other health care professionals need a resource where they can reliably answer most questions quickly and accurately (i.e., with the best available evidence)

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  • Cool Technology for Pharmacy

    One of the best pharmacy jobs I ever had was working for a small compounding pharmacy in the Bay Area of California. Many of the prescription items compounded in this particular pharmacy had to be flavored based on the needs of the patient; sometimes animal, sometimes human. Regardless, the art of flavoring was always a challenge but also a lot of fun. I learned quite a bit about how to mask bitterness, how to use various sweeteners to get the flavor just right and how to use various flavor combinations to create some pretty tasty medications; it’s an art. And don’t underestimate the amount of science that goes into creating flavors like these or the science behind using those flavors to mask unpleasant tastes. It takes time, energy and patience.

    FLAVORx, a company in Columbia, MD has taken a lot of the experimentation out of the flavoring equation by creating a system for dealing with “yucky medicine”.

    According to the FLAVORx website, their product is in use by over 35,000 pharmacies nationwide. The company website offers a handy Pharmacy Locator to assist you in finding a pharmacy nearby that can flavor your child’s, or your own, medication.

    FLAVORx lets children and their parents customize the medicine to whatever they’d prefer it to taste like

    Our scientifically tested FLAVORxâ„¢ Flavoring System is available at pharmacies nationwide and is designed to make any liquid medication easier for your child to take. Using our unique Bitterness Suppressor and Sweetness Enhancer, Pharmacists mask the unpleasant flavor associated with many prescription and over-the-counter liquid medications. And with our wide assortment of kid-approved flavors, your child (with the help of the Pharmacist) can customize their medicine to suit their individual tastes.

    All FLAVORxâ„¢ flavors are sugar-free, gluten-free, dye-free, casein-free, inert, and non-allergenic. Our flavors are made from a blend of natural and artificial ingredients and we never use phosphates or other potentially harmful chemicals.

    Available flavors include apple, banana, banana orange, bubblegum, chocolate, chocolate cherry, citrus punch, grape, grape bubblegum, grapeade, lemon, orange, raspberry, sour apple, strawberry, vanilla, watermelon and wild cherry.

    Check out the FLAVORx Favorable Flavors tool (PDF)

  • SaaS and pharmacy

    Software as a service (SaaS) has recently been popping up in healthcare related news, from Fujitsu’s SaaS solution for drug trials to the host of web-based applications from Pharmacy OnceSource.

    SaaS is different than the traditional enterprise software model because the provider of the software licenses it to the customer as an on-demand service. The vendor often times hosts the software on their own servers where data is manipulated and returned to the customer for viewing. It’s kind of like renting software.

    The beauty of SaaS applications like those from Pharmacy OneSource are that they can be viewed from any device with a web-enabled browser; Mac, PC, smartphone, etc. In addition, the application is owned, delivered, maintained and managed by the provider, limiting the burden on the customer. A by-product of this model is that delivery of the application over the web ensures that the software is always up to date.

    The SaaS model appears to be popular in the “business” world at present, but is increasing in popularity in healthcare secondary to its simplified deployment and reduced cost. With advances in cloud computing strategy, better data storage models and faster internet connections I think it’s only a matter of time before we start to see more SaaS solutions in pharmacy practice. And why shouldn’t we? By their very nature SaaS applications lend themselves to use on mobile devices like the tablet PC and iPad, which in turn offers greater flexibility for pharmacists practicing at the bedside. Just a thought.

  • Pharmacy workflow on life support

    A friend from Talyst stopped by the pharmacy and spent the greater part of Monday afternoon and Tuesday morning taking a look at what it means to work in an acute care hospital pharmacy. We have several pieces of Talyst automation and technology in our pharmacy and he was interested in how we used it and how it fit into the general scheme of things. As we roamed the pharmacy, I began describing our Pyxis system, how we handle our replenishment, how we put our order away, how we package bulk medications, how we barcode syringes, how we handle an IV batch, how we handle infusions for our smart pumps, and so on and so forth ad infinitum. It was a good exercise for me as it often improves my understanding of something when I try to explain it to someone else.
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