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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Author: Jerry Fahrni
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Pharmacy workflow on life support
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Pillbox – a website for tablet/capsule identification
The National Library of Medicine has a website know as Pillbox beta that allows anyone to use various identifiers on a tablet or capsule, i.e. imprint, shape, color, size and/or scoring, to quickly identify a medication. I’ve used systems like this many times for the emergency department when a patient would roll in the door with ten different medications all thrown together in a plastic baggie. The nurse would bring them to the pharmacy and say “I need you to tell me what these areâ€. I tried holding the baggie to my head like the Great Carnac on Carson, but most of the time I had to use other references to help me out.
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“What’d I miss?” – Week of January 24th
As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
– What’s that? Oh, Avatar is still #1 at the box office. It’s now #2 on the list of top grossing movies of all time with its crosshairs squarely set on #1.
– KevinMD: “But when this health-care reform package passes, and if it does to the economy and to medical practice what many of us fear, will anyone be accountable? Will they step up and say, ‘yep, that was me! Sorry, I’ll try to fix it!’ It’s unlikely. That’s not how politics are conducted.†– Scary thought
– The Apple iPad was announced this week. It’s basically a giant iPod Touch. It isn’t available for purchase yet, but is already creating quite a buzz in heath care. Every card carrying clinician is claiming the iPad is going to revolutionize how they practice health care. I’m looking forward to getting my hands on one and spending some quality time figuring out how best to use it, but I’m a little gun shy about making claims like that.
– You can find positive blog posts on the iPad everywhere, so here a couple of negatives to help balance it out: interesting view from a 16-year old boy and another from VentureBeat and one final one from GottaBeMobile.
– Hitler responds to the iPad. I find these “Hitler†videos very funny. Be warned, however, they contain some offensive language.
– Here’s a tablet PC survey aimed at health care spurred on by the arrival of the iPad.
– Healthcare IT Consultant Blog: “Medical records for about 4,400 UCSF patients are at risk after thieves stole a laptop from a medical school employee in November, UCSF officials said Wednesday. The laptop … stolen on or about Nov. 30 … was found in Southern California on Jan. 8. There is no indication that unauthorized access to the files or the laptop actually took place, UCSF officials said, but patients’ names, medical record numbers, ages and clinical information were potentially exposed.†– This is why you never, ever store patient information on any type of physical media be it hard drive, CD, flash drive, etc. This is also why storage of patient information on the cloud should be considered.
– This is funny.
– Pharmcotherapy : “The genetic study of disease states can be the stepping stones for thoroughly understanding the genetic basis of ADEs. Gene polymorphisms are implicated in the development of diseases and corresponding disease-like ADEs.†– Pharmacogenetics, the study of genetic variation on the effects of drug, has been around for several years now, but has never really taken hold like many thought it would. The idea behind genetic testing to determine how you will respond to medications makes sense, but I don’t see it in practice. I wonder why?
– The Palmdoc Chronicles: “VisualDx Mobile for the iPhone and iPod Touch aids physicians in their decision making efforts by increasing diagnostic accuracy, helping to reduce health care costs associated with unnecessary return visits, referrals, and tests– all of which increase patient satisfaction.†– Clinical decision support for the iPhone/iPod touch.
Endgadget: “Researchers aim to give surgeons 3D maps, directions of human body – the group’s TLEMsafe system does provide surgeons with a complete 3D map of the lower body, which can actually be personalized for each individual patient, giving surgeons a reference and means to practice before any actual surgery takes place — and, yes, even an “automated navigation system” during surgery.†– Pretty cool stuff.
– LiveScience: “Researchers have built a new super-small “nanodragster” that improves on prior nanocar designs and could speed up efforts to craft molecular machines.†– This is amazing, The nanodragster is built using a combination of phyenylene-ethynylene molecules for the chassis and buckyball wheels. Cool!
– medGadget: “To see if clinical measurements can be performed using a cheaper solution, researchers at University of Melbourne tested Nintendo’s Wii Balance Board (WBB) against a laboratory-grade force platform (FP), and concluded that the cheaper option can provide results “suitable for the clinical setting” – So having a Wii is totally worth it, right?
– ASHP: “Health care facilities can expect the Environmental Protection Agency (EPA) by October to release a set of best practices for managing excess, expired, and unwanted pharmaceuticals.†– What to do with these medications has always been an issue.
– LA Times: “Unfortunately, even great stories have their endings, and the chapter on Warner’s NFL career closed today when the 38-year-old quarterback announced his retirement.” – I’m disappointed for my team, but happy for Warner. The man is a class act and a lock for the Hall of Fame. Check out his stats sometime. They are impressive. Kurt Warner is one of the few professional football players that I would like to meet in person. Perhaps I’ll get the opportunity some day. Good luck Kurt.
– I went 1-1 last weekend, bringing my playoff record to 7-3. The Vikings game was one of those rare moments in the NFL where the better team lost. Even with all the Vikings turnovers and bad penalty calls, they were only one play away from a trip to Miami for the Super Bowl. I was really hoping the Vikings could pull it off, but it wasn’t meant to be. My hat goes off to the Saints for hanging staying in the game. Now I hope Favre retires and enjoys being one of the greatest quarterbacks to have ever played the game.
– I’ll give you my Super Bowl pick next week.
Have a great weekend everyone.
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Cool Technology for Pharmacy
This week’s Cool Technology for Pharmacy is the OnDemand 400 for RxMap from MTS, a company that specializes in adherence packaging systems.
According to the MTS website:
OnDemand ® 400 for RxMap ® is the first pharmacy automation equipment system designed specifically for multi-med adherence packaging.
This efficient system uses OnDemand technology to dispense multiple medications for
a single patient quickly and accurately and in a fraction of the time it would take to do it manually. This pharmacy automation equipment system utilizes a custom interface to work with your existing information systems, enabling automated workflow management in the pharmacy. This single data input process reduces input time and the possibility of data entry errors. OnDemand ® 400 for RxMap ® uses bar-code technology to accurately dispense multiple medications into one compartment – as many or as few as needed. RxMap ® Adherence Packs vary in size and shape to meet the needs of the customers you serve. The finished product is a patient – specific adherence package filled “just-in-time†for your customer. -
Workforce training and allocation for modernization of HIT
The most recent issue of Hospital Pharmacy (Vol 45, No 1, 2010) has an article by Fox and Felkey that discusses the demand that the ARRA will place on the current and future HIT workforce. According to the article “the workforce to shepherd implementation, training, and support [for the modernization of heath care delivery] simply does not exist today; consequently, we could face a situation where health systems and clinics are financially ready to adopt HIT but do not have the personnel to carry it out.†I believe this is absolutely true and have alluded to it in the past (here and here).
More importantly, the shortage of HIT personnel will be further exacerbated by the need for clinicians to enter the technology field. The article supports this thinking by saying that “some experts have suggested that clinically-trained individuals are more suited to the design, selection, implementation, and management of HIT because they have a fundamental understanding of the processes of health care delivery. Alternatively, individuals trained in IT are more technically inclined, but lack firsthand experience with health care delivery systems†Another truism and a problem that is certainly not unique to the HIT field. Companies like Microsoft, Google, GE, Siemens, etc hire pharmacists and other clinician for their unique experience in the health care industry.
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Has interest in technology come and gone for pharmacsits?
I spent some time yesterday talking with some good people over at Pharmacy OneSource about pharmacy technology, clinical decision support, data mining, and a whole bunch of other interesting items. During one point of a conversations the history of Pharmacy OneSource came up. Part of that history includes the merger of Pharmacy OneSource with HealthProLink (HPL) sometime in late 2005.The mention of HealthProLink (HPL) brought back fond memories of a time when pharmacy informatics was really starting to take off and I was infatuated with the Palm Pilot <insert flashback sequence here>. HPL was a set of software tools for collecting and quantifying pharmacist intervention data as well as ADR/ADE information. In addition, the application offered access to several clinical calculators and a fairly robust reporting system. I was part of the implementation team for HPL when I worked at Community Medical Centers – Fresno and used it daily for a couple of years.
This was also a time when Palm Pilots were all the rage and every pharmacist I knew carried one in their lab coat pocket. The Palm OS was a stroke of genius because of its minimalistic approach to the user interface. Anyone could pick up a device using the Palm OS and figure out how to use it in a matter of minutes. They were a model of simplicity and functionality. In addition, several development environments were available for application development as well as several “readers†and database applications. This led to the development of hundreds of medical references, medical calculators, free and commercial peripheral brains and countless ways to track patients, labs, and medications available for devices running the Palm OS. It is the only time in my career as a pharmacist that the entire profession embraced a new technology and used it to their advantage. The literature was full of “studies†using handheld devices for documenting clinical interventions1-4, carrying individually created documents and “peripheral brainsâ€5,6 performing pharmacokinetic calculations, accessing drug information and performing drug interaction checking.7-12 The entire handheld movement was quite impressive to watch.
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“What’d I miss?” – Week of January 17th
As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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Cool Technology for Pharmacy
Bar code medication administration (BCMA) is nothing new, but remains a hot topic in healthcare nonetheless. Another topic that has generated significant interest in healthcare over the past couple of years is the use of smart pumps, which I have posted on before. Unfortunately for most hospitals the two remain independent of one another with no appreciable integration. The integration of smart pumps with BCMA was one topic of discussion at this years ASHP midyear. I attended a couple of presentations from healthcare systems that had successfully integrated information from their pharmacy information system (PhIS) directly into their smart pumps for use with their BCMA system. Like many other ideas presented at large conferences, the situation is the exception rather than the rule.
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Conceptual design for electronic communication in the outpatient setting
From Implementation Science 2009 Sep 25;4:62:
Abstract:
BACKGROUND: Health information technology and electronic medical records (EMRs) are potentially powerful systems-based interventions to facilitate diagnosis and treatment because they ensure the delivery of key new findings and other health related information to the practitioner. However, effective communication involves more than just information transfer; despite a state of the art EMR system, communication breakdowns can still occur. 123 In this project, we will adapt a model developed by the Systems Engineering Initiative for Patient Safety (SEIPS) to understand and improve the relationship between work systems and processes of care involved with electronic communication in EMRs. We plan to study three communication activities in the Veterans Health Administration’s (VA) EMR: electronic communication of abnormal imaging and laboratory test results via automated notifications (i.e., alerts); electronic referral requests; and provider-to-pharmacy communication via computerized provider order entry (CPOE). AIM: Our specific aim is to propose a protocol to evaluate the systems and processes affecting outcomes of electronic communication in the computerized patient record system (related to diagnostic test results, electronic referral requests, and CPOE prescriptions) using a human factors engineering approach, and hence guide the development of interventions for work system redesign. DESIGN: This research will consist of multiple qualitative methods of task analysis to identify potential sources of error related to diagnostic test result alerts, electronic referral requests, and CPOE; this will be followed by a series of focus groups to identify barriers, facilitators, and suggestions for improving the electronic communication system. Transcripts from all task analyses and focus groups will be analyzed using methods adapted from grounded theory and content analysis.
Although the information in the article is only a design concept, it is still worth reading. Concepts like these could be useful for many outpatient as well as many inpatient alerts; labs that are outside normal parameters, results from blood tests, incorrect antibiotic choice following culture results, etc. With the advances in mobile technology, especially mobile communication devices, this is worth serious consideration.
