Jerry Fahrni

Category: None of the above

  • The new Bing AI – dissapointing

    I was pretty excited the first time I heard about “Bing AI”. From what I read and heard via Podcast; it was going to be something big. One could simply ask it to do something amazing and it would. Need to plan a trip to Greece with flight, hotel, and itinerary? No problem. Need a presentation for the boss? No problem.

    So, I signed up to get on the waiting list. I didn’t have to wait long. On Thursday, February 23, 2023, I got access to Bing AI. I couldn’t wait to take it for a test drive. And what better way than to ask a healthcare related question?

    Because I heard people use the term “write me an essay” for AI bots before, I decided to test Bing AI with the following request:

    “Write me an essay describing why masking doesn’t work to prevent covid-19. Use the latest information and references available.”

    My request was purposely specific. You all know where I was going. I wanted the bot to mention the Danish study on COVID masking, the Bangladesh study on COVID masking, and of course arrive at the most recent Cochrane review. I wanted Bing AI to find the “best” information we had, dissect it, present it in a way that I could understand, and formulate “a conclusion” based on current data/information. In my mind, worst case scenario would have been an analysis of the data followed by something along the lines of “more study is needed”. Best case, it analyses the data, looks at the “best studies”, walks through the Cochrane review, and states something to the effect that “data suggests that masking offers no benefit”. Bing AI did the only thing it should have never done, it choked.

    The response was incredibly disappointing. It basically read like a blog post trying to convince me of something I know isn’t true. Instead of providing me with data analysis, it regurgitated a very lopsided view of current political talking points.

    “According to several studies and experts…” wasn’t the best way to start. “Expert” is a worthless connotation today. I’ve found that most people claiming to be experts simply aren’t. When someone says, “an expert said”, my eyes instantly glaze over, and I go to my mental happy place to get away from the stupidity.

    Bing AI completely whiffed on the Danish study – neither mentioning it nor explaining why it is no longer cited in most conversations. It did mention the Bangladesh study but parroted talking points from one side of the argument only. The bot wasn’t sharp enough to evaluate the literature in its entirety and do a better job of presenting the data. If you dig into the Bangladesh data, the actual data, the study doesn’t show that masks help. It shows that there is no difference. Not only that, but the Bangladesh study is flawed in many ways. Don’t believe me? Look up the difference between red and purple masks in the study.

    Bing AI finished by citing the CDC. No one should ever cite the CDC as a source of truth for anything these days. They lost all credibility a couple of years ago for anyone with two or more brain cells. “Proven strategy”? Hardley.

    The AI failed to mention the Cochrane report at all, which was surprising. Not deterred, I pressed by asking “What about the cochran [sic] study showing that masks don’t work?” The response was frightening. Instead of delving into the information and presenting a factual account of the Cochrane review, it again parroted political taking points from one side of the aisle, trying to convince me that Cochrane review was worthless. That alone set off all kinds of red flags in my mind. To me it demonstrates that there is something seriously wrong with what’s going on behind the scenes on the Bing AI project.  

    Cochrane reviews have long been held as the gold standard for literature review and analysis. Several times during my career I’ve seen practice changes based on Cochrane reviews. They are (were?) held in high esteem and considered to be without bias. Seriously, there used to be things like that.

    Not surprisingly, however, the Cochrane review on the use of masks to prevent transmission of viruses has created quite a flurry of activity. Those of us that know masks are worthless look at it as yet another piece of evidence to support what is true. For those that still cling to the notion, it feels like another attack on their religion. The best they can do is try to discredit the results, which in this case, causes much more damage than they could ever image. It shows just how deeply handling of SARS-CoV-2 has forever changed the landscape of medical information found in “trusted” literatures sources. The ramifications of the damage done will reverberate through the halls of healthcare for a long time to come.

    Based on the Bing AI responses, it appears at least to me, that the problem with “AI” is that the information it is gathering is biased by the folks in the background developing what and how it learns. In my mind, Bing AI should take in data, analyze it better than any person, and present the data back to the requester in a way that allows one to apply it accordingly. It should never, ever use summary weblogs and political talking points to “formulate opinion”. I believe we are looking at a classic case of garbage in, garbage out. Kind of like Wikipedia.

    I’m now dumber for having spent time with Bing AI. Want some advice? Do the work yourself. Keep your mind sharp and active. Don’t trust what someone else says, even if it is “cutting edge AI”.

    AI will only harm humanity, not help it.    

  • The Fallacy of Masking

    Wearing masks is a rather touchy, sometimes dangerous subject. There are individuals on both sides of the argument. Unfortunately, I work in an industry where those on one side are heroic humanitarians and those on the other are villains. Typically, such things don’t worry me, but in these days of cancel culture, it can be detrimental to one’s career, and by extension, one’s livelihood. As such, the essay below is a sanitized version of the original. When I first penned this piece, many weeks ago now, I was mad. Mad at still wearing a mask at work more than two years after two-weeks to flatten the curve. Masking was supposed to be a temporary solution to help ease the infection rate. Somehow, it has become standard operating procedure in healthcare culture and it’s chipping away at my soul. Fortunately, my wife stepped in after viewing what I had written and told me to take a breath. She said “_____ isn’t going to like that”. She was right, of course. They weren’t going to like it. So, I stepped away for a couple of weeks before coming back to complete the task.

    TLDR; masks don’t work, they are unnecessary, and they’re a nuisance. You need read no further if you wanted to know my opinion.

    When someone tells you that masking prevents COVID-19, you know one of two things: 1) they are ignorant, which is common, or 2) they are being disingenuous and selective with their information, which is also common. There are no other options available.

    Do masks prevent disease? No, at least not to any appreciable amount I can find. Do they prevent transmission? No, not with any certainty. Do they decrease severity of disease once inoculated? No. Do they reduce viral load in the air? Maybe, but it depends on what you read and how that information is used. “Airborne viral load” doesn’t seem to corollate to inoculation, much less severity of disease, hospitalization, or mortality. In short, viruses get past masks, even N95s tapped to one’s face. I’m not kidding. ().

    If you would just “follow the science”, Jerry. The battle cry of anyone that wants me to put one on. But does “the science” really support it? Not that I can find. There is data suggesting that they help and evidence saying they don’t. How can that be? It happens all the time. The problem is that most available data supporting or refuting the practice is weak. Studies suffer from poor design, confounding variables, and in some cases, outright bias.

    “The science” argument assumes that science is always right. We should all know better. Science changes all the time. Science, by its very design, is never right or wrong. It is nothing more than a system of collecting data and applying it to a given construct. The best we can do with science is collect information and make decisions based on what we know combined with personal experience. Humans have been doing it this way for an exceedingly long time. Science is ever changing, providing data at one point in time from which we can only move forward. If anyone ever tells you that science “proves something once and for all,” you should run away.* The best we can hope for from scientific endeavors is to find information that supports or refutes our thoughts. That’s it, nothing more.

    “1500 years ago, everybody “knew” that the earth was the center of the universe. 500 years ago, everybody “knew” that the earth was flat. And 15 minutes ago, you “knew” that humans were alone on this planet. Imagine what you’ll “know” tomorrow.” – Kay, Men in Black

    Unfortunately, rational behavior and the search for enlightenment and understanding went right out the window with COVID-19. I cannot explain why because this has not happened before in my lifetime. I believe the phenomena is unprecedented. Even in the face of overwhelming common sense – and sometimes supporting data – people continue to do things that defy logic. There are two things I learned a long time ago that seem applicable: 1) smart people can be really dumb, and 2) people is power are not necessarily the smartest people in the room.

    But Jerry, they’re doing it for your own good. Be careful letting someone else determine what is best for you, especially when that someone else may have a personal stake in your compliance. Forcing folks to do certain things – outside of having laws to prevent society from slipping into chaos – is a path from which we cannot return. People that gain power rarely ever give it back. And people that concede control of their own lives concede everything.

    “The nine most terrifying words in the English language are: I’m from the Government, and I’m here to help.” – Ronal Reagon.

    If you are genuinely concerned about how best to control exposure to pathogens, do not listen to a politician, do not talk to your doctor, and whatever you do, do not listen to me. Instead, seek the advice of someone that specializes in minimizing risk associated with exposure to dangerous things. I am of course speaking about Industrial Hygienists. Those folks know a thing or two about limiting exposure to hazards.

    “[The] science and art devoted to the anticipation, recognition, evaluation, and control of those environmental factors or stressors arising in or from the workplace, which may cause sickness, impaired health and well-being, or significant discomfort among workers or among of the citizens of the community” .

    In general, Industrial Hygienists support the notion that masking is not the answer. Their hierarchy of controls, which we use in pharmacy to handle hazardous drugs, is all about dilution and elimination of the threat through engineering controls (dilution, destruction, containment), administrative controls (limiting time exposed), and PPE (respirators, not masks). It is all about turning over the air in the space you are in and not hanging out with people that have active disease. Ever heard of an HVAC system? How about negative pressure rooms? Air Changes Per Hour (ACPH) anyone? Any healthcare professional reading this will be familiar with the concepts. We use them all the time in the hospital to control infectious diseases, at least as long as I have been in healthcare.

    As I dig further into the question of masking, I find more data suggesting that these things can cause more harm than good (https://brownstone.org/articles/more-than-150-comparative-studies-and-articles-on-mask-ineffectiveness-and-harms/). Why is it that no one wants to talk about that? If someone tells you to do something and it causes harm, it would be wise to take a moment to assess the situation.

    There is at least some evidence suggesting that masking children has led to reduced learning, reduced development, and physical, emotional, and social harms. My daughter is a speech language pathologist. She works for both a school system and a hospital. Ask her what it has been like for the last couple of years working with masked children. I can hear the frustration and concern in her voice when we talk about it. I feel bad for the families that will have to deal with the repercussions of this for years to come. It is heartbreaking. The value of a child’s health should never be placed below that of an adult. The adult protects the child, not the other way around.

    But Jerry, if we can save just one life it will all be worth it. I hear this a lot when I oppose masking. It’s a strawman argument, perpetuating the idea that “anti-maskers” don’t care if people die from COVID. Simply not true. I don’t want anyone to die. It’s a terrible, deeply disturbing thing. However, humans simply don’t live with “zero risk” in mind. There are many examples of people doing things every day that come with inherent risk. If our society was designed to “save everyone” we would wear clothing made of bubble wrap, limit cars to 25 miles per hour, force people to wear helmets while walking on busy streets and eliminate all forms of air travel. You know, going down in a Boeing 747 over the Atlantic Ocean, albeit rare, is 100% fatal. Eliminating air travel is the way to go, no question about it. It would all be worth it if we could just save one life. Can you imagine a world like that? No? Neither can I.

    As humans, we make decisions every single day based on risk and benefit. I am willing to risk the transatlantic flight to visit a beautiful foreign country. Others are too. It is how we live.

    With that said, I am as guilty of perpetuating the nonsense as anyone. I have always considered myself a strong man, capable of making tough decisions even in the face of extreme adversity. I have had my share over the years. Well, here I sit, writing about being “forced” to wear a mask. To my shame and embarrassment, I caved to the masking issue as soon as my livelihood was threatened. It turns out that my moral and ethical values are worth exactly as much as my salary. My failure to “stick to my guns” has given me pause to reflect on many of my beliefs and where I truly stand. It turns out that cowardice comes in many forms.

    In closing, I find no issue with people that choose to wear a mask. Go for it, it is a personal choice. I respect that. All I ask in return is the same courtesy. You do your thing and I’ll do mine. Perfect harmony.

    *I have had many people tell me that science proves that God does not exist. I find that argument amusing. By saying such a thing, they propose that all science for all time has been completed and there is nothing more to learn.

  • Rethinking Chromebooks

    A couple of years ago, I tried switching from a Windows laptop to a Chromebook. It didn’t work. At the time, I was simply too entrenched in my specific needs to make the switch. Things have changed since then. For over a year, I’ve been using an ASUS Chromebook Flip C302 as my primary computing device. Besides having a mouthful of a name, it’s a great little machine. The combination of it plus my Samsung Note 9 has been nearly perfect. I say nearly perfect because I recently ran into an issue where my Chromebook couldn’t cut it. Some will call it an edgecase, but it created a problem nonetheless.

    I recently found myself in need of a resume. I have one, sort of. It’s been years since I actually needed a resume, so I haven’t really stayed on top of it. I tried building one from scratch, but quickly realized that it was garbage, so I hired a professional. This particular professional, like many others, uses Microsoft Office, specifically Microsoft Word to create documents. I wasn’t concerned. As a Chromebook user and Microsoft Office 365 subscriber, I assumed everything would be seamless. I mean, I could simply use the web version of Word, right? Yes and no. It turns out that the online version of Word doesn’t play all that well with all desktop versions of Word.

    The resume contained a lot of formatting that didn’t translate well from the desktop to the web version. My attempts to make edits and leave comments from within the web version were a disaster. Formating got destroyed, things disappeared from the page, and I quickly became frustrated. Within a day of going back and forth with the author of my new resume, I realized that I had found an instance where a Chromebook simply wouldn’t cut it.

    Sooo, what’s a guy to do? I haven’t purchased a Windows laptop for myself in nearly five years. I literally started digging through my computer graveyard, i.e. the closet for one of my old machines. There were plenty to choose from. In the end, I ended up using an old 15.6-inch Sony VAIO to edit and complete the resume. The VAIO is a bit long in the tooth, but it’s a nice big machine to type on. I appreciate the screen real estate for going back and forth between documents, notes, etc. It worked out quite well.

    In the end, I received a new resume and went on my merry way. However, it made me realize that as much as I like my Chromebook, the platform still “isn’t there” yet. At least not for me. For Chromebooks to be truly mainstream, this type of thing can’t happen. At least not as long as such a large number of folks continue to use Microsoft Office as their content creation suite of choice. I understand that this is as much Microsoft’s fault as Googles, but when given the option, it seems logical to stick with a Windows machine for the immediate future.

    Consider this, I can use Chrome on a Windows machine to seamlessly do everything I can do on a Chromebook. I can’t do the opposite, at least not seamlessly. I’m sure the Chromebook zealots — and Microsoft haters — will disagree, but it doesn’t change the fact that my struggles were real. As PC laptops continue to get better, and Chromebooks continue to become more expensive, a decision that used to simple is much more complicated now. This is especially true now that Microsoft has embraced Chromium in their new Edge browser.

    Given that one can purchase a nice Windows laptop from Lenovo, Dell, HP, or Microsoft for around the $1000 price point, it makes spending $800-$1000 on a nice Chromebook a tough sell. I’ll continue to use my Flip for now — as I said above, it’s a great little machine — but I’m currently on the hunt for a new Windows laptop. I’ve narrowed my search down to a select few machines from Microsoft and Lenovo.

  • Some Random Thoughts

    A week or so ago a colleague tagged me on Twitter in reference to a Reddit post in which my name, or rather my site jerryfahrni.com came up. The thread was basically pharmacists listing places to go to get pharmacy related “informatics” information. My site popped up as a place to go. However, someone correctly pointed out that the blog has been quiet for a while now.

    This got me thinking, why haven’t I written anything? Or more accurately, why haven’t I posted anything that I’ve written? I sat in my thinking chair and gave this question my full attention.

    Three things came to mind: 1) lack of something new to write about, 2) a correlation between interest in my job and volume of written material, and 3) content creation and ownership.

    Nothing New Under the Sun

    First and foremost, there’s nothing new and exciting in the world of pharmacy automation and technology. As I have mentioned many, many times before, pharmacy moves at a glacial pace. That hasn’t changed. I’ve racked my brains over the past week to come up with something new and exciting in pharmacy that would be worth putting pen to paper. I came up empty. Nothing, nada, zilch.

    There are technologies that I still find interesting, like RFID and IV room stuff, but they remain basically unchanged from when I first became interested in them nearly ten years ago. Yes, a decade ago, at least.

    I continue to stay abreast of many healthcare-related technologies, but most of the effort inside companies these days is focused on integration and electronic health records (EHRs). Good things for healthcare to be sure, but I have almost no interest in EHR’s. And for companies trying to create integrated systems, they’re only kidding themselves. Several companies have been telling me for years that they are “working on a bi-directional interface with [insert system here]”. Some are close or appear to be close, but none that I’m aware of have completed the task. By the time these companies get a completely functional bi-directional interface up and running, it won’t matter. The ship will have sailed, as the saying goes.

    Case in point, one of my favorite pharmacy technologies five years ago — IV workflow management systems — is dying a slow, painful death. Yes, adoption rates for these systems is the highest it has ever been. However, not only is there a lack of interest in these systems from inside the profession, but companies like EPIC are building many of the same features directly into the EHR. The IV workflow functionality that I’ve seen inside EHRs is limited and poorly designed, but it doesn’t matter because it’s readily available and free. Soon, acute care pharmacies will be using substandard IV workflow management software without giving it a second thought. And once it takes hold, it will almost certainly spell the end for many, if not most, of the companies competing in this space.  

    Interest in My Job

    I found an interesting correlation between my writing and my job. The more interested and engaged I was in my job, the less I wrote. I suppose that makes sense. When I’m bored, I go in search of something to do, hence reading and writing about stuff.

    For example, for the last 14 months I’ve been working on a project like no other I’ve ever been involved with. From the outside, much of the work would seem mundane and boring. However, it’s work that I had not previously done and the learning curve for the first few months was steep. My interest was held by learning new things about the job. I wasn’t actively seeking anything outside my job to hold my attention.  Simple, really.

    With that said, interest in my job is only a minor reason for the lack of blog posts. The real killer is below. 

    Content Creation and Ownership

    When I started jerryfahrni.com, I never thought that I would have to worry about the things I wrote. But the world is a strange place.

    When I write something and post it, I’m putting it out there for the world to use however they see fit. Basically, I believe it’s open source. Take it and do whatever you want with it. Some companies, however, wanted to “own” my content, i.e. my thoughts. So I stopped putting my ideas in writing on the web. Not that I was ever going to do anything with them, but it felt wrong that a company could do such a thing. As a result, many of my ideas remain on the pages of notebooks sitting on my bookshelf.

    Others companies preferred that I not post anything about any of the technologies or processes that they used. And by preferred, I mean they threatened me. That made things difficult. At times, I had to significantly limit what I wrote for fear of reprisal. This was a killer for me.

    Finally, when I started consulting full time I found it increasingly difficult to be completely frank with my readers. I sometimes worked for companies that made the products I was writing about. I had to be careful not to offend anyone that was or could potentially be a client. Composing blog posts became akin to walking through a virtual minefield.

    Parting Thoughts

    For the most part, I couldn’t find a way around the obstacles described above. Over time, it became so difficult to create content that it was no longer interesting or fun. And when that happens, it’s time to put on the brakes and re-evaluate.

    I remain interested in pharmacy, especially automation, technology, and workflow design. I still write from time to time, but not often. I still love to talk about this stuff, so if you see me out and about, please engage me in conversation.

    I am planning to attend ASHP Midyear in December. I’m truly looking forward to it as it will be the first time in many years that I will be attending as “just another pharmacy”. I can see and say whatever I like (smile).

  • Ownership of healthcare data

    A couple of weeks ago my brother wrote a piece about access and ownership of medical records. My brother isn’t a healthcare professional but he is an intelligent, tech-savvy individual that has been forced to navigate the healthcare system due to his own plight as well as time spent helping with my mother’s care prior to her death following complications of a liver transplant. I have also written about this myself, albeit from a slightly different perspective.

    “Seriously though, why should our medical records be locked in a system we cannot access? We can learn something from Twitter, Facebook, and Google. We should own our medical records — via an open standard — and allow doctors and hospitals to ask our permission to see them. Much like friending someone on a social network. The doctor looks me up, asks if they can see my records, I get a message saying the doctor would like access to my records, and I choose to let them or not. My choice, my records.”

    Robert brings up an interesting concept. How one would go about creating such an open standard, and where that data would be stored are two things that have to be addressed. To be absolutely “neutral”, I suppose the U.S. government would have to handle both. That’s not comforting. Remember, the government created the DMV and IRS. Yikes!

    Allowing people to keep, store, and manage their own healthcare data is clearly not an option. There are those that would be quite good at it and those that would suck at it.

    I often consider banking when I think about healthcare data. Many of us (all?) use credit and ATM cards, ATM machines, banks, mobile pay, and so on daily. We never really think about our data, i.e. who has it, where it’s stored, how to access it, etc. However, when I need to look at something, the information is nearly always readily available and retrievable. Also, when I go to buy a car or home, finance something, etc. it always seems easy for those that need access to the information to get it. I don’t “own” my financial data, per se, but it’s always there for me and whoever else needs it.

    “Case in point. I have a problem with one of my knees. In 2004 I had surgery to remove cartilage, a bone spur, and some arthritis from that knee…Fast forward to 2017 and that knee has become an issue…I made an appointment with my family doctor to discuss the problem. Before going I tried to locate the doctor that did the surgery back in 2004, but she’s moved on. I contacted her old group to see if they had my records. Nope…I visit my doctor last week [and] explain there is a history here but I cannot tell her exactly what was done. My only explanation is I had surgery in 2004 to do X, Y, and Z. But I don’t know the exact terms nor do I know where the cartilage was removed or how much…She orders and x-ray and while she’s doing this she explains she’d like to do an MRI but the Insurance company requires she order an x-ray and order physical therapy before doing the MRI.”

    I had a similar experience a couple of years ago. I fell down my stairs at home — seriously, that happened — and ruptured my quadriceps tendon. I’ve never felt pain like that in my life. I thought I broke my leg. Anyway, I ended up in a local ED where I got x-rays, an ultrasound, and an MRI. Diagnosis: ruptured quadriceps tendon. Solution: surgery.

    Fast forward a couple of days later in the surgeon’s office. I had a copy of all my records from the ED visit on a CD. I thought I was being proactive. Not so. The surgeon’s computer and EHR system were not compatible with the data stored on the CD from the ED. The surgeon re-ordered two separate MRI’s. No kidding.

    My leg about a week after surgery.

    “This [the system] is broken”. Yep, there is no question that the system is broken. Just ask anyone that’s navigating it for the first time. Even my mother, who spent years in and out of hospitals secondary to her liver condition struggled to navigate the system at times.

    “…I know the EHR is only a tiny fraction of our dated system but I’d like to have a complete medical history. It’s my history…To fix this will take eons. Medicine is so far behind when it comes to technology. Look at systems like Epic. It is seen as a leader in its field, but it’s a closed system. How does that benefit anyone but Epic? It doesn’t….We need an Open API with services offered by many providers that are patient driven. Allow data to move between systems. Don’t make your money by holding patient data hostage. Make your money by building the better service.”

    My brother echos the sentiment of Ralph Waldo Emerson, “Make a better mousetrap, and the world will beat a path to your door.” I wish it worked that way in healthcare. But for some reason we continue to accept garbage. I am certainly not familiar with all EHR’s, but I have worked with several. They’re all terribly bloated and cumbersome. Not only that, they offer little in the way of cooperative information exchange. Sure, they all claim to play well with others, but my personal experience — along with that of many others — paints a different story.

    My brother and I don’t agree on much, but I think we’re on the same page here. We may not agree on which route to take, but we certainly have the same destination in mind. And that destination is better access to and sharing of healthcare data. 

  • Books in medicine, out of date and out of touch

    Nature Microbiology: “… I know it is a big deal in some fields to publish books and careers get decided by books. But for those of us working in medicine or public health, are books and book chapters worth the effort? Is the juice worth the squeeze?? … Based on my experience of contributing over a dozen book chapters, and serving as an Associate Editor of one textbook, my answer is no. I can give you half a dozen good reasons.”

    The author goes onto describe three specific concerns he has with book publishing in medicine:

    • Timeliness, or lack thereof. “A delay of 2 – 5 years might not matter in some fields (e.g. anthropology or history or statistical methods), but it matters in medicine and science!” You don’t say.
    • Affordability. Anyone that’s every purchased a science or healthcare related textbooks of any kind can attest to this. Some of my pharmacy school textbooks came with staggering price tags. Same thing applies to medical literature/journals. The subscription cost of some journals is criminal.
    • Access. No doubt a huge problem. “I also worry that those who really need my book can never get hold of it.” I find that this is also a huge issue with medical literature/journals. Getting ahold of articles isn’t easy. You can always get the information, as long as you’re willing to cough up the dough.

    The author is spot on with his assessment. This is especially true in my area of expertise, i.e. pharmacy automation and technology.  I’ve read the so-called pharmacy informatics textbooks. They’re out of date and expensive. I regret purchasing both of them.

    I suppose the big question after reading the piece in Nature Microbiology is how to solve the problem. I don’t have an answer. Going completely digital isn’t the solution, at least not with current technology. Hundreds (thousands?) of hours in front of a computer monitor has convinced me of that. It’s like gazing into a flashlight. Headaches and eyes that feel like sandpaper at the end of the day have led me to re-embrace paper. I know, I know, it feels antiquated to me as well. But I haven’t found a technology yet that completely replaces the ease and utility of using pen and paper for some things; reading literature and taking notes, for example.

    With that said, there are certain things that publishers can do to speed things up, improve access, and cut cost. The open-source literature movement has taught me that.

    Universities should also take a more active role in pushing publishers to do the right thing. It never ceases to amaze me when customers refuse to push back. I see this in hospitals with automation and technology vendors. Hospitals will purchase and continue to use technology that they are unhappy with. Why? Something akin to Stockholm Syndrome, perhaps.

    It will be interesting to see what publishers do moving forward. The current system is stuck in time, and as long as the end-user continues to accept the model, it will continue.

  • Ramping back up…

    Hello, old friend, it’s been a while.

    I have neglected this weblog. The reasons are not important. I continue to write, explore ideas, and think about technology. However, for the past several months I’ve been using a more traditional method to record my thoughts, i.e. pen and paper. There’s something cathartic about writing in a notebook, and I’ve filled a few.

    The world of pharmacy technology has, at least in my mind, become a bit stale. I’ve been exploring other technologies that I don’t routinely see in pharmacies, such as artificial intelligence and neural networks, augmented reality, nanotechnology, 3D printing (see some of this in healthcare), autonomous vehicles, and so on. This has allowed me to keep my sanity while continuing to work as a practicing pharmacist.

    I continue to explore pharmacy topics but in a more philosophical way. I’ve had many long discussions with pharmacists both young and old about the profession, past, present, and future. Some of the discussions have been enlightening and encouraging. Others have been disturbing and gut-wrenching. Overall, the profession is heading in a direction I don’t want to go. I’ve seen and heard things that lead me to believe that the profession as a whole is on life support.  If one were to gaze into the future and be truly honest with themselves, they would realize that pharmacy exists out of nostalgia more than necessity. But that’s of no importance here, at this moment.

    This weblog is a personal space, where I can write about pharmacy and other topics of interest to me. It was never intended to be used for business. I have to remember that. With that said, I think it might be time to revive my digital presence here. I have a lot of things to talk about. Some pharmacy related, some not. Some technology related, some not. Some uplifting, some discouraging. All interesting, at least to me.

    I’m thinking about a career move that would free up my weekends again. If that happens, perhaps we can even enjoy some Saturday Morning Coffee together. I miss my Saturday Morning Coffee.

  • Calling all students and professionals with an entrepreneurial spirit!

    Here’s something special happening in the local Fresno area….

    Calling all students and professionals with an entrepreneurial spirit! We’d like to invite you to join our new FREE HealthTech Initiative course. Find out more about this exciting class that will help develop healthcare products and services here: CHSU.ORG/HEALTHTECH-INITIATIVE

    We are looking for individuals to join teams with people from all types of disciplines including:

    • Health (Medical, Vet, Dental, Nursing, Pharmacy, …)
    • Computer Sci (Web/PC/Mobile app development, …)
    • Business (Entrepreneurship, marketing, pricing, …)
    • any individual interested in health care

    Class meets on Wednesday evenings from 5:30 pm to 7:30 pm at the California Health Sciences University (CHSU) in Clovis CA.

    • The class is FREE
    • The first class is August 23rd
    • The 15-week course ends on December 6th
    • Dinner is included

    Participants work in teams, and we will help you join a good team. You will not sit around for long-winded lectures. This course will provide participants with a “hands-on” introduction to leading an entrepreneurial enterprise by building a business model and constructing a prototype product or service. Participants work in teams, and all good ideas are acceptable.

    Teams will meet once a week to report progress. Teams demonstrate their prototype and business models to people or organization who are potential customers. Teams revise their prototypes and business models based on feedback. The step-by-step “Lean Startup” process is based on the National Institutes of Health (NIH) program to train medical scientists/entrepreneurs.

    Location: CHSU ANNEX BUILDING, ROOM 103-A, 45 N. CLOVIS AVENUE (NE CORNER OF SIERRA & CLOVIS), Clovis, CA 93612

    FOR MORE INFORMATION, CONTACT

    Dr. Charles Douglas at cdouglas@chsu.org or 559.573.8026.

    RSVP at: CHSU.ORG/HEALTHTECH-INITIATIVE

  • Laying the foundation for your technology implementation team

    I’ve been thinking a lot lately about the right way to go about putting new technology into a pharmacy. Making the decision to add technology doesn’t mean running out and purchasing a million-dollar piece of equipment and shoving it in a corner. It’s much more complicated than that. You must first lay the foundation for the work to be done.

    Here are some things that I think should be considered before putting new technology in the pharmacy:

    Give everyone fair warning of what you plan to do. No one likes to be surprised and people fear change. The best policy is to give people plenty of warning before making a change, which will allow them to get used to the idea. This will go a long way in gaining support for the project. Being aware of what’s coming is always preferable to being surprised by what has already been done.

    Gauge user beliefs and feeling. It’s best to take the temperature of pharmacy personnel prior to getting started. Is it going to be an uphill battle? Are the pharmacists and technicians open to the idea of implementing new technology? Is the pharmacy morale where it should be? Does your department fear change?

    The success of the implementation depends heavily on how well the department is warned and prepared for the change. People often see technology as a threat to control over their work environment, resulting in pushback. Helping staff understand what it is you hope to accomplish, how it will help them, and offering opportunities for staff to become vested in the project can go a long way in ensuring a successful implementation.

    Get support/buy-in for the project. Support for any project is a must. Recruit from the top of the organization to the bottom. Failure to do so may result in a failure to launch.  Whenever possible it is best to have support from the highest level of the organization, executive sponsor or someone from the board if you have one.  Influence matters. And don’t forget to involve all departments that will be impacted by the change, including nurses and physicians when appropriate.

    Create a buzz. Create some excitement. Don’t act like the project is required, but rather a choice that’s going to make things better.  This is the power of advertising. We fall for it all the time, from cars to smartphones.

    User involvement and participation. When individuals believe that the implementation of technology is relevant, they are much more likely to have a positive attitude toward the project. The best way to get individuals to believe in the technology is to get them involved and allow them to participate in all phases of the project. “Increasing user participation … enhances post-development user involvement and attitude”.(1)

    Involve as many people as possible as often as possible. When people are involved, it gives them a sense of ownership, making them vested in the project’s success. It also helps deal with negative vibes that may come from others.

    Volunteers only. It is important that all participants be volunteers as mandated participation has been shown to be ineffective and potentially detrimental to the success of this type of project. (2)

    Champions. Champions are the people that go above and beyond the general participant. Champions believe in the technology and the benefits it will provide. They can often have a contagious zeal about the project, and are sometimes referred to as “evangelists”, or in extreme cases “zealots”. Whatever you call them, you need them. When it comes to implementing new technology in the pharmacy, champions can be your best source of support and are often useful in putting a spotlight on the project in a positive way while swaying negative feelings about the project. 

    Finding Champions shouldn’t be too difficult. There are usually early adopters in every group. They will often present themselves while taking the initiative to learn more about the project without being asked.

    Develop rules for participation. This is really quite simple. It is important that the rules for participation be laid out well in advance, and that each member of the team signs off on them. There should be no surprises for what’s expected from participants once the project is underway. The following rules are examples:

    • Be willing and able to engage in the project
    • Be willing to be positive about the project
    • Be willing to work with others to advance the project
    • Be willing to commit to attending meetings
    • Be willing to commit to handling extra work, even if it means staying late or doing some reading at home in the evenings or on the weekends. I understand that no one wants to put in a bunch of unpaid overtime on these projects. However, on occasion, a little extra work needs may need to be done to keep things moving forward. One should enter into participation with the understanding that this could happen.
    • Be willing be engage in every aspect of the project, not only the items that are assigned. It is vitally important that each participant has at least a basic understanding of the overall scope of the project and what each member of the team is assigned to do. Things happen. People get sick, quit their jobs, move to another state, and so on. Such unforeseen events should not completely derail the project timeline or goals. 

    Sway the naysayers. Every project has its opposition. As the saying goes, you can’t please everyone all the time. Unfortunately, naysayers tend to be the most vocal personalities in any group. They’re not afraid to say what’s on their mind; whether positive or negative. The downside is that outwardly negative comments about a project have a way of spreading like wildfire. They’re caustic and often seep into the minds of even the staunchest supporter without warning. And once planted, negative thoughts grow like a cancer.

    Naysayers and their negative comments have their place. They often point out things that others fail to see, helping avoid pitfalls along the way. The trick is to use the information to your advantage and allow naysayers to offer their thoughts in an environment that won’t bring down the rest of the pharmacy. Give them space to vent, and then do your best to use the information to flip them. If you can show the naysayers in the group that you’re willing to listen to them and take their concerns seriously, you may be able to get them on your side. That’s a huge victory for any project. On the other hand, never force change on a naysayer. Forcing change or mandating them to join your side rarely works. It’s like dealing with a donkey, the harder you pull, the harder they resist.

    Build a team with high potential for success. According to Harvard Business Review’s (HBR’s) 10 must Reads On Emotional Intelligence (3), the source of great success lies with teams that can achieve high levels of participation, cooperation, and collaboration among members.

    Team members must be chosen carefully and meet three basic conditions:

    1. Mutual trust of one another
    2. Have a sense of group identity – a feeling that they belong and the project is worthwhile
    3. Have a sense of group efficiency – belief that the team can perform well and that the group is better than the individual members.

    Collectively, HBR refers to this as the groups “emotional intelligence” (EI). And while the knowledge and experience among group members is important, EI may be more important still. Keep this in mind when you begin building the project team.

    Chose a project leader. Being “the leader” is a burden that many well-qualified individuals shy away from. With that said, someone has to be in charge. Someone has to be given authority over the group. Someone has to be willing to make the tough decisions and hold people accountable.

    Not everyone is cut out to be a leader. I am of the opinion that leaders are born, not made. You either have it or you don’t. I know because I’ve tried many times to lead and failed. It wasn’t for lack of knowledge or desire, but rather a lack of natural leadership and charisma. On the flipside, I’ve been around many people that just have “it”; “it” being a knack for getting people to follow them and do what they say, i.e. they’re natural born leaders.

    What distinguishes good leaders from great leaders is “a group of five skills that enable the best leaders to maximize their own and their followers’ performance.” (3)

    The five skills are:

    • Empathy
    • Motivation
    • Self-regulation – controlling negative impulses
    • Self-awareness – knowing strengths and weaknesses
    • Social skill – being able to build a rapport with others to get desired results

    Find a project manager. As ridiculous as this may sound, the project manager is an often overlooked position when discussing project teams. Let me go on record now as saying that a good project manager is absolutely vital to the success of any project; arguably the most vital consideration to the success of a project.

    It is the job of the project manager to manage all aspects of the project, including the scope, the timeline, the cost, the quality, and the people. They apply their knowledge, skills, tools, and techniques to help projects be successful.

    “The role of the project manager is that of an enabler. Her job is to help the team get the work completed, to “run interference” for them, to get scarce resources that they need, and to buffer them from outside forces that would disrupt the work.”(4)

    Things to consider when selecting a project manager:

    1. The person must have leadership qualities, have good self-management and time management skills, and be a taskmaster.
    2. The project manager cannot serve two masters. Individuals that serve as a project manager must not be required to do any of the actual work in the project. According to Lewis (4), “as team sizes increase, it becomes impossible to work and manage both[the work and the team], because you are constantly being pulled away from the work by the needs of your team members”. Having project managers attempt to manage the project in addition to working on the project is a recipe for disaster.
    3. The person must have a proven track record. We all know people that can’t manage the paper piles in their office much less a multi-faceted project requiring meticulous attention to detail.

    I encourage everyone involved in a large project to read a book or two on project management. Being a project manager is not as easy as it sounds and should be given the respect it deserves.

    That’s it. Piece of cake. Go forth and build your implementation team.

    —

    • Vaughan PJ. Internal Report of Information Technology Services. University of Colorado at Boulder. 2000.
    • Hunton, J.E. and Beeler, J.D., Effects of User Participation in Systems Development: A Longitudinal Field Experiment. MIS Quarterly, 21(4), 1997, pp. 359-388.
    • Hbrʼs 10 Must Reads On Emotional Intelligence. 1st ed. Boston (Massachusetts): Harvard Business Review Press, 2015. Print.
    • Lewis, James P. Fundamentals Of Project Management. New York: American Management Association, 2007. Print

  • So I bought a Chromebook 

    I’ve had a Chromebook for a while now. My wonderful wife got me the original Samsung Chromebook in early 2012 for my birthday, I think. The device has been a trusted couch companion ever since. I mostly use it to check email, watch YouTube videos, surf the internet, and so on. It has a small 11.6-inch screen and limited horsepower. The little guy was never meant to be used for any heavy lifting. I have a Windows 10 laptop for that.

    A few months ago I got the itch to buy another machine. I would dearly love to have a Microsoft Surface Book or Lenovo ThinkPad Yoga. It is my personal belief that these are the two best machines on the market today. With that said, they’re expensive, and honestly, they’re overkill for what I do. I mostly do research on projects and create content, typically in the form of documents, spreadsheet, blog post, and presentations. My presentations can get pretty gnarly in terms of size and media content, but still, a Core-i7 with 16 GB of RAM just feels extreme for my needs. So why not a Chromebook? Yeah, why not, indeed.

    So I set about making a list of things that I wanted from a Chromebook. Two of the most important items were:

    1. A 14-inch or larger screen. I’ve historically preferred smaller screens, especially between 12-13-inch. However, I’ve been thinking about trying a laptop with a larger screen for a while. And what better way to do it than with an inexpensive Chromebook?
    2. Long battery life. This is a no-brainer.

    After the two items above, my list grew to include:

    • Under $500. Let’s face it, it’s hard to spend more than $500 on a Chromebook knowing that for around $700 I could get a really nice Windows 10 tablet.
    • Good keyboard. I do a lot of typing, so whatever machine I buy has to have a good keyboard.
    • Backlit keyboard. This seems to be a polarizing topic. I feel that it’s important, at least for me. I do a lot of early morning and late night surfing. I don’t always have a great light source, so having a backlit keyboard is nice.
    • At least 32 GB of local storage. Chromebooks are notoriously bad when it comes to local storage. I can’t see buying something with less than 32 GB of storage.
    • Touchscreen. Once you’ve used a laptop with a touchscreen, it’s hard to go back. It would be especially handy should my Chromebook support Android apps.
    • Expandable storage.  Any acceptable way to increase storage, not only an SD card slot. As long as there’s a free USB port, I’m good.

    I was pretty excited when I saw the Samsung Chromebook Plus and the Asus Chromebook Flip C302 hit the market. Both have touchscreens and offer a 2-in-1 configuration. The Samsung pulled at me hard, but besides having only a 12.3-inch screen, it was also missing a backlit keyboard, and was at the very edge of my $500 mark. For reasons unknown, the Flip C302 doesn’t capture my interest. It has a backlit keyboard and better storage options than the Samsung, but meh.

    After reading a lot of reviews and looking through countless “best Chromebooks of 2017” lists, I came to the conclusion that a 14-inch Chromebook with a backlit keyboard just wasn’t in the cards. I ended up going with the Acer Chromebook 14, in gold. I got a great price at Amazon.  It lacks almost everything on my list, but it does have a 14-inch screen and remarkable battery life.

    The Acer Chromebook 14 has an all metal build, a good but not great 14-inch screen, a good keyboard, solid battery life, and it’s snappy. It’s also easy on the eyes. When up close and personal, no one would mistake it for a $2000 premium laptop, but it’s still a handsome device.

    I’ve been using my new Chromebook for about two weeks. So far things have been pretty good, but I definitely have some minor quibbles.

    There are several keys missing from the Chromebook keyboard. For example, there are no dedicated ‘delete’, ‘home’ or ‘end’ keys. I’m a content creator, so I use those keys a lot. Fortunately, there are Chromebook equivalents, like ‘alt’ + ‘backspace’ = ‘delete’, or ‘search’ + ‘right arrow’ = end of line, etc. I keep a copy of the Chromebook shortcuts handy. Fortunately, you can also remap certain keys. For example, remapping the relatively useless ‘search’ key to CAPS LOCK. Seriously, who doesn’t need to type IN ALL CAPS ONCE IN A WHILE. I’m slowly starting to get used to the keyboard function and layout, but it hasn’t been a smooth transition.

    The “right-click” on Chromebooks is not a right-click, at all. In fact, the right click is a two finger tap. This tiny difference is giving me fits. Who knew that I right-clicked so often?

    Everything being in a browser tab will take some getting used to. I’ve been using the Windows OS for more than 20 years. I’m comfortable with a bunch of little windows on my screen, not just a single browser with multiple tabs. Changing some of the web apps to “open as window” has helped. I did this for Google Docs and Google Music. It has nothing to do with functionality, but it makes my screen more familiar, which ultimately makes me feel better. Don’t judge me!

    I’ve always considered myself a heavy user of web-based apps. I spend most of my time in the Chrome browser flipping through websites, reading literature, using Gmail/Google Calendar/Google Keep/Google+, using the web versions of Twitter and Facebook, and so on. Working in “the web” is great, except when it’s not. There are some web applications that simply don’t measure up to their desktop counterparts.

    Here are some examples:

    Evernote – I’ve been trying to extricate myself from Evernote for quite some time, but I haven’t found a suitable replacement. The application is too valuable to the way I work, so for now it stays. Unfortunately, the Windows 10 desktop version of Evernote is significantly better than the web version. Converting back to the “old” version of the web app has helped, but it’s still not the same.

    Microsoft Office vs. Google Docs – As a content creator, I use Microsoft Office 365, a lot. I create documents, blog posts, spreadsheets with graphs, and presentations. For the most part, replacing the web versions of Word with Google Docs hasn’t been an issue. For example, I’m using the online version of Office 365, Word specifically, to write this post. I used Google Docs for Sunday’s post. Both worked fine. I prefer Word, but Docs is usable. Replacing Excel with Sheets is ok, but I’m struggling with graphs. Google Slides is another story. Slides is way behind Microsoft PowerPoint in my opinion. The desktop version of PowerPoint is much better than the web app, and the web app is still much better than Google Slide. This might be a deal-breaker for me. I’ve found a few workarounds for PowerPoint Online, but honestly, I don’t like workarounds. It’s not all terrible. I do like the auto-save functionality when using Google Docs or Office 365 Online. Every change I make is automatically saved. No more losing 20 minutes worth of work because I was too lazy to hit ‘CTRL S’.

    Zotero – I’m a pharmacist. I read literature. I’m also a digital pack rat. I collect and store lots and lots of journal articles, whitepapers, presentations, and so on. I refer to them when composing blogs or papers and when building presentations. Using a reference management tool is a must. In my case, that reference manager is Zotero. I collect all my references in Zotero. It pulls complete bibliographies from digital object identifiers (doi’s), allows me to link to full article PDFs stored in OneDrive, and gives me the option to attach notes to each entry. New projects – articles, blog posts, presentations – get their own folder. Each time I reference a journal article for the project, the reference gets copied into the project folder. When the project is complete, I simply print a bibliography of all the references used. It works great. Fortunately, Zotero has a nice desktop application with great functionality and it’s free. Unfortunately, Zotero’s web app is an abomination. I don’t know how it’s possible to have such a great little desktop app and completely ignore “the web”. Of all the things that have given me trouble, this is the biggest. I don’t know if I can get past this one. The inability to use Zotero on the web has had a negative impact on the way I work.

    Notepad – Yep, one of the simplest applications on the planet. I use it a lot. Sometimes I’ll use it for nothing more than a quick, disposable note. Other times I’ll use it as a quick and dirty way to eliminate all formatting associated with a bit of text, i.e. copy the text and paste it into notepad; this is a great trick when I’ve tried some crazy formatting and can’t seem to back out. Notepad is always open on my Windows 10 desktop. While there are lots of note-taking apps for Chrome, I haven’t found an equivalent. For the time being, I’m using Google Keep. It’s not the same, but it works.

    In many ways, the Acer Chromebook 14 meets my expectations: it has a solid build, it has a nice 14-inch screen, good keyboard, the integration with my Android smartphone (Samsung Note 5) and Google Home is nice, it has ridiculously good battery life – I’m getting ten plus hours per charge — and it’s nice to look at. In other ways, the Acer Chromebook 14 has failed to meet my expectations: lack of a backlit keyboard, Android apps not yet available even though the device itself was introduced over a year ago, and lack of solid web-based apps. In all fairness, that last item isn’t the Chromebook’s fault, but it makes a big difference.

    Overall, I find that the Acer Chromebook 14 is a great machine. I’m sure it could be a Windows 10 laptop replacement for someone, but probably not for me. At the moment, I’m still on the fence about keeping it. At sub $300, it might be worth keeping around. But then again, a new Windows 10 tablet would be nice.