I used a telemedicine service for the first time and loved it

My daughter woke the other morning with the following complaints:

  • itchy eye
  • watery eye
  • “feels like there’s sand in my eye”
  • and from my observation, redness in the “white” of her eye

Hmm, I’ve seen this before. My initial thought was conjunctivitis, a.k.a. “Pink eye”.  I called our family pediatrician looking for something to hold us over the weekend until we could be seen on Monday. Basically I was saying it looks like Pink eye, so let’s  treat it like Pink eye for the rest of the weekend and I’ll follow up with you on Monday. Unfortunately I got the nurse practitioner on call. She wasn’t very cooperative. She wanted me to take my daughter to the urgent care to rule out periorbital cellulitis. Really? You jump from itchy, red eye with a slight watery discharge to periorbital cellulitis? I thought that was rather ridiculous, so I ignored her and hung up the phone.

Sounded like a good time to try a telemedicine service. My insurance company, Anthem Blue Cross, offers a a service called LiveHealth Online. I followed the link provided by my insurance company, downloaded the app, and by 7:30 am on Sunday morning my daughter and I were sitting on the couch in our living room speaking with a Family Practice physician about her eye.

I let my daughter do all the talking. I was simply there to make sure things went smoothly. The physician asked several questions about how my daughter was feeling, about her eye, who she’d been in contact with, and what she had been doing over the past several days. The physician had my daughter hold her eye up to the front facing camera on her Galaxy S5 from several different angles to better view of the eye. Conclusion? Conjunctivitis, probably viral. The physician decided to treat with some anti-bacterial eye drops “just in case”. A prescription was electronically sent to our pharmacy and that was it. From beginning to end the entire visit took less than 15 minutes.

It’s been about 36 hours since we started treatment and her eye has improved significantly. Overall I have to say that my first experience with telemedicine was fantastic. A trip to the urgent care would have taken several hours and been quite inconvenient. I have to say, I believe now more than ever that telemedicine has a place in healthcare, especially for things like this.

Periorbital cellulitis my rear.

Desire to see more collaboration between pharmacies and local universities

Bitwise Industries in Fresno is an interesting place. It’s basically a tech hub pulled together by some great local minds. Located in a nice little area in downtown Fresno, BitWise has tasked itself with taking “a burgeoning tech industry that was growing in silos in California’s heartland, add places that inspire community, collaboration, and growth, create accessible education that equips and empowers a homegrown army of technologists, deploy talent to execute technology success stories”. I visited the facility with my brother, Robert when it first opened. Impressive and inspiring.

But this post is not about BitWise. It’s about something I’ve been thinking about for a couple of years. BitWise was simply a catalyst to remind me to revisit my idea.
Continue reading Desire to see more collaboration between pharmacies and local universities

Moving from the Motorola Moto X to the Samsung Galaxy S5

s5_blackA short time ago I was an unwilling participant in my Moto X being dropped on a concrete floor.

Over the past year or so I’ve been working with a colleague on a book about the state of automation and technology in pharmacy IV rooms. During this time I’ve made several site visits to acute care pharmacies to look at the technology, workflow, etc in their IV rooms. As part of the data collection process I not only take a lot of notes, but snap lots of photos and record video of technicians working with the technology. I find the photos and video invaluable when reviewing my notes.

Prior to entering the cleanroom at one large hospital back east, the pharmacist in charge insisted that he wipe down my Moto X with alcohol. I wasn’t thrilled with the idea, but it was either let him do it or not take it in. I opted to let him wipe it down. During the process he dropped my Moto X. It hit the concrete floor pretty hard and bounced. The back popped halfway off. Not good. Since that time my Moto X has been acting weird, freezing up, not taking voice commands, and so on. I finally decided to replace it through the insurance I carry on the device.
Continue reading Moving from the Motorola Moto X to the Samsung Galaxy S5

Access to information and learning

“Intellectual growth should commence at birth and cease only at death.” ― Albert Einstein

I’ve recently returned from the ASHP Summer Meeting. I learned some new things, which serves as a reminder to me of the importance of continuous learning and access to information in our profession.

As a pharmacist I’ve been involved in a lot of systems over the years designed to keep me up to date. All have been successful in their own way, but obviously some were better than others.
Continue reading Access to information and learning

On the job, six months as an independent

Through an interesting series of events over the past several months I’ve slowly transformed myself from an employee to an independent contractor, so to speak. I suppose I’ve officially become a consultant of sorts, but I’m not thrilled with the term “consultant”. My dislike for the term comes from my experience with consultants over the years. I’ve worked with many, but found few that were actually helpful. It’s obviously not fair to lump them all into the same basket, but those are the breaks.

Immediately after losing my job in July 2013 I tried to jump back into pharmacy, quickly realizing that it wasn’t going to happen. Fortunately I was able to piece together “full-time work” by combining some per diem hours at a local hospital and some ad hoc product management work for a small company working on a new pharmacy application. The hospital work was good, but limited to 10-20 hours per week for about three months. As luck would have it as the hospital job was coming to an end another small company building pharmacy software reached out and just like that I had a second job as an ad hoc product manager. Then a few hours helping a group with strategic planning, then a few hours on a marketing campaign, then some time analyzing state specific pharmacy laws, and so on.

I’ve had a fair number of inquiries from various companies covering a host of projects. Some turned into work, while others were nothing more than discussions. I’ve had to turn down two jobs due to various circumstances. Hopefully those circumstances will clear up later this year, which means I’ll be able to open myself up to another group of potential opportunities.

Truth be told I’ve entered the world of consulting completely by accident, and it turns out that I like it. I like it a lot. My schedule is flexible and within my control, and the variety of work prevents me from getting bored. I’ve also discovered that the companies that engage me have a desire to do good work. They’re looking for a fresh perspective and aren’t afraid to hear a different opinion. They’re motivated to build some really great products. I’ve been impressed with all the groups I’ve had the privilege to work with. They make rapid, decisive choices and move swiftly to make things happen. I respect that.

It’s not all rainbows and unicorns. There are new things to worry about like paying my own taxes and getting health insurance for me and my family, but the positives clearly outweigh the negatives. Overall I’m enjoying the ride.

Application for Wacom’s new WILL technology in healthcare

PC World: “Wacom has grand designs for a new graphical language…WILL, short for Wacom Ink Layer Language, will store pen strokes in a Stroke File Format and allow them to be streamed using its Stroke Messaging Format. The file formats capture not only coordinates and pressure, but also who made an ink stroke, and when…One of the more far-fetched usage scenarios Wang proposed for WILL involved digitally signing documents using a pen that would certify who had manipulated it thanks to a built-in DNA sampling device.”

Like it or not the human race still loves to communicate via pen and paper.1 It’s a process that’s been ingrained in us for a very long time. It’s natural, and it’s going to be quite some time before we’re able to move to a completely different medium for communication. We’re well on our way to a digital world, but that won’t replace our need to use pen and paper for a great many things for quite some time to come.
Continue reading Application for Wacom’s new WILL technology in healthcare

5 Shady Ways Big Pharma May Be Influencing Your Doctor

AlterNet: “When it comes to acknowledging the influence of gifts and money on behavior, doctors, like everyone else, suffer from self-delusion. Most say they believe it affects the other guy, not them, and many become offended at the idea that they are “for sale.”

Trips to resorts and strip clubs will likely continue to diminish under the Physician Payments Sunshine Act, but there are many other ways, often sneaky, that Pharma can entice doctors to prescribe its expensive, patent drugs.”

Physicians, just like everyone else, are subject to bias. I rarely come across a physician that’s been practicing for more than 10 years that relies on up to date scientific data and/or guidelines to drive their prescribing habits. I can’t tell you the number of times I’ve had a physician say “because the drug rep told me” in response to my question regarding their use of a specific drug over another. That answer doesn’t instill confidence. 

Here are the 5 methods of influencing prescribing habits as listed in the article:

  1. Spying on Prescribing – “By selling the names, office addresses and practice types of almost every doctor in the US to marketing firms the AMA netted almost $50 million a year
  2. Continuing Medical Education Courses“…these classes are often “taught” for free by Pharma-funded specialists, sparing doctors from having to pay for them but providing the objectivity of a time-share presentation.
  3. Ghostwriting – “Being published in medical journals is essential to academic doctors but researching, writing and reworking papers is a formidable job. Luckily for doctors, Pharma is willing to help—as long as they write what Pharma wants.”
  4. Speakers Bureaus – “Few things combine the ego stroking and fast cash of being paid to speak—and Pharma has no trouble finding takers at $750, $1000 and more per pop.”
  5. Clinical Trials – “Pharma-funded clinical trials can be paydirt to doctors, yielding as much as $10,000 per patient in some cases.”

Merry Christmas 2013

Wishing all of you a very Merry Christmas!

And there were shepherds living out in the fields nearby, keeping watch of their flocks at night. An angel of the Lord appeared to them, and the glory of the Lord shone around them, and they were terrified. But the angel said to them, “Do not be afraid. I bring you good news of great joy that will for all the people. Today in the town of David a Savior has been born to you; he is Christ the Lord.

Luke 2:8-11

Back in the saddle again

“I`m back in the saddle again, out where a friend is a friend” – Gene Autry

It was 49 days between the time I was unceremoniously released from duty as a product manager by my previous employer until I finally went back to work. You can see my thoughts on my search for a job here.

On Thursday, September 12, 2013 I found myself in familiar territory as I reported for duty as a per diem IT Pharmacist at Kaweah Delta Medical Center. The position calls for two shifts a week. It’s a start.

For those of you that don’t know, Kaweah Delta is where I got my start as an IT Pharmacist back in November 2007. the idea of an IT Pharmacist was new and it was an exciting time. I spent about three years at Kaweah Delta implementing technology and automation left and right. I was fortunate to have been involved with a pharmacy remodel, smart pump implementation, BCMA implementation, the first stages of CPOE implementation, the early stages of mobile technology, among other things. It was also during that time that I started experimenting with this blog and social media. I learned a lot during my time at Kaweah Delta. They were good to me, but I left in 2010 to explore other opportunities.

When I left Kaweah Delta in 2010 the IT Pharmacy department was one person, me. Since that time they’ve grown the service to include 2.5 full-time pharmacists and a full-time pharmacy technician. They’ve done a lot of good things since 2010, and thankfully they’re doing a lot more. They are currently preparing to implement the NEPS Labeling Solution for their labeling needs as well as implementing DoseEdge in their IV room. Fortunately for me they ran out of bodies to do all the work and were contemplating hiring another pharmacist when I made contact in search of employment. Timing is everything they say.

I won’t lie, the first two days in the “new” position were a bit humbling. I felt like the kid that went away to college at the big university only to find out that he couldn’t make it and had to return home and start over at the local junior college. I am now at the bottom of the very ladder of which I used to sit atop. My excursion into the world outside the pharmacy walls has literally cost me six years of career path time, i.e. I’m right where I was in November of 2007. Actually, that’s not true. In the strictest sense I’m in a position lower than I was in November 2007.  So in reality it’s more like ten years of career path time, unless pharmacy career time is like dog years. In that case I should be ok unless I have the dog years thing backward, at which point I’m screwed.

Everyone at Kaweah Delta has been great. I’ve had to explain my situation to several people, but no one has openly mocked me yet, which I believe the pharmacist code allows. Regardless of all that, it feels good to be back in the saddle again.