Jerry Fahrni

Category: Pharmacy Informatics

  • Integration and standardization are still stumbling blocks in healthcare

    I spent a good chunk of my morning in meetings and workgroups for the implementation of our barcode medication administration system (BCMA). Most of these sessions are dominated by nursing as many consider BCMA a nursing system.
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  • What are you going to do with all that data?

    info_overloadInformationweek.com: “The rollout of e-prescription, digital medical record and other clinical systems by healthcare providers is undoubtedly creating gigantic new mountains of data. The next big challenges for healthcare is in using that data to make better clinical decisions and save costs, and becoming more proactive in helping patients avoid imminent medical problems. “It’s estimated that in five years, one-third of world’s data will be medical data,” Noffsinger [Richard Noffsinger, CEO of Anvita Health] says. “There are tons of medical data now, and that’s growing,” he says.” – Pharmacists are, by nature, driven by data. We analyze hundreds of data points every day; lab values, medication dosages, cultures, patient demographics, etc. Gathering data has never been a problem, knowing what to do with it is a whole different story. Finding someone that can turn raw data into discrete packets of usable information is like finding your very own genie in a bottle. It sounds like a good job for an IT pharmacist.

  • Siemens Innovations ’09 – Opening Session

    This mornings opening session for Siemens Innovations ’09 was delivered by Janet Dillione, CEO of Health Services Siemens Healthcare. Not surprisingly, the opening speech was focused on the American Recovery and Reinvestment Act (ARRA) and healthcare reform. Healthcare information technology took center stage from about an hour.

    Some items of interest to me were:

  • Based on the presentation slides, it appears that Siemens is betting on CPOE being the gate through which all hospitals will have to travel to qualify for “meaningful use” healthcare dollars. However, Dillione does not necessarily believe that most hospitals will be able to accomplish CPOE implementation by the end of 2011. This statement is particularly interesting when you consider that Siemens has a unique insight into their customer base, and would love nothing more than to install CPOE in hundreds of healthcare systems across the United States. It makes me wonder how hospitals will choose to handle CPOE over the next 18 months.
  • Soarian will be the focus of Siemens implementations over the next year as they build the foundation for CPOE with better clinical functionality and documentation. Dhillone spent a lot of time hyping the speed and stability of the most recent Soarian release.
  • Doing more with less was a common theme throughout the opening remarks. Focus was placed on hospitals doing a better job of managing patients with chronic healthcare conditions like diabetes, asthma, and heart failure by making better use of “clinical people”, specifically physicians and nurses. That’s right, pharmacists were never mentioned.
  • Not one time did Dillione mention pharmacists or advancing their line of pharmacy based products. I found this a little disappointing as pharmacists have been shown to be cost effective when used appropriately. In addition the Siemens Pharmacy system is tied into many other Siemens products, including CPOE, BCMA, admitting, financials, and lab.
  • “Integration” is out and “Interoperability” is in. Time was spent discussing the need to make Siemens products interoperable. I think we need to develop some standards for much of the software available in healthcare before claiming interoperability. As far as I’m concerned all Siemens products should be plug-and-play out of the box when utilized with other Siemens products. The problem exists when a third party vendor needs to tie into your primary system (i.e. Siemens Pharmacy, Siemens MAK, Siemens Soarian, etc.). To the best of my knowledge basic guidelines may exist, but there is certainly no standard. Did I hear someone say “cloud”? Well, I certainly think that’s an approach we should be investigating. It’s difficult to ignore interoperability when all the information is centrally located and all you have to do is create access to it.

    • Sessions I’m attending today include: Siemens Pharmacy/Med Administration Check Solutions Update, A Detailed Approach to Workflow Data Collection and MAK Design, and Barcoded Medication Administration: Is It a Luxury or Standard of Care?.

    More to follow…..

  • Why I wanted RxCalc

    I have a couple of passions when it comes to pharmacy. The first is a love of pharmacy technology. Very few pharmacists have an appreciation for the “operations” side of pharmacy which includes automated dispensing cabinets, automated carousels, automated TPN compounders, Pharmacy Information System, etc. These tools are absolutely necessary if we want to get pharmacists out of the physical pharmacy and at the bedside where they belong. My second passion is a little less known discipline known as pharmacokinetics. I have no idea why I like pharmacokinetics; I just do. Some kids like PB&J and some don’t. It’s just the way it is.
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  • A couple of articles on medication errors worth reading

    The entire June issue of the British Journal of Clinical Pharmacology (BJCP)  is dedicated to medication errors. It’s worth your time to browse all the articles, but the two below were of particular interest to me.

    Agrawal A. Medication errors: prevention using information technology systems. British Journal of Clinical Pharmacology. 2009 ;67(6):681-686.
    The article covers all the usual suspects when it comes to reducing medication errors via technology. Technologies discussed include CPOE, barcoding, BCMA, medication reconciliation, personal health records, automated dispensing cabinets and decision support systems. No great amount of detail was presented, but the article is well referenced. The entire abstract can be found here.

    Cheung K, Marcel L. Bouvy, Peter A. G. M. De Smet. Medication errors: the importance of safe dispensing. British Journal of Clinical Pharmacology. 2009 ;67(6):676-680.
    The article discusses several strategies for reducing dispensing errors, including barcoding and automated carousels. For each strategy presented, the authors provide some level of support found in the literature. The article is worth adding to your collection. The entire abstract can be found here.

    One final item worth mentioning is a brief editorial written by J K Aronson, the President of the British Pharmacological Society. In it he states “Computerized systems can contribute to prevention as well as detection, but they are expensive and can generate their own forms of error. Simpler and cheaper methods are available and should be widely implemented. For example, error reporting is important in both detection and prevention, and pharmacovigilance has a role to play. However, chief among the preventive methods is education.” – I find this statement both insightful and accurate.

  • Poor economy equals fewer pharmacy IT projects

    Healthcare IT News: “The economy is forcing hospitals to consider delaying or scaling back their IT projects, according to a survey of America’s “most wired” hospitals and health systems.The Most Wired Survey, conducted annually by Hospitals & Health Networks magazine, the journal of the American Hospital Association, found that even with incentives being made available to implement IT, hospitals  still have a long way to go.”
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  • Medical Informatics Training

    Non-Clinical Jobs: “If you’re a physician [or pharmacist], at what point do you need “formal training” in medical informatics if you wish to pursue a career in health IT? It’s hard to answer, because it largely depends on how motivated you are to self-learn. Have you been keeping up with all the recent changes in health IT? Are you familiar with health IT language? Are you a member of HIMSS? Are you tech-savvy? Have you been actively involved in your hospital’s health IT committee? Do you hold any certifications in health IT? You’re probably not going to find a “crash course” on health IT that will teach you everything you need to know in a very short amount of time. However, if you’re willing to invest some time and energy into formal education , then you may want to take a look at some programs that leverage distance-learning and online classrooms.” – If you’re interested in formalized informatics education in California, check out Stanford or the University of California, San Francisco. You can get a list of available programs in North America here.

  • Open source software for hospital use.

    HIT Consultant Blog: “…But bringing state-of-the-art technology to health care is expensive, often running well into eight figures. Still, there are ways to keep the cost down and also provide excellent care. Forbes caught up with David Whiles, CIO of Midland Memorial Hospital in Midland, Texas, to look at ways to save huge amounts of money without sacrificing quality…So what did you do? – We came across the VistA (Veterans Health Information Systems and Technology Architecture) system, which was developed by the Veterans Administration. That’s used by all the 160-plus VA hospitals in the United States, plus all of their outpatient ambulatory clinics. It’s been in use by the Veterans Administration for more than 20 years. It’s a very mature system. It’s won a number of accolades from the Institute of Medicine.” – Imagine that, open source software being used in a hospital. The software may be a few years old, but thinking outside the box and implementing open source software in a hospital sure sounds cutting edge to me. Where do I apply?

  • Where is pharmacy informatics headed?

    Recently I read an interesting article in the American Journal of Health-System Pharmacy. The question of what defines a pharmacy informaticist was raised. I’ve mused over that question many times myself. Because there is no standardized definition for a pharmacy informaticist, it is extremely difficult to define their role. A look at the many different job descriptions for IT pharmacists posted on the American Society of Health-System Pharmacists (ASHP) website is testimony to that.
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  • Use AutoPharm Remote Ordering to restock your clean room.

    Prior to the days of a clean room, most pharmacies had a designated area with one or move laminar flow hoods where they compounded intravenous (IV) medications. For lack of a better term this area was cleverly called the “IV Room”. The laminar flow hoods created a sterile work environment from which the pharmacy technicians could work. It was not uncommon for anyone making an IV preparation to simply leave the “IV Room” and wonder around the pharmacy looking for supplies when they ran short.
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