Jerry Fahrni

Category: Pharmacy Informatics

  • Interview with Healthcare IS [audio]

    I was recently interviewed by Healthcare IS. The audio interview is only about 20 minutes long and covers me answering some general questions about pharmacy informatics, my thoughts on working as an IT pharmacist, etc.

  • Cerner “smart room” tour [video from 2010]

    “…a tour of the All-Digital Smart Room and discusses components including Cerners Room Wizard, Clinical Dashboard, myStation, medical device integration and RxStation.”

    The video references Fisher-Titus Medical Center in Norwalk.

    • “Medications tab” ~5:33. Home meds, current meds, and discharge meds presented with option to view drug information.
    • “Medical device integration” ~8:45 to feed info into the EHR.
    • “Cerner RxStation” ~9:35. Not sure why they call it RxStation. Looks like an ADU to me. The first thing that comes to mind when I see “Rx” is “pharmacy”. “RxStation” is a poor choice of name in my opinion.

  • Maximum effort and repetitive tasks [Article]

    I thought this was interesting as the objective of the effort was to “develop an equation, for repetitive tasks, that uses frequency and/or duty cycle (DC) to predict maximum acceptable efforts (MAE) relative to maximum voluntary efforts (MVE).”

    Huh? Exactly.

    I found this at CafeErgo:
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  • Pharmacy needs a new method for sharing non-clinical information

    Last week I found myself in Florida for work. I had a little extra time on my hands so I stopped by NOVA Southeastern University to visit with a friend and colleague, Kevin Clausen (@kevinclausen). Kevin is not only a pharmacist, but professor and researcher at the Center for Consumer Health Informatics Research at NOVA Southeastern. He’s one of a select few pharmacists that are dedicated to pharmacy informatics in academia.

    Kevin and I talked about a lot of topics, but one topic that was of particular interest was getting information published in journals. As an active researcher Kevin has a laundry list of published articles to his credit, giving him keen knowledge of the process for publishing research in peer-reviewed journals. One thing that struck a chord with me was the effort and time required to get an article published. Apparently it can take multiple article revisions and upwards of a year to get an article accepted by a certain journals.

    No one that’s been involved in the process would be shocked by this; not even me. I’ve heard this before from other people in my profession. The problem is that the model doesn’t work for informatics, automation and technology (IAT). The speed at which the field is evolving means that information is often obsolete by the time it hits the peer-reviewed journals.

    The basic question is whether or not information about pharmacy IAT requires the same rigors as research aimed at the clinical side of pharmacy. Does a study of turnaround time during pharmacy distribution with carousel technology vs. robotics require the same intense scrutiny that a study looking at the use of an ACEI vs. an ARB in PWD and HTN would?  Not likely. While one could argue that the method of distribution may impact patient care it is unlikely that the impact would be worth little more than a friendly debatable among colleagues.
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  • UpToDate now available for #Android

    The Palmdoc Chronicles:

    Android users rejoice. If you are an UpToDate subscriber, you now can download the new UpToDate Android app.

    Description
    Find clinical answers at the point of care or anywhere you need them! Now you can access current, synthesized clinical information from UpToDate® — including evidence-based recommendations — quickly and easily on your AndroidTM phone or tablet. This app is free to download. However, an individual subscription is required to log in and use it.
    Features of UpToDate include:
    • Persistent login
    • Easy Search with Auto-complete
    • Bookmarks and History
    • Mobile-optimized Calculators
    • Ability to earn CME/CE/CPD credit

    This is the first public release of the Android app for UpToDate. Like the first UpToDate iOS mobile app, you need to login and you need an Internet connection. It is more convenient to have a native app rather than access UpToDate from the browser and you get more options than just the browser version. I suppose eventually UpToDate will release an “UpToDate Complete” for Android much like the iOS UpToDate Complete.
    Update: It seems that this first release, although a free app, is available only to those who have access to the Google Play store in North America.

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  • Lexi-Drugs to include CHEST guideline and Beers Criteria

    This is pretty cool. The CHEST guideline was always useful when it came to cardiology and the use of anticoagulants. And for those of you that don’t know, the Beers Criteria is a list of potentially inappropriate medications for use in the elderly. When I did LTC medicine we kept a pretty close eye on the “Beer’s List”.

    You can find more information on Lexi-Drugs here.

  • Quick Hit: Update on keeping up with medical literature with MedInfoNow

    Wow, it’s hard to believe that it’s been over four months since I posted this piece on using MedInfoNow. The post caught the attention of someone at MedInfoNow, which resulted in some interesting dialogue in the form of email exchange and a couple of phone calls. I found the company to be genuinely interested in how their customers (clients?) use their product and what they can do to improve the experience.
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  • Reviewing an #archetype

    I’ve been meaning to write this for a while, but you know how things go.

    While at HIMSS12 in Las Vegas last month I was asked to do a little review work. That’s not all that uncommon. People ask me to do things on occasion; review a blog post, review an app, give my opinion on something and so on. But this was completely different as Dr. Heather Leslie (@omowizzrd), Director of Clinical Modeling for Ocean Informatics and Editor for the openEHR Clinical Knowledge Manager asked me to review an archetype. A what? Yeah, that was my response when Heather and I first spoke about the topic nearly two years ago.

    According to good ol’ Merriam-Webster an archetype is “the original pattern or model of which all things of the same type are representations or copies: also : a perfect example“. Simple enough, but still too vague for my brain so I went in search of a better explanation which I found at Heather’s blog – Archetypical.
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  • #HIMSS12 Day 3

    Actually Day 3 was yesterday, but I’m just now getting around to putting some thoughts on paper.

    Best session I attended was Care Coordination in Practice: Managing Data Volume and Data
    Reconciliation    . The presentation was all about big data and how we’re failing to use it appropriately in healthcare. The slide deck was great. It’s available here if you’re interested.

    A couple of things I found interesting in the presentation:

    1. There are approximately 1-2 billion clinical documents produced in the United States each year. That’s mind boggling if you stop and think about for a minute.
    2. More than 60% of key clinical data are not found in coded lists.The remainder of the information is found in free text, scanned documents, etc. That’s a problem because a lot of clinical decision support is based on information in coded lists. So what are we missing? A lot.

    The takeaway from the presentation: “Get massive amounts of data flowing, then build structure slowly and incrementally. Don’t wait.” The presenter referred to this as “the Google approach to data”. I’m a fan of all things Google so that works for me.

    I had coffee with Pauline Sweetman yesterday (@psweetman). Pauline is a pharmacist from the UK that I’ve been tweeting back and forth with for a couple of years. We had a pretty interesting conversation around the differences and similarities between hospital pharmacy practice in the U.S. and UK. Good stuff.

    I also had a great conversation with Dr. Heather Leslie (@omowizard), a physician out of Melbourne, Austrialia that’s doing a lot of work with the openEHR project. During our short visit she persuaded me to participate in their Adverse Reaction archetype review; as a pharmacist of course.She’s always looking for additional help if anyone is interested. It’s a worthwhile project so at least have a look.

    I spent more time roaming around the exhibitor area, specifically looking at RFID technology. I’m a fan of RFID, but it doesn’t seem to be catching on in healthcare. There are several reasons why, but we should still be looking hard at it’s application. I’m not sure whether RFID will become important or it it’s a bridge technology to something else. But the only way to find out is start using it and see where it goes.

    One product that uses RFID technology that I found particularly interesting comes from a company called MEPS Real Time, Inc. Their product features a dispensing cabinet with real-time RFID driven inventory management to go along with a RFID med tray tracking system. Of course you wouldn’t use RFID for everything because it would be labor intensive and expensive, but for high dollar drugs it might make sense. It was pretty impressive.

    MEPS_HIMSS12

  • #HIMSS12 Day 2

    Today was the first real day of action for me at HIMSS12. I attended a couple of sessions and spent some time in the exhibitor area. The education sessions I attended were pretty vanilla. The most interesting of them was the first one I sat in on called “Got Smartphones? Leveraging Physician’s Smartphone Usage in HIT”. Rebecca Kennis and Dr. Afzal ur Rehman from UHS Hospitals described their journey toward building an iOS application for physicians to access clinical information from their HIS.

    The application, called iCare, was quite nice. It had a nice flow to it and some pretty solid functionality. It gave physicians access to the patient medical record, medication lists, laboratory results, in addition to allowing physicians to record billing information and generate sign out notes for other physicians. It’s an Apple fanboy’s wet dream.

    A few things that I thought were of particular interest:

    • Dr. Rehman said that they didn’t ask for help collecting data from any of their vendors because “they wouldn’t get it [the help they needed]”. That speaks volumes for what UHS thinks of their HIT vendors.
    • Dr. Rehman eluded to the fact that UHS was willing to dummy down their security measures because physicians didn’t like long passwords. Someone from the audience pointed this out and asked how he was able to convince IT to allow 4 character passwords. His response was a bit of a grin and “we had to twist their arms”.
    • UHS has given the iCare application to physicians with iPhones, but will not allow nurses to use it because they feel it is too big of a security risk. I can’t decide exactly what that means. The security risk is the same whether it is a physician or nurse. Are they saying that the number of nurses represents a greater potential for risk, or does it mean that they don’t trust nurses? I didn’t have the opportunity to ask the question.

    I attended my first ever Tweepup at the HP booth in the exhibitor area. The event was sponsored by HP and brought together about 10 participants. I was able to meet Dr. Joseph Kim, which was a treat. I read a lot of his blog posts and share his interest in all things tablet PC related. We only had a few minutes to talk, but I enjoyed it.

    The exhibitor area for HIMSS12 dwarfs the exhibitor area for ASHP Midyear. I couldn’t see everything today. I’ll have to go back for more tomorrow; maybe even on Thursday depending on how far I get. Two things I took away from what I was able to see today:

    1. It’s all about the data. Everyone had something to say about collecting data, mining it and using business intelligence to put it to good use. There were a number of products on display in the vendor area, including small standalone systems to large integrated solutions from some of the big boys. How important will data be to the future of healthcare? Hard to say, but a lot of people are betting the house on it.
    2. Tablets are pervasive in healthcare. Tablets are the new smartphone. Everyone is carrying one and all the vendors are trying to take advantage of it. Anyone trying to sell any type of EHR, documentation system, imaging system, etc. is pushing the idea of using a tablet. Companies like Panasonic, Motion Computing, HP and Fujitsu had their lineup displayed in full force. To top it off just about every vendor in the place is offering up an iPad2 as a drawing prize. Have we seen the end of the desktop? Hardly, but it’s obvious where we’re headed.

    Overall I’d call day 2 a rousing success