Jerry Fahrni

Category: Pharmacy Informatics

  • #ASHPMidyear day one comes to an end

    Each day at ASHP Midyear offers some great experiences, and today was no exception.

    I spent a good part of my first morning at the Talyst User Group Meeting. It’s encouraging to speak with other pharmacists that use pharmacy automation and technology in interesting ways. User Groups are a great way to get focused information from end users. I always take something away from groups like this. I wish there was a way to apply the format to other areas of pharmacy informatics.

    Following the user group meeting I spent some time roaming around the exhibits. Yes, before they’re open “to the public”; vendor badge. While the exhibits weren’t complete, they certainly offered a glimpse of what I can expect for the rest of the week. It also gave a me a good idea of who I’d like to visit and spend some time talking too. It’s always interesting to talk with the vendors in person. Sometimes you can get information that you simply can’t find anywhere else.

    I did manage to attend a single session today titled A Hitchhiker’s Guide to Telepharmacy. I haven’t spent much time learning about telepharmacy so I thought this would be a good opportunity to gain some knowledge. To my surprise it turns out that telepharmacy isn’t at all what I thought it was. One of the first slides in the presentation defined telepharmacy as “a central pharmacy, either retail or associated with a hospital, is connected via computer, audio, and video link to one or more remote sites. A licensed pharmacist at the central site conducts remote order entry and then supervises the dispensing of medication at the remote site through the use of video conferencing technology.” (Darryl Rich, The Joint Commission, 2007). Huh? I thought telepharmacy would represent a more clinical approach to patient care through the use of audio and video.

    The U.S. Department of Health & Human Services defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site.” I assumed telepharmacy would basically be the same thing. Guess not. The Joint Commission definition of telepharmacy stated above is simply remote checking. I’m not sure I like that.

    At least my day ended on a positive note. I had dinner with a friend at a great little Mexican restaurant called Tortilla Jo’s in Downtown Disney. We spent a couple of hours talking about all kinds of stuff including pharmacy, informatics/automation and life. Good stuff.

    Here’s looking forward to tomorrow.

  • Oh yeah, on my way to #ASHPMidyear 2010

    Here I sit in the airport waiting for my flight to take me to ASHP Midyear 2010 in Anaheim, CA.  ASHP Midyear is the premiere conference/meeting for pharmacists each year. Sure there are larger healthcare conferences/meetings every year, but none are dedicated entirely to the pharmacy profession.

    As this is only my second ASHP Midyear in my career I’m excited to see if the experience matches that of last year. I’m sure it will as I continue to be impressed by the number and variety of sessions crammed into such a short period of time. Of course I’m particularly interested in the informatics sessions, but it’s ok if you find yourself sitting in on one of the talks updating you on what’s happening in the clinical world. I won’t hold it against you.

    The week for me will kick off on Sunday morning with the Talyst Users Group meeting followed by a session on RFP’s and contracts put on by the ASHP Section of Pharmacy Informatics and Technology’s Advisory Group on Pharmacy Operations Automation. I’ll round out Sunday’s activities by attending the McKesson Safe Compounding Reception. And it will only get better from there as the week will be filled with sessions on clinical decision support, barcoding, telepharmacy, the application of social media to pharmacy, and so on and so forth.  My week will conclude with the session titled mHealth: There’s an App for That where I will be presenting information on the integration of the iPad into pharmacy services.

    The information I’m presenting was pretty cutting edge at the time I submitted the slides, but is now clearly dated. That’s the downside of having to submit presentation slides so far in advance. Anyway, it should still be worth the time and effort. I’ve always found it educational for myself to present information to people as someone always has something interesting to add or a good question to stimulate the thought process.

    I’m looking forward to the next five days. I’ll be Tweeting (@jfahrni) as much of the event as possible in addition to posting about the day’s activities whenever feasible. I hope to see you there. If you’d like to get together and talk a little pharmacy informatics/automation don’t hesitate to give me a Buzz, Tweet or email.

  • Wolters Kluwer acquires Pharmacy OneSource

    You may not be familiar with Wolters Kluwer, but if you’re a pharmacist I’m sure you are familiar with their products: Facts & Comparisons, Medi-Span, Ovid, ProVation Medical, UpToDate. While Facts & Comparisons has become an afterthought in the drug information world, products like UpToDate and ProVation Medical are gaining traction in the healthcare industry. This is especially true as physicians, pharmacists and other healthcare providers look for ways to access information while on the go, i.e. access from mobile devices.

    Wolters and Kluwer just bolstered their position and gained significantly more credibility with their purchase of Pharmacy OneSource. Pharmacy OneSource is the maker of several innovative pharmacy products such as Accupedia pediatric dosing software, Sentri 7 clinical surveillance software and Quantifi for pharmacist intervention documentation. Pharmacy OneSource not only provides several interesting and innovative applications, they also offer them by way of the Software-as-a-Service (SaaS) model, which is uncommon in the pharmacy world.

    I’ve blogged about Pharmacy OneSource several times as I’m not only a fan of their products, but their distribution model and use of cloud computing as well. It’s no secret that I believe in cloud computing as the future for many applicaitons in pharmacy and feel that Pharmacy OneSource has created a solid foundation on which the rest of the industry can build. My only hope for the Wolters Klumer acquisition of Pharmacy OneSource is that their innovative products and strategy won’t change. Often times the first thing to go when a smaller company is purchased by a larger company is innovation. Here’s hoping that won’t happen.

  • The National Drug Code (NDC) is a gremlin in the works of pharmacy

    The National Drug Code, or NDC number as it’s affectionately called in pharmacy, is a set of numbers used to uniquely identify “human drugs and biologicals“. Every pharmacist is familiar with the NDC number, but if you’re not it’s basically a  unique number assigned to each package of medication. It’s an 11 digit number in a 3-segment format, i.e. XXXXX-XXXX-XX.

    The first segment consists of five digits and indicates the manufacturer of the drug. The second segment is four digits used to identify the medication and strength. And the final segment of two digits represents the package size.
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  • Thoughts on the #PPMI Twitterchat

    ASHP and the ASHP Foundation have undertaken an initiative to change the way pharmacists practice pharmacy. And that initiative is called The Pharmacy Practice Model Initiative (PPMI); go figure. It’s quite an aggressive goal and one that I hope results in some great ideas on how to get pharmacists to the bedside where they have been shown to improve patient care and save hospitals money. Of course I’m banking on judicious use of technology to help lead the way, but that’s just my bias speaking.
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  • Pharmacovigilance, what’s in a name

    I read an interesting discussion about pharmacovigilance (PV) software a few weeks ago on one of the pharmacy listservs I belong to. The conversation struck me as odd because much of it sounded an awful lot like a discussion on clinical decision support (CDS). This led me to wonder whether or not PV and CDS are the same thing, completely different or subsets of one another. I am not familiar with the term PV myself, so I set out to gather some information. And here’s what I found.
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  • Impressive offerings in the new edition of ACI eJournal

    The third issue of the eJournal Applied Clinical Informatics (ACI) is available online and it’s packed with some pretty interesting stuff. Even though CPOE and CDS have been topics for discussion for quite sometime, they’ve somehow managed to fly under the radar for the most part.

    Here’s some stuff on CPOE and CDS in the third edition of ACI that caught my eye:

  • Don’t dismiss the value of an operationally sound pharmacist

    As pharmacists begin to move out of the physical pharmacy to the patient bedside I think it will become important not to forget the value of a pharmacist that is well versed in how to handle the operational side of pharmacy. Don’t get me wrong, I think pharmacists should be used more for therapeutics than for the role of physically dispensing medications. However, consider a practice model for pharmacy where technicians are more involved with the day to day operations and automation plays a bigger role in the dispensing process. In this instance a pharmacist will be needed for technician oversight as well as to control the workflow of the pharmacy. In addition that pharmacist will need to have intimate working knowledge of the automation and technology used in the pharmacy space. I don’t believe that a pharmacist needs to see every single item dispensed from the pharmacy, but I do think global oversight is necessary. There are opportunities for positive interventions in all aspects of acute care pharmacy practice.

    I began my career as a “operational specialist”. The hospital where I was employed used a hybrid model of satellites and centralized dispensing. They needed stability in the dispensing area secondary to the pharmacist shortage. The pharmacy manager came to me and offered me a unique opportunity to handle the workflow in the main pharmacy from an operational standpoint. The hours were’t great, working Monday through Friday from 1:30pm until midnight, but it gave me a chance to try something new. I spent about a year in this role and found great value in the lessons learned through trying variations on the age old themes of cart fills, ADC replenishment, IV batches, etc. It was worth it.

    Do I see the need for an operational specialist in acute care pharmacy? Perhaps, but not in the traditional sense. I see the need for a pharmacist trained in automation and technology with additional skills to manage people and workflow. After all, it is still important that patients receive their medications as safely and efficiently as possible. I envision a role similar to the one I’m in now, with the only difference being less focus on the clinical application of technology for a more mechanical one. Most informatics pharmacists handle both areas of technology now, but as clinical decision support, rules engines, computerized provider order entry, and so on become more prevalent it may become necessary to split the jobs into separate specialties; clinical pharmacy software and pharmacy automation and technology. There’s plenty going on in pharmacy informatics to justify such a design. Similar to pharmacists that have chosen to specialize in Cardiology or Infectious Disease, I think we’re headed for a time when informatics pharmacists will begin to tease out specialized roles in healthcare information technology.

    Just a thought.

  • Musings on poor resource management in healthcare

    I’ve recently had the displeasure of running up against some significantly poor resource management that has had a negative impact on my ability do my job, and it got me thinking about what kind of overall impact poor resource management has on healthcare. I’ve held a full time position as a pharmacist in four hospitals and worked either part time or per diem in two others. That’s a total of six separate facilities in five different cities, so I’m going to assume that I have a fair sampling. No two facilities were the same, but they all suffered from the inability to manage resources, i.e. people, hardware, software, reference material, etc.

    I’m sure running a hospital doesn’t come cheap, but I believe you have to create a balance that gives you not only the ability to move forward, but also creates an environment that allows one to perform at a high level.  The problem I see in healthcare is a general lack of foresight when it comes to moving forward.  For example, you can’t purchase a new piece of automation hardware for the pharmacy and expect it to run itself forever at no cost for maintenance, optimization and upgrades. But that’s how we, i.e. healthcare, view things. While I’m general speaking about things related to pharmacy because that’s what I know, the basic principles can be applied to almost anything.
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  • Update: Siemens Innovations 2010 Presentation

    Today was the big day. I gave my presentation at about 11:00 am and it cleared the room. There were about 100 attendees for the CPOE presentation just prior to mine and about 90 of those people got up and left when it came time for me to do my thing. I guess mobile pharmacy just isn’t interesting to most people.

    Anyway, the presentation is below. There is an embedded video near the end that didn’t pull into SlideShare. It’s about a 30 second look at how we use Citrix on the iPad to access various clinical applications. I attempted to upload in to YouTube, but kept getting an error. I’ll try again later. If you want to see the elongated version of the videos simply go to YouTube and type in “Kaweah Delata iPad“, or something similar, and several options will pop up.