Jerry Fahrni

Category: Pharmacy Informatics

  • Workforce training and allocation for modernization of HIT

    The most recent issue of Hospital Pharmacy (Vol 45, No 1, 2010) has an article by Fox and Felkey that discusses the demand that the ARRA will place on the current and future HIT workforce. According to the article “the workforce to shepherd implementation, training, and support [for the modernization of heath care delivery] simply does not exist today; consequently, we could face a situation where health systems and clinics are financially ready to adopt HIT but do not have the personnel to carry it out.” I believe this is absolutely true and have alluded to it in the past (here and here).

    More importantly, the shortage of HIT personnel will be further exacerbated by the need for clinicians to enter the technology field. The article supports this thinking by saying that “some experts have suggested that clinically-trained individuals are more suited to the design, selection, implementation, and management of HIT because they have a fundamental understanding of the processes of health care delivery. Alternatively, individuals trained in IT are more technically inclined, but lack firsthand experience with health care delivery systems” Another truism and a problem that is certainly not unique to the HIT field. Companies like Microsoft, Google, GE, Siemens, etc hire pharmacists and other clinician for their unique experience in the health care industry.
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  • Simplified and standardized intervention documentation

    Every pharmacist that has worked in an acute care environment is familiar with documenting interventions. Information from captured interventions is often assigned a dollar value and used by pharmacy and hospital administration to justify pharmacy services or additional pharmacist FTEs.

    Interventions captured can range from secondary issues like illegible handwriting and incomplete orders, to pharmacokinetic consults, renal dosage adjustment and prevention of adverse drug events caused by allergies, drug-drug interactions, disease-drug interactions, etc.

    Several methods have been used over the years to capture pharmacist initiated interventions, and no two have been the same. I’ve worked at several facilities over the years, and the systems used have included a paper method, a Microsoft Access database, a PDA system built with Pendragon Forms for the Palm Pilot, a third party software system and of course the pharmacy information system (PhIS) itself. Each had advantages as well as disadvantages. The two things they had in common were that they cumbersome and lacked standardization.
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  • MedEx: a medication information extraction system for clinical narratives

    The practice of informatics: Application of information technology: MedEx: a medication information extraction system for clinical narratives

    Hua Xu, Shane P Stenner, Son Doan, Kevin B Johnson, Lemuel R Waitman, Joshua C Denny

    Abstract

    Medication information is one of the most important types of clinical data in electronic medical records. It is critical for healthcare safety and quality, as well as for clinical research that uses electronic medical record data. However, medication data are often recorded in clinical notes as free-text. As such, they are not accessible to other computerized applications that rely on coded data. We describe a new natural language processing system (MedEx), which extracts medication information from clinical notes. MedEx was initially developed using discharge summaries. An evaluation using a data set of 50 discharge summaries showed it performed well on identifying not only drug names (F-measure 93.2%), but also signature information, such as strength, route, and frequency, with F-measures of 94.5%, 93.9%, and 96.0% respectively. We then applied MedEx unchanged to outpatient clinic visit notes. It performed similarly with F-measures over 90% on a set of 25 clinic visit notes.

    Xu H, Stenner SP, Doan S, et al. MedEx: a medication information extraction system for clinical narratives. Journal of the American Medical Informatics Association. 2010;17(1):19-24.

  • Year end thoughts for 2009

    2009 brought many new and exciting changes not only in my personal life, but in the world of pharmacy and technology as well. I’ve learned many new things, gained some skills previously absent from my armamentarium, met some great new people, discovered the “real” internet for the first time, traveled more than ever before, discovered I don’t know diddly squat about a great many things, and am more excited about the next year than I can remember in recent history.

    Below is a list of opinions about a great many things that I have seen and done over the past year. Some are pharmacy related, some are technology related, some are personal, and some are just random thoughts.
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  • Cool Technology for Pharmacy

    Pandora Data Systems (PDS) is a company that, in the past, has designed software solutions to take information from automated dispensing cabinets (ADCs) like Pyxis, store it, manipulated it, run queries against it and produce reports that allow pharmacy departments to view medication usage trends; including trends to identify diversion.PDS now appears to be expanding their role with the introduction of PandoraVIA.

    PandoraVIA is the next generation of data crunching software from the company. According to the PDS website “PandoraVIA is the new, full-featured reporting system from Pandora Data Systems. It’s designed to be a highly scalable and affordable platform built with Microsoft’s latest technologies. These technologies take the full functionality from our Pandora (Legacy Edition) and PandoraSQL products and move them to the next level.”

    The new software framework is designed to accommodate various modules depending on the needs of the customer. The system currently supports Pyxis, AcuDose, Omnicell, MedDispense and Cerner. However, after spending some time with the Pandora representatives at AHSP Midyear they informed me that their new system could add custom data from almost any source based on need.

    PandoraVIA utilizes XML, SOAP, and WSDL to meet the needs of the healthcare system, and is capable of a host of reports that can be exported in a variety of formats.

    A system that can aggregate data from many different sources offers real value to many healthcare disciplines, especially pharmacy which is often driven by data. Data mining is important, but not always easy because of the myriad of systems utilized and the general poor quality of integration. In addition, many IT departments aren’t equipped with the necessary resources to handle a project of this magnitude; believe me, I’ve tried.

    Data I would like pulled into such a system include our Alaris Smart Pump data, our pharmacy information system (Siemens Pharmacy) data, our automated dispensing cabinet (Pyxis) data, our carousel, packaging and inventory control (Talyst) data, and our bar code medication administration data. Aggregate data from these systems could be mined for an infinite number of possible trends and uses.

    Posted via email from fahrni’s posterous

  • Lexi-Comp medical references for the Droid

    Recently I was fortunate enough to be a beta tester for the new Android version of Lexi-Comp’s suite of medical information software. I was very excited for the opportunity as I’ve been using what I would consider inferior drug information resources since purchasing my Droid about a month ago. The installation was a problem initially as the databases wouldn’t install directly to the microSD card on the Droid. As you can imagine, the databases are large and immediately filled up the physical memory on the device. Within a couple of weeks of reporting the problem to Lexi-Comp they had corrected the issue and sent me a new build that installed seamlessly.
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  • Technology to prevent medication errors (article)

    Forni A, Chu HT. Technology Utilization to Prevent Medication Errors. Curr Drug Saf. 2009 Oct 7 [ePub]

    This is a nice review article explores current technologies available to healthcare and what role they play in the reduction of medication errors. The article provides a short review of literature to support each technology reviewed. Technologies covered include: Computerized Physician Order Entry (CPOE), Clinical Decision Support Systems (CDSS), Patient Monitoring: Electronic Surveillance, Reminders, and Alerts, Telemedicine, Bar Code Medication Verification (BMV), a.k.a. Bar Code Medication Administration (BCMA), Smart Infusion Pumps, and electronic medication administration record (eMAR).

    The article concludes with:

    The implementation of health information technology can result in a reduction in ADEs and can impact the quality of patient care. Systems integration and compliance are vital in achieving a safe medication use process. Hospitals that have extensive computerized technology and have greater automation tend to have better patient outcomes, including fewer complications, reduced inpatient mortality and lower hospital costs. Regulatory agencies and payers are now using performance standards and financial incentives to force practices changes. This may increase the speed and likelihood of technology implementation. While many providers may dismiss technology as being beyond their scope of practice or responsibility, both practitioners and patients should be prepared for these changes.

    It’s time for healthcare system to take note of this and begin planning accordingly. You can’t escape the explosion of technology available, nor can you afford to ignore the implications of choosing not to use it.

  • Biometric identification and facial recognition

    CrunchGear reports on a new product called Lockface USB flash drive from Futen, a Japanese company. The flash drive uses facial recognition to identify its users. According to CrunchGear: “The first thing to do is to register a number of pictures of your face. After that, the Lockface verifies your face every time you need to access data on it (the verification process takes about a second). The USB drive doesn’t require extra software to be downloaded or installed. Alternatively, you can also use a password, completely ignoring the face recognition function of the device. It uses 256-bit AES to encrypt the data. Futen says the device has an error rate of about 2% (it verifies the “wrong” person in 1.91% of cases and won’t verify the right person in 1.98% of cases).”
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  • Solution to illegible handwriting puzzle

    Thanks for all the people who ventured a guess. Only the medications are transcribed and the original image is posted below the answers as a reference.
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  • Clinical Surveillance

    There is a nice article in the November 2009 issue of Hospital Pharmacy on the use of clinical surveillance in pharmacy. I’ve mentioned these types of systems before here and here.

    From the article:

    Clinical surveillance tools are atype of clinical decision support system (CDSS), providing pharmacists with patient information that has been filtered according to predefined criteria and is presented at appropriate times to enhance patient care. These tools pull data from 3 sources—admission/discharge/transfer (ADT), laboratory, and pharmacy—and use clinical rules to analyze the data and alert the user of instances that meet the rules’criteria. Though there is some variability in methods across the different vendors’ products, these Webbased applications enerally function by interfacing (HL7) with the hospital’s information systems to securely pull the data to the vendor’s server where the data are analyzed against a set of clinical rules. Some vendors allow the client to build their own rules, some provide a foundational set of rules, and others do not allow user-defined rules. This is an important distinction to make when evaluating the different applications.

    For more information try visiting John’s Evernote repository for Clinical Decision Support.