Jerry Fahrni

Category: Pharmacy Technology

  • ASHP Midyear 2015 Technology Summary

    This year’s ASHP Midyear Clinical Meeting was held at the Ernest N. Morial Convention Center in New Orleans, Louisiana on December 6 through December 10, 2015.  For many, the Midyear Meeting is about the latest in clinical advances, but for me, it’s an opportunity to see all the new pharmacy automation and technology. And the best place to see the latest and greatest technology is in the exhibit hall.

    Below you will find my thoughts on what I saw while roaming the exhibit hall. By no means is this an exhaustive list, but rather items that I think are worth mentioning and thinking about.

    PHARMACY CLEAN ROOM

    “Sterile compounding is a significant but perilous core pharmacy process in dire need of improvement.” – ISMP Jan 2015

    The pharmacy clean room (a.k.a. iv room) continues to get a lot of attention, and rightly so. With the introduction of USP Chapter <800> and proposed changes to USP Chapter <797>, the clean room is on everyone’s mind. This year’s exhibit hall was a direct reflection of this.

    • The clean room automation and technology space is It was bound to happen. Over the past few years, several vendors have introduced products designed to help pharmacists with compounding sterile products or meeting clean room regulatory requirements.
      • Aesynt is now part of Omnicell and CareFusion is part of BD. BD has had more time to ramp up their messaging and it was obvious in their exhibit this year.
      • The Plus Delta Technologies booth was empty. Plus Delta’s products include PD, a medication tracking system, and IVTtrac, a semi-automated iv workflow management system. It is unclear whether the company has been sold, has gone belly up, or is simply keeping a low profile
      • APOTECA was not present in the Midyear Exhibit Hall this year. If you recall, APOTECA is the company responsible for APOTECAchemo, a robot for compounding hazardous drugs. Last year about this time they introduced APOTECAps, a semi-automated iv workflow management system. The company was conspicuously absent.
    • There was a good number of booths offering clean room consulting. More than I’ve seen in past years.
    • Aesynt – previously McKesson Automation, now part of Omnicell – was focused on data analytics in the clean room with two new products: REINVENT and Formulary Tool Kit (FTK). I wrote about REINVENT after the ASHP Summer Meeting in Denver. FTK is a tool designed to help pharmacies extend BUD in the cleanroom.
    • BD and Baxter seem to be running parallel races. Baxter had a press release at the meeting that focused on DoseEdge BD did the same for Cato. Baxter will be pushing their Epic integration in the coming year.
    • Baxter was showing off their DoseEdge scales for the first time ever at a Midyear event. DoseEdge has had gravimetric functionality for quite some time, but the concept has never been popular with their customers. Apparently that has all changed. Based on conversations with insiders, this appears to be a direct result of pressure from BD’s gravimetric-centric approach.
    Imaging platform and scales from DoseEdge (left) and BD Cato (right)
    Imaging platform and scales from DoseEdge (left) and BD Cato (right)
    • MedKeeper showed off a new booth at Midyear with Verification front and center. Verification is MedKeeper’s semi-automated iv workflow management system. Something that caught my eye while I was in the MedKeeper booth was the images captured by Verification. They’re really quite good. I was especially surprised to find that some of the images I was looking at were taken from outside an isolator. That’s right, the device was mounted outside the isolator, thus limiting the hardware in the hood.
    Verification by MedKeeper – images shown on screen taken from outside an isolator
    Verification by MedKeeper – images shown on screen taken from outside an isolator
    • Talyst had Talyst IV Room on display. Talyst IV Room is part of the company’s mobile inventory management solution and offers users the ability to build IV kits utilizing barcode scanning for verification, as well as the ability to track sterile preparations throughout the compounding process.
    Talyst IV Room product on display
    Talyst IV Room product on display
    • Grifols introduced a new hazardous drug compounding hybrid robot, Kiro Oncology. Kiro is a bit different from previous robots as it uses two robotic arms to compound sterile preparations. It’s an interesting concept.
    Kiro Oncology robot from Grifols
    Kiro Oncology robot from Grifols
    • Compounding robots were out in full force: Aesynt with v.STATION, ARxIUM with RIVA, and Grifols with Kiro Oncology.

    RFID-ENABLED TECHNOLOGY

    RFID-enabled technology was more prevalent at this year’s ASHP Midyear than I can recall in previous years. Booths that had RFID-enabled products on display were typically busy, and the people in those booths were engaged in conversation.

    Does this mean that pharmacy has finally turned the corner on RFID? Perhaps, but the technology still has some barriers, both real and perceived to overcome. It is clear to me, however, that RFID has niches in pharmacy and vendors are finding those niches.

    Three booths that I thought were particularly busy were MEPS Real-Time, Inc., Kit Check and FFF Enterprises.

    • MEPS Real-Time, Inc. was showing off their Intelliguard RFID system, which includes an RFID-enabled medication tray management system, controlled temperature cabinets (CTCs) – both refrigerated and room temperature – and a virtual logbook for tracking medication trays.
    • Kit Check had their “Little Blue Box” scanning station in the booth, which is part of their RFID-enabled medication tray management system. In addition, Kit Check was showing off their RFID-enabled Anesthesia Check system, which I thought was pretty cool. The design is well thought out and offers some nice functionality.
    • FFF Enterprises is a distributor of plasma products, vaccines, biopharmaceuticals, and biosimilars. Part of their product line includes Verified Inventory Program-Consignment (VIPc), which includes RFID-enabled refrigerators that offer automatic track and replenishment for their product line. Cardinal Health does something similar.

    SencorpWhite was on hand with a small booth providing information on their RFID capable carousels. They didn’t have a physical carousel in the booth as in previous years, but instead opted for literature and a looping video to support their product offering.

    PharMEDium announced that they will be making pre-filled syringes with RFID tags embedded in the labels. This is big, but the announcement went unnoticed by many. I wouldn’t have known about the move had I not been speaking to one of the vendors mentioned above. I verified this with one of the PharMEDium executives and was informed that the RFID-enabled pre-filled syringes will not be proprietary to any single company, and will be made available to anyone looking for pre-filled syringes with embedded RFID tags.

    COLD CHAIN TECHNOLOGY

    It has been clear for quite some time that refrigeration is going to be important for the next generation of pharmaceuticals, including biologicals. Pharmacies will need to invest in and utilize better security, as well as real-time monitoring for temperature, humidity, and inventory.

    • The exhibit hall was full of vendors offering real-time monitoring. Have a data connection, i.e. “the internet”? If so, then you have everything you need to use many of these systems. Vendors are offering cloud-based storage of information, which means anytime, anywhere access to data. Real-time monitoring and alerts mean that pharmacy directors will have peace of mind that their pricey inventory is in date, properly stored, and in stock. It’s a win-win.
    • All the major pharmaceutical grade refrigerator vendors had a presence in the exhibit hall: Helmer, Follett, Migali Scientific. Not to mention seeing many other vendors with one of these brands in their booth. Partnerships and alliances appear to be the most efficient method of ensuring that you can offer a refrigerated solution to your customers.

    Some items that I felt were particularly interesting in the cold chain area:

    • RFID-enabled refrigerators. See the section on RFID for more detail.
    • The Evolve line of pharmacy-grade refrigerators from Phononic were quite impressive. These refrigerators are powered by SilverCoreâ„¢ Technology. They have no compressor, meaning they have no mechanical parts, run quiet, use less electricity, and generate less heat. The refrigerators use solid-state heat pump technology coupled with a non-hazardous, non-toxic refrigerant. In addition, the units provide alerts for temperature, door, battery, memory, loss of Wi-Fi, and loss of power. Check the image below showing the solid-state “pump”.
    Phononic compressor-free refrigeration technology
    Phononic compressor-free refrigeration technology
    • Vaccine Smart-Fridge. I wrote about this back in September. The Smart-Fridge is an interesting concept. The system offers single-point access to vaccines, providing real-time alerts on inventory shortages and temperature. Automated temperature monitoring ensures that things stay within their appropriate temperature range, and analytics and historical dispensing data are collected and made available to the user.

    STRIP PACKAGING FOR AMBULATORY CARE

    Strip packagers have been around for a long time. They were popular in acute care for a while, but not so much anymore. However, there appears to be renewed interest in the technology for use in ambulatory care pharmacy, especially as a method of improving medication adherence. I spoke to several strip packaging vendors that are seeing renewed interest in the technology. Most attribute this to the introduction of strip packaging as a medication adherence platform made popular by recent coverage of PillPack.

    I wrote about PillPack back in February of 2014.

    MISCELLANEOUS

    DYNALABS DVxâ„¢ Onsite Drug Verification System. DVx allows users to quickly and easily verify drug identity and strength (concentration) in real-time. The demo was impressive. The representative that I spoke with said that DYNALABS currently had a limited reference library, but were adding new drugs all the time.

    ScriptCenter by Asteres. Think of ScriptCenter as something similar to the Amazon Locker model. Pharmacies fill medications, place them in the ScriptCenter kiosk, and allow users to pick them up at their convenience. Kind of an ATM-style solution to medication refill pickup. The system sends messages to patients when their prescription is loaded and ready. Users can pay with credit card or payroll deduction. You can even load OTCs into ScriptCenter. I spoke to Dana Darger, Director of Pharmacy at Regional Health in Rapid City, SD about ScriptCenter. He has been using the unit to provide employees with 24/7 access to medication refills. So far he’s been pretty happy with the results. Dana commented that ScriptCenter has helped alleviate congestion in the outpatient pharmacy as well as give hospital employees easy access to their refills.

    ScriptCenter by Asteres
    ScriptCenter by Asteres

    Cactus Smart Sink. I wrote about the Cactus Smart Sink while attending Midyear. The Smart Sink is a pharmaceutical waste disposal container that renders its contents “unrecoverable, non-retrievable and unusable”. It’s small and unassuming. I thought it was pretty slick.

    Swisslog Nexus Station. One has to wonder how a tube station can be exciting. Well, if you’ve ever worked in a pharmacy where items are queued up due to volume, then you’ll appreciate the Swisslog Nexus Station. The Nexus allows users to load up to five tubes at a time in a Lazy Susan-like configuration. Tubes can be loaded as non-secure or secure and the Nexus will keep track. Much more efficient than a “one-up” tube station.

    Nexus Station by Swisslog
    Nexus Station by Swisslog

    A PDF version of this report may be downloaded here.

  • BD introduces simplified comprehensive IV management [#AHSPMidyear15]

    Like many others, I received a press release from BD while attending the 2015 ASHP Midyear Clinical Meeting in New Orleans. The press release touted the introduction of “a simplified way for hospitals to manage intravenous (IV) medication to help improve safety and reduce waste”. The press release goes on to explain how BD has combined their technology with that of CareFusion, which they acquired last year.

    I didn’t think much of it at the time. I get lots of these throughout the year, especially during conferences like ASHP Midyear. I always approach them with a heavy dose of skepticism, and for good reason. Announcements like these often describe a Picasso when in reality you’re getting something closer to Dogs Playing Poker.

    However, Medgadget Tweeted about BD’s “simplified comprehensive IV management” earlier today. I found that interesting as it didn’t really seem to fit Medgadget’s typical fare. When I clicked on the link in the Medgadget Tweet I was taken to the official BD press release. Hmm.

    Here’s the plan laid out by BD in the press release:

    • Starting in the IV room of a hospital pharmacy, BD Catoâ„¢ Medication Workflow Solutions have been integrated with the CareFusion SmartWorks platform to seamlessly integrate with pharmacy IT systems to receive IV orders. Throughout the medication preparation process, the BD Cato System helps detect potential errors optimize drug utilization, simplify preparation steps and improve documentation compliance.
    • If preparing hazardous drugs, clinicians may use a closed system drug transfer device (CSTD), and BD’s Hazardous Drug Safety portfolio of solutions can help minimize the risk of hazardous drug exposure for health care workers and patients through products like the BD PhaSealâ„¢
    • After the medication has been safely prepared and is ready to deliver to the patient floor, the Track and Deliver module of Pyxis® ES Link enables the pharmacy and nurses to see exactly where the medication is during transport and when and where it is delivered. This helps nurses better manage their time and reduces calls to the hospital pharmacy inquiring about status and whereabouts of medication.
    • Once the medication makes it to the patient bedside, the Alaris® System with bi-directional electronic medical record (EMR) interoperability bridges the gap between an EMR and an infusion pump. With only one additional barcode scan to a nurse’s workflow, the pharmacist-verified physician’s order can pre-populate the Alaris System, reducing manual keystrokes and infusion programming errors.
    • EMR interoperability also enables automated documentation back to the patient’s EMR, where the nurse validates the data in the EMR and commits it to the patient record, eliminating the need for manual documentation and ensuring that documentation is complete and accurate. In addition, Alaris® Viewer Suite for Charge Capture takes all of the data from the Alaris System and displays it in a patient-specific report, making it easier for billers and coders to make an accurate claim for reimbursement.
    • Finally, through Pyxis ES Link, a nurse can submit an IV refill request that will be displayed in the Med View Dashboard and enable pharmacists to proactively plan for IV replenishment needs, reducing the risk of interrupted therapy and waste. The refill order is sent to the BD Cato Medication Workflow Solutions and the process begins again.

    The concept is interesting, but before passing ultimate judgment I need to see the entire process at a live site. I will contact BD next week to see if I can get more information and find a customer using the entire system.

    I’ll update you if/when I find out more.

  • Automated intravenous fluid monitoring at the bedside

    Over the years I’ve had a lot of ideas, some good and some not. When an idea comes to me, I typically record it in a notebook that I have sitting on my desk. Occasionally I return to the notebook and review the ideas to see how many of the ideas still have merit. Sometimes an idea has become outdated, and rarely an idea will have materialized as a product of similar design built by a company. And then there’s a group of ideas and concepts that still hold value but haven’t been seen in the market.

    Today I was rummaging through some of my old ideas. One of them from 2010 caught my attention. In 2010 I thought it would be cool if someone could use technology to analyze the IV fluid being administered to a patient in real-time. Basically, such a system would prevent the wrong IV medication from being hung on a patient, thus preventing a medication error.
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  • Cleanroom technology for pharmacy – DRUGCAM

    DRUGCAM is an interesting piece of pharmacy cleanroom technology. On one hand it falls into the semi-automated systems category because the person using it has to manually manipulate all the components of the sterile compound they’re making. In other words, it’s not a robot. On the other hand DRUGCAM uses some interesting technology and software to automate some of the steps in the process.

    DRUGCAM uses multiple cameras(1) to automatically detect the items being used during the compounding process. As the user passes components in front of the cameras, the system automatically identifies them. No bar code scanning required. That’s probably a good thing outside the U.S. as I’ve learned that not all countries require manufacturers to place a bar code on their drug containers. If the system doesn’t recognize the item, the user is notified via visual cues on the screen.

    DRUGCAM uses the same technology to automatically detect the volume of fluid pulled into syringes, and also detect when the same syringe is empty following addition of the contents to the final container. I’m not sure how the system determines the correct syringe position, but it’s pretty interesting.

    One other thing that makes DRUGCAM unique is that it takes video of the entire compounding process. I’ve mentioned this idea to several vendors over the past few years, but no one really seemed interested in the idea of using video.(2) I think it offers potential advantages over still photos. For one, if something looks weird you can always move forward or back in the compounding process to see what went wrong.

    Check the video below. It shows DRUGCAM being used in a glovebox.

    DRUGCAM is not currently available in the U.S. If you’d like more information just follow the link to the DRUGCAM website.

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    (1) When I saw DRUGCAM at the ASHP Summer Meeting back in June 2013 the engineer told me that the system utilized two cameras, but I can’t find that information on the product website.
    (2) Everyone I’ve talk with was concerned about the storage requirements for the video. My brother works for a company that designs security cameras, software, etc. Those companies have been dealing with high-definition video storage for years.

  • More from #ASHP Midyear

    Yesterday was more of the same, i.e. I spent several hours in the exhibit hall yesterday trying to make my way through my “game plan”. And again I failed to complete my mission. I spent a lot of time speaking to various people about some of the things I saw on Monday.

    Some of my stops and thoughts from yesterday:
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  • #ASHP Midyear 2014 update

    I spent several hours in the exhibit hall yesterday trying to make my way through my proposed “game plan”. Didn’t even get close. I kept getting sidetracked by one thing or another.

    Stops I did make were all interesting, and included:
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  • CareFusion announces partnership with Kit Check at #ASHP Midyear

    Last night I attended the first ever CareFusion Insider Event held at ASHP Midyear. The event was designed to spotlight CareFusion and their product line. Some new things were announced like the introduction of a Pyxis Mini and a new focus for the Rowa Dose System. CareFusion has had the Rowa Dose System for a while, but it was initially targeted at markets outside the U.S.

    Something I hadn’t expected was an announced partnership with Kit Check. I have written about Kit Check and Anesthesia Check before.

    According to the press release “today announced the companies will partner by connecting their hardware, software and RFID solutions to offer improved efficiency and accuracy in medication handling from pharmacy dispensing to OR point of use”.

    It’s unclear how deep the integration will run, but it’s clear after last night’s event that CareFusion is pushing a more integrated approach across the entire healthcare continuum.

    I’ll be stopping by both the Kit Check and CareFusion booths over the next couple of days to find out more.

  • #ASHP Midyear 2014 game plan

    ASHP Midyear is next week in Anaheim, California. I arrive in Anaheim on Sunday afternoon, and will be there until Wednesday morning. I always look forward to Midyear as it gives me an opportunity to connect with friends I haven’t seen in a while and learn some new things.

    One of the great benefits that Midyear offers me is an opportunity to look at large amounts of pharmacy automation and technology in one place at the same time. Midyear is the only place where you will find so many vendors in one space. The exhibit hall is typically full, and it’s where I spend a lot of my time.

    While I enjoy visiting with all the exhibitors, limited exhibit hall hours means that I have to prioritize where I spend my time.

    My must-see list this year includes:
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  • Interesting developments in robotic IV preparation overseas

    One of the unexpected benefits of writing In the Clean Room has been the interest that it has generated outside the U.S. Mark and I have had some interesting conversations with people from all over the world as a result.

    One of our colleagues from Germany shared these interesting new developments from overseas. All three of the “robots” listed below are designed for compounding hazardous drugs, i.e. chemotherapy. The number of different approaches and concepts used for robotic sterile preparation is amazing.

    PharmaHelp from Fresenius Kabi
    Basically a hood with built-in automated compounded technology. The concept appears to be focused on batch preparation driven by workflow management software. The process is aided by RFID and gravimetric technology.* PharmHelp reminds me of a combination of the EXACTAMIX Compounder and INTELLIFILL I.V. There is a video at the site, but I couldn’t find a way to embed it here.

    KIRO Oncology from KIRO (Mondragon)
    Two things of interest with KIRO Oncology: 1) Dual-armed approach. The use of two robotic arms makes sense as one of the current limitations to the compounding robots I’ve seen in the U.S. is the use of a single arm. The use of a single arm creates a rate-limiting step, 2) It is “self-cleaning”. Check the video below, “self-cleaning” starts at about 1:35.

    MOTOMAN from YASKAWA (Japan)
    A MOTOMAN dual arm robot from YASKAWA. Again, dual-arm approach. I’d like to see more video on this guy as the video below isn’t very good. When I do a web search for MOTOMAN I find mostly industrial use robots. Not sure how far they are with using their technology in the IV room.

     

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    *It’s important to note that not all countries utilize bar code scanning technology like we do in the U.S. The FDA did us a big favor when they required drug manufacturers to place bar codes on medications. Not so in other countries. Many drug products in other countries do not contain bar codes.

  • In the Clean Room: A Review of Technology-Assisted Sterile Compounding Systems in the US [report]

    For the better part of the past year I’ve been working on a project with Mark Neuenschwander of The Neuenschwander Company looking at technologies used in pharmacy clean rooms to prepare sterile compounds.

    The research into this area took much longer than originally anticipated. We discovered along the way that this subject is much more complex than it appears on the surface. Information is difficult to find, some of the technologies are little more than marketing material on a company website, and the subject matter is in its infancy.
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