Jerry Fahrni

Blog

  • “What’d I miss?” – Week of March 13, 2011

    As usual there were a lot of things that happened over the past week, and not all of it was related to pharmacy automation and technology. Here are some of the things I found interesting.
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  • How not to design an application for pharmacy

    I’ve used Pyxis PARx before, but only in combination with a carousel storage system. I recently had the opportunity to play with the standalone version of PARx and all I have to say is yikes!

    The system utilizes an older version of Windows Mobile on a clunky Motorola handheld. To get from log-in to a useful place in the application required me to go through no less than four screens. The touch screen was unresponsive and difficult to use, the device was painfully slow and the connectivity was lacking.

    So, to sum up my experience with PARx – used with carousel technology it’s great, but try to use the standalone product and you might find yourself spewing profanity.

     

  • Cool pharmacy technology – UCSF Robotics

    UCSF: “Although it won’t be obvious to UCSF Medical Center patients, behind the scenes a family of giant robots now counts and processes their medications. With a new automated hospital pharmacy, believed to be the nation’s most comprehensive, UCSF is using robotic technology and electronics to prepare and track medications with the goal of improving patient safety.

    Not a single error has occurred in the 350,000 doses of medication prepared during the system’s recent phase in.”

    Robotics is nothing new, but it seems like everyone is taking notice of the new robotics in the pharmacy at UCSF. I suppose all the people pointing it out to me has something to do with the fact that UCSF School of Pharmacy is my alma mater, but you never know. Anyway, I’m pleasantly surprised to see UCSF taking such an active role in advancing pharmacy practice. When I spoke with some colleagues sill working for UCSF a little over a year ago they were still practicing pharmacy invented in the dark ages. Not any more.

    Now I’m trying to get a hold of someone at UCSF that will let me stop by for a tour, and all of a sudden no one knows me. Poetic justice I suppose.

  • Lenovo continues to impress

    Electronista: “Lenovo gave its ThinkPad X series a major refresh on Tuesday with a generational leap. The X220 notebook and X220t tablet both use a newer 12.5-inch, IPS-based rich color display but thrive with a new external ThinkPad battery pack. They can last up to nine and eight hours respectively on extended internal batteries, but the battery pack pushes them up to 15 hours on the X220t and a full 24 hours on the X220.

    X220t owners also get their own touches with a much brighter 300-nit touchscreen that uses Gorilla Glass to improve their resistance to shattering or just casual scratching. The X220 notebook is the lighter of the two at under three pounds, where the swiveling display adds an extra 0.9 pounds to the X220t.”

    I purchased a Lenovo X201 tablet back in November 2010. It’s a fantastic machine and I haven’t regretted the purchase for a moment. I consistently get about six hours of battery life out of the extended battery pack. The idea of getting more than double that with the new X220t is mind boggling. Throw in an extra 0.4-inches of brighter touchscreen and the strength of Gorilla Glass and I think Lenovo has another winner on its hand.

     

  • FMEA and BCMA, two acronyms that work well together

    During my time as an IT pharmacist I was fortunate enough to be part of two Failure Modes and Effects Analysis (FMEA) groups; one for CPOE and another for BCMA. The FMEA process is labor intensive and time consuming, but well worth the effort in my opinion. In both the CPOE and BCMA instances several important pieces of information were discovered that may have otherwise gone unnoticed.

    I don’t often see articles that talk about using FMEAs, which is a real shame secondary to their value. So it was a pleasant surprise to see a recent article in Pharmacy Purchasing & Products on the use of an FMEA post BCMA implementation. I’m not familiar with using an FMEA after the fact, but it makes more sense to me now after reading the article.

    According to the author, they “had conducted an FMEA prior to initially employing BCMA; however, we never performed any post implementation follow-up on the system.” An all too common occurrence in healthcare, i.e. implement and forget. We did something similar at Kaweah Delta when I worked there, but we referred to the process as a gap analysis rather than calling it an FMEA. Regardless of the verbiage, the results were similar.

    The reason cited for the second FMEA was an increase in errors associated with the BCMA system. “Errors were primarily due to unscannable bar codes, mislabeled medications, the wrong medications being dispensed, and most commonly, nursing staff’s failure to scan.” This sounds familiar. The errors cited are simply side effects of the implement-and-forget mentality. Regardless of the system in place, humans inevitably develop bad habits and workarounds. We need to be constantly reminded to do the right thing. Implementation is only a small part of the work involved with any new system. Follow-up, maintenance and optimization is when the real work begins.

    And the results of the second FMEA? “Three months after completing the FMEA, the team compared the before and after scan rates. We found significant improvements in the scanning of both the patients and the medications throughout the system. In addition, we have witnessed a culture change: nurses now become anxious if they cannot scan a product.” Not bad.

    Read the article, it contains some good information.

  • Cool pharmacy technology – StoreRx

    It’s not often that I take note of pharmacy technology designed for the outpatient setting, but I had to make an exception when I came across the StoreRx robotic prescription storage system by ARX.

    What little outpatient pharmacy I remember, keeping track of patient prescriptions once filled was always a headache. I’ve seen several systems designed to make use of hanging bags like the WillCallRx system by TGCRx (PDF), but I never like the bag system; not sure why. However the StoreRx robot uses a different system altogether.

    Unfortunately for you and me, I couldn’t find a video of the StoreRx system in action anywhere on the internet. That’s a real bummer as I’d like to see it doing its thing.

    According to the ARX website:

    StoreRX is the most space efficient way of storing your customer’s prescriptions inside a robot. It enables accurate tracking of completed prescriptions, which is ideal for prescriptions with several bags and also for monitoring those which have not been collected.

    The white and brown medium grade e-flute cardboard boxes come in 2 different sizes, large and small. Both are easily recognised and efficiently stored by the robot. The StoreRX boxes are fully recyclable and bio degradable, but of course, these robust boxes can be re-used again and again.

    Prescriptions can be stored and located using the patient name, as opposed to looking up the required packs, making the prescriptions easier to locate during busier periods.

    Other outpatient pharmacy will-call systems can be found here.

  • Top posts for week ending March 6, 2011

    Below is a list of the most read blog posts over the last week based on number of hits:

    1. Automated unit-dose packagers for acute care pharmacy
      • A look at some of the high-volume unit dose packaging machines on the market today
    2. The evolution of tablets for pharmacy –
      • With all the hoopla surrounding tablets today, what impact do I think these devices will have on pharmacy practice? Good question. Read on if you want to know my opinion
    3. Cool Technology for Pharmacy (Alaris Smartpump June 18, 2009)
      • The Alaris System utilizes “smart pumps” combined with software to create limits, called guardrails, on infusion concentrations and rates. I’m surprised that this post continues to land at the top of the list week in and week out.
    4. Quick update: Pharmacy iPad use
      • An older post, April 2010, that no longer applies to much of what’s going on with tablets in healthcare today.
    5. HIMSS Interoperability Showcase – Omnicell video
      • Great stuff. Omnicell is making great strides in healthcare at the moment. You’d be wise to keep an eye on them.
    6. Best iPhone / iPod Touch Applications for Pharmacists
      • As with the iPad post above, this information is dated, but strangely still relevant. The post originally appeared September 2009. One of these days I need to get around to updating the information.
    7. The National Drug Code (NDC) is a gremlin in the works of pharmacy
      • The NDC is a real hassle in pharmacy. Read on if you want to know why.
    8. Barcodes on patient wristbands
      • Wristbands are a popular item for discussion in any barcode medication administration (BCMA) project. They’re just not user friendly. The difficulty associated with scanning a patient wristband is one more reason why RFID may be worth a second look.
    9. Moving storage around in the “cloud”
      • I’m a big fan of the cloud, but it still has a long way to go.
    10. First Impressions – Lenovo T410s Laptop
      • Still loving the T410s Laptop. Update on battery life: consistently getting about 4 hours with both batteries in.
    11. Medscape Mobile available for Android
      • Medscape Mobile is also available for the iPhone, iPad and BlackBerry, just in case you don’t have an Android device.
    12. Pediatric labels for bar code medication administration (BCMA)
      • Still a problem for many facilities looking at BCMA.
    13. Why not a computerized pharmacist?
      • IBM’s Watson is cool. Potentially for the pharmacy practice model of the future.
    14. Is the tablet PC dead?
      • It’s not dead yet, but it has one foot in the grave.
    15. New study equals new opportunity for pharmacists – ADSs in the ED
      • A post based on the February 2011 issue of Annals of Emergency Medicine that talks about patients entering the emergency department (ED) secondary to an adverse drug event (ADE). It’s not a good thing in case you were wondering.

  • Is the tablet PC dead?

    Mashable: “Microsoft will release a tablet-oriented version of Windows no sooner than 2012, Bloomberg reports, citing sources familiar with the matter.

    Despite Steve Ballmer’s bombastic statements in July last year, when he said Microsoft is “hardcore” about tablets and that we can expect “a lot” of Windows-based tablets by the end of 2010, none of the tablets that actually did hit the stores made any significant impact on the market.

    The reasons for this are quite clear: Windows 7 simply isn’t optimized for use with modern tablets with finger-based input. Remember the long, painful transition from Windows Mobile 6 to Windows Phone 7? Once again, it will take time for Microsoft to deliver the user experience it needs to be able to compete with Apple’s iOS and Google’s Honeycomb.”

    While the tablet PC may not be dead, it’s certainly on life support. The lack of a significant “Windows” presence in the new tablet market is troubling to say the least. I use a tablet PC nearly every day and for the life of me can’t figure out why Microsoft hasn’t taken a different approach to this market. Apple is kicking the crap out of them, as are Android tablet makers Motorola and Samsung. Why? Because Microsoft isn’t making tablets that people are interested in using.
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  • New study equals new opportunity for pharmacists – ADEs in the ED

    The February 2011 issue of Annals of Emergency Medicine has an article that reveals that patients that come through the emergency department (ED) secondary to an adverse drug event (ADE) “had a higher risk of spending additional days in the hospital per month and higher rate of outpatient health care encounters. The adjusted median monthly cost of care was 1.90 times higher (Can $325 versus $96; 95% CI 1.18 to 3.08).” In other words people that suffer and ADE create a burden on the healthcare system.

    The study was conducted in Canada, which by itself holds little significance. But I would wager a guess that most patients in Canada receive their prescriptions from a single primary care physician while patients in the US receive their medications from multiple physicians at the same time, i.e. patients in the US probably have a greater potential for ADEs.

    Medication reconciliation across the healthcare continuum is probably the best weapon we have in the fight against ADEs in the outpatient setting. And who can better manage a patient’s medication reconciliation than pharmacists? Uh, no one. Getting a pharmacist involved sounds like a good investment to me.

     

    Hohl CM, Nosyk B, Kuramoto L, et al. Outcomes of Emergency Department Patients Presenting With Adverse Drug Events. Annals of Emergency Medicine. 2011

  • The evolution of tablets for pharmacy

    Everywhere I look these days someone is showing off a new tablet; in the media anyway. Out in public I typically see mostly iPads with the Galaxy tablet coming in a distant second. I’m not sure that this will change anytime soon, but it’s clear to me that tablets will become mainstream devices for many people over time. The technology is simply too good to ignore. No one knows if the tablet will ever replace desktop machines, but I have an idea that they will for many, especially as the tablet market matures and hardware vendors begin to meet the needs of consumers. Case in point is the growing number of iPad keyboard cases you can find floating around on the internet. People want the iPad experience, but they also want a solid keyboard to work with so vendors obliged consumers by creating things like the ClamCase.

    To the best of my knowledge the next twelve months will bring tablets of all shapes, sizes and OS flavors to the market. I’ve seen information on tablets with screen sizes ranging from 7-inches to just over 10-inches, and operating systems including Android, Windows 7 (8?), WebOS, BlackBerry, and of course iOS. Did I miss any? It’s possible that I did as I’ve seen a few others thrown in the mix over the past several months, but I believe these constitute the bulk of what we’ll see.

    With that said, what impact do I think these devices will have on pharmacy practice? That’s a good question. Because I’m a tablet enthusiast I’d like to think they will revolutionize pharmacy practice as we know it, but in reality it probably won’t make much difference at all. Why? Site back and I’ll tell you.
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