Jerry Fahrni

Tag: Automation

  • Can “a computer” take over for a pharmacist?

    Two things happened to me recently that have pushed this question to the front of my mind.

    IBM_Watson

    The first is by way of some comments that were left in response to something I wrote in June about Google’s new symptom search. The comment is as follows:

    “...I have to question your closing statement: The idea of such a vast amount of knowledge at one’s fingertips is mind boggling, to say the least. Google, like any reference, has “information”, but I’m not sure if I would classify it as a “vast amount of knowledge”. Actually, knowledge on the part of the reader is what is required to make sense of the information that a source like this provides. The ability to interpret drug literatures only comes with education, training, and experience…”

    The second item comes from a Reddit thread that I got involved with a few days ago. In the thread a user asks whether or not a pharmacist could be replaced “by a computer” in another 20 years. I argued that it could certainly happen. Someone countered by saying that it couldn’t happen because “the evaluation side, the interpretation of a patient, taking it’s [sic] history into account” couldn’t be done by decision-making software.

    Depending on which side of the fence you’re on, there is potential for some good discussion here.

    As I see it, information by itself holds little value. Having the skills to apply information to a given situation, i.e. “having knowledge”* makes all the difference in the world. Many think that it is this that makes humans indispensable in certain roles, like pharmacists. However, don’t be too quick to dismiss the ability of artificial intelligence (AI) and machine learning (ML) to mimic the actions of a human, especially in healthcare. Both AI and ML are powerful tools that can be used to appropriately apply information to any given situation. If a piece of software is able to use ML and AI to apply information to a situation based on past experience, doesn’t this become “knowledge”? I think it does.

    This is what pharmacists do throughout their career – take what they’ve learned, add it to what they’ve experienced, and apply it to a given situation – and why seasoned veterans are so valuable. It’s not that they’re smarter than their younger counterparts; it’s that they’ve been around longer and seen more. The knowledge gained by veteran pharmacists is often the difference between making average decisions and making great decisions. As pharmacists practice, they gain more knowledge.  As time goes by it becomes increasingly rare to see new situations. I’m sure that computers can take information and combine it with previous actions and outcomes to make decisions. They do it all the time.

    Not all knowledge requires depth of logic and “freedom of thought”. Take for example a pharmacist that gains knowledge by reading through a new set of treatment guidelines, or a journal article, or by attending a conference lecture. After digesting the information – use drug x in this situation – the pharmacist is ready to apply it. This is one of the things that make pharmacists better as clinicians over time, i.e. learning new things from others. Can’t a computer use the same information and be given parameters from which to apply it? Sure. How is that different from a human pharmacist? On the surface it’s not.

    So while I understand the desire for pharmacists to push back on the idea of being taken over by computers, I fundamentally disagree. I believe that 80% of what pharmacists do right now could be successfully emulated by a combination of technologies. Decisions made by pharmacists rarely require some special power of observation. Most are actually pretty cut and dry. What about those times that require a judgement call? That’s the other 20%. And while I think you need a pharmacist to make those calls today, I don’t think it will be long before technology can do the same thing. After all, most judgment calls are simply something learned plus experience. Computers may not be able to think on their own, but they can certainly take information, search for a previous encounter, and “make a decision”.

    Obviously this is just my opinion, take it for what it’s worth.

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    *one definition of knowledge – “facts, information, and skills acquired by a person through experience or education; the theoretical or practical understanding of a subject.”

  • IV room technology …just sayin’

    From a recent article in August 2012 issue of Pharmacy Practice News:

    Within the first month of implementation [of a bar-code medication preparation (BCMP) system], 85% of all IV drugs in the children’s hospital IV room were covered by the BCMP system, which does the following: “prints” labels to a touchscreen computer from which a technician can pick which dose he or she wants to prepare; verifies via bar-code technology that the correct medication and diluent were chosen, provides instructions to technicians about how make the preparation, allows technicians to take pictures of the preparation process and automatically time stamps each step in that process for future record keeping and management reporting.

    The unique bar code that is assigned to each product then can be used to track the medication to the nursing unit, or whatever end location has been provided, with a location bar code.

    Since the implementation of the BCMP IV system, which both Drs. Fortier and Maughan describe as a “best practice for the near future,” MUSC staff have seen “eight to 10 medications a day that could have been an error [with] the old system,” according to Dr. Maughan. “That represents 1.3% to 3% of the total number of doses dispensed.”

    It’s no secret that I think the IV room is an area that pharmacy has yet to address properly when it comes to automation and technology. We simple haven’t developed a product that will change the way pharmacy compounds IV’s. I have some thoughts on that, but will keep them offline for now. If you’re interested in talking about the future of IV room practice feel free to drop me a line. Sorry, I digress.
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  • Yo, wouldn’t a high-tech laminar air flow hood be cool

    We have so much technology around these days. I mean we have real-time patient monitoring, near field communication, telemedicine, smartphones, music and video in the cloud, and so on ad infinitum. So why is it that hospital pharmacies use the same old horizontal hoods that they’ve always used?

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  • Prevalence of medication administration errors in two medical units with automated prescription and dispensing [Article]

    From the Journal of the American Medical Informatics Association1. I was a little shocked by the number of errors, but as you can see in the abstract below, and in the title, the errors were during the administration phase of the medication use process. Seems a bit odd to look at medication errors during administration when talking about automated prescribing and dispensing. I’m sure there is an explanation in the full article. However that requires a subscription. Interesting nonetheless:

    Abstract
    Objective     To identify the frequency of medication administration errors and their potential risk factors in units using a computerized prescription order entry program and profiled automated dispensing cabinets.

    Design Prospective observational study conducted within two clinical units of the Gastroenterology Department in a 1537-bed tertiary teaching hospital in Madrid (Spain).

    Measurements Medication errors were measured using the disguised observation technique. Types of medication errors and their potential severity were described. The correlation between potential risk factors and medication errors was studied to identify potential causes.

    Results In total, 2314 medication administrations to 73 patients were observed: 509 errors were recorded (22.0%)—68 (13.4%) in preparation and 441 (86.6%) in administration. The most frequent errors were use of wrong administration techniques (especially concerning food intake (13.9%)), wrong reconstitution/dilution (1.7%), omission (1.4%), and wrong infusion speed (1.2%). Errors were classified as no damage (95.7%), no damage but monitoring required (2.3%), and temporary damage (0.4%). Potential clinical severity could not be assessed in 1.6% of cases. The potential risk factors morning shift, evening shift, Anatomical Therapeutic Chemical medication class antacids, prokinetics, antibiotics and immunosuppressants, oral administration, and intravenous administration were associated with a higher risk of administration errors. No association was found with variables related to understaffing or nurse’s experience.

    Conclusions Medication administration errors persist in units with automated prescription and dispensing. We identified a need to improve nurses’ working procedures and to implement a Clinical Decision Support tool that generates recommendations about scheduling according to dietary restrictions, preparation of medication before parenteral administration, and adequate infusion rates.

    1. J Am Med Inform Assoc. 2012 Jan 1;19(1):72-8. Epub 2011 Sep 2.

  • Cool Pharmacy Technology – Eyecon Pill Counter

    1. Scan the bottle
    2. Pour the tablets onto the Eyecon Pill Counter counting platter. The Eyecon Pill Counter uses “Machine vision technology” to count the tablets.
    3. Package the tablets

    That’s pretty simple. Sure beats the heck out of counting the tablets by hand. 5…10…15…20….

    More information on the Eyecon Pill Counter can be found here.

  • What do pharmacists want?

    pulling_out_hairIt’s a simple question with a simple answer. In today’s pharmacy environment pharmacists want to do more “clinical” activities and distance themselves from the physical pharmacy. See, I told you it was simple.

    For the last several months I’ve been listening to people tell me what pharmacists, and pharmacies, want. I find it interesting that most of the opinions differ from mine. No big deal as opinions are opinions, remember? But today I had a brief, albeit passionate discussion over what pharmacists want. The people telling me what pharmacists wanted weren’t healthcare professionals. They were engineers, sales people, etc. I know that comes off a bit elitist, but it’s not. I don’t pretend to know what an engineer knows, so perhaps they shouldn’t pretend to know what I know. Fair? I think so.

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  • Cool Pharmacy Technology–Apoteca

    I have a soft spot for robotics, especially for IV preparation. I’m not quite sure that pharmacy is ready to fully embrace the idea, but we’re well on our way.

    APOTECAchemo is an IV preparation robot modeled in the image of i.v.STATION. Prior to yesterday I had not heard of APOTECA. Fortunately someone visiting my site left me a link to the U.S. website. The site contains limited information with the exception of the video below. However, a quick internet search led me to the Loccioni Humancare website where I was able to find additional information.

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  • HIMSS11 Interoperability Showcase – Omnicell video

    Omnicell is pushing interoperability with pharmacy information systems. Interesting stuff.

    Check out the demonstration video below. I love the “vending machine” style dispensing idea. It’s something I’ve been waiting to see for a few years now.

  • Cool Technology for Pharmacy – Sharp SX Bagger

    Some items in a pharmacy are simply difficult to bar-code. Perhaps they’re too small, have an awkward shape or their surface won’t accommodate ink or an adhesive. The problem creates some interesting workarounds, and not always for the better.

    One solution is to individually package each item and place the drug information and a bar-code on the outside of the packaging material; overwrapping, if you will. I’ve never been a big fan of overwrapping items because it can be time consuming and cumbersome. Today I ran across a machine that I think offers a genuine option for medications that are difficult to bar-code.
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  • Why automated medication kiosks could be good for pharmacy practice

    I followed a little banter on Twitter this weekend regarding the use of automated dispensing kiosks to dispense medications to patients instead of using a physical pharmacy. There are many pharmacists out there that believe the use of automated medication dispensing in the outpatient arena is bad practice and separates patients from their pharmacists. I don’t share their sentiment. I’ve blogged about these devices before, here and here, and believe they could be used to improve the pharmacist-patient interaction. I actually had the opportunity to watch an InstyMeds Prescription Medication Dispenser in action under a physician dispensing model late last year and thought it was well done.

    It is unclear to me why pharmacists fear these machines, but it reminds me of the fear surrounding automated dispensing cabinets during their inception back in the day.  Now they’re an integral part of acute care pharmacy practice. Perhaps pharmacists believe that patients won’t get the necessary consultation and instruction that they would had they visited their local retail pharmacy. As one that has worked in a retail pharmacy environment, albeit briefly, I don’t buy into that belief. Under the right set of circumstances, and with thoughtful implementation, kiosks could free up pharmacists to spend more time with patients in emergency departments and urgent care clinics across the country. After all, don’t pharmacists argue for more clinical face time with patients and less association with the physical medication dispensing process? That’s what I’ve been hearing from pharmacists for years.

    I would argue that placing kiosks in certain locations could improve medication therapy management and patient compliance. The odds of a mother with a tired, cranky, ill child going out of her way to visit a local retail pharmacy at midnight is much lower than grabbing a prescription at an automated dispensing machine in the urgent care clinic following the child’s exam. It certainly couldn’t hurt. Now throw in a consultation from the pharmacist prior to going to the medication kiosk and you have a winning combination.

    Kiosks certainly wouldn’t fit every situation, but there is certainly room in the pharmacy practice model for their thoughtful use. Think about it.