Jerry Fahrni

Tag: Bad

  • Quick Hit – “I don’t see the icon”

    blind_computerSeveral times on this blog I have discussed the need to advance pharmacy through the use of new and exciting technologies. Yesterday I experienced something that brings light to the reason pharmacy practice is still in the Stone Age, where it may live forever.

    We had a minor pharmacy system upgrade yesterday. The system was down for about 45 minutes. Although minor, the upgrade required the removal of the previous version of the pharmacy software prior to installing the new version. Overall the process went smoothly. However, within a few minutes of giving the pharmacists the all clear I began receiving phone call after phone call because the upgrade “didn’t work” and they couldn’t “get into Siemens”. The problem: the install client failed to put the shortcut icon for the pharmacy system on their desktop. Seriously, that’s the problem? Wow!

    The “problem” brought the pharmacy to a standstill. So, the next time you talk about carousel technology, automated packaging, or clinical decision support software, remember that many pharmacists still struggle with using a computer; a device that is common in nearly every household in America.

    I bet Steve Jobs doesn’t have these problems. ;-)

  • Quick Hit – What makes someone an expert?

    mrknowitallI’ve often asked myself this question as I tend to deal with “experts” in various fields from both the pharmacy and IT world. I’ve met several individuals over my short 12 year career that I wouldn’t give two cents for their opinion, but somehow they’ve been crowned an expert in their field. I find it interesting that some people refuse to challenge an expert for fear of some unforeseen negative consequence. Haven’t you ever listen to someone else’s opinion on something and think to yourself “that doesn’t sound right”, but were afraid to open your mouth and say something? Of course you have. We all have. I fell into the trap myself several weeks ago. I started following someone on Twitter because of who they were supposed to be; an expert in the world of cutting edge technology. What I found was a string of opinions that I got tired of reading secondary to their short-sided viewpoint. This particular individual would quickly dismiss other opinions as irrelevant and mock those that offered conflicting views. I found the person to be not only full of himself, but full of crap as well. I grew tired of the message, finally woke up and hit “unfollow”; done deal. I wish it was always that easy.

    So, back to my original query: who pinned the expert badge on this person? Do experts become experts because people refuse to challenge them? Does it have to do with level of education, school attended, profession, genetics, or [insert reason of choice here]? Who knows, maybe it’s a combination of everything. I can tell you from personal experience that titles and education are meaningless when it comes to raw intelligence and common sense. I work with people every day that aren’t experts in anything per se, but I trust their opinion on matters of great importance. I prefer to discuss issues with intelligent people and arrive at my own conclusions instead of getting bullied into someone else’s view. Then again maybe that’s just me.

  • Pharmacist perception of Wikipedia as a drug information resource

    homer-simpson-dohThe Annals of Pharmacotherpy (Vol. 43, No. 11, pp. 1912-1913): “Approximately 80% of pharmacists use the Internet to obtain drug information.1 Wikipedia, often found at the top of Internet search results, is a free-access, collaborative, online encyclopedia that can be edited by anyone.2 Incidents of vandalism have occurred, since the site allows anyone to contribute. For example, an incident occurred in which a fake biography was created as a joke to implicate prominent writer and journalist John Seigenthaler for the assassination of John F Kennedy. It took about 4 months until the fake biography was detected and deleted by Wikipedia.3 Although Wikipedia does have an internal quality review, the ability of internal editors to find and correct erroneous information may not be timely. As reported by Clauson et al.,4 the information found on Wikipedia may not be complete and accurate, especially in regard to drug information. Published data regarding pharmacists’ use of Wikipedia to obtain drug information is lacking. Therefore, the objective of this study was to measure pharmacists’ use and perception of Wikipedia for obtaining drug information.” – This letter to the editor discusses the results of a questionnaire given to pharmacists regarding the use of Wikipedia for drug information. I was disturbed to read that 28% of respondents reported using Wikipedia for drug information. Strange that it doesn’t appear on any of my drug information resources lists, and never will. I expect better from pharmacists.

  • Dealing with the shortcomings of healthcare information systems

    This week has kept me busy dealing with issues surrounding our various clinical systems and how they fit, or don’t fit, into various processes. If you’ve been reading this blog then you are probably a little too familiar with one of the problems; the dreaded allergy issues which I’ve discussed here and here. The issue runs much deeper then I’m willing to go into here, but suffice it to say that it’s been a real pain in the rear. The other significant issue has to do with bar code medication administration and “things we can’t do” with our current system.

    Anyway, I’ve been in meeting after meeting this week listening to people argue over things that I consider outside of our control and basically spending a lot of time talking about what our systems can’t do. As you can imagine the discussions can become quite energetic. During one particularly heated discussion I asked a key player to forget about what we couldn’t change and asked them to focus on the issues that could be controlled. The end result was a general consensus that we could control and correct approximately 60% of the problem by working within the confines of the systems and deal with the remaining 40% through education and accountability. The arguing took 60 minutes, the ultimate solution took 15.

    Believe me, I am painfully aware of the shortcomings of our various clinical systems, but I really don’t see the need to dwell on things that are outside of my control; a lesson I learned from my wife. Oh sure, I get frustrated and vent every now and then, but the bottom line is that I have to work within the limitations of the systems put in front of me.  You see engineers do it all the time; focus on how to make it better not on what can’t be done. I think healthcare professionals could learn a lot from engineers. Just a thought.

  • Why my Firefox browser is more advanced than our hospital’s HIS

    frustration.cartoonEach day I roll into work ready for another exciting day of pharmacy technology. I’m usually bright-eyed and ready for a new challenge because I’ve spent the previous night scouring the web and reading about all the incredible technology being put into place all over the world; tablet pcs, electronic paper and ink, advanced nanoparticles, automated dispensing devices, mobile phones, advances in social networking, and so on ad infinitum. Then there are days like today when I have something land in my lap that just makes me shake my head and wonder if healthcare will ever catch up to the rest of the world.
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  • For those that need a reason to support CPOE and EMR implementation

    Pharmacists see hand written orders like the one below almost daily. The order has to be interpreted by a pharmacist, usually with a little hand waving and guessing (kind of like being a pharmacy Jedi), and entered on the patient’s medication profile before the nurse can access the medication from the automated dispensing cabinet and get it to the patient. Even though I’m used to looking at orders like this, there is simply no excuse for what you see below.

    There are two medications contained in the hand written orders below. I double-dog dare you to find them. It’s kind of like a “Where’s Waldo” puzzle. Leave your guesses in the comment section of this post. Good luck.

    .

    ugly_order

  • Wikipedia as a drug reference….bad idea.

    Medicine 2.0 Congress blogspot : “Readability of the Top 50 Prescribed Drugs in Wikipedia  – Devin explained that a sample of 50 most prescribed drug in United State were selected and the content related to those prescribed drugs in Wikipedia were indentified and saved as HTML files for evaluation. Each Wikipedia entry was analyzed independently by two investigators using Flesch-Kincaid Grade Level. A Health information readability analyzer was also used to integrate dimensions that other readability tools lacked such as : lexical, the most easy to read; semantic, the most difficult to read; cohesion and syntactic. Eventually, descriptive statistics was used to analyze the scores generated by these tools. Devin concluded by stating that the reading level of the 50 prescribed drug entries in Wikipedia are higher that the reading level of consumers. Therefore, there is a potential barrier of health and drug information for some Wikipedia users. To improve the Wikipedia, the vocabulary can be simplified; and in order to improve the consumers’ comprehension, the lexical and syntactic constructs need to be enhanced without compromising cohesion and structure.” – Similar to information provided by drug reps, Wikipedia is not a credible drug reference and should never be used as such. While interesting, Wikipedia may contain opinions and information presented in a biased manner. The fact that there is a study on the usability of drug information in Wikipedia is disturbing. When looking for drug information, healthcare professionals should always use credible references like Lexi-Comp, UpToDate, MD Consult, or something similar. If detailed information is needed, consult the primary literature. Consumers should consult their local pharmacist for credible drug information.

  • When does medication safety become counterproductive?

    Being a pharmacist I’m exposed to lots of procedural changes implemented in the name of patient safety. Tall man lettering, black box warnings, pop-up warnings for allergies, drug interactions, pregnancy indicators, lactation indicators, “high risk drugs lists”, shiny labels to identify sound-alike-look-alike-drugs (SALAD), separation of stock for similarly named medications, bar coding, double checking, triple checking, and so on and so forth ad infinitum. As the “IT Pharmacist” I get to see all these changes up close and personal because I’m often involved in their implementation in one way or another. Do we actually have any evidence to support using all these things?
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  • Visual aid for House Democrats’ health plan. Really?

    I’m a visual type of guy. I can frequently work something out on paper long before I can conceptualize it in my “mind’s eye”. That is until I saw the organizational chart of the House Democrats’ Health Plan (image below). Any questions?

    healthplan_dia

  • Is the Cleveland Clinic prejudice against the obese?

    This has nothing to do with pharmacy informatics or technology, but sometimes I run across something that is so ridiculous that I feel compelled to comment.
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