Jerry Fahrni

Tag: Pharmacy Informatics

  • Has interest in technology come and gone for pharmacsits?

    I spent some time yesterday talking with some good people over at Pharmacy OneSource about pharmacy technology, clinical decision support, data mining, and a whole bunch of other interesting items. During one point of a conversations the history of Pharmacy OneSource came up. Part of that history includes the merger of Pharmacy OneSource with HealthProLink (HPL) sometime in late 2005.

    The mention of HealthProLink (HPL) brought back fond memories of a time when pharmacy informatics was really starting to take off and I was infatuated with the Palm Pilot <insert flashback sequence here>. HPL was a set of software tools for collecting and quantifying pharmacist intervention data as well as ADR/ADE information. In addition, the application offered access to several clinical calculators and a fairly robust reporting system. I was part of the implementation team for HPL when I worked at Community Medical Centers – Fresno and used it daily for a couple of years.

    This was also a time when Palm Pilots were all the rage and every pharmacist I knew carried one in their lab coat pocket. The Palm OS was a stroke of genius because of its minimalistic approach to the user interface. Anyone could pick up a device using the Palm OS and figure out how to use it in a matter of minutes. They were a model of simplicity and functionality. In addition, several development environments were available for application development as well as several “readers” and database applications. This led to the development of hundreds of medical references, medical calculators, free and commercial peripheral brains and countless ways to track patients, labs, and medications available for devices running the Palm OS. It is the only time in my career as a pharmacist that the entire profession embraced a new technology and used it to their advantage. The literature was full of “studies” using handheld devices for documenting clinical interventions1-4, carrying individually created documents and “peripheral brains”5,6 performing pharmacokinetic calculations, accessing drug information and performing drug interaction checking.7-12 The entire handheld movement was quite impressive to watch.
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  • The digital peripheral brain

    The Palmdoc Chronicles:” I’ve had a Palm Pre for about 2 months now and I can declare that the device has seen tremendous improvement with firmware updates (pushed OTA) and a steadily increasing amount of useful applications in the Palm App Catalog and the unofficial Homebrew scene.

    How usable is it as an smartphone for doctors? Well I can say it pretty much does replace your old PalmOS device as it is. One of the cool features of the old Palm PDAs is the ability to keep snippets of information in the Memos (Notes) in various categories for instant recall. These notes may be protocols, clinical pearls or practically any bits of information which you want to look up while rounding for instance.

    WebOS’ builtin “post-it” type Memos is ok if you are keeping about 10-20 notes but pretty useless if you are talking about 300-500 notes or more. There are several solutions at hand which overcome this limitation.”

    The blog goes on to describe a few applications that can be used to create a peripheral brain out of the Palm Pre smartphone. One of these applications is the ever popular Evernote, which I use daily on my tablet PC as well as my Droid.

    The information presented at the Palmdoc Chronicles isn’t restricted to the Palm WebOS. The iPhone, Motorola DROID, RIM BlackBerry devices, and a host of other smartphones are capable of storing memos, notes, PDFs and numerous other forms of information documentation.

    The idea of using a PDA as a peripheral brain isn’t new. Felkey and Fox 1 were talking about it back in 2002 when the precursor to the Palm WebOS was popular among healthcare professionals. It’s interesting how the idea is as good today as it was nearly a decade ago.

    1. Felkey BG, Fox BI. PDA interface: Creating the Digital Peripheral Brain. Hosp Pharm. 2002; 37:1222-1224

  • 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.

  • “What’d I miss?” – Week of December 20th

    As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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  • 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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  • Cool Technology for Pharmacy

    Installing and using Citrix Receiver on your iPhone/iPod Touch

    While at ASHP Midyear a colleague and friend of mine, @pillguy, was able to pull up the pharmacy system at his hospital using Citrix on his iPhone. At that moment I was attacked by a green monster and nearly consumed with envy. I can not yet match this feat of superiority with my Droid, but I’m hopeful.
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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.

  • Requirements for a pharmacy informatics professional

    In a post from ASHP Midyear I mention that “pharmacists are highly educated clinicians that deserve to practice informatics at that same level. [They] should be the individual involved in making sure that systems are designed to include pharmacy workflow, that the reports being written provide the necessary information to be clinically relevant, that current clinical standards are adhered to during implementation of new systems, be the representative at the table during discussions of integration and interoperability of hospital systems, etc”

    A couple of things caught my eye since writing those words and I would like to share them with you here.
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  • Cool Technology for Pharmacy

    My Cool Technology for Pharmacy this week strays a little from my normal hardware and software approach and focuses on the concept of RxNorm. The reason for this deviation is simple; my ignorance of RxNorm was never more evident than during my time at ASHP Midyear this week. I don’t like it when I lack understanding of what people are talking about, and this happened on a couple of occasions during discussions involving RxNorm. This was especially true during a presentation by Dr. Usha Desiraju of First DataBank. Dr. Desiraju’s presentation focused on the use of RxNorm and interoperability.

    So I was forced to do a little reading. The entire idea seems simple enough, but like many good ideas implementation and acceptance is a little like trying to push the wrong end of two magnets together. In the simplest terms I can muster, think of RxNorm as a standardized language used to identify each unique medication across multiple systems.
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