“What’d I miss?” – Week of October 25th

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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Using technology to advance pharmacy practice through education

funny_tech_cartoonI found an interesting article in the October issue of the American Journal of Health-System Pharmacy. The article, titled Informatics in clinical instruction (Am J Health Syst Pharm. 2009 Oct 1;66(19):1694, 1699), gives a description of a software system designed by the authors that “allows students at one site to receive online and teleconference instruction from preceptors at multiple sites through remote, interactive discussion. It also allows “blogging” based on assigned videotapes, simulation modules, live patient cases, discussion questions, and primary literature review. In addition, the system facilitates clinical encounter documentation, including interviewing patients, taking physical assessments (e.g., blood pressure), taking medication histories, assessing for adverse effects (e.g., abnormal involuntary movements), and addressing potential or actual medication-related problems(MRPs).”
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Using a “micro shuttle” to control drug delivery

microshuttle_in_cellQueen Mary University of London: “The capsules, which have a diameter of two micrometers (about the size of a bacterium), are built by wrapping strands of a metabolism-resistant material around spherical particles, which are then dissolved in acid, leaving behind an empty container. To fill the capsules, the scientists heat them in a solution that contains the desired drug compound. This makes them shrink and traps some of the solution and compound inside. The loaded capsules are introduced into live cells by a technique known as electroporation – a tiny electric shock – which makes the cell walls permeable for micrometer-sized particles. The cells are unharmed by this treatment and retain the capsules.” – The article refers to the capsules as “micro shuttles” and states that the release of medication could also be controlled “by a biological trigger like a drop in blood sugar levels, or activated manually with a pulse of light.” – I worked on something similar as an undergrad. We applied various currents to polyaniline, forcing the polymer to take up and hold certain molecules. Reversing the current resulted in the polyaniline dropping the substance. Crazy technology! It makes me want to get into R&D.

View on technology-enabled practice from ASHP

The September issue of the American Journal of Health-System Pharmacy contains a vision statement written by the ASHP Section of Pharmacy Informatics and Technology. The statement represents their thoughts on the current state of pharmacy practice and contains a healthy dose of ideas on how technology can help support and improve pharmacy practice.
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Hi-Tech patch for migraine relief

ZelrixZelrix is a transdermal patch containing sumatriptan for the treatment of acute migraine headache developed by NuPathe, a pharmaceutical company specializing in the treatment of neurological and psychiatric disorders. The patch is based on NuPathe’s proprietary SmartRelief™ platform, which according to the manufacturer’s website is “a non-invasive technology that utilizes low-level electrical energy to transport drugs through the skin in a safe and effective manner. The rate and amount of drug delivered is controlled electronically, so that the patient receives consistent therapy each and every time. Iontophoresis is an established drug delivery technology with multiple applications currently being used by physicians.” The SmartRelief™ iontophoresis utilizes pre-programmed, embedded electronics in the patch to provide consistent therapeutic drug levels. This is very interesting technology with many potential applications. Imagine the uses in professional sports where iontophoresis is frequently utilized to administer NSAIDS and corticosteroids for the treatment of inflammation

IT departments may be stuck without enough help to go hi-tech

This from the July 2009 issue of Hospitals & Health Networks: “Experts worry that hospitals may not have the resources to keep up. As if it already weren’t tough enough to find and retain quality health information technology professionals, the recent passage of the Health Information Technology for Economic and Clinical Health Act as part of the Obama administration’s broader economic stimulus package may only make the task more difficult. “We had a shortage of talent before this stimulus was initiated,” says Timothy R. Zoph, chief information officer at Northwestern Memorial Hospital in Chicago. “This will exacerbate the problem.”” – I’ve mentioned before that I think healthcare IT is headed for a rude awakening with all the new technology beginning to trickle our way. Demands placed on IT departments to develop solutions for BCMA, CPOE, cloud computing, increased security and a host of other computer based advancements will eventually lead to system failure secondary to limited resources. When you bring a new system online, the work isn’t necessarily finished. Continued development and maintenance are ongoing processes that require dedicated resources. If IT departments aren’t adding additional resources to manage these new systems then you have to ask yourself if everyone was sitting around watching videos on YouTube before the new systems came on line, or are resources going to be stretched paper thin after implementation. If the answer is the latter, then you’re in trouble. With the steep learning curve in healthcare informatics, in part due to legacy systems, I think it’s time to take a good, hard look at outsourcing. Just my two cents.

Mac tablet coming soon?

9to5mac.com: “The translations are a little sketchy but the ChinaTimes is basically saying that in October, Apple will launch a $800, 10-inch tablet.   Most of this information has been published before so it isn’t certain whether or not this is a rehash of that information or from new sources.  The biggest question at this point is which OSX will it run?  Will it be the Mac OS, the iPhone OS or some hybrid?  The iPod launches are usually in September so a iPod platform device would indicate some deviation.  Also, Apple’s tablet patents seem to indicate that they are working on a full MacOS tablet.” – I really hope this is accurate, especially if the Mac tablet runs on the iPhone OS. Unfortunately the Mac tablet rumor has been floating around for years and has yet to materialize into something tangible. Those of you that know me understand my infatuation with tablet computers. The tablet platform is the perfect combination of desktop power and mobile utility. Pharmacy has yet to unlock the power of tablet computers in the clinical setting, but I believe that will change in the near future. I push my tablet agenda every chance I get.

Beyond patient safety with technology and automation

I had reason to do some thinking about healthcare automation over the weekend, and after much thought decided that healthcare, specifically pharmacy, was a little strange in several ways. As an industry, healthcare rarely looks beyond patient safety when talking about technology and automation. Let’s face it, patient safety is the rally cry for any department in need of a jumpstart to complete a project that has stalled for one reason or another. Unfortunately the investment of time, energy and capital resources typically stops immediately after implementation secondary to meeting the patient safety goal. However, this model seldom allows for technology and automation to be taken to the next logical step.
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Technology + Medical Home = Pharmacist Opportunity


“Pharmacists certainly have the skills, training, and knowledge to be prime players in a coordinated approach,” said Judy Cahill, executive director of the Academy of Managed Care Pharmacy. “An inherent shortcoming to this idea, however, is lack of pharmacist access to patients’ medical records. For them to play a pivotal part in care management, the medical record is essential.”

Keckley agrees. Lack of pharmacist access to patient medical records currently limits the role of pharmacist to medication management only, rather than offering an opportunity to manage care between patients and providers, such as nutritionists and physical therapists, he saids.

Two developments can change that: the increasing use of electronic medical records and the industry-wide promotion of electronic prescription transmission. EMRs will allow pharmacists access to diagnostic rationales and long-range patient treatment histories. For example, an EMR can give pharmacists access to laboratory data. HIPAA privacy concerns may have to be addressed through authorization forms, and state boards of pharmacy may have to reexamine current regulatory practices.

But these concerns are already being addressed through medication therapy medication initiatives across the country — many sponsored by health plans that see a cost advantage in having pharmacists counsel patients. E-prescribing not only gives pharmacists access to insurance information — data available through pharmacy benefit management software — it also enhances communication with physicians.

Several emerging e-prescribing models, sponsored by health plans, include e-prescribing as a component of EMRs. “Bring into that the use of clinical management tools, which are the tools that DM companies now market, and pharmacists will be able to offer a degree of coordination, especially for patients with chronic diseases, that no other provider, including physicians, are as readily able to provide,” said Keckley. “Plans could consider paying for that service.”

This is a prime example of how technology can be used to expand the pharmacist’s role in patient care.

Get more information about a medical home here.