Show Notes:
Host: Jerry Fahrni
PillPick by Swisslog1
BoxPicker by Swisslog1
RIVA by ARxIUM (formerly Intelligent Hospital Systems)
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1. Make sure to check out the videos for both PillPick and BoxPicker at the Swisslog website.
Tag: Pharmacy Technology
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More thoughts on the ASHP national survey results for informatics and pharmacy practice
On Monday I spoke briefly about two articles in AJHP that summarize two recent ASHP surveys. The first covers Pharmaccy Informatics in U.S. Hospitals(1), while the second focuses on pharmacy practice in acute care hospitals(2).
Both surveys contain a wealth of information, and provide a snapshot of what pharmacies in the U.S. are doing. While conducted at different times by different groups, I think it’s more interesting to look at the two surveys together. As I mentioned in my podcast, the adoption of automation and technology goes hand in hand with pharmacy operations. You can no longer have one without the other.
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Cool Pharmacy Technology – Kiro Oncology System
I’ve recently had conversations with several companies outside the U.S. developing robotic technology for the i.v. room. One of those systems is the Kiro Oncology System. Check the video below.
A couple of things worth noting:
- The system uses dual robotic arms during the compounding process. This is something that is important for the next generation of i.v. room robots. The current crop of i.v. room robots here in the U.S. use a single arm. Think about the inefficiency of one-armed sterile compounding.
- The Kiro Oncology System is self-cleaning. This is a concept that appears to be more popular “in Europe†than it is here in the U.S. Kiro Oncology isn’t the first overseas group I’ve dealt with that is pushing the idea of self-cleaning. None of the U.S. vendors have ever mentioned it.
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Automated intravenous fluid monitoring at the bedside
Over the years I’ve had a lot of ideas, some good and some not. When an idea comes to me, I typically record it in a notebook that I have sitting on my desk. Occasionally I return to the notebook and review the ideas to see how many of the ideas still have merit. Sometimes an idea has become outdated, and rarely an idea will have materialized as a product of similar design built by a company. And then there’s a group of ideas and concepts that still hold value but haven’t been seen in the market.
Today I was rummaging through some of my old ideas. One of them from 2010 caught my attention. In 2010 I thought it would be cool if someone could use technology to analyze the IV fluid being administered to a patient in real-time. Basically, such a system would prevent the wrong IV medication from being hung on a patient, thus preventing a medication error.
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Cleanroom technology for pharmacy – DRUGCAM
DRUGCAM is an interesting piece of pharmacy cleanroom technology. On one hand it falls into the semi-automated systems category because the person using it has to manually manipulate all the components of the sterile compound they’re making. In other words, it’s not a robot. On the other hand DRUGCAM uses some interesting technology and software to automate some of the steps in the process.
DRUGCAM uses multiple cameras(1) to automatically detect the items being used during the compounding process. As the user passes components in front of the cameras, the system automatically identifies them. No bar code scanning required. That’s probably a good thing outside the U.S. as I’ve learned that not all countries require manufacturers to place a bar code on their drug containers. If the system doesn’t recognize the item, the user is notified via visual cues on the screen.
DRUGCAM uses the same technology to automatically detect the volume of fluid pulled into syringes, and also detect when the same syringe is empty following addition of the contents to the final container. I’m not sure how the system determines the correct syringe position, but it’s pretty interesting.
One other thing that makes DRUGCAM unique is that it takes video of the entire compounding process. I’ve mentioned this idea to several vendors over the past few years, but no one really seemed interested in the idea of using video.(2) I think it offers potential advantages over still photos. For one, if something looks weird you can always move forward or back in the compounding process to see what went wrong.
Check the video below. It shows DRUGCAM being used in a glovebox.
DRUGCAM is not currently available in the U.S. If you’d like more information just follow the link to the DRUGCAM website.
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(1) When I saw DRUGCAM at the ASHP Summer Meeting back in June 2013 the engineer told me that the system utilized two cameras, but I can’t find that information on the product website.
(2) Everyone I’ve talk with was concerned about the storage requirements for the video. My brother works for a company that designs security cameras, software, etc. Those companies have been dealing with high-definition video storage for years. -
Applications to assist with Antimicrobial Stewardship
A couple of days ago I wrote about The California Antimicrobial Stewardship Program Initiative, and how it’s an opportunity for pharmacists to get out and stretch their clinical legs.
Antimicrobial stewardship requires a lot of real-time surveillance and monitoring of patients, labs and cultures, medication use, and so on. There are basically two ways to accomplish this. One is tedious and inefficient, while the other is smart and efficient.
The tedious, inefficient method is the one used by many healthcare facilities. Pharmacies in these facilities simply throw pharmacists at the problem by having them look at a bunch of patients manually every day in search of anomalies. It’s very time consuming. It’s like looking for a crooked needle in a needle stack.
The smart, efficient method involves the use of clinical decision support systems. These systems are connected to several data feeds from other systems throughout the hospital, such as ADT, pharmacy, lab, and so on. The data is aggregated and analyzed against a set of rules designed to find patients with potential problems. These patients are tagged and referred to a pharmacist for follow up, i.e. the pharmacists are only presented with the crooked needles. It’s a much better way to go about things.
There are several systems on the market designed to perform real-time surveillance and clinical decision support. The list below includes many, but is certainly not exhaustive.
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Cool Pharmacy Technology – Intelliguard RFID Solutions from MEPS Real-Time
Last week I spent some time down south in San Diego visiting a couple of hospitals and speaking with the good folks at MEPS Real-Time. My objective for the visit was twofold: 1) see MEPS RFID Solutions in a live environment, and 2) speak with the people at MEPS and get an inside look at their technology. I was able to accomplish both goals.
MEPS Real-Time is a company that specializes in providing RFID solutions for healthcare specifically targeted at acute care pharmacies. Their Intelliguard® RFID Solutions product line currently includes a Kit and Tray Management System, Controlled Temperature Cabinets, and a Vendor Management Inventory (VMI) System.
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#ASHP Midyear final thoughts
I concluded my time at ASHP Midyear in Anaheim on Tuesday evening. Here are my parting thoughts.
- The show felt more lively this year than the past couple. It’s hard to explain, but it felt like people were interested in everything around them; a good sign.
- There was an infusion of new products in the exhibit hall. The “normal†stuff was there, but it is clear that the vendors are once again ramping up. The introduction of meaningful use several years ago put a stranglehold on pharmacy budgets and projects. Everyone put all their eggs in one basket, i.e. all resources redirected to a single goal. During that time hospital pharmacies entered a black hole in regards to the implementation of new technology. It appears that equilibrium has been restored.
- The “Pharmacy of the Future†Pavilion was anything but the pharmacy of the future. It was nothing more than a giant advertisement for the vendors. Nothing stood out as futuristic.
- There was virtually no discussion/exhibits for track and trace. Given the state of H.R. 3204, the Drug Quality and Security Act (DQSA), this is going to be a big deal over the next several years. I expected to see more. Then again, the exhibitors have to reserve their booths a year in advance. Hard to plan around that.
- Didn’t see much to do with Telepharmacy. In fact, I can only think of a single exhibit and that was an outpatient system.
- The acquisition of CareFusion by BD is interesting for several reasons, but I wonder how the two companies will handle their i.v. workflow management systems. CareFusion has PyxisPrep and BD has BD Cato. Given the limitations of PyxisPrep in its current state it would be hard for me to imagine them not going with BD Cato as their flagship system in the i.v. room. Only time will tell.
- The acquisition of CareFusion wasn’t the only big move that BD made this year. Apparently BD has partnered with Aethon for medication tracking outside the pharmacy.
- Envision’s exit from the i.v. workflow management space should be interesting. With their intellectual property for image capture/remote verification going to BD, I wonder what will become of the rest of the product, i.e. the software. The product had a solid foundation and some nice functionality. Hmm, gives me a couple of ideas.
- APOTECA was conspicuously absent from the exhibitor floor. I found that odd considering that they are one of only two manufacturers of hazardous compounding robots in the U.S. The company also introduced a semi-automated i.v. workflow management system, APOTECAps earlier this year. I fully expected to see the products on display at ASHP Midyear. Not the case.
- Omnicell entered into an agreement with Baxter to both sell and integrate with DoseEdge. This should allow Omnicell to track CSPs prepared with DoseEdge throughout their suite of products. Everyone is scrambling to get into the i.v. room.
- As mentioned previously, Closed System Transfer Devices (CSTDs) seemed to be popular among the exhibitors. At least three separate companies – EQUASHIELD, BD, ICU Medical – were showing off their products. I’m not surprised with USP <800> looming in the not too distant future.
- RFID seems to finally be picking up some steam in pharmacy practice. Several companies were displaying RFID solutions. Several others announced partnerships with those same companies. The most popular areas for RFID appear to be refrigerated inventory management, anesthesia, and medication trays/carts.
