RxInformatics.com

GottaBeMobile.com: Motion Computing is introducing a two peripherals and some software that should help tablet users that work in the healthcare industry. The motion folks are exhibiting their wares at the Healthcare Information and Management Systems Society Conference in Atlanta." - The peripherals being referred to are ReadyDock (PDF) for the C5 and F5 Tablet PCs and a new RAM Mount with integrated lock. 

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.

In a previous post I mused about using an automated packaging system like InSite from Talyst as a type of automated dispensing cabinet for acute care patients. InSite was designed for long-term care and would simply be too large for the needs of an acute care nursing unit, but the technology is ideal.

However, the ATP-71 (PDF) from Swisslog is a bulk packager that can hold up to 71 canisters in a relatively small footprint: 31.5 inches wide x 29.6 inches deep x 30.6 inches high. For comparison, a Pyxis MedStation 4000 2-drawer main unit is 22.8 inches wide x 26.7 inches deep x 27.7 inches high. I would say that makes the two units comparable in terms of size, and I can tell you from personal experience that a 2-drawer main isn’t very big up close.

According to Swisslog: “Swisslog’s high-speed packaging and barcoding solutions are not only fast and efcient, they provide many levels of patient safety. Color coded fll-to-light trays, locking canisters, and accurate labeling with barcode capabilities enable pharmacies in any size hospital to make patient safety the highest priority. Many additional accessories and interfacing capabilities complement the packager and provide gains in workfow effciency.”

VentureBeat: "Recognizr uses FaceLib, a mobile face recognition library from Polar Rose, which is available for Android and iPhone. FaceLib can recognize faces in photo or video but, in common with other facial recognition products, is more accurate for photos. Recognizr also uses Polar Rose’s server-side solution FaceCloud because you can’t store profiles of all potential matches in the phone — although recognizing people who are already in the phone’s address book can be handled locally on the device."

The application from Polar Rose combined with the interface from TAT (The Astonishing Tribe) pulls up information associated with the recognized faze from places like Facebook, YouTube and LinkedIn.

There was a time when I thought all a pharmacist needed to do his job was a pen and a calculator. It was just so cumbersome to carry anything else. If you wanted to have mobile drug information it meant carrying a drug reference book with you everywhere. Who can forget being in pharmacy school where every self respecting pharmacy student had a Drug Information Handbook stuffed in their lab coat pocket along with all the other stuff they carried like a homemade peripheral brain scribbled on the pages of a notebook or on those neat little 3x5 cards.

Looking for patient information wasn’t any less cumbersome. If you needed to read a patient’s history and physical, you went to the chart. If you wanted to look at lab results you had to wait for the lab, or the unit secretary, to print them out and attach them to the chart. If you wanted to see what time a medication was administered, you had to look in the medication administration record, i.e. the MAR. Data was scattered all over the place. Of course, no one thought it a problem because that was the most advanced system available at the time.
Healthcare technology has come a long way, and as pharmacists most of the information we need is much easier to find. Yet here we are still trying to figure out a way to create a unified patient health record that can be used by healthcare professionals not only across the street, but across the continent or world.

CMIO: “In the past, major barriers to EHR adoption included high upfront costs and lack of IT resources to implement and maintain the technology,” the report stated. “A SaaS model solves both of these issues and Ovum believes it is the best approach for physician offices and small hospitals. With a predictable, monthly expense, a subscription-based SaaS EHR is a much easier cost for providers to swallow." Speech recognition tools have helped increase EHR adoption among clinicians by increasing the accuracy of the patient health record—providers don’t need to make as many corrections. Speech recognition should feed directly into the PHR without the lag time of transcription, according to the report.” – It makes sense that Software-as-a-Service (SaaS) and speech recognition could be used to increase EHR adoption rates. Together they offer several potential benefits as well as creating a better user experience. In fact, I'm a fan of both and have blogged about how I think they could be used in pharmacy; here and here. However, in regards to speech recognition, an educational session at the 95th Annual Meeting of the Radiological Society of North America (RSNA) reports that “a study by Zoltani and colleagues conducted at their facility found that 68 percent of more than 17,000 finalized reports contained errors, 15 percent of which could potentially change the meaning of the report. A radiologist's experience, sex and caseload were not associated with significant differences in error rates.”

Unless you’ve been comatose for a while, you’ve certainly heard about the Apple iPad. The device has already been crowned the de facto device for everything from e-reading to creating a new wave in healthcare unlike anything we’ve ever seen. Of course this is all speculation as the device hasn’t been officially released yet.

Many people have speculated that the iPad will be a great device for healthcare. Whether or not that will be the case remains to be seen. One thing is for certain: everyone is banking on the iPad being a big hit in healthcare. Based on the success of the iPhone as a favorite among physicians and nurses, this certainly isn’t a wild prediction. Will this success translate to the pharmacy? Good question.

The DoseEdge Pharmacy Workflow Manager, formerly IntelliFlowRx Workload Management Software by Baxa, is a system designed to track and manage intravenous (IV) medication dosages prepared by pharmacy personnel in a clean room environment. The system is touted as “The world’s first and only fully integrated workflow manager for the IV room.”

The system is designed to flow something like this:

- IV medication orders entered by the pharmacist, or other healthcare professional, are sent to the DoseEdge system where they appear on the DoseEdge touchscreen.
- When the technician, or pharmacist in some cases, accesses the order via the touchscreen instructions for preparation of the product are displayed.
- The product label is generated.
- The barcode on each injectable ingredient used for the preparation of the IV product is scanned to ensure the correct medications have been selected. Items identified as incorrect result in an audible message of “product not allowed for this dose.”
- The barcode on the IV product label generated by the pharmacy is scanned to ensure that ingredients are appropriately matched.
- Each ingredient is drawn into a syringe.
- An image of the syringe with appropriately drawn medication is taken for review by the pharmacist, or technician, whichever the case may be. This is a nice feature as it allows one to see the actual amount of drug drawn into the syringe prior to shooting it into the fluid bag.
- Ingredients are injected into the fluid bag and an image of the final product is taken.
- A final scan of the product barcode is done to complete the fill.

Part of the process of implementing barcode medication administration (BCMA) is evaluating hardware; mostly scanners. There are several makers of barcode scanners including Honeywell, Symbol, Metrologic, Datalogic and Code Corp. Having so many choices always makes the selection process interesting.

One suggestion from several hospitals I spoke with that were already live with BCMA, was to use the same barcode scanner on the nursing floors that were used in the pharmacy. That sounds logical, right? Sure, if the barcode scans correctly in the pharmacy, then nursing should be able to scan the same barcode using the same scanner.

The scanner of choice in our pharmacy department is the the Code Reader 3500 from Code Corp. So of course this is the scanner I recommended in my report to the BCMA hardware sub-committee. For whatever reason, the committee decided to go with a different brand of scanner. Unfortunately the scanners we purchased won’t scan some of the more complex barcodes coming out of pharmacy, making them virtually useless. The scanners purchased by the hospital are on their way back to the wholesaler as I patiently await for round two.

Take away lesson: use the same barcode scanner for the nursing units that the pharmacy department uses to meet their barcoding needs.

Over the weekend I spent a little time looking at trends in pharmacy and technology. As expected the healthcare technology market is expanding rapidly and this expansion is creating a need for pharmacists with technology know-how. To prove my point I created a job trends graph from indeed.com using the following search criteria: "pharmacy informatics", "clinical pharmacist" and "director of pharmacy". As expected the search trends for "clinical pharmacist" and "director of pharmacy" are relatively flat, but the trend line for "pharmacy informatics" is striking. It looks like a new pharmacy career path is born.

Our facility is running a trial of DynaMed, “an evidence based medicine point-of-care” database. It reminds me of UpToDate.

From the DynaMed site:

• According to the National Academy Press (2001) 44-98,000 American deaths per year occur due to preventable medical errors; medical errors are estimated to cost the U.S. $17 to $29 billion annually
• Using the "best available evidence" for clinical decision-making improves health outcomes and reduces health care costs
• Busy clinicians use "fast and easy" resources expected to answer most of their questions instead of resources designed to provide the best current evidence
• Clinicians sometimes turn to textbooks and online resources with substantial breadth, but these resources do not use the best available evidence
• Physicians and other health care professionals need a resource where they can reliably answer most questions quickly and accurately (i.e., with the best available evidence)

The application is web-based and easy to use. I only played around with it for about 30 minutes, but was satisfied with what I saw. DynaMed has a nice list of clinical calculators and supports the use of handhelds, including the iPhone, iPod Touch and Android based devices.

I'll spend some more time evaluating DynaMed next week, but at this time I prefer UpToDate over DynaMed for the following reasons:

1) UpToDate appears to, on the surface at least, contain more in-depth information on any given condition

1) UpToDate use Lexi-Comp for their drug information

2) UpToDate has a nicer user interface

One of the best pharmacy jobs I ever had was working for a small compounding pharmacy in the Bay Area of California. Many of the prescription items compounded in this particular pharmacy had to be flavored based on the needs of the patient; sometimes animal, sometimes human. Regardless, the art of flavoring was always a challenge but also a lot of fun. I learned quite a bit about how to mask bitterness, how to use various sweeteners to get the flavor just right and how to use various flavor combinations to create some pretty tasty medications; it's an art. And don't underestimate the amount of science that goes into creating flavors like these or the science behind using those flavors to mask unpleasant tastes. It takes time, energy and patience.

FLAVORx, a company in Columbia, MD has taken a lot of the experimentation out of the flavoring equation by creating a system for dealing with “yucky medicine”.

Software as a service (SaaS) has recently been popping up in healthcare related news, from Fujitsu's SaaS solution for drug trials to the host of web-based applications from Pharmacy OnceSource.

SaaS is different than the traditional enterprise software model because the provider of the software licenses it to the customer as an on-demand service. The vendor often times hosts the software on their own servers where data is manipulated and returned to the customer for viewing. It's kind of like renting software.

The beauty of SaaS applications like those from Pharmacy OneSource are that they can be viewed from any device with a web-enabled browser; Mac, PC, smartphone, etc. In addition, the application is owned, delivered, maintained and managed by the provider, limiting the burden on the customer. A by-product of this model is that delivery of the application over the web ensures that the software is always up to date.

The SaaS model appears to be popular in the “business” world at present, but is increasing in popularity in healthcare secondary to its simplified deployment and reduced cost. With advances in cloud computing strategy, better data storage models and faster internet connections I think it's only a matter of time before we start to see more SaaS solutions in pharmacy practice. And why shouldn't we? By their very nature SaaS applications lend themselves to use on mobile devices like the tablet PC and iPad, which in turn offers greater flexibility for pharmacists practicing at the bedside. Just a thought.

The National Library of Medicine has a website know as Pillbox beta that allows anyone to use various identifiers on a tablet or capsule, i.e. imprint, shape, color, size and/or scoring, to quickly identify a medication. I've used systems like this many times for the emergency department when a patient would roll in the door with ten different medications all thrown together in a plastic baggie. The nurse would bring them to the pharmacy and say “I need you to tell me what these are”. I tried holding the baggie to my head like the Great Carnac on Carson, but most of the time I had to use other references to help me out.