RxInformatics.com

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.

This week's Cool Technology for Pharmacy is the OnDemand 400 for RxMap from MTS, a company that specializes in adherence packaging systems.

According to the MTS website:

OnDemand ® 400 for RxMap ® is the first pharmacy automation equipment system designed specifically for multi-med adherence packaging.

This efficient system uses OnDemand technology to dispense multiple medications for a single patient quickly and accurately and in a fraction of the time it would take to do it manually. This pharmacy automation equipment system utilizes a custom interface to work with your existing information systems, enabling automated workflow management in the pharmacy. This single data input process reduces input time and the possibility of data entry errors. OnDemand ® 400 for RxMap ® uses bar-code technology to accurately dispense multiple medications into one compartment - as many or as few as needed. RxMap ® Adherence Packs vary in size and shape to meet the needs of the customers you serve. The finished product is a patient - specific adherence package filled “just-in-time” for your customer.

The most recent issue of Hospital Pharmacy (Vol 45, No 1, 2010) has an article by Fox and Felkey that discusses the demand that the ARRA will place on the current and future HIT workforce. According to the article “the workforce to shepherd implementation, training, and support [for the modernization of heath care delivery] simply does not exist today; consequently, we could face a situation where health systems and clinics are financially ready to adopt HIT but do not have the personnel to carry it out.” I believe this is absolutely true and have alluded to it in the past (here and here).

More importantly, the shortage of HIT personnel will be further exacerbated by the need for clinicians to enter the technology field. The article supports this thinking by saying that “some experts have suggested that clinically-trained individuals are more suited to the design, selection, implementation, and management of HIT because they have a fundamental understanding of the processes of health care delivery. Alternatively, individuals trained in IT are more technically inclined, but lack firsthand experience with health care delivery systems” Another truism and a problem that is certainly not unique to the HIT field. Companies like Microsoft, Google, GE, Siemens, etc hire pharmacists and other clinician for their unique experience in the health care industry.

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 interventions^1-4, 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.

PROmanager-Rx is an automated system from McKesson designed for dispensing unit-dosed oral solids. PROmanager-Rx has a 12,000-dose capacity and uses a conveyor system and bar-code scanner to fill orders generated through the pharmacy information system.

The system automates storage, dispensing, restocking, and various inventory management functions via the McKesson Connect-Rx software platform. And of course the system interfaces with McKesson’s pharmaceutical distribution system.

According to the McKesson product brochure:

The PROmanager-Rx™ system helps hospital pharmacies get the most out of manufacturer packaged oral solid medications. And relieves the burden of medication packaging.

It’s the only fully automated system that directly stores and dispenses pre-packaged oral solids. PROmanager-Rx is ideal for patient-centric filling. Bar-code-driven robotics scan every dose for the greatest possible safety and accuracy.

Pharmacists are freed from packaging and dispensing activities so they can play more integral roles on the clinical care team. Bar-code scanning also simplifies tasks such as managing returns, expired meds, and overall inventory.

Forni A, Chu HT. Technology Utilization to Prevent Medication Errors. Curr Drug Saf. 2009 Oct 7 [ePub]

This is a nice review article explores current technologies available to healthcare and what role they play in the reduction of medication errors. The article provides a short review of literature to support each technology reviewed. Technologies covered include: Computerized Physician Order Entry (CPOE), Clinical Decision Support Systems (CDSS), Patient Monitoring: Electronic Surveillance, Reminders, and Alerts, Telemedicine, Bar Code Medication Verification (BMV), a.k.a. Bar Code Medication Administration (BCMA), Smart Infusion Pumps, and electronic medication administration record (eMAR).

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).”