New BCMA study

This BCMA study (link and abstract below) is very well done.  Unfortunately, it does not advance the notion that BCMA decreases medication errors, IMHO.  Here is my assessment, what is yours?

The key issue that goes unanswered here is the value of BCMA over an electronic MAR (eMAR).

The errors that may decrease with the use of an eMAR without BCMA needs to be considered when extolling the virtues of BCMA.  BCMA over the use of an eMAR is still of questionable value, from the results of this study.  The cost in time, materials and implementation of eMAR to BCMA is huge.  The benefit according to this study is negligible.

The pre-study was with paper MARs.  Then an eMAR with BCMA capabilities was implemented.  One of the largest benefits noted was a decrease in omitted dose errors.  I would suggest that using an eMAR alone would help with omitted doses. BCMA does nothing to prevent these types of errors.  An eMAR with the use of scheduling, work lists and reminders would presumably help decrease omitted dose errors. The study conclusions would be invalid if omitted dose errors where excluded in the targeted preventable ADEs calculation.   Therefore I conclude that the benefit of BCMA over eMAR in this study is zero.

 Effectiveness of a Barcode Medication Administration System in Reducing Preventable Adverse Drug Events in a Neonatal Intensive Care Unit: A Prospective Cohort Study.

 Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine; University of Iowa, the University of Iowa Hospitals and Clinics; University of Iowa Children's Hospital Iowa City, IA.

 OBJECTIVE: Patients are at risk of harm from medication errors. Barcode medication administration (BCMA) systems are recommended to mitigate preventable adverse drug events (ADEs). Our hypothesis was that a BCMA system would reduce preventable ADEs by 45% in a neonatal intensive care unit.

 STUDY DESIGN: We conducted a prospective, observational, cohort study of a BCMA system intervention in a neonatal intensive care unit. Participants were admitted neonates during 50 weeks. Medication errors and potential or preventable ADEs were detected by a daily structured audit of each subject's medical record, with assignment of an event as a preventable ADE made by blinded assessors. The generalized estimating equation method was used in modeling the targeted, preventable ADE rate with covariates.

 RESULTS: A total of 92 398 medication doses were administered to 958 subjects. The generalized estimating equation method yielded a relative risk of preventable ADE when the system was implemented of 0.53 (95% confidence limits 0.29 to 0.91, P = .04), adjusted for log(10)doses of medication/subject/day, a significant predictive covariate (P < .001), as well as for birth weight, sex, Caucasian race, birth cohort number, and nursing hours/subject/day.

 CONCLUSION: The BCMA system reduced the risk of targeted, preventable ADEs by 47%, controlling for the number of medication doses/subject/day, an important risk exposure.

 PMID: 18823912 [PubMed - as supplied by publisher] 

Health 2.0 Opportunities

Wondering what opportunities exist for pharmacy applications in a Health/Medicine/Web 2.0 world?

Reporter's notebook: Money woes don't slow Health 2.0

 

By: Rebecca Vesely / HITS staff writer

Posted: October 28, 2008 - 5:59 am EDT

No question about it. Health 2.0 is here to stay.

 This was plain to see at the second-annual Health 2.0 conference in San Francisco. The evidence wasn't necessarily in the presentations, but what people were doing during them. Gone were the flip-phones and cumbersome PDAs of last year. There even seemed to be fewer laptop computer users (despite a doubled attendance to about 1,000 people).

 Instead, conference-goers sat in darkened halls thumbing on their iPhones and slimmer-than-ever BlackBerrys.

 In healthcare, there's much talk about the medical home. But what if the medical home is in the palm of your hand?

 “We're just at the beginning of mobile healthcare,” said Alan Greene, a pediatrician and chief of future health of Atlanta-based ADAM, a company developing consumer health applications for Google Health and the iPhone, among other platforms. “Which means we are just at the beginning of patient-centered medicine—to do it where they are.”

 The Health 2.0 conference, held at the Marriott in downtown San Francisco on Oct. 22 and 23, drew lots of technology startups and venture capitalists, a few health plans and even fewer providers and employers.

 Engaging consumers and getting them to trust the technology were key themes at the confab.    

John Poikonen, Pharm.D. | Director of Clinical Informatics| UMass Memorial Medical Center |508-334-1159 | 978-501-4887 (cell) | john.poikonen@umassmemorial.org

CMS ePrescribing Conference

If you would have told me there would be ~1,500 people gathering from around the country on ePrescribing with multiple Governors, a Senator and CMS officials only 2,3, or 4 years ago, I would have said you where nuts. 

The media coverage is below, here is my spin.  First with all of the vendors, people and press it was a very energizing place.   Our Governor Deval Patrick gave some prepared opening remarks that seemed kind of canned.  The Governor of the Island of Rhode, Donald Carcieri followed.  He was much more conversational; rarely referring to notes and seemed to me have more ‘skin in the game’.  Someone must have slipped him a note “Senator Kerry is not coming (death in the Bidden family), talk for as long as you possibly can”.  He did.  Most speakers (and questioners) wandered off to more grandeur themes and topics.  Some highlights:

• Massachusetts is the “caddle for eHealth Reform” as the #1 ePrescribing state in the country. 
• 4 million or 14% of total prescriptions are electronic.
• We have also secured a Medicaid wavier to continue our health insurance mandate.  
• Given that Deval and Barrack are buddies this may be the national template sooner not later.
• Rhode Island has been flip flopping with the Commonwealth on being #1 for the last few years.  But hey they only 30 miles X 40 miles of territory to deal with.
• Over the last 3 months 20% of the Rxs are eRx’s and should be #1 next year.
• The Social Security problem is easy.  It is actuarial.  Politically  it is a bitch, but the solution is quite easy.
• Healthcare reform and payment is very, very difficult.
• HIT is key (you all understand this)
• RI has a cool public-private health information exchange in the works.
• Kevin Marvin, Pharmacy Informatics Guru, slips me a note on his solution to world peace or at least drug cost savings:
• Eliminate Medicaid Rebates
• Eliminate Direct to Consumer adds
• Adopt RxNorm as a standard (it was some other more articulate statement, but that is what I interrupted and remember)
• Secretary Levitt of HHS has a very good story about the demise of Argentina and the potential road to ruin we are on.  My take away:  do not let the RPh license lapse, it might get really ugly on a economic scale.   On a positive not the connection with cell phone and Airlines was upbeat.
• Way to deal with Change
• Fight it
• Accept  it
• Lead it

 

• Session Highlights  (see Slide Links below)
• CMS has all Plan formularies in a codified manner for a nominal fee per Tracey McCutcheon, Deputy Director of Medicare Drug Benefit and C&D Data Group, Center for Drug and Health Plan Choice.

 

Press coverage

Boston Herald ..

Local NPR (WBUR) ..

Government Health IT ..

Healthcare IT News ..

Local TV Coverage ..

 

Map of States and ePrescribing rates <http://www.surescripts.com/images/2008_map_nation.jpg>

 

Slide of all sessions!

http://www.e-prescribeconference.com

 

 

RxNorm and Routed Generics

The concept of a routed generic as the atomic level of a medication in EHRs, PHRs, CPOE and ACPOE systems is popular.  It is becoming a larger issue with Med Rec.  For example, I know I take oral fish oil, but I can never remember the exact strength.  So identification of the drug (and route) is common for people to state.

One of the problems with RxNorm is that there is not explict support for this concept.

• Do we need to ask the NLM for more support for this concept?
  
• Is there an easy SQL fix to this issue in the data structure?
  

Any input is appreciated.