Vote for the Top Ten Articles of 2008

Please vote for the top Pharmacoinformatic articles of the year here. This completely subjective and unscientific poll of the Work group leadership will then be posted to the list servs.

Thanks for your participation.
-jp

Pharmacists Role in Health 2.0?

Dr. David Kibbe's "Great American Health 2.0 Motorcycle Tour", is very interesting. The senior health IT advisor for the American Academy of Family Physicians travels the country talking to people at TelaDoc, American Well, PatientsLikeMe, change:healthcare, Google Health, Healthline, MedHelp, Kosmix, New York Times columnist Tara Parker-Pope, Hello Health and a Tennessee MinuteClinic.

What I kept on thinking about is the role of the pharmacist in this context. Not sure I have any insight, do you?

Thanks to Neil Versel's excellent Healthcare IT Blog for posting this.

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Canary in the Coal Mine?

PC Magazine will publish their last print edition in January 2009. Even though I now read most things online, PC Magazine was alway fun to get in the mail and devour. Some print editions are just more enjoyable to read than online editions. PC Mag was one, NEJM for some reason is another. AJHP and JAMIA for unknown reasons to me just are not. I prefer to read those on line or read the individual PDFs.

So while I morn the death of PC Magazine print edition, I wonder if this is the canary in the coal mine for print journals in general and specifically AJHP and JAMIA?

At the ASHP House of Delegates I introduced an amendment to urge AJHP have an option for online edition only. Even if it is a small percentage that choose the option, it would decrease production and prevent a ton of waste. I recently cleaned my home office, it was incredible how much AJHP made up the dump run. After some debate, the motion passed with a wide majority.

What some some people "in the know" discussed with me (off line) was that AJHP gets a lot of revenue from the print edition. Having some choose online only would decrease the circulation numbers and potentially decrease revenue. Online advertising remains healthy, even in this down economy. So, part of me thinks ASHP or their advertising agent is not exploiting the online journal enough. Wouldn't be more honest with advertisers to show them that x% choose online versions only? That percentage where not looking at the print version anyway, therefore the advertisers where not getting the value they might have thought they where.

I would like to continue to urge that AJHP have an option to receive the journal in an online version only. It would help with the environment and help keep my office less cluttered. The canary in the mine has died, it is time to take measures to insure AJHP remains healthy.

Nothing from nothing leaves nothing

The previous post reminds me of the great Bill Preston tune that goes "Nothing from nothing, leaves nothing; if you gotta have something, then you need to believe in me".

The Intellidot studies add nothing to the knowledge base of BCMA. Subtracting that from nothing (no studies that document the value of BCMA) leaves us nothing.

You need to believe is something (or a higher authority) on the value of BCMA, instead of evidenced based practice, if you believe in BCMA.

Still waiting for some study, any study, that shows it's value. I can be convinced, just waiting. Sure we need to to build systems that assume that humans are not perfect. It is just BCMA has not proven that it is the solution.

Intellidot response on the ASHP list serv

The following is a response to numerous comments from my post on the press release of 100% error reduction, that is in this blog as well.  I felt it responsible to post his response here as well.

Thanks to everyone who submitted comments and opinions on the Nursing News article published on Nursezone.com.  As a member of the Section Advisory Group on Automation for the ASHP Section on Pharmacy Informatics and Technology, I certainly understand the premise of your opinions and comments.  I feel strongly that the Listserv should not be used by vendors to promote or defend a product or company.   With that in mind, let me attempt to at least clarify some of the points that have been mentioned so that Listserv participants have complete and accurate information.

First, most IntelliDOT customers like to do a before-and-after study surrounding the implementation of our BCMA product.  Sample size is typically about 250 pre-implementation transactions and 250 post-implementation transactions.  We advise them to follow the David Bates study methodology.  As stated in the article, only serious errors (does not include dose timing errors or dose omissions for something like a vitamin) were counted which accounts for the small number of pre-BCMA errors.  I suspect like users of other BCMA vendors our customers have seen some very positive results. 

Furthermore, the individual hospital studies were done by these hospitals to meet their internal needs, and it was not originally our intent to publish a compilation of these studies.  However, users of our system encouraged us to do so, so the summary results were made available at our website.  We have no intent to pass this article off for more than what it is which is very clearly described by the author.  Ron categorized it as “additional information”, which is a good description of its intent.  Also, the info from the various hospitals that submitted data was collected at or around their date of BCMA implementation, so it was not in any way selectively collected by the company over the four year period.  That said, we are going to review the wording in the posted article to make sure the intent is clearly stated.

In reference to the sample size, I agree the sample size is limited although it does far exceed the sample size in the Barker-Bates study which is the largest multi-facility study to date (50 med administrations each in 36 hospitals).  An observation study with a much larger sample size done by an independent clinical group (ASHP or other) is a good idea.  Such a study that includes all BCMA vendors with results comparatively and categorically analyzed would be most valuable to pharmacists and nurses planning to implement a BCMA system.  We welcome such research and would be happy to participate in and support it.

Reference was also made on the Listserv to “a very small bar code” that IntelliDOT uses, specifically saying it may be a potential competitive advantage.  In fact, IntelliDOT’s BCMA system reads all standard manufacturer bar codes as well as those applied by pharmacy packaging systems….just as I suspect other BCMA systems do.  The “small bar code” is probably a reference to the proprietary “DOT” symbology that IntelliDOT uses as a way for nurses to document observations and comments during administration without having to type them.  The DOT is not a symbol that is interchangeable with a bar code and has not been applied to medication, patients, or name badges when using IntelliDOT’s BCMA system.  Therefore, the benefit of the DOT lies in its application, not in how it competes with bar codes.

In one of the listserv messages, the question is raised of how a system can insure that a patient wrist band - and not some other bar code - is scanned.  Simply stated, the bar code on the wrist band must be unique and not easily reproduced when using a BCMA system in the hospital.  It cannot be the same as the patient bar code that prints on hospital forms or labels.  There are ways to make the wrist band bar code unique and difficult to reproduce.  Access to the reprinting of patient wrist bands also needs to be limited, controlled and tracked.  In my opinion, proper management of bar coded patient wrist bands is an inherent part of a successful BCMA system, and our customers have been successful in doing it.

Finally, a posted comment suggests that having the observer intervene to prevent a serious error from occurring may account for the 100% reduction in serious errors.  In fact, while observation of med passes was taking place, the RNs doing the observing did intervene if a serious error was about to be made.  This was obviously in the patient’s best interest.  However, these interventions only occurred during the pre-implementation phase, although the study plan also included such intervention in the post-implementation phase if it were needed to prevent a serious error.  In either case, the near error would be tabulated as an error, not at as accurate administration.  At no time was an intervention used to avoid an error when using the BCMA system to pump up the success rate of using the BCMA system.

I plan to attend the ASHP meeting in Orlando and would be happy to further discuss this article and any ideas for future studies.  I can also be reached on my cell number below.

Happy Thanksgiving to all!

Thanks again,

Paul Seelinger, RPh

Sr. Director of Clinical Operations

IntelliDOT Corporation

The Bedside Patient Safety Experts

13520 Evening Creek Drive North, Suite 400

San Diego, CA 92128

Cell: 310-961-0630

Fax: 866-212-9947

ASHP Meeting Informatics Presentations and events

Sunday, December 7

Time	Event	Comments	Location
8:30 a.m. – 12:30 p.m.	Workshop: Skills for Assessing Readiness for Health Information Technology Implementation	(FYI) Workshop Fee: $85 Registration is limited to 60 participants.	W304C. Level 3
3:00 – 5:00 p.m.	Residency Preceptors’ Town Hall		Valencia W415A, Level 4
3:15 - 4:15 p.m.	ASHP New Member Welcome Reception		W202C, Level 2
5:30 – 7:00 p.m.	ASHP Best Practices Award in Health-System Pharmacy Poster Reception		The Peabody Orlando Florida – Ballroom, Convention Level

Monday, December 8

Time	Event	Comments	Location
9:00 – 10:30 a.m	Opening General Session		West Hall D2, Level 2
2:00 – 5:00 p.m.	BCMA in 2008: Trends, Regulations, and Innovations	MPA: Robert Christiansen	W209A, Level 2
5:15 – 6:15 p.m.	ASHP Section of Pharmacy Informatics and Technology – Barcoding Networking Session	Facilitated by C. Urbanski – EC Liaison required, but other EC members optional	W308A, Level 3

Tuesday, December 9

Time	Event	Comments	Location
8:00 – 11:00 a.m.	Information Technology and the Pharmacy Department: Collaboration or Conflict?	MPA: John Poikonen	W209A, Level 2
2:00 – 5:00 p.m.	Lessons Learned: What Health-System Pharmacists Can Learn from the VA Informatics Experience	MPA: Lynn Sanders	W209A, Level 2
4:30 – 7:30 p.m.	The 3rd Annual Pharmacy Informatics Networking Event	Coordinated by Kevin Marvin (non-ASHP sponsored)	Houlihans, 9150 International Drive, Orlando.

Wednesday, December 10

Time	Event	Comments	Location
8:00 - 9:50 AM	Clinical Decision Support in Pediatric and Adult Populations	MPA: Lolita White	W208A, Level 2
10:00 – 11:00 a.m.	Spotlight on Science Featured Speaker: Stephen G. Kaler, MD MPH Clinical Director, National Institute of Child Health and Human Development, National Institutes of Health Topic: Translational Medicine: Effects on Drug Development, Research, and Health-System Pharmacy		West Hall D2, Level 2
11:15 a.m. – 12:15 p.m.	ASHP Section of Pharmacy Informatics and Technology – CPOE Networking Session	Facilitated by C. Hardy – EC Liaison required, but other EC members optional	W304F, Level 3
12:30 – 1:30 p.m.	ASHP Section of Pharmacy Informatics and Technology – Informatics Residency Networking Session	Facilitated by D. Tjhio – EC Liaison required, but other EC members optional	W304F, Level 3
2:00 – 5:00 p.m.	Informatics Bytes 2008: Pearls of Informatics	MPA: Elizabeth Fields	W209A, Level 2
7:30 – 10:30 p.m.	ASHP’s Happenin’ Street Party at Universal Studios® Florida

Thursday, December 11

Time	Event	Comments	Location
10:30 AM - 12:00 PM	We Are the Experts: Optimizing the Pharmacist's Role in CPOE Implementation	MPA: Kevin Scheckelhoff	W204C, Level 2
12:00 – 2:00 p.m.	Thursday Networking Luncheon Featured Speaker: Kevin Carroll		Valencia W415C, Level 4
2:00 – 4:00 p.m.	Using Informatics and Basic Research to Improve Medication Safety	MPA: Heidi Cozart	W207A, Level 2

McKesson agrees to $350 million settlement

Below is another piece from Modern Healthcare.  Wow, $350M is a lot to say “I did nothing.”

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Pharmaceutical distributor McKesson Corp. announced it would pay $350 million to settle a class-action lawsuit alleging the company conspired with First DataBank to inflate drug prices paid by consumers and third-party payers.

In a conference call, Chairman and Chief Executive Officer John Hammergren was adamant that the allegations are false. “We did not manipulate drug prices and did not violate any laws,” Hammergren said.

“McKesson has denied and continues to deny each and all of the claims and contentions alleged in the class action, and has denied and continues to deny that it has committed any violation of law or engaged in any wrongful act alleged, or that could have been alleged, in the class action," the settlement said.

According to the complaint brought by the New England Carpenters Health Benefits Fund, McKesson and First DataBank in 2001 allegedly came up with a scheme to “artificially raise and fix” the spread between wholesale average costs and average wholesale prices published by First DataBank, violating the Racketeer Influenced and Corrupt Organization Act. An antitrust lawsuit based on the same allegations was dismissed in August.

The agreement remains subject to approval by the U.S. District Court in Boston, and it does not dispose of similar lawsuits brought by federal, state and local agencies. McKesson has set aside a reserve fund of $143 million for those claims, which the company likewise denies. Executive Vice President and Chief Financial Officer Jeff Campbell said that he expected the total pre-tax charge of $493 million to swing the company to a loss in its third quarter, which ends Dec. 31.

First DataBank reached a separate settlement agreement in 2006 and amended it in May 2008, agreeing to pay $1 million and reduce the markup factor for many drugs in its list. A hearing for final approval of that agreement is set for Dec. 17. — Gregg Blesch / HITS staff writer

Mediware purchases Hann's On for $3.5 million

Below is a posting from Modern Healthcare.  Phil Hann is one of the all time great guys in the industry.  He belongs in the Pharmacy Informatics Hall of Fame and deserves 10 times, heck 100x this amount.  He was my boss back in the day;  When he was a victim of a Corporate downsizing, he put it all on the line to follow his dream and started a pharmacy information system company.   His product was as elegant and brilliant as he is.  I hope Phil does not ride off into the sunset on his Harley for too long as we need him in the profession.  All the best to everyone at Hanns On!

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Mediware Information Systems acquired nearly all the assets of Hann’s On Software in a $3.5 million cash agreement.

The Lenexa, Kan.-based developer of software systems for blood and medication management will use Santa Rosa, Calif.-based Hann’s On products to grow its medication-management offerings. The purchase will allow Mediware to expand its focus on smaller hospitals, alternate-site infusion and specialty-pharmacy markets, according to a news release. The deal includes an additional earning opportunity based on operational performance

Levels of Security on pharmacy informatics

The Pentagon just recently banned computer flash drives due to virus threats on the various netwroks. We see in hospital systems today many "worms" and virus entering the overall networks - only having it necessary to shut down thew systems and resorting to the old paper systems until the systems are up and running. I think a study of measuring medication errors during these times of "technology down time" might be interesting to track and whether these errors are more profound than the ones we were used to seeing when eveything was on paper overall and steps were in place to dispense with the paper trails. I think having a mixed system of computer versus paper might be more detrimental in the long term.

Why a pharmacy informatics blog?

What is needed is a pharmacy informatics blog of general interest news, views and discussion. List serv’s, while useful are not the right medium for some things, nor is a traditional web site.

AMIA will be rolling out some blog and Wiki tools for members. Some topics beg for a wider audience than only an AMIA list serv, blog or wiki. So…. I have set up the following blogs for such things.

http://pharmacyinformatics.blogspot.com/

http://pharmacyinformatics.wordpress.com

The intent of a blog would be for a finite number of high quality contributors to regularly submit items of interest to the entire pharmacy informatics community. I have seeded some entries for examples. The intent would be that few can post and anyone could comment, although it has been recommended to me by others that moderating comments is a good idea.

The intent would be that a designee from each of the major pharmacy organizations have a contributor to the blog.  Some have been contacted and are in process.  Again, the intent is that we have small number (less than 10) quality contributors. As AMIA, ASHP, HIMSS and others change committees, presumably a new fresh set of contributors would participate. Anyone would be able to comments to a blog post.

Not sure Blogger or WordPress is the best platform, but it will work for a proof of concept and get the ball rolling.

So, in summary the pharmacy informatics community should have the following resources:

• Organizational specific collaboration via list servs, wikis and blogs.
• Non organizational specific forum for expressing views by leaders in PI, that disseminates information, news and commentary for the benefit of the entire pharmacy informatics community.

Please let me know your thoughts on a PI centric blog and if you would like to be a contributor.

eRx in California

Need to read this to see if interoperability with the pharmacy systems is addressed -jp

Getting Connected: The Outlook for Electronic Prescribing in California
Manatt Health Solutions
November 2008

The benefits of transmitting prescriptions electronically, rather than through paper transactions, have been shown to increase efficiency, lower costs, and do a better job of protecting patients from dangerous drug interactions and other medical errors. So why isn't the technology being used more widely, and what can be done to promote its adoption?

This issue brief assesses the technology's progress in California and examines how greater coordination between providers, health plans, and pharmacies could help overcome persistent barriers. It reviews efforts at the state and federal level to promote e-prescribing through regulation and other incentives, as well as the development of data standards and other cooperative infrastructure needed to make it a viable alternative to paper methods.

The authors conclude that accelerating the adoption of e-prescribing will require a coordinated effort on multiple fronts, including advocacy and education among California policymakers, the intelligent alignment of industry incentives, and easy access to technology tools and technical incentives.

The complete issue brief is available under Document Downloads below.

Document Downloads

Getting Connected: The Outlook for Electronic Prescribing in California (547K)

100% reduction in errors?

A new study posts some astonishing results.  Some thoughts: 

• It was sponsored and is being trumpeted by a BCMA Vendor.  The potential for internal bias is high. 
• Although all studies of new drugs come from manufactures of the drug, they need to adhere to FDA scrutiny. It would be great to have this study come under peer review.  
  
• If anyone has contact info or pull with Intellidot, they should be encouraged to submit it to a peer review journal. 
  
• 39 incidents out of 2,389 observations averted does not seem like a lot to me (1.6%).  Although the argument is that if it was you or your child involved you would want the BCMA technology.  It would also be interesting to calculate the ROI per incident avoided.