RxInformatics.com instead

Please go to the following site for ongoing blog post and discussions.

http://rxinformatics.com/

RxInformatics is a collaborative site with Chad Hardy and John Poikonen. Rather than support his blog, I will be consolidating on this site.

I will cross post to my personal blog as well at http://rxdoc.org/ or http://pharmacyinformatics.wordpress.com/

Thank you all for your comments and interest!

John Poikonen, PharmD

ASHP Hypocrisy

I have commented on the cluelessness of Am Soc of Health System Pharmacists (ASHP) on-line publishing model in the past via their forums.

My motivation for this is to get them to wake up and realize the potential of a full scale on line presence and to get them off of their antiquated paper publishing model before they go by the way of the Rocky Mountain News and Seattle Intelligencer

A new bizarre irony and hypocritical situation has emerged. While endorsing electronic medical records they still will not allow members to opt out of getting publications on paper. Their journal is extremely valuable and of high quality that I read religiously on lne. Every two weeks a large (rather nice, but incredibly wasteful) package arrives. Every two weeks I populate my town’s landfill with more waste.

Posted via web from RxDoc.Org

Why is there not a Sermo for Pharmacists? Lets start one

See http://www.sermo.com/

The Sermo business model is based on “Information Arbitrage.” This is the opportunity that arises when breaking medical insights intersect with the demand for actionable, market-changing events in healthcare. Our clients include some of the nation’s most prestigious healthcare companies, financial services institutions and government agencies: any organization that can benefit from early insight into clinical events. These parties create a financial incentive that is used to generate, sustain, and support participation in the online physician community.

Through information arbitrage, our clients are able to:

• Help forecast potential problems or new uses for commercially significant medical products and therapies
• Gain early insight into outbreaks and other changes in disease states and conditions that can affect the public health
• Perform epidemiologic research investigations
• Perform real-time surveys of the opinion of practicing physicians on topics related to medical care
• Assess the success and adoption of best practice recommendations
• Find opportunities to improve medical practice, and protect and promote patient safety and the public health

Clients pay a subscription fee and in return can post questions to the Sermo community. If you vote on one of these postings, you may be financially rewarded for your astute observations.

Posted via web from RxDoc.Org

(NQF) has revised its list of practices that have proven effective in reducing adverse events - Pharmacy Informatics perspective

The National Quality Forum (NQF) has revised its list of practices that have proven effective in reducing adverse events.  This is a very impressive list of practices.  It also revealing what is not on the list.

From a pure pharmacy informatics perspective the following practices are good to see.  CPOE and Pharmacy leadership are, of course, welcome additions to this list.  Using technology to enhance medication reconciliation and antimicrobial stewardship will go a long way to enhancing care as well and need a full court press by pharmacy and informatic departments.

Bar Code Medication Administration (BCMA) is not on the list.  This is not a big surprise.  I have settled into a role and view of a counter balance to most of my pharmacy colleagues.  There is a wide effort to implement BCMA to decrease adverse events without much evidence that it does anything.   Spouting a negative view on this practice is not comfortable nor one that I believe will last forever.  I fully believe that this practice will eventually be proven effective.  At this time it clearly is not.  Given this list of these proven practices, spending time and effort on BCMA if all of these practices are not fully exploted, may even be harmful.  We all have limited resources and time taken away from proven practices to ones of dubious value needs to be evaluated.

What say you?

John Poikonen
john@poikonen.NET
http://twitter.com/poikonen
Blog = http://pharmacyinformatics.wordpress.com/

Posted via email from RxDoc.Org

No More NUPOR Mooing and Musings #3

The first article on NUPOR is out in the April 1^st, Am J Health System Pharmacy. It is brilliant and will change the face of pharmacy as we know it (IMHO of course).

Opportunity cost of pharmacists’ nearly universal prospective order review

Allen J. Flynn

Am J Health Syst Pharm 2009;66 668-670
http://www.ajhp.org/cgi/content/full/66/7/668

I will have a letter in response (and support) of this from an informatics point of view in the next issue, April 15^th AJHP. There already are other responses in press and will be appearing soon. This topic is also covered in my blog. Click this for more info (if you dare/care)

http://pharmacyinformatics.wordpress.com/?s=NUPOR

There is a link at the bottom of the article’s full text to submit a response the article. I encourage you to do this whether you agree, disagree or have additional points to make. This is the AJHP link to send a direct response.

http://www.ajhp.org/cgi/eletter-submit/66/7/668

I look forward to hearing and viewing the responses.

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Two Very Different Views of eRx and EHR benefits

E-prescribing savings will offset the $19 billion feds will spend for health IT
and
Bad Bet on Medical Records

While not exactly apples to apples, example of the diverse opinions.  Mine is somewhere in the middle.  I do not think eRx will achieve this lofty goal.  The Washington Post editorial is a bit biased.  Not sure what the authors axe to grind is?

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Health Affairs March April 2009 Issue

The latest issue of Health Affairs is packed full of content on health information technology from almost every angle.  This issue will keep me reading for some time.  There is a web site that has the entire audio, video and powerpoints from a briefing in Washington DC.  Twitter has a series of tweets done from the meeting that is insightful, especially if you read when viewing the video; you get this weird virtual feeling of being there.  One of the articles, free to all, called Social Media In Health Care is excellent.

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Getting Started on Twitter

On Twitter, for those that want to enter the twitterverse, here is a suggestion.  Following these people initially will help you put your toe in the water (to better understand) without jumping in and drowning.

• http://twitter.com/Berci Fascinating medical student in Hungary, quickly becoming the first Web 2.0 Medical superstar.
• http://twitter.com/kevinmd Kevin Pho, MD from Nashua NH in primary care and winner of the best medical blog of 2008.
•  And if you can stand it:http://twitter.com/poikonen

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50 Successful Open Source Projects That Are Changing Medicine

I have a new appreciation for Open Source projects, primarily through this book (currently free download). It seems to me that an Open Source project focused on medication clinical decision support is needed.  There will be more on this later as I am working with some others to develop this idea.  In the mean time this is a fantastic list of projects, fyi.  Found at http://nursingassistantguides.com/2009/50-successful-open-source-projects-that-are-changing-medicine/

 

50 Successful Open Source Projects That Are Changing Medicine

February 19, 2009

Open source healthcare is forging forward quickly on the Internet. But, fast developments often produce many failures. But, many medicinal open source projects that have gained success development. This success shows that open source alone is not the solitary factor in development. Instead, look to great management, public relations, marketing and a sound program that stands up under the scrutiny of a growing number of peer users and, often, patients.

To limit this list to 50 projects means that we’ve tapped only the tip of the mountain of open source projects available to the healthcare industry. The following list is categorized alphabetically, and each link under every category is arranged alphabetically as well. We use this methodology to show that we do not favor one resource over another.

Ambulatory Care

1. ClearHealth: Medical software designed by clinics and hospitals and powered by Open Source software. ClearHealth includes modules for document storage, customizable reporting/forms, lab results and prescription management.
2. EGADSS: EGADSS is an open source tool that is designed to work in conjunction with primary care Electronic Medical Record (EMR) systems to provide patient specific point of care reminders in order to aid physicians provide high quality care.
3. GNUmed: Use this free/open source software, released under the GNU Public license to andle your patient’s records.
4. IndivoHealth: Indivo is a personally controlled health record system that enables patients to own complete, secure copies of their medical records.
5. OpenEHR: In the clinical space, it is about creating high-quality, re-usable clinical models of content and process - known as archetypes - along with formal interfaces to terminology. OpenEHR could take you there.
6. OpenEMR: OpenEMR is a free medical practice management, electronic medical records, prescription writing, and medical billing application.
7. OpenMRS: OpenMRS is a community-developed, open-source, enterprise electronic medical record system framework.
8. Tolven: An opportunity to use electronic Clinician Health Record (eCHR) and electronic Personal Health Record (ePHR) systems.
9. Ultimate EMR: Ultimate EMR was designed as a Commercial Open Source application rich in features and that can be combined with many other products and tools.
10. WorldVista EHR: WorldVistA EHR is an open source electronic health record based on the highly acclaimed VistA system of the United States Department of Veterans Affairs (VA).

Collaboration

1. GNU Projects: The Free Software Foundation provides a variety of free and open source software and publishes a list of various open source licenses and comparative features.
2. Medsphere: Medsphere.org is a community gathering place where healthcare administrators, clinicians, developers and enthusiasts can interact, share, and collaborate.
3. Open Health: This Yahoo! Group focuses on discussion of FOSS health I.T.-related topics.
4. Open Source Health Informatics Working Group: IMIA OSWG brings together experts and interested individuals from a wide range of health professions and with a range of interests in the potential application of free/libre and open source solutions within their domains of expertise.
5. OS-WG: The mission of the OS-WG (Open Source Working Group) is to act as the primary conduit between the broader open source community and AMIA (American Medical Informatics Association).
6. OSHCA: OSHCA’s membership comprises a community of people, civil societies and professional bodies in health care and informatics industries that promotes the Free/Open Source Software Concepts in Health Care.

Integration

1. Gello: ANSI-accredited HL7 standard for creating computable, unambiguous clinical queries.
2. i2b2: i2b2 (Informatics for Integrating Biology and the Bedside) is an NIH-funded National Center for Biomedical Computing based at Partners HealthCare System. Their work is designed to facilitate the design of targeted therapies for individual patients with diseases having genetic origins.
3. IHE Open Source: This project holds an implementation of the Cross-Enterprise Document Sharing (XDS) profile as defined by IHE (ihe.net).
4. Mirth: Mirth is an open source cross-platform HL7 interface engine that has established itself as the baseline for healthcare information exchange. Mirth allows messages to be filtered, transformed, and routed based on user-defined rules.
5. Records for Living: OpenHealth services allow for a wide variety of safe, secure reports and services to be delivered to consumers, leveraging the power of their electronic medical records.

Imaging/Visualization

1. BrainStorm: BrainStorm is an integrated free Matlab toolkit dedicated to Magnetoencephalography (MEG) and Electroencephalography (EEG) data visualization and processing.
2. Medical Exploration Toolkit: Advanced two- and three-dimensional visualizations with easy application building and efficient case management.
3. MicroDicom: MicroDicom is application for primary processing and preservation of medical images in DICOM format.
4. O3-RWS: O3-RWS is the Radiology Workstation of the Open Three (O3) Consortium. O3-RWS is an Open Source, IHE based, Internationalized, Modular and Portable Image Display.
5. SMIViewer: A free (soon to be open source) DICOM volume analyzer for research/teaching on Windows.

Medical Practice Management Software

1. CARE2X: Care2x integrates data, functions and workflows in a healthcare environment.
2. iHRIS Suite: Open source HRIS solutions, distributed under the GPL, to supply health sector leaders and managers with the information they need to assess HR problems, plan effective interventions and evaluate those interventions.
3. MirrorMed: MirrorMed is a free and open source EHR and practice management system written in PHP. This is a Web-based application that is capable of running a healthcare practice.
4. OpenDental: Previously known as Free Dental, OpenDental is an open source Practice Management Software licensed under the GNU General Public License.
5. OpenTAPAS: Technology Assisted Practice Application Suite (TAPAS) is a model to assist primary care physicians use technology in a targeted manner in their practices. It is an open source (GPL 2.0) collection of tools.

Online Publications

1. PLos Medicine: A peer-reviewed open-access journal published by the Public Library of Science.
2. LinuxMedNews: This is your site for Linux, Free and Open Source medical software news, and has been since March 2000.

Programs

1. Debian Med: The goal of Debian Med is a complete system for all tasks in medical care which is built completely on free software.
2. Eclipse Open Healthcare Framework (OHF) Project: The project is composed of extensible frameworks and tools which emphasize the use of existing and emerging standards in order to encourage interoperable open source infrastructure, thereby lowering integration barriers in healthcare informatics technology.
3. NHS: A UK NHS Interface (CUI), program guidance and product library available to NHS users and service providers using N3.
4. ODIN: ODIN is a C++ software framework to develop, simulate and run magnetic resonance sequences on different platforms.
5. Open Three (O3) Consortium: An innovative open-source project dealing with the multi-centric integration of hospitals, RHIOs and citizen (care at home and on the move, and ambient assisted living), based on the about 60 HECE bilateral cooperation Agreements with healthcare facilities. Use their imaging, collaboration and other software.
6. OpenGalen: Their goal is to promote healthcare through stimulating the use and development of GALEN experience and technology as a basis for teaching, training and services in the area of medical terminology, language, knowledge and information and in anything directly or indirectly related in the widest sense.

Public Health and Biosurvellance

1. EpiSPIDER: This experimental map is generated from news reports from both expert-curated and general news sources on epidemics.
2. Influism: To be used for pandemic preparedness planning by health care offices, this download computes the effect of interventions like antiviral treatment of cases and social distancing.
3. OpenEMed: Biosurveillance and clinical data repository based on Web services and modules. Offers solid interoperability and federation of clinical data.
4. RODS: “Real-time Outbreak and Disease Surveillance” (RODS) is an open-source public health surveillance software.
5. Sispread: This open source tool was created to help people concerned by public health to easily perform epidemic simulations and to analyze their results.

Software

1. ATP III Cholesterol Management: This interactive guideline tool will assist the clinician in implementing the ATP III Cholesterol Guidelines at the point of care on a Palm OS.
2. BMI Calculator : This calculator runs on any device running the Palm Operating System (Palm OS) and PocketPC 2003.
3. Heart Attack Signs: This Palm OS program provides physicians and other health care providers talking points for discussing heart attack warning signs and survival steps with patients.
4. IPath : iPath is an open source platform for telemedicine applications such as consultations, case discussions, virtual staff meetings and more.
5. MedMapper: Medical decision making algorithm tool. Visual design tool generates Tcl/Tk code. Non-programmers can design interactive algorithms. Generates notes for inclusion in medical record.
6. Zephyropen : Open source SDK for health monitoring devices and downloads for OSX, PC and cell phones.

 

John Poikonen

john@poikonen.net

On Line Presence 

http://twitter.com/poikonen

http://pharmacyinformatics.wordpress.com

http://www.evernote.com/pub/poikonen/PublicPharmacoinformatics

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Hospitals try ATM for drugs

 

Hospitals try ATM for drugs   3/16/2009 11:46 AM  from  http://www.nationalpost.com/story-printer.html?id=1393577
Hospitals try ATM for drugs Machine connects to call centre to dispense pills Tom Blackwell,  National Post  Peter J. Thompson/National Post Hundreds of Toronto patients have been picking up their prescription drugs in recent months much as they might withdraw cash or buy a can of soda -- from special vending machines that some observers believe could transform the pharmacy business. Customers using the PharmaTrust kiosks insert their prescription into a slot and, a few minutes later, the device spits out their medication. Skeptics question whether the machines will ever duplicate the benefits of meeting in person with a druggist. Proponents, though, say the Canadian-made invention, which allows users to communicate with a real pharmacist by video link, offers real convenience when there is no pharmacy open, or close by. "I think it could be the next BlackBerry," says Dr. Sharon Domb, medical director of family medicine at Toronto's Sunnybrook Health Sciences Centre, which has been testing the technology since last June. "The feedback has been positive: 'It's great, it's fast, I don't have to go anywhere else.' " Another hospital -- Cam-bridge Memorial in southwest Ontario -- plans to install the machines in its emergency department next month, while more are to be rolled out in a large, east-end Toronto doctor's office at about the same time. Some pharmacists will undoubtedly feel threatened by the technology, says Jeff Poston, executive director of the Canadian Pharmacists' Association. But he predicts the machines will have only a niche role, likely in remote communities that have limited pharmacy services, since the devices offer patients a "lesser" form of communication with the druggist. "I tend to think the face-to-face encounter with the pharmacist would win hands down," he said. Yet the notion of purchasing prescription medicine somewhat as one would buy a bag of chips does not seem as jarring to many patients as it sounds. Shelly Dev, a long-time patient of Dr. Domb's at Sunnybrook, even suggests the machine's built-in telephone allows for a more private conversation with the pharmacist, while the whole transaction is far quicker than visiting a drugstore. She used one of the dispensers for the first time on Friday to fill a prescription for antibiotics, and was done in less than five minutes. "It's very easy to use," said Dr. Dev, who is an intensive-care physician at Sunnybrook. "Usually, for most folks, you go see your physician ... you leave, you go to another place to drop off your prescription, you have to go back to pick it up. It's monotonous." When customers insert their prescription, the ATMlike machine -- made by PCA Services Inc. -- snaps high-resolution photographs of both sides and transmits them to a pharmacist waiting in the firm's Oakville, Ont., call centre. He or she reads the information, directs the machine to start dispensing and waits while robotic technology finds the prescribed medicine from among 340 different drugs stored inside. Once the pharmacist has verified the kiosk has picked the right product, the machine pops out the order. During the transaction, the customer speaks to the pharmacist via a telephone and video screen built into the kiosk. Just over 800 patients used the machines at Sunnybrook to obtain 1,200 prescriptions between June and September. A survey of 108 of them indicated that more than 95% received their drug in less than five minutes and would use PharmaTrust again, said Peter Suma, president of PCA. None of the prescriptions was incorrectly filled, he said. Not everyone, however, was able to take advantage of the pharmaceutical ATMs. About a third of patients who tried discovered that their medicine was not available, said Dr. Domb, though PCA offers to deliver those orders to the patient's home the next day. Despite such limitations, Mr. Suma predicts his kiosks will be embraced by consumers accustomed to instant, technologically aided service, especially when the devices are "deployed ubiquitously." "Although this seems controversial now, I bet the telephone seemed controversial to the guys who were delivering messages back then," he said. And steps are being taken in one province, at least, to allow much wider distribution of the machines, which in Ontario can be set up now only in hospitals and clinics. The Ontario College of Pharmacists recommended last week the province change the law to allow all "remote" dispensing-- whether it involves a machine or a technician based in an isolated locale -- as long as a licensed pharmacist oversees the transaction. "It could be a very good thing, provided the safeguards for the public and accountability are in place," said Deanna Williams, the college's registrar. The financially strapped Cambridge hospital will earn some revenue from the machines, but contracted with PCA chiefly to offer convenience to emergency patients who show up 24 hours a day, said Julia Dumanian, the hospital's CEO. Relatively few pharmacies in the community are open late, let alone all night, she said. Meanwhile, PCA is on the verge of striking deals with major clients in the United States and the United Kingdom. In those cases, the company plans to partner with another organization, which would run the call centre, much as RIM works with cellphone networks to provide Blackberry service, said Mr. Suma. © 2009 The National Post Company. All rights reserved. Unauthorized distribution, transmission or republication strictly prohibited.  Click here to download: Evernote.enex (16 KB)

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(NQF) has revised its list of practices that have proven effective in reducing adverse events - Pharmacy Informatics perspective

The National Quality Forum (NQF) has revised its list of practices that have proven effective in reducing adverse events.  This is a very impressive list of practices.  It also revealing what is not on the list.

From a pure pharmacy informatics perspective the following practices are good to see.  CPOE and Pharmacy leadership are, of course, welcome additions to this list.  Using technology to enhance medication reconciliation and antimicrobial stewardship will go a long way to enhancing care as well and need a full court press by pharmacy and informatic departments.

Bar Code Medication Administration (BCMA) is not on the list.  This is not a big surprise.  I have settled into a role and view of a counter balance to most of my pharmacy colleagues.  There is a wide effort to implement BCMA to decrease adverse events without much evidence that it does anything.   Spouting a negative view on this practice is not comfortable nor one that I believe will last forever.  I fully believe that this practice will eventually be proven effective.  At this time it clearly is not.  Given this list of these proven practices, spending time and effort on BCMA if all of these practices are not fully exploted, may even be harmful.  We all have limited resources and time taken away from proven practices to ones of dubious value needs to be evaluated.

What say you?

John Poikonen
john@poikonen.NET
http://twitter.com/poikonen
Blog = http://pharmacyinformatics.wordpress.com/

Posted via email from poikonen's posterous

No more NUPOR Mooing and Musings #1

From the Executive Summary on the Global Conference for Hospital Pharmacy Practice (August 2008):

“Optimally, all medicine orders should be reviewed by a pharmacist , but many countries do not have adequate resources to support this practice. Hospital pharmacists should assess which patients or patient care areas are in the greatest need of this service and then focus their order-review efforts on those patients or patient-care areas.”

The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, transmission, re-transmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer.

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No More NUPOR - Near Universal Pharmacist Order Review

The concept of studing the possibility to eliminate NUPOR with better computerized clinical decision support originated with Allen Flynn, pharmacist informatics guru at Univ of Michigan Medical Center.  He will have a brilliant commentary in the Am Journal of Health System Pharmacy in the April 1, 2009 issue.  I will have a follow up in the April 15th issue and Dennis Tribble, CTO/CPO, ForHealth Technologies will have a subsequent letter on the subject in the May or June time frame.

The basic premise is that we need to study the impact of mandating near universal pharmacist order review on patient care and the profession.  If computerized clinical decision support can do some part or segment of order review as good or better than pharmacists, then that will free pharmacists to do more beneficial services for patients.  The AJHP commentaries will explore this in some depth.   I encourage all to read and comment on this revolutionary topic.  Please comment directly in the new AJHP response system on the AJHP.org site that is below the articles.  Of course I welcome comments to this blog, but that will have wider exposure (for now, at least).

At a speech by Robert Wachter of the great blog Wacher’s World he indicated that when you gore sacred cows, expect a lot of Mooing.  NUPOR is a pharmacy sacred cow.  From time to time I will be posting the various Mooing and Musings on this topic.  I welcome your comments as this plays out, which I suspect might be a number of years.

John Poikonen, PharmD

Posted via web from poikonen's posterous

Checking out the amazing service Posterous.com

This service will post via emails or SMS text to Twitter and Blogs automatically.
See this for more info.  http://www.posterous.com/faq/
Very intriguing.  Single email will post to everything.

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Nancy-Ann DeParle

Here is one ray of hope for transformative change in healthcare. Nancy-Ann DeParle has been tapped to head the White House Health Care transition plan. She has been on some company boards that provide some insight that is positive. Presumably she 'gets' pharmacy (Medco), Health IT (Cerner) and Boston (Boston Scientific). Ok, that last one is a stretch.

I had the pleasure to shadow the CEO of Cerner a while ago. If he is anything, he is passionate on the impact technology can and should have on health care. She would not be on the board unless she was totally committed to the use of technology to improve health.

As an aside, the Cerner CEO is a rapid Republican. His wife even ran for Congress but lost b/c she was way to the right of most rational mortals. So I love it that a (soon to be former) board member will be part of the Obama Administration.

http://www.nytimes.com/2009/03.../03health.html?_r=2&hp

Ms. DeParle has extensive experience in the business world that has prompted questions from some liberals and from some of the people who vet appointments for Mr. Obama. Ms DeParle is now or has been a director of huge health care companies including Medco Health Solutions, a pharmacy benefit manager; Cerner, a supplier of health information technology; Boston Scientific, a medical device company; DaVita, which runs kidney dialysis centers; and Triad Hospitals.