Pharmacy Informatics Exchange

RxInformatics.com instead

2009-03-31T06:39:00.000-07:00

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

2009-03-30T10:16:00.001-07:00

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

2009-03-21T18:06:00.001-07:00

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

2009-03-21T15:05:00.001-07:00

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

2009-03-19T10:25:00.001-07:00

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.

Posted via email from poikonen's posterous

Two Very Different Views of eRx and EHR benefits

2009-03-17T11:41:00.001-07:00

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

2009-03-16T11:01:00.001-07:00

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.

Posted via email from poikonen's posterous

Getting Started on Twitter

2009-03-16T10:23:00.001-07:00

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

Posted via web from poikonen's posterous

50 Successful Open Source Projects That Are Changing Medicine

2009-03-16T10:04:00.001-07:00

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

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.
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.
GNUmed: Use this free/open source software, released under the GNU Public license to andle your patient’s records.
IndivoHealth: Indivo is a personally controlled health record system that enables patients to own complete, secure copies of their medical records.
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.
OpenEMR: OpenEMR is a free medical practice management, electronic medical records, prescription writing, and medical billing application.
OpenMRS: OpenMRS is a community-developed, open-source, enterprise electronic medical record system framework.
Tolven: An opportunity to use electronic Clinician Health Record (eCHR) and electronic Personal Health Record (ePHR) systems.
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.
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

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.
Medsphere: Medsphere.org is a community gathering place where healthcare administrators, clinicians, developers and enthusiasts can interact, share, and collaborate.
Open Health: This Yahoo! Group focuses on discussion of FOSS health I.T.-related topics.
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.
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).
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

Gello: ANSI-accredited HL7 standard for creating computable, unambiguous clinical queries.
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.
IHE Open Source: This project holds an implementation of the Cross-Enterprise Document Sharing (XDS) profile as defined by IHE (ihe.net).
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.
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

BrainStorm: BrainStorm is an integrated free Matlab toolkit dedicated to Magnetoencephalography (MEG) and Electroencephalography (EEG) data visualization and processing.
Medical Exploration Toolkit: Advanced two- and three-dimensional visualizations with easy application building and efficient case management.
MicroDicom: MicroDicom is application for primary processing and preservation of medical images in DICOM format.
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.
SMIViewer: A free (soon to be open source) DICOM volume analyzer for research/teaching on Windows.

Medical Practice Management Software

CARE2X: Care2x integrates data, functions and workflows in a healthcare environment.
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.
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.
OpenDental: Previously known as Free Dental, OpenDental is an open source Practice Management Software licensed under the GNU General Public License.
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

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

Programs

Debian Med: The goal of Debian Med is a complete system for all tasks in medical care which is built completely on free software.
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.
NHS: A UK NHS Interface (CUI), program guidance and product library available to NHS users and service providers using N3.
ODIN: ODIN is a C++ software framework to develop, simulate and run magnetic resonance sequences on different platforms.
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.
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

EpiSPIDER: This experimental map is generated from news reports from both expert-curated and general news sources on epidemics.
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.
OpenEMed: Biosurveillance and clinical data repository based on Web services and modules. Offers solid interoperability and federation of clinical data.
RODS: “Real-time Outbreak and Disease Surveillance” (RODS) is an open-source public health surveillance software.
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

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.
BMI Calculator : This calculator runs on any device running the Palm Operating System (Palm OS) and PocketPC 2003.
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.
IPath : iPath is an open source platform for telemedicine applications such as consultations, case discussions, virtual staff meetings and more.
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.
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

Posted via email from poikonen's posterous

Hospitals try ATM for drugs

2009-03-16T09:49:00.001-07:00

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.

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

2009-03-13T03:53:00.001-07:00

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‘No More NUPOR’ Mooing and Musing #2

2009-03-09T13:11:00.001-07:00

The original ‘No More NUPOR’ post is here. To remind you - NUPOR is Near Universal Pharmacist Order Review, the current state of practice for medication orders. There is a group of informatics professionals that are questioning this scared cow. Here is the latest in what will be a series of commentaries on the subject.

The following is a series of email conversations with some very high placed influential pharmacy leaders. Their names are not revealed as the points are more important than who said them.

First this was noticed in the March 2009 Journal of Health System Pharmacy.

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.”

This position more or less endorses the concept of NUPOR that is clearly not universally accepted, yet a standard of practice in the US.

The next suggestion was that this statement

“is essentially the "endorsed" preamble to (no more) NUPOR....”

Which was then noted that

“This is essentially the internationally "endorsed" preamble to (no more) NUPOR....”

It occurred to me that some may take pot shots that the US is far better than most countries, to which I shot back (with out thinking beyond that)

“I can hear is now “what do those for-ners know’, we are better than that. That’s when you pull out this graph (below). [not from Michael Moore but a software biz plan]”

This is an amazing graph from a presentation at the 2008 Connected Health Seminar at Harvard by Brian Bosworth founder of Keas, Inc.

Wouldn’t you know it? This was received within seconds:

“I attended and participated in the global conference in Basel and I also sit on the Joint Commission International (JCI) standards committee. I would caution any of you about looking at the statements from the conference or the JCI standards as something to which we should aspire in this country. For these groups the bar is set pretty low in order to establish a minimum baseline toward which to strive. For example, many countries don’t even have pharmacists in hospitals at this point in time – so I couldn’t even get the JCI committee to agree that a pharmacist should designated as being responsible for pharmacy services in hospitals.”

Clearly the person had not seen my post, so I thought I was going to be in big trouble. I responded back:

Opps. I better qualify my previous email. My only point in the slide I sent (which strikes me as incredible) is that if Life Expectancy is a macro indicator of how well a health system does, then we suck and are paying way too much. A socialist view is that it is all insurance company greed and overhead, which, I admit is partly my view. Culture (mostly obesity) comes into it, so does delivery of pharmaceuticals. So, from a micro pharmacy view, looking at other countries health delivery systems need to be looked at and not dismissed out of hand.

Phew, dodged a bullet on that with the response

I agree 100% with you John that most of the money spent on healthcare in this country is a waste - and going to insurance executives, pharmaceutical companies, administrative overhead, bureaucratic BS and consultants. And individuals need to start taking responsibility for their own health – like all the third world countries. Then we would have much more money to give to GM!

No more NUPOR Mooing and Musings #1

2009-03-09T11:47:00.001-07:00

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

2009-03-07T12:03:00.001-08:00

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

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Checking out the amazing service Posterous.com

2009-03-07T10:13:00.001-08:00

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

2009-03-05T04:59:00.000-08:00

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.

http://medpedia.com/

2009-02-18T18:03:00.000-08:00

YIPPEE. worth checking out.

Your credentials have been verified and you have been granted Editor privileges on Medpedia. You may now directly edit the Article pages of the collaborative encyclopedia.

The goal of the Medpedia project is to create a new model of how the world will assemble, maintain, critique and access medical knowledge. The repository of up-to-date, unbiased medical information will be written and maintained by health experts like you, and will be freely available to everyone.

As an Editor, you will receive permanent, public recognition for your contributions to this transformational project.

Please click the link below to begin developing your presence in Medpedia by adding to and editing the Articles in your areas of expertise

http://medpedia.com/

Welcome,

The Medpedia Project

-------

Medpedia - a new model for sharing and advancing knowledge about health, medicine and the body.

Penicillin Allergies

2009-02-17T07:47:00.001-08:00

Here is a really interesting study, per Jim Carpenter in Portland, on a very high documented true allergy rate of self reported Penicillin allergies in a ED. 91% of people that stated a PCN allergy did not have a IgE mediated response. Wow, that sounds high to me.

As Jim points out in his Twitter post, this may have significant implications for CDS alerting. Some logic based on the patients condition and infection where a PCN or Cephalosporin may be the best choice might invoke a suggestion to do a skin test to determine if a true allergy exists. The article has a table of potential cost savings.

http://www.annemergmed.com/webfiles/images/journals/ymem/asraja.pdf

How Twitter Changed by Life

2009-02-16T07:40:00.001-08:00

Ok, this might be a stretch, my life has not changed all that much, but Twitter is fascinating. This slide show posted by Berci, famous for all things Medicine 2.0 is useful to introduce you to Twitter. btw my name on Twitter is "poikonen" -jp

http://scienceroll.com/2009/02/14/how-twitter-changed-my-life-slideshow/

How Twitter Changed My Life

View more presentations from Minxuan Lee. (tags: micro twitter)

Clinicians Ignore most eRx Alerts

2009-02-11T03:42:00.001-08:00

What in medicine do we tolerance 90%+ false positive rates, without getting rid of it?
We have a long way to go in CDS. Below is from a ASHP press release on a new Archives of IM study, recommended read.
-jp

Clinicians Ignore Most e-Prescribing Alerts
Kate Traynor

BETHESDA, MD 09 February 2009—A large study of electronic prescribing in the outpatient setting suggests that prescribers override most warnings that indicate a medication allergy or drug interaction, according to a report in the February 9 Archives of Internal Medicine.

The analysis of data for 2872 prescribers in Massachusetts, New Jersey, and Pennsylvania over a nine-month period in 2006 found that the clinicians accepted 23% of alerts for medication allergies and 9.2% of drug interaction alerts. Alerts were almost always ignored for medications that had been previously prescribed for the patient.

The study examined more than 3 million electronic prescriptions generated using Zix Corporation's PocketScript program. Of these, about 6.6% resulted in an interaction alert to the prescriber. Less than 2% of the alerts were for medication allergies; the rest informed the clinician that the selected medication potentially interacts with another drug currently taken by the patient.

Drug interactions were classified in the prescribing program as low, medium, or high severity, and the severity level was displayed on the prescribing device's screen. About 62% of the alerts in the study were classified as high severity, and 29% were of medium severity. High-severity alerts were overridden about 90% of the time, and lower-level alerts were disregarded about 93% of the time.

According to the report, PocketScript's severity classifications are produced by pharmacists at a health information technology company. The report's authors suggested that reexamining and reclassifying some of the high-severity alerts, particularly those that are most often overridden, may increase prescribers' acceptance of drug-interaction warnings.

Prescribers took some high-severity drug–drug interactions more seriously than others. For example, warnings not to use noncardioselective beta-blockers and macrolides together were accepted 43.1% of the time.

The next-most-commonl...

View Original Article

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Patient Safety and a Tale of Two Pilots: US Airway’s Sullenberger and KLM’s Van Zanten

2009-02-05T05:56:00.001-08:00

When a New York policeman commandeered a chopper after receiving a “plane down” distress call, he expected to find a Cessna or a Piper in the river. “I never, in a million years, expected to see US Airways in the Hudson,” said Sgt. Michael Hendrix when...(read more)

View Original Article

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AJHP versus NEJM

2009-02-03T07:30:00.001-08:00

The Efficient MD - Life Hacks for Healthcare: Twitter Dispatches from the New England Journal of Medicine's Horizons Conference

I happened on this blog that is very interesting. This post on what the NEJM is doing, struck me as something AJHP might consider.

This initiative by NEJM is outstanding. Clearly they are skating to where the puck is being shot, not to where it is now.

The New England Journal of Medicine is seeking to bring together a group of visionary medical students and trainees to help NEJM push the boundaries of traditional medical publishing. We are looking for creative minds to join the editors for a weekend to explore what's possible. We anticipate a vigorous dialogue around the ideas that invited participants and other speakers share with the group.

Twitter feed of the conference

http://search.twitter.com/search?max_id=1172796326&page=1&q=%23NEJM

My bias and unfounded perception is that AJHP is stuck in the mud a bit. Part of this bias is the (weird) push back I have gotten on the Green Initiative passed by the HoD; right or wrong.

Medication Errors Occurring with the Use of Bar-Code Administration Technology

2009-02-02T14:15:00.001-08:00

Below is a very nice article on how to overcome workarounds and process improvement.

My 'beef' with this and many other bar code studies is that it assumes that BCMA is a good thing. This is a false assumption.

The studies and references in this paper do not support the benefit statements.

"Studies have shown that BCMA can reduce medication errors by 65% to 86%. 5,6,7 "

*Reference 5 is a HIMSS presentation (no peer review)

*Reference 6 is pure speculation piece in AJHP (no science)

*Reference 7 is based on reportable errors. What if folks where so busy or ticked off that they did not report errors, post implementations. The author of this reference even has communicated to me that this study was never intended to be used as evidence for showing decrease errors.

Also: "one hospital in Pennsylvania showed that the direct-observation accuracy rate before BCMA was 86.5%; after BCMA, the rate rose to 97%.8"

*This reference is a post study from complete manual to full eMAR and BCMA. What if 99% of the benefit was with eMAR and not bar coding?

Medication Errors Occurring with the Use of Bar-Code Administration Technology -

Medication Errors Occurring with the Use of Bar-Code Administration Technology

Pa Patient Saf Advis 2008 Dec;5(4):122-6.

Abstract

Bar-code medication administration (BCMA) systems can improve medication safety by verifying that the right drug is being administered to the right patient. Studies have shown that BCMA technology can reduce medication errors by 65% to 86%. But BCMA technology alone does not ensure a safe medication-use system. A number of reports submitted through PA-PSRS describe medication errors that occurred in organizations that used a bar-code system for administration. Some of these errors result from failures to use this technology appropriately, employing workarounds or overriding alerts, disruptions in the medication administration process, and dispensing errors that arise in the pharmacy. Strategies to address problems with this technology include reviewing BCMA logs to evaluate overrides and identify system weaknesses and monitoring and measuring compliance with the technology to identify and remove any barriers to its appropriate use.

A prospective cohort study of medication errors by Leape et al.1 determined that 39% of errors occurred during the prescribing phase, 12% during transcription, 11% during dispensing, and 38% during administration. Close to half of the errors that occurred during the prescribing phase were intercepted before they reached the patient; in contrast, only 2% of errors that occurred during the administration phase were intercepted. Another study using direct observation in 36 healthcare facilities found that medication administration errors occurred in almost 20% of doses administered.2 Data from U.S. Pharmacopeia’s (USP’s) medication error reporting database, MEDMARX®, indicates that an error at the point of administration is least likely to be intercepted before reaching the patient, compared to other phases of the medication-use process.3

One form of technology that may address administration errors is a bar-code medication administration (BCMA) system. BCMA c...

[Pharmacoinformatics Feed From Poikonen's Evernote]

Study: Health IT Use Can Lower Hospital Mortality Rates, Costs

2009-02-01T06:29:00.001-08:00

Landmark study in Archives of Internal Medicine with nice editorial by David Bates. I have some thoughts on what the pharmacy department might be doing in these hospitals where there was a difference in mortality; will post later. Would like to see similar study on outcomes with and without BCMA (Hey – a guy can dream).

Study: Health IT Use Can Lower Hospital Mortality Rates, Costs - iHealthBeat -

Study: Health IT Use Can Lower Hospital Mortality Rates, Costs

Hospitals' use of health IT is associated with lower mortality rates, complications and costs, according to a new study published in the Archives of Internal Medicine, Reuters/Washington Post reports (Steenhuysen, Reuters/Washington Post, 1/26).

Study Details

The researchers divided clinical IT systems into four categories:

Clinical decision support;
Medical notes and records;
Order Entry; and
Test Results.

The researchers surveyed physicians at 41 urban hospitals in Texas about their use of IT systems in each of the four categories. The researchers then looked at the relationship between IT usage and the rates of inpatient death, complications, costs and lengths of stay for 167,233 patients ages 50 and older who were admitted to the participating hospitals in 2005 and 2006.

The study was funded by the Commonwealth Fund (Conn, Modern Healthcare, 1/26).

Study Findings

The study found that patients at hospitals that ranked highest in health IT use by physicians were 16% less likely to develop complications than patients treated at hospitals where physicians used IT less.

The study also found that patient mortality rates were 15% lower at hospitals that ranked highest in the use of software to automate patient records and notes.

In addition, heart attack patients had a 9% lower risk of dying and bypass patients had a 55% lower risk of dying at hospitals with high scores in use of software to track physicians' orders, according to the study.

"If these results were to hold for all hospitals in the United States, computerizing notes and records might have the potential to save 100,000 lives annually," Neil Poe of Johns Hopkins University School of Medicine, who worked on the study, said (Reuters/Washington Post, 1/26).

[Pharmacoinformatics Feed From Poikonen's Evernote]

(AHRQ) Medical Errors & Patient Safety Update

2009-01-28T06:39:00.000-08:00

Great idea to standardize evidence of interventions

(AHRQ) Medical Errors & Patient Safety Update -

Agency for Healthcare Research and Quality (AHRQ) Medical Errors & Patient Safety Update

AHRQ Awards Contract to Develop Criteria to Assess the Evidence Base for Patient Safety Practices On January 8, AHRQ awarded a contract to develop a set of criteria to be used for assessing the evidence base for the effectiveness and safety of patient safety practices (PSPs) in future evidence reviews and for use by implementers of PSPs. The $1 million contract, Assessing the Evidence for Context-Sensitive Effectiveness and Safety of Patient Safety Practices: Developing Criteria was awarded to RAND, Johns Hopkins University, and the University of California-San Francisco, working in partnership with the Karolinska Institute (Sweden) and a technical expert panel. AHRQ recognizes that there is a need for a suitable set of criteria by which to assess which patient safety practices will work and are safe in specific settings. All across the country, providers, hospitals, health systems and policymakers are attempting to improve the safety of patient care, and are looking for guidance on what works. This 1-year initiative will be the first to take into account the complexity of patent safety interventions in the real world and tie those components to research and evaluation considerations. Those considerations include assessment of theoretical models for designing PSPs and the usefulness of innovative methods for evaluating intervention results. For more information, please contact the AHRQ Project Officer, Denise Dougherty, at Denise.Dougherty@ahrq.hhs.gov or 301.427-1868.

[Pharmacoinformatics Feed From Poikonen's Evernote]

Drug Induced QT Prolongation

2009-01-28T06:35:00.000-08:00

Here is a series of articles on medication QT Prolongation. My sense is it is a under recognized problem, although I have no basis for this view, just a feeling. This would make for an interesting CDSS to incorporate wave form analysis.

Drug Induced QT Prolongation -

Editors' view

Drug-induced long QT syndrome and drug development

J. M. Ritter,

Department of Clinical Pharmacology, School of Medicine at Guy's, King's College & St Thomas' Hospitals, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH UK

ABSTRACT

No Abstract

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-2125.2008.03275.x About DOI

Introduction

September's issue is themed around cardiovascular clinical pharmacology. It includes articles on a range of topics, spanning a review of the role of the renin-angiotensin system in atrial fibrillation [1], through the effect of atorvastatin on high-sensitivity CRP in acute coronary syndrome [2], and the pharmacokinetics and pharmacodynamics of nicorandil in healthy and acute heart failure subjects [3] to the influence of paraoxonase-1 (PON-1) phenotype on the response of paraoxonase activity to statins [4]. Several papers [5–7] relate directly or indirectly to effects of drugs on the electrocardiographic QT interval, and it is on this subject that this Editors' View is focused.

The vulnerable period and the long QT syndrome

George Ralph Mines identified the 'vulnerable period' within the cycle of the cardiac action potential/pacemaker (or resting) potential [8]. (Mines [9], a contemporary at Cambridge of AV Hill, also described cardiac re-entry and identified the active principle of munchi arrow poison as strophanthin. He was appointed professor of physiology at McGill University in Canada aged 28, but died tragically soon thereafter – of which more later).

A ventricular extra beat falling early in the cardiac cycle, so that it coincides with ventricular repolarisation (the 'R on T' phenomenon), can provoke ventricular tachycardia (VT), and/or ventricular fibrillation (VF). The QT interval is measured from the beginning of the QRS complex (whether Q or R wave) to the end of the T wave. The latter may be difficult to define, especially when a U wave succeeds the T; however, the U wave tends to b...

[Pharmacoinformatics Feed From Poikonen's Evernote]

RxNorm and CMS in eRx 2009 Call Letter

2009-01-26T04:05:00.000-08:00

It seem clear from this CMS correspondence that RxNorm will be replacing NDC codes (finally). It is time to contact your pharmacy system vendor to insure that they put the RxNorm code in their data structure. All of the major drug database vendors support the RxNorm CUI codes.
RxNorm and CMS in eRx 2009

Call Letter -

H. RxNorm CMS will continue to utilize a Formulary Reference File (FRF) and proxy National Drug Codes (NDCs) for HPMS submission of Part D formularies. For CY2009, CMS also will introduce the RxNorm nomenclature for the FRF drugs because we are exploring RxNorm as a potential alternative to proxy NDCs for formulary submissions in future years. RxNorm is a standardized nomenclature for clinical drugs produced by the National Library of Medicine (http://www.nlm.nih.gov/research/umls/rxnorm/index.html). CMS is working with the Page 60 60 National Library of Medicine to evaluate whether RxNorm would provide a more effective means of drug product identification for the FRF. CMS recognizes the value of a standardized nomenclature system for the purpose of Part D formulary submission and review and for its potential application as electronic prescribing evolves. For each CY2009 FRF proxy code, the RxNorm semantic names and RxNorm concept unique identifier (RXCUI) code (when available) will be included. Part D sponsors should be aware that FRF format changes will be forthcoming. CMS wishes to clarify again that the submission process for CY 2009 formularies will not involve the use of RxNorm concept unique identifiers. We will continue to investigate the benefits of using these codes for subsequent plan years. Should CMS determine that the utilization of RxNorm would be a beneficial means for indicating drug coverage during the formulary submission and review process for CY 2010, we will notify plans in the fall of 2008 of such changes.

[Pharmacoinformatics Feed From Poikonen's Evernote]

Rock and Roll Health IT Funding

2009-01-21T13:11:00.001-08:00

The source of this report is interesting. Time to turn up the amps to “11”

Economist's Letter to Obama Calls for Health Care IT Investment

In an open letter to President Obama published in the February issue of Rolling Stone, Nobel Prize-winning economist Paul Krugman calls for spending federal money "on things of lasting value," such as health IT, Healthcare IT News reports.

Krugman -- a professor of economics and international affairs at Princeton University and columnist for the New York Times -- writes that health care IT, "like similar infrastructure investments, would help create jobs," which then would address the economic crisis.

Krugman writes that Obama should "improve information technology in the health care sector, a crucial part of any health care reform."

Obama has said he wants to spend $50 billion over five years to support the adoption and use of health care IT (Monegain, Healthcare IT News, 1/19).

More Opinion and still lack of science on BCMA

2009-01-21T12:52:00.001-08:00

This is getting downright weird. I am starting to feel like Henry Fonda in 12 Angry Men, calling for real proof of decrease med errors rather than jumping on the BCMA bandwagon.

New Report on Lessons from AHRQ-Funded Barcode Medication Administration Projects

The AHRQ National Resource Center for Health Information Technology has released a new report that summarizes key findings from grantees who have examined how applications such as barcode medication administration can improve the quality, safety, efficiency, and effectiveness of health care. The report focuses on lessons learned, challenges, and opportunities associated with introducing these applications into real-world clinical settings so that others who wish to implement and use barcode medication administration and electronic medication administration record technologies can learn from the experiences of these AHRQ projects. Select to access the report.

------------------------------------------------------------------------------------------

Would like to hear reactions to the just released report.

My spin: It is my view that the statement below from the report does NOT support BCMA.

“Research has demonstrated successful reductions in the rate of medication administration and dispensing errors after the implementation of barcoding systems,8-16”

Reference 8 and 9 are on the dispensing process that are elegant and very convincing for the dispensing process not BCMA.

Reference 10-16 are not research studies showing reduction in errors but opinion pieces. They assume that BCMA will decrease errors and give commentary from that perspective. None of the references are research to show decrease medication errors. Something as important as this needs science not opinion.

8. Poon EG, Cina JL Churchill W, Patel N, et al. Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy. Ann Intern Med 2006 Sep 19;145(6):426-34.

9. Poon EG, Cina JL, Churchill WW, et al. Effect of bar-code technology on the incidence of medication dispensing errors and potential adverse drug events in a hospital pharmacy. AMIA Annu Symp Proc 2005:1085.

10. Patterson ES, Rogers ML, Render ML. Fifteen best practice recommendations for bar-code medication administration in the veterans health administration. Jt Comm J Qual Saf 2004 Jul;30(7):355-65.

11. Wright AA, Katz IT. Bar coding for patient safety. N Engl J Med 2005;353:329-31.

12. Patchett JA. Bar coding: A practical approach to improving medication safety. ASHP Advantage; North Shore LIJ; Hospira; 2004:1-11.

13. Department of Health and Human Services: Food and Drug Administration. Bar code label requirements for human drug products and biological products; final rule. Federal Register 2004;69(38):201-601.

14. Department of Health and Human Services: Food and Drug Administration. Bar code label requirements for human drug products and biological products; final rule. Federal Register 2004;69(38):201-601.

15. The Joint Commission. http://www.jointcommission.org/. Accessed August 30, 2008.

16. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.

If BCMA was a drug

2009-01-20T13:42:00.001-08:00

So would you take a drug that had zero studies on its safety and efficacy? Would labeling claims such as “over 24 million doses administered with zero serious side effects” have the wrath of the FDA down on them.

In light Coca-Cola being served with a class-action lawsuit, charging the Atlanta beverage giant with deceptive and unsubstantiated claims on its Vitaminwater beverages, consider Intellidot’s claim in a recent advertising.

“Our barcode point-of-care system has allowed our clients to deliver over 24 million medication administrations with zero serious five rights med errors.”

Intellidot is asking for and just might get into some deep do do over unsubstantiated statements such as this. The studies to which they refer are internal, not peer reviewed and of a relative small sample size as admitted by the company in a ASHP list serv post. Desperate times call for desperate marketing is my guess.

Nursing Informatics Conferences in 2009

2009-01-18T17:49:00.001-08:00

Am Nursing Informatics Assoc. speaker proposals due January 25, for Las Vegas conference April 23-25, 2009. They do not pay for anything but a registration, fyi.

http://www.ania.org/Speaker&Poster%2009.htm

Also found this http://www.ni2009.org/ The 10th International Congress on Nursing Informatics welcomes you to Helsinki Finland on 28 June – 1 July 2009. Paper submission date has passed (bummer).

Helsinki is a wonderful place to visit, both as a historic, majestic city and summer solstice in Finland is quite a celebration. Let’s have the 1st International Pharmacy Informatics Congress there in 2010.

Pharmacology in Second Life

2009-01-18T08:34:00.000-08:00

Pass this on to your pharmacology profs (and watch them weep)

Pharmacology in Second Life

http://scienceroll.com/2009/01/15/pharmatopia-pharmacology-in-second-life/

I may have mentioned this before: This Medical Students blog is fantastic. Following him on Twitter is fascinating.

Pharmacoinformatics or Pharmacy Informatics Working Group

2009-01-13T13:44:00.000-08:00

It has been kicked around in the AMIA working group that perhaps we should change the name of the working group. Currently it is the Pharmacoinformatics Working Group. Here are some some items for your thought and considerations. First is our mission statement:

Mission

To promote interaction among AMIA members who are interested in the intersection of technology and medication management. This includes all aspects of the process from prescribing, dispensing, administration, monitoring, and educating about medication use within health care delivery systems.

Prescribing – clinical decision support to facilitate rational prescribing
Verifying/Dispensing – interpretation, translation and perfection of medication orders, including informatics and technology in dispensing
Administration – the information flow and decision support with electronic medication administration, 5 right checking and documentation
Monitoring – relating to the use of ADE surveillance/prevention, pharmaco-epidemiology, pharmaco-vigilance and pharmacoeconomics to enhance patient outcomes
Education – promoting professional and patient education

Here are some graphical representations. First is informatics defined by Ted Shortliffe.

This is an adaptation for pharmacy

Note that Pharmacy informatics does touch patients, society and then moves to professional pharmacy practice.

The next few diagrams are adaption from Terry Seaton's work. We discussed the exact location of each circle and could not exactly get it right. Both are submitted for your view.

and this one, that is a little bit different.

So the question remains. Pharmacoinformatics or Pharmacy Informatics.

The Best Medical Blogs for 2008

2009-01-07T03:06:00.000-08:00

The polls are open to vote on the best Medical Blogs.

http://www.medgadget.com/archives/2009/01/the_2008_medical_weblog_awards_the_polls_are_open.html

Twitter List

2009-01-06T16:59:00.000-08:00

http://www.medicalstudentblog.co.uk/twitter-doctors-medical-students-and-medicine-related/

If you are on Twitter, lets get the pharmacist list longer1

BMJ YouTube Channel

2008-12-31T06:12:00.001-08:00

British Medical Journal has a Youtube channel that is very interesting. (via the ScienceRoll Blog)

In a search I did not see anything on pharmacy or therapeutics. Anyone?

Clinical Pharmacy Services Save $4.81 on the Dollar

2008-12-30T14:41:00.001-08:00

This is from a recent ASHP newsletter. I find this to be freaking awesome. Hope to comment on the ones that have informatic implications for even better improvements and ROI.

An evaluation of studies published from 2001 through 2005 found a median savings of $4.81 for every dollar spent on clinical pharmacy services. The savings ranged from $1 to $34.60 per dollar spent.
http://www.pharmacotherapy.org/pdf/free/Pharm2811_Perez-EconEval.pdf

Best of Medicine 2.0 in 2008

2008-12-27T18:10:00.000-08:00

Wow have a few days off? Check these out.

From The Scienceroll.com - a terrific blog, fyi. This post lists the best of Medicine 2.0

http://scienceroll.com/2008/12/22/web-20-in-medicine-services-of-2008/

Dean Giustini at UBC Academic Search - Google Scholar Blog created an incredibly useful list of the best web 2.0-based medical services of 2008.

I have a few databases of similar sites:

And hundreds of posts here.
Follow Dean Giustini and Ves Dimov for more.

DDI Software and Pharmacists

2008-12-24T06:57:00.001-08:00

This study in JAMA documents that 1 in 25 elderly Americans take a potentially harmful combination of medications. Is this and indictment on the lousy job pharmacists are doing picking up on these combos and how bad the DDI checking software is?

Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States
JAMA. 2008; 300:2867-2878. ABSTRACT | FULL TEXT | PDF

Chemoinformatics

2008-12-18T14:27:00.000-08:00

We spent some time defining pharmaco and pharmacy informatics. Now Chemoinformatics!

This is really interesting from Russ Altman's Blog.

http://rbaltman.wordpress.com/2008/12/17/biology-chemistry-bioinformatics-chemoinformatics/

More BCMA Emotion, no science

2008-12-16T06:27:00.001-08:00

At the BCMA networking session at the ASHP meeting, the floor was opened up for questions. So of course, I needed to ask “the ROI question” to the panel that was assembled.

So here is my recollection of my question: Given the current financial situation and the fact that there are no good studies to show the value of BCMA, how do you justify the practice?

The responses where to the effect:

There is no ROI. We are doing everything to make the medication administration safe at our hospital, that is what we are all about.

I put up all of the headlines of the medication administration errors to the Board and then told them a couple of incidence of near misses, and they sucked it up.

My kids swim team has layers of redundancy in the time keeping; shouldn’t we have protection for medication administration?

Wouldn’t you want this if your child was in the hospital?

We have the statistics on near misses that are very impressive.

Nurses are convinced that it works and would never go back to the old way.

The near miss statistic was uncovered as bogus, in a later story of how nurses have all of the insulin stickers on the back of their badges and scan until they get a correct scan. Where, presumably each scan is logged as a near miss.

I could not help think of what my old room mate taught me with example after example of selling cars. People buy with emotion and justify with logic. I clearly heard lots of emotion from the panel. They where making emotional arguments and justifying the practice with logic, devoid of any science.

Excuse me, but isn’t pharmacy a scientific profession. Shouldn’t we have a scientific explanation for BCMA as a practice.

The science behind unit dose distribution was marvelous. Yet, we continue to make emotional pleas for BCMA.

This will not hold up over time, we need more science or we are toast.

Twitter for Health presentation

2008-12-03T10:31:00.001-08:00

Anyone on Twitter? It is very cool. Well, let me just say I am still attempting to find the ‘sweat spot’ for the use of this technology. This PPT helps.

My twitter name is “poikonen” if anyone dives in.

| View | Upload your own

This is via the blog http://healthinformaticsblog.com/

Vote for the Top Ten Articles of 2008

2008-11-28T08:06:00.001-08:00

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?

2008-11-28T06:04:00.001-08:00

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.

Powered by Qumana

Canary in the Coal Mine?

2008-11-27T07:59:00.000-08:00

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

2008-11-26T14:06:00.000-08:00

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

2008-11-26T08:12:00.001-08:00

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

2008-11-25T10:36:00.001-08:00

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

2008-11-24T09:23:00.001-08:00

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

-----------------------------------------------------------

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

2008-11-24T09:19:00.001-08:00

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!

-------------------------------------------------------------

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

2008-11-23T10:59:00.000-08:00

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?

2008-11-21T14:38:00.001-08:00

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

2008-11-18T13:23:00.000-08:00

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?

2008-11-13T08:17:00.000-08:00

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.

New BCMA study

2008-10-29T14:42:00.001-07:00

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

2008-10-29T10:56:00.000-07:00

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.

CMS ePrescribing Conference

2008-10-27T12:10:00.001-07:00

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

2008-10-06T07:40:00.001-07:00

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.

2008-09-30T19:25:00.000-07:00

AHRQ’s new teleconference on Clinical Decision Support

October 27, 2008, from 2:30 pm – 4:00 pm Eastern Time
Moderator: Jon White, Agency for Healthcare Research and Quality
Presenters:

· Ben-Tzion Karsh, Ph.D., University of Wisconsin Department of Industrial and Systems Engineering

· Ross Koppel, Ph.D., University of Pennsylvania Department of Sociology, and Center for Clinical Epidemiology and Biostatistics, School of Medicine

· David F. Lobach, M.D., Ph.D., Division of Clinical Informatics, Department of Community and Family Medicine, Duke University

Sponsored by the AHRQ National Resource Center for Health IT

This is the second in a series of four free 90-minute Web conferences over the next few months that will focus on how clinical decision support—a clinical system, application, or process that helps health professionals make good patient care decisions—can be used to inform and improve health care delivery. Featured presenters are Ben-Tzion Karsh, Ph.D., M. S. I. E., University of Wisconsin Department of Industrial Engineering and Systems; Ross Koppel, Ph.D., University of Pennsylvania Department of Sociology, and Center for Clinical Epidemiology and Biostatistics, School of Medicine; and David F. Lobach, M.D., Ph.D., Division of Clinical Informatics, Department of Community and Family Medicine, Duke University. They will discuss existing evidence about the relationship between CDS and workflow, levels and stages, including findings regarding order sets and alerts, specific CDS implementations, their impact on workflow and share lessons learned from those implementations.

Select to register for the Web conference.

CPOE v BCMA

2008-09-26T09:46:00.000-07:00

There was a thread on this in the AMIA Pharmacoinformatics list serv.

Today, there was a very good teleconference with David Bates and Robert Wachter where the moderator addressed the topic of CPOE versus BCMA was met head on. Dr Wachter restated his politically based, non-evidenced view from his blog. Dr. Bates disagreed on two fronts. First the epidemiological studies are clear – more harm is done from mistakes in prescribing. Second, the best evidence for safety is with CPOE. There was agreement that optimally both should be done. For me the answer seems crystal clear.

Top Blogs

2008-09-25T05:50:00.001-07:00

Clipped from: http://www.rncentral.com/nursing-library/careplans/top_50_health_2.0_blogs

Health and Technology

Health 2.0 is inextricably linked to technology, so read about how technology and health care affect each other in these blogs.

32. Health Populi. Written by a health economist, this blog looks at how health care and technology intersect. Recent posts include health care debt trends and the economic impact on health insurance, medical treatment, and prescription drug use.

33. iHealthBeat. Actually more of a journal than a blog, this site offers updates on Monday through Friday on how technology affects the health care industry. A part of the California HealthCare Foundation, some of the news is a bit more geared to California and the west coast.

34. HIStalk. This Health IT blog serves primarily as a news aggregator for all the HIS inside industry scoops, but it also provides reader-written posts about the industry.

35. The Healthcare IT Guy. Written by a CEO of a health care IT company, this blog offers plenty of reviews for great health 2.0 sites as well as updates about health care as it pertains to technology.

36. eHealth. Blogging on the nuances of eHealth, health 2.0, and medicine 2.0, this writer discusses the various aspects of technology and health care systems.

37. Neil Versel's Healthcare IT Blog. Read about podcasting, blogging, open source, privacy and more as these aspects of technology pertain to the health care industry.

38. Future of Health IT. This news aggregator blog lets you know the latest news on IT trends and happenings as they relate to the health care industry.

39. The Healthcare Information Systems Blog. While currently undergoing a re-focusing of direction, this blog generally examines health care and its association with technology innovation.

40. Efficient MD.com. This site offers the latest on technology, best practices, and lifehacks. Stay on top of what technology your physician has available in her field.

41. Kidney Notes. Not necessarily just focusing on kidneys, this blog offers a good mix of medical technology news, funny journal articles, and other random fun-ness. Medical professionals and laypeople alike will enjoy reading this blog.

42. davidrothman.net. Combining medical librarianship and Internet technology, this blog offers great 2.0 tools and tips for those in the health care industry.

43. Laika's MedLibLog. Another blog heavy on the medical library end of health 2.0 and written by a Dutch medical information specialist, this blog offers topics such as WikiMindMap, Dutch medical blogs, and more.

From Public Pharmacoinformatics — Pharmcoinformatics Public Site

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

John Poikonen

john@poikonen.net

Pharmacy Informatics Information Collaborative Exchange

2008-09-16T10:01:00.000-07:00

Various professional medical and pharmacy organizations have informatic ideas, programs, initiatives going on. The idea that came out of the AMIA Pharmacoinformatics working group is to coordinate the various activities.

The idea would be a representative from AMIA, HIMSS, ASHP and other organizations will use this communication tool for the fostering of input, ideas and collaboration on the advancement of pharmacy informatics.

Pharmacy Informatics Exchange

RxInformatics.com instead

ASHP Hypocrisy

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

Through information arbitrage, our clients are able to:

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

No More NUPOR Mooing and Musings #3

Two Very Different Views of eRx and EHR benefits

Health Affairs March April 2009 Issue

Getting Started on Twitter

50 Successful Open Source Projects That Are Changing Medicine

50 Successful Open Source Projects That Are Changing Medicine

Ambulatory Care

Collaboration

Integration

Imaging/Visualization

Medical Practice Management Software

Online Publications

Programs

Public Health and Biosurvellance

Software

Hospitals try ATM for drugs

Hospitals try ATM for drugs

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

‘No More NUPOR’ Mooing and Musing #2

No more NUPOR Mooing and Musings #1

No More NUPOR - Near Universal Pharmacist Order Review

Checking out the amazing service Posterous.com

Nancy-Ann DeParle

http://medpedia.com/

Penicillin Allergies

How Twitter Changed by Life

Clinicians Ignore most eRx Alerts

More on the BCMA AHRQ Report

Patient Safety and a Tale of Two Pilots: US Airway’s Sullenberger and KLM’s Van Zanten

AJHP versus NEJM

Medication Errors Occurring with the Use of Bar-Code Administration Technology

Study: Health IT Use Can Lower Hospital Mortality Rates, Costs

(AHRQ) Medical Errors & Patient Safety Update

Drug Induced QT Prolongation

RxNorm and CMS in eRx 2009 Call Letter

Rock and Roll Health IT Funding

Economist's Letter to Obama Calls for Health Care IT Investment

More Opinion and still lack of science on BCMA

If BCMA was a drug

Nursing Informatics Conferences in 2009

Pharmacology in Second Life

Pharmacoinformatics or Pharmacy Informatics Working Group

The Best Medical Blogs for 2008

Twitter List

BMJ YouTube Channel

Clinical Pharmacy Services Save $4.81 on the Dollar

Top articles of 2008

Best of Medicine 2.0 in 2008

DDI Software and Pharmacists

Chemoinformatics

More BCMA Emotion, no science

Twitter for Health presentation

Vote for the Top Ten Articles of 2008

Pharmacists Role in Health 2.0?

Canary in the Coal Mine?

Nothing from nothing leaves nothing

Intellidot response on the ASHP list serv

ASHP Meeting Informatics Presentations and events

McKesson agrees to $350 million settlement

Mediware purchases Hann's On for $3.5 million

Levels of Security on pharmacy informatics

Why a pharmacy informatics blog?

eRx in California

100% reduction in errors?

New BCMA study

Health 2.0 Opportunities

CMS ePrescribing Conference

CMS ePrescribing Conference

Press coverage

Slide of all sessions!

http://www.e-prescribeconference.com

RxNorm and Routed Generics

CPOE v BCMA

Top Blogs