Wednesday, December 31, 2008

BMJ YouTube Channel

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?

Tuesday, December 30, 2008

Clinical Pharmacy Services Save $4.81 on the Dollar

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

Monday, December 29, 2008

Saturday, December 27, 2008

Best of Medicine 2.0 in 2008

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.

Wednesday, December 24, 2008

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

Thursday, December 18, 2008

Chemoinformatics

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/

Tuesday, December 16, 2008

More BCMA Emotion, no science

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.

Wednesday, December 3, 2008

Twitter for Health presentation

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/

Friday, November 28, 2008

Vote for the Top Ten Articles of 2008

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

Thanks for your participation.
-jp

Pharmacists Role in Health 2.0?

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

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

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

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Thursday, November 27, 2008

Canary in the Coal Mine?

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

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

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

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

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

Wednesday, November 26, 2008

Nothing from nothing leaves nothing

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

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

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

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

Intellidot response on the ASHP list serv

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

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

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

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

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

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

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

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

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

Happy Thanksgiving to all!

Thanks again,

Paul Seelinger, RPh

Sr. Director of Clinical Operations

IntelliDOT Corporation

The Bedside Patient Safety Experts

13520 Evening Creek Drive North, Suite 400

San Diego, CA 92128

Cell: 310-961-0630

Fax: 866-212-9947

Tuesday, November 25, 2008

ASHP Meeting Informatics Presentations and events

Sunday, December 7

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

Monday, December 8

Time	Event	Comments	Location
9:00 – 10:30 a.m	Opening General Session		West Hall D2, Level 2

2:00 – 5:00 p.m.	BCMA in 2008: Trends, Regulations, and Innovations	MPA: Robert Christiansen	W209A, Level 2
5:15 – 6:15 p.m.	ASHP Section of Pharmacy Informatics and Technology – Barcoding Networking Session	Facilitated by C. Urbanski – EC Liaison required, but other EC members optional	W308A, Level 3

Tuesday, December 9

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

Wednesday, December 10

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

Thursday, December 11

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

Monday, November 24, 2008

McKesson agrees to $350 million settlement

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

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

Sunday, November 23, 2008

Levels of Security on pharmacy informatics

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

Friday, November 21, 2008

Why a pharmacy informatics blog?

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

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

http://pharmacyinformatics.blogspot.com/

http://pharmacyinformatics.wordpress.com

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

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

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

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

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

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

Tuesday, November 18, 2008

eRx in California

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

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

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

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

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

The complete issue brief is available under Document Downloads below.

Document Downloads

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

Thursday, November 13, 2008

100% reduction in errors?

A new study posts some astonishing results. Some thoughts:

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

Wednesday, October 29, 2008

New BCMA study

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

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

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

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

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

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

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

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

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

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

PMID: 18823912 [PubMed - as supplied by publisher]

Health 2.0 Opportunities

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

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

By: Rebecca Vesely / HITS staff writer

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

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

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

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

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

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

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

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

Monday, October 27, 2008

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

Monday, October 6, 2008

RxNorm and Routed Generics

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

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

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

Any input is appreciated.

Tuesday, September 30, 2008

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.

Friday, September 26, 2008

CPOE v BCMA

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.

Thursday, September 25, 2008

Top Blogs

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

Tuesday, September 16, 2008

Pharmacy Informatics Information Collaborative Exchange

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.