Rx Informatics

Pharmacogenomics 101 Podcast

01/22/2012

At the Am Medical Informatics Association meeting in Nov 2011, I had the pleasure of meeting Yohan Lee, PhD, an energetic and knowledgeable genomic researcher. We had a conversation on some general principles on pharmacogenomics and pharmcogentics via Skype recently. Here is a podcast of that conversation.

Direct link to Podcast

http://rxinformatics.com/content/yohan-lee-phd-amia-pharmacoinformatics

Link to iTunes download

http://itunes.apple.com/us/podcast/rxinformatics.com-podcast/id321829051

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Fifty Usability Ideas for Pharmacy inspired by iTunes

12/20/2011

It seems that this is the year of usability in medical applications. There are lots of studies and examples of how better usability impacts patient care and workflow. A couple of years ago Allen Flynn from the Univ of Michigan Hospitals and pharmacy informatics extraordinaire, presented this concept of a pharmacy profile, a la iTunes. This is awesome and a classic. Thanks to Allen Flynn for allowing to share his brilliant ideas. A pdf of the entire iTunes pharmacy profile is attached.

Fifty Usability Ideas for Pharmacy inspired by iTunes

1. Pharmacy Department’s on-screen message box

2. Patient selection via Venue -> Unit -> Name

3. Updating counts of orders to be verified in parenthesis (y)

4. Drug information summary box updated for current drug
5. Contextual hyperlinks to drug info databases as buttons

6. On-screen clock

7. Large name panel with age, sex, weight, CrCL

8. Name panel scrolls on command to show current visit details

8. Active, discontinued and home medications toggle

9. Dynamic search capability

10. Pharmaco-surveillance provided as patient-specific alert buttons

11. System status signal with double-click for detailed information

12. Active orders count

13. Note management functions include Add, Edit and Remove

14. Pause function

15. Expandable window

16. Drug list with column sort, columns add, column arrangement

17. Window-shade order detail view without dialog boxes

18. Step-wise order verification using dynamic evaluation panes

19. Order risk ranking based on drug, order and patient information

20. Order provenance information for ordering clinician and process

21. IV push guidelines directly integrated into verification workflow

22. Rule-based forcing functions for verification steps

23. Metadata Dosing Evaluator with statistical indicators

24. Metadata Characteristic Selectors control the metadata used

25. Metadata Frequency Evaluator based on previous orders

26. Supply chain analysis pane with ADM and inventory information

27. Related home medications by generic name and therapeutic class

28. Previous orders for same order item listing

29. Allergy review pane with allergy data collection forcing function

30. Related findings pane with lab, vital signs and physiologic data

31. Alerts and responses pane shows clinicians’ CDS responses

32. Ordering clinicians’ names with hyperlinks to paging system

33. Order level notes function

34. Patient level notes function

35. Hover over PRN column to see detail of prn reasons

36. Hover over Dose and Frequency column to see scheduled times

37. ADM product availability column updated by ADM system

38. Verified order check-box

39. PRN assessment pane

40. Add customized verification panes to the verification process

41. Active ingredient by active ingredient verification

42. Switch all oral dosage forms from solids to liquids and vice-versa

43. Change all appropriate IVPB diluents from D5 to NS or vice-versa

44. Calculated CrCL on screen has selectable equation options

45. Body surface area onscreen

46. User’s recently verified medication list (not shown)

47. Patient’s individualized IV compatibility chart (not shown)

48. Last 24 hours and cumulative lifetime dose (not shown) columns

49. Infusion titration history graph pane (not shown)

50. Unused PRN indicator

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Dennis Tribble’s Acceptance Speech – Distinguished Service Award

12/14/2011

While we disagree on the value and integrity of ASHP, I agree with everything in this speech. He is an unbelievable pioneer and innovator in pharmacy informatics. Congratulations to Dennis!

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Podcast with Terry Seaton, Pharm.D.

12/11/2011

Dr. Seaton is the new AMIA Pharmacoinformatics Working Group Chairperson.

Here is a new podcast introducing him with his background and terrific ideas for pharmacy informatics and more.

iTunes <LINK> to RxInformatics Podcasts
iTunes <LINK> to this episode
Direct <LINK> to this episode

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The Pharmacist by Michael Cassidy due out in early Dec here is the trailer

11/25/2011

The Pharmacist (Official Trailer) from Michael Cassidy on Vimeo.

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ACCP Address includes CDSS

11/16/2011

Lawrence Cohen is the incoming President of the American College of Clinical Pharmacy. His inspiring address entitled

Boldly Positioning Clinical Pharmacy in Volatile Times specifically singles out clinical decision support. <LINK> It is great and reassuring to see a pharmacy leader that "gets it".

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ASHP: Continually in pursuit of hypocrisy. Part II

11/15/2011

Since this hypocrisy has to do with informatics, it is posted here. Other professional society craziness can be found on Google Plus in the links below.

The Am Society of Health System Pharmacists (ASHP) CEO report has a number of hypocritical and delusional aspects. Part I <LINK> addresses ASHP’s patient safety policy and handling of the State of Ohio’s “lynching” of a pharmacist. This one addresses ASHP's claim to being at the right table when policy is made. Subsequent posts will deal with the financial management and leadership aspects in the 2001 CEO report. Part III on taking unpopular positions is here <LINK>.

Under the heading of “Being at the right table” the ASHP CEO pounds his chest about being at the right table on health care policy and information technology issues. He notes the Pharmacy HIT Collaborative as an example. In the HIT and health reform land grab ASHP was no where near the table and are struggling to nibble on crumbs. There is not even a mention of pharmaicsts in any of the HITECH, ARRA or any health reform legislation. They seem to be coming to the table for scraps after everyone else has had a feast.

These legislative initiatives were the equivalent of the Oklahoma land give away, GI bill and moon shot for health information technology. Pharmacists, the most connected health professionals, should have been at least part of the HITECH act to be “eligible providers” around electronic prescriptions and CPOE. As it stands there is not even a requirement to receive eRx’s and CPOE orders electronically. So claiming to be at the right table is, well, hypocritical. It borders on delusion.

The Pharmacy HIT Collaborative is generally a very positive strategic initiative. It desires some thoughtful consideration. Please take a look at those efforts. Even at its best, this initiative does not put ASHP at the table at all. At its worst that it puts pharmacy farther down the hall by taking a counter productive approach to EHR involvement. The specific tactics of the collaborative are a bit confusing that I will address in a separate post.

What say you?

2011 Report of the Executive Vice President and Chief Executive Officer: ASHP: Continually in pursuit of truth (right)

http://www.pharmacyhit.org/

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Google Plus discussion group from the UK on Hospital eRx and Admin

11/12/2011

Google Plus is the real deal for social networking. That is a topic for another post. +Pauline Sweetman is a pharmacist informatics guru in the UK that is a must follow person in your RxInformatics circles. She points out a Google + site that will be of interest to this group.

There is now a Google+ page on UK Electronic Prescribing and Medication Administration. Another good site to add to your circles.

https://plus.google.com/u/0/111017406789447114550/posts

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Bar Code Comments needed (add RxNorm)

10/28/2011

Your comments are needed. Please see this for the specifics:

http://www.ofr.gov/(S(j45ojizo0zqw1ugj34vngo5j))/OFRUpload/OFRData/2011-27657_PI.pdf

Most of the questions revolve around the technology requirements. The real issue and need is to get rid of the NDCs (or supplement them) and add RxNorm Codes for product identification. My 2 cents. Better people than me can comment on the pure technology issues.

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