RxDoc.Org http://rxdoc.org John Poikonen, PharmD mail:jp@rxdoc.org posterous.com Sun, 22 Jan 2012 14:58:30 -0800 Pharmacogenomics 101 Podcast http://rxdoc.org/pharmacogenomics-101-podcast http://rxdoc.org/pharmacogenomics-101-podcast 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

Link to iTunes download

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Tue, 20 Dec 2011 11:11:00 -0800 Fifty Usability Ideas for Pharmacy inspired by iTunes http://rxdoc.org/fifty-usability-ideas-for-pharmacy-inspired-b http://rxdoc.org/fifty-usability-ideas-for-pharmacy-inspired-b

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 image of the entire iTunes pharmacy profile is attached.


Image


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

Itunes_rx

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Wed, 14 Dec 2011 07:51:19 -0800 Dennis Tribble's Acceptance Speech - Distinguished Service Award http://rxdoc.org/dennis-tribbles-acceptance-speech-distinguish http://rxdoc.org/dennis-tribbles-acceptance-speech-distinguish

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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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Sun, 11 Dec 2011 06:06:45 -0800 Podcast with Terry Seaton, Pharm.D. http://rxdoc.org/podcast-with-terry-seaton-pharmd http://rxdoc.org/podcast-with-terry-seaton-pharmd 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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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Fri, 25 Nov 2011 10:42:00 -0800 The Pharmacist by Michael Cassidy due out in early Dec here is the trailer http://rxdoc.org/the-pharmacist-by-michael-cassidy-due-out-in http://rxdoc.org/the-pharmacist-by-michael-cassidy-due-out-in

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

 

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

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Fri, 25 Nov 2011 10:33:00 -0800 The Pharmacist by Michael Cassidy » Thanksgiving Treats and Trailer — Kickstarter http://rxdoc.org/the-pharmacist-by-michael-cassidy-thanksgivin http://rxdoc.org/the-pharmacist-by-michael-cassidy-thanksgivin

We hope this 90 second trailer gets you even more excited to see the full and final product.  We hope you enjoy it!

On behalf of The Pharmacist Cast & Crew, Happy Thanksgiving!

via kickstarter.com

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Wed, 16 Nov 2011 04:32:11 -0800 ACCP Address includes CDSS http://rxdoc.org/accp-address-includes-cdss http://rxdoc.org/accp-address-includes-cdss
Image

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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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Tue, 15 Nov 2011 11:00:00 -0800 ASHP: Continually in pursuit of hypocrisy. Part II http://rxdoc.org/ashp-continually-in-pursuit-of-hypocrisy-part-73165 http://rxdoc.org/ashp-continually-in-pursuit-of-hypocrisy-part-73165

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 2011 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) 

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Sat, 12 Nov 2011 06:35:06 -0800 Google Plus discussion group from the UK on Hospital eRx and Admin http://rxdoc.org/google-plus-discussion-group-from-the-uk-on-h http://rxdoc.org/google-plus-discussion-group-from-the-uk-on-h 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.

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Mon, 07 Nov 2011 06:14:00 -0800 ASHP: Continually in pursuit of hypocrisy.… http://rxdoc.org/ashp-continually-in-pursuit-of-hypocrisy http://rxdoc.org/ashp-continually-in-pursuit-of-hypocrisy
ASHP: Continually in pursuit of hypocrisy. Part III

This is Part III on the hypocrisy in the American Society of Health System Pharmacists (ASHP) ASHP CEO 2011 report that he entitled Continually in the Pursuit of the Truth. Here are links to Part I and Part II on other hypocrisy's in the report. At least a couple more items are in the works.

https://plus.google.com/u/0/107878174927164666208/posts/7iKCyimcCnn
https://plus.google.com/u/0/107878174927164666208/posts/TqbAaGXw9A1

In talking about pharmacists as leaders the CEO boasts about taking positions that are not popular. He cites telling the truth about the contributions of pharmacists in light of some negative AMA statements. How is this not popular? This does not seem all that brave to me. Standing up to physicians is what he is bragging about? Oh my, I see pharmacists and nurses do this every day in the course of their job. Doing this directly and in the heat of patient care takes a lot more courage than writing an opinion piece and throwing it over the wall. Of course he must defend the role of the pharmacist, that is his job. That was not exactly going out on a limb for the truth or taking a unpopular position. A true leader should be able to do better than that. I have the pleasure and honor see pharmacy leaders working with and challenging physicians at the academic medical center where I work all of the time.

There is a really good sequence in a movie Ratatouille. It is a commentary on critics. In many ways the work of a critic is easy. I do not pretend to be better or even know how to run a professional organization. However, like the famous quote about pornography “you know it when you see it”, I know incompetence and arrogance when I see it. I see it in ASHP all of the time in representing their members and the way they approach professional issues. Part IV and V of ASHP’s continual pursuit of hypocrisy to come.

In criticizing the ASHP, I am sensitive that this might start to be perceived as the ramblings of a disgruntled member. But, as a member of ASHP for 30+ years and a former elected official in the organization, I care deeply about the organization and its impact on the pharmacy profession. Their stewardship of this organization, with its actions and arrogant aristocratic airs, has reached a point that I must speak out. It is my sincere hope that the leadership take this criticism in a constructive manner.Edit

Ratatouille final taste
via plus.google.com

 

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Fri, 28 Oct 2011 11:34:49 -0700 Bar Code Comments needed (add RxNorm) http://rxdoc.org/bar-code-comments-needed-add-rxnorm http://rxdoc.org/bar-code-comments-needed-add-rxnorm Your comments are needed.  Please see this for the specifics:

Image

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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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Thu, 06 Oct 2011 04:40:20 -0700 Favorite Steve Jobs posts http://rxdoc.org/favorite-steve-jobs-posts http://rxdoc.org/favorite-steve-jobs-posts
I had a few tears in my eyes this morning driving to the airport.  Here are some terrific links in tribute to Steve Jobs

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Fri, 23 Sep 2011 10:52:00 -0700 Clinical Informatics Becomes a Board-certified Medical Subspecialty http://rxdoc.org/clinical-informatics-becomes-a-board-certifie http://rxdoc.org/clinical-informatics-becomes-a-board-certifie

Clinical Informatics Becomes a Board-certified Medical Subspecialty Following ABMS Vote

September 22, 2011

AMIA to offer prep courses for clinicians who sit for Board Exam

via amia.org

Wow. Meanwhile pharmacy org and pharmacists are left in the dust. There are some dedicated people that have made a go of making Pharmacy Informatics a specialty. It remains in the distant future. It is my hope that this kicks us in the behind....

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Thu, 08 Sep 2011 11:16:00 -0700 More important than Informatics - Courage http://rxdoc.org/more-important-than-informatics-courage http://rxdoc.org/more-important-than-informatics-courage

Some things are more important than informatics.  Yes I know for this group that is hard to believe. 
Please take the opportunity to see this months editorial in Hospital Pharmacy, entitled "Having the courage to do the right thing".  I was deeply moved by it.
Now, consider the non-actions and mis-directions of one of pharmacy's professional organizations, ASHP, elaborated in this piece: Continually in pursuit of hypocrisy. Part I
I welcome your comments.

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Thu, 08 Sep 2011 10:54:55 -0700 The Pharmacy e-Health Information Technology Collaborative http://rxdoc.org/the-pharmacy-e-health-information-technology http://rxdoc.org/the-pharmacy-e-health-information-technology Readers of this web site should be aware of a wide collaborative effort from many pharmacy organizations.  Here is a brief overview.  It is highly recommended to understand what this effort is doing.

The Pharmacy e-Health Information Technology Collaborative (Collaborative) launched a new website www.pharmacyhit.org.
The primary work of the Collaborative is to assure the meaningful use of standardized electronic health records (EHR), which support safe, efficient, and effective medication use and continuity of care, as well as facilitates access to the patient care services of pharmacists and other members of the interdisciplinary patient care team.  The website is designed to showcase the Collaborative’s objectives and the work of its members.

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Thu, 08 Sep 2011 08:27:21 -0700 ASHP: Continually in pursuit of hypocrisy. Part I http://rxdoc.org/ashp-continually-in-pursuit-of-hypocrisy-part-86905 http://rxdoc.org/ashp-continually-in-pursuit-of-hypocrisy-part-86905
The following was posted on Google+

In reading the 2011 American Society of Health System Pharmaicsts (ASHP) CEO report recently published I was struck on a number of levels. It brings up issues around leadership, courage, integrity, informatics, fiscal and professional responsibility. This first response is about the absurd hypocrisy exhibited in the report. I will address these other issues in subsequent postings.

The hypocrisy starts with the title “Continually in the pursuit of the truth”. This is so far from reality as to render the title and its contents almost laughable. The tactics employed by our CEO are reminiscent of the political ploys undertaken by fringe elements on both sides of the political aisle. They hope that through sheer repetition and misdirection that their statements and distortions will actually become "the truth." The actual truth has and will always prevail in the end. 

In addition to elaborating on the ‘pursuit of the truth’ in the title, the CEO talks about the “policy issues that will translate into important actions on behalf of our membership”. Consider this statement in light of ASHP's woeful inaction on the Eric Cropp case. The history of this case represents one of the most tragic events in hospital pharmacy history and a gross miscarriage of justice for health system pharmacists. <Link> In this case, a hospital pharmacist, Eric Cropp, was incarcerated for doing exactly what hospital pharmacists, or ASHP’s membership, do every day. Human error and set of system circumstances resulted in the death of an infant. Now consider the ASHP policy on a just culture for heath professionals. The application of this policy to the Cropp case clearly points to an unambiguous travesty of justice. Even the father of the infant has acknowledged that Mr Cropp was “lynched” by the State of Ohio. 

So, if we are to take the CEO at his word, that there is a continual pursuit of the truth and important action taken on behalf of membership, then is it reasonable to assume that there was some action taken on this injustice? Did ASHP do anything to uncover the facts in the case or take a stand on this issue? Clearly, a constituent being incarcerated for doing his job, despite the tragic result, is an issue of great importance to its membership. You would think that it should rise to the level of the organization being moved to take "important actions” based on their policies. A true leader should have the courage to stand up for justice. Yet the leadership of ASHP did nothing. They buried their head in the sand and did not even bother to pursue the truth. They did nothing during the trial and subsequent incarceration of Eric Cropp. 

ASHP's deafening silence continued. Did they help the cause championed by the parents of the dead infant to pass landmark legislation in Ohio around pharmacy technicians? Nope, nada, nothing. Trumpeting the pursuit of truth and policy issues translating to their membership is laughable. This type of hypocrisy and misdirection is disgraceful from a leader of a pharmacy organization. We deserve better.

Table of Contents — August 15, 2011, 68 (16)
2011 Report of the Executive Vice President and Chief Executive Officer: ASHP: Continually in pursuit of truth. Am J Health Syst Pharm August 15, 2011 68:e62-e65; doi:10.2146/sp110017. Full Text; Full...

 

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Thu, 08 Sep 2011 08:23:00 -0700 ASHP: Continually in pursuit of hypocrisy. Part I http://rxdoc.org/ashp-continually-in-pursuit-of-hypocrisy-part http://rxdoc.org/ashp-continually-in-pursuit-of-hypocrisy-part

The following was posted on Google+

In reading the 2011 American Society of Health System Pharmaicsts (ASHP) CEO report recently published I was struck on a number of levels. It brings up issues around leadership, courage, integrity, informatics, fiscal and professional responsibility. This first response is about the absurd hypocrisy exhibited in the report. I will address these other issues in subsequent postings.

The hypocrisy starts with the title “Continually in the pursuit of the truth”. This is so far from reality as to render the title and its contents almost laughable. The tactics employed by our CEO are reminiscent of the political ploys undertaken by fringe elements on both sides of the political aisle. They hope that through sheer repetition and misdirection that their statements and distortions will actually become "the truth." The actual truth has and will always prevail in the end. 

In addition to elaborating on the ‘pursuit of the truth’ in the title, the CEO talks about the “policy issues that will translate into important actions on behalf of our membership”. Consider this statement in light of ASHP's woeful inaction on the Eric Cropp case. The history of this case represents one of the most tragic events in hospital pharmacy history and a gross miscarriage of justice for health system pharmacists. <Link> In this case, a hospital pharmacist, Eric Cropp, was incarcerated for doing exactly what hospital pharmacists, or ASHP’s membership, do every day. Human error and set of system circumstances resulted in the death of an infant. Now consider the ASHP policy on a just culture for heath professionals. The application of this policy to the Cropp case clearly points to an unambiguous travesty of justice. Even the father of the infant has acknowledged that Mr Cropp was “lynched” by the State of Ohio. 

So, if we are to take the CEO at his word, that there is a continual pursuit of the truth and important action taken on behalf of membership, then is it reasonable to assume that there was some action taken on this injustice? Did ASHP do anything to uncover the facts in the case or take a stand on this issue? Clearly, a constituent being incarcerated for doing his job, despite the tragic result, is an issue of great importance to its membership. You would think that it should rise to the level of the organization being moved to take "important actions” based on their policies. A true leader should have the courage to stand up for justice. Yet the leadership of ASHP did nothing. They buried their head in the sand and did not even bother to pursue the truth. They did nothing during the trial and subsequent incarceration of Eric Cropp. 

ASHP's deafening silence continued. Did they help the cause championed by the parents of the dead infant to pass landmark legislation in Ohio around pharmacy technicians? Nope, nada, nothing. Trumpeting the pursuit of truth and policy issues translating to their membership is laughable. This type of hypocrisy and misdirection is disgraceful from a leader of a pharmacy organization. We deserve better.

Table of Contents — August 15, 2011, 68 (16)
2011 Report of the Executive Vice President and Chief Executive Officer: ASHP: Continually in pursuit of truth. Am J Health Syst Pharm August 15, 2011 68:e62-e65; doi:10.2146/sp110017. Full Text; Full...

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Thu, 08 Sep 2011 08:18:51 -0700 Inch by Inch http://rxdoc.org/inch-by-inch-28405 http://rxdoc.org/inch-by-inch-28405

With an HIS go live event and football just around the corner, this seemed like a good inspirational speech.

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Mon, 08 Aug 2011 11:44:37 -0700 AMIA 2011 Symposium Pharmacoinformatics sessions of interest http://rxdoc.org/amia-2011-symposium-pharmacoinformatics-sessi http://rxdoc.org/amia-2011-symposium-pharmacoinformatics-sessi
I was going through the AMIA 2011 Symposium final program, in October.  I cut and pasted the really cool sessions and posters for pharmacoinformatists in the Google Doc link below, for your pleasure.

Pharmacoinformatics Session of interest at the AMIA 2011 Symposium.  Already getting excited.... (Ok, I know, get a life:))

We are working to get Pharmacist CE for this years sessions.  Stay tuned.

John Poikonen | john@ePharmD.Net |

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen Mon, 08 Aug 2011 10:43:00 -0700 National Television Features for Dr. Sam & the Managed Care Blues Band ® http://rxdoc.org/national-television-features-for-dr-sam-the-m http://rxdoc.org/national-television-features-for-dr-sam-the-m

National Television Features for Dr. Sam & the Managed Care Blues Band ®
via managedmusic.com

More diversion. Dr. Sam is one of the nicest gents in the industry. I had the pleasure to hang with him while at Eclipsys. The blues and HITECH -- what could be better.

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]]> http://files.posterous.com/user_profile_pics/923407/jp_hdm_head.png http://posterous.com/users/1gB227NrodP John Poikonen poikonen John Poikonen