A digression

My fourth post. Five more weeks of internship. This summer is disappearing faster than I can type pneumonoultramicroscopicsilicovolcanoconiosis. What's not disappearing is my writer's block. I could write about the data analysis I did to explain how our pharmacy was able to dispense more products than it purchased. (Still haven't figured that one out but the data might have lied, if physical laws hold.) I could describe bedside barcoding and the challenges associated with its implementation. I could outline the reasons the pharmacy department chose to hold off on the wikipedia idea, for now they say. But none of those things is condensing into fine stories in my mind.

Instead, I will talk about the most important lesson I learned this summer. It starts with the importance of taking initiative. My most meaningful assignments to date were the ones I brought onto myself. And not one of the pharmacists the interns had the pleasure of meeting this summer did not go the extra mile. They all went so far beyond their job descriptions that they had to squint, I imagine, to read their job descriptions, and they excelled. The benefits are obvious. That isn't the lesson. The truth is... I'm slowly realizing that what really matters is having free time. Sounds counterintuitive, doesn't it? But without free time, there is no opportunity to take initiative. The goal is always to improve the status quo. What is valuable now will not be valuable forever. A crammed schedule blinds us to what is better and what could be better. Have some idle moments, and they keep our minds fresh and open to new possibilities. They make it possible for us to seize the new opportunities that emerge. The danger is that we never realize our schedules were maxed out until we are idle. Because it's so natural to become wrapped up in our work.

With this revelation, I am restructuring my agenda to include "nothing."

On WORx

Two weeks ago, I received a crash course on WORx from my manager Rick. It was so interesting that I decided to recreate part of it here. For you, Dear Reader.

Inpatient patient data originate with ADT: admission, discharge, transfer. This information is sent to WBI (an interface engine), which converts the data to a form that all systems used by all hospital departments can understand. In pharmacy, WORx takes in the processed data. WORx is the inpatient pharmacy management program that supports dispensing, billing, and clinical activities. When physicians write new prescriptions in CareLink (digital prescriptions), the orders are transferred directly to WORx. WORx also keeps track of the formulary. You can consider the formulary a list of most-used drugs, with complementary drug data (names, strengths, indications, etc.) pulled from First Data Bank. In particular, the drug ID or "master code" is taken from First Data Bank, and it is saved as "product code" in WORx. An IT digression... With any kind of database (the formulary is a database), we want the item ID to be unique. Inconveniently, the drugs in First Data Bank are not sorted by manufacturer or package size. Two otherwise identical products with different manufacturers or packaging share the same master code in First Data Bank and will therefore get assigned the same product code in WORx. ID promiscuity makes housekeeping difficult. The solution? In case of duplicates, we append additional digits to the master code before storing it as product code.

With patient data from WBI/CareLink and drug data from First Data Bank, WORx is set to manage inpatient pharmacy. It is involved with labeling, documentation, and providing clinical checks. It also supplies information to other systems. Some examples:

• Health Quest is the hospital billing system. WORx provides pharmacy information for prospective billing.
• The Robot packs drugs. WORx dictates which medications and how much.
• Omnicells supply medications to nurses directly. WORx sends over the orders so that narcotics (for example) are not withdrawn for unauthorized purposes.
• CareWeb is a browser-based program that displays patient lab results, etc. WORx drops information there.

This is by no means an exhaustive summary of WORx. There is so much complexity and beauty in the system. I'm almost sorry that it will soon be replaced by Epic. Although Pete, my coworker who works with WORx most extensively, might disagree.

What I'm working on

The advantages of using a wiki(pedia) for documentation...

Speed: Wikis are minimalist web pages containing mostly plain text (usually). They load quickly.
Search: Users can perform site-wide searches, which is akin to sifting through multiple Word documents in one shot, quickly, and without having to open them.
Structure: Wikis are made up of directories, which can contain children directories that contain grandchildren directories. Upon demand, the wiki can generate a genealogy tree for easy navigation.
Archiving: Everything--modifications, old versions, new versions, users who made the changes, timestamps--is documented. It's possible to revert to an older version with a single click regardless of the damage done to the current version (unless the page itself is deleted, perhaps, in which case its history is probably also deleted).
Collaboration: Users can be individually authorized for viewing, editing, and moderating different sections of the wiki. Editing a page is not unlike editing a Word document--the interface is simple and intuitive for basic tasks.
Feedback: Polls, ratings, notifications, and other extensions are available on demand.

These are points I might have to present to the pharmacy department sometime this summer. We currently use a document library to keep track of department guidelines and procedures. It's a web directory that authorized pharmacists upload Word documents and pdf files to. The library worked well and fit very nicely into our existing web interface, but, as the directory got larger, the loading time got longer. Dr. Stevenson, Director of Pharmacy, brought up wikis during a manager meeting. It was a good idea, so I began my research. We started out with three potential platforms: MediaWiki (open source), SharePoint (Microsoft), and Confluence (Atlassian, an Australian software company you probably haven't heard of). Within MCIT-Rx, we decided that MediaWiki was too rough, the user interface too hostile for non-technical audiences. So it was SharePoint or Confluence. Even though the hospital had a tight relationship with Microsoft, we didn't choose SharePoint because it was unnecessarily complicated. (SharePoint came as a package in which the wiki was only one small component.) And we were left with Confluence.

As wonderful as Confluence is, there are drawbacks. There is no way to integrate it seamlessly into the internal pharmacy website so, for pharmacists, getting to the wiki will require an extra log-in step. Also, we don't have our own Confluence. The Medical School does. Technically, we will be using their service. While they are very friendly people, it's still inconvenient for us because we don't have control over the backbone. That becomes an issue during downtimes, etc.

Those are my research. Ultimately, whether a wiki is worth pursuing will be determined by the pharmacy department.

Hello. My name is Jennifer. I'm a P2. My internship this summer is right here in Ann Arbor. I work with the Pharmacy Group in Clinical Systems Management in Medical Center Information Technology at the University of Michigan Health System--for short, MCIT-Rx. I have been part of the team since last May. There are seven of us. I'm the only student and everyone else is a full-time employee. They are Pete, Rob, Todd, Robin, Russ, and Rick, our boss and the only licensed pharmacist. We are situated in the heart of the Pharmacy Department in the University Hospital, down on level B2. Scroll to the bottom of this post for some photos. These IT folks are quite photogenic.

IT folks are also team players. Our agenda is always full and we constantly juggle multiple projects. Pete is our expert for WORx, the inpatient pharmacy management system. Robin and Russ support Omnicells, dispensing machines scattered throughout the hospital that nurses use for easy medication retrieval. Todd is our web developer and database man. Rob works with the Robot, an automated drug packing machine, and QS1, the outpatient pharmacy management system. Rick, our leader and ambassador to pharmacy management and MCIT, oversees our projects. Me? I dabble in a little bit of everything. I support IT support. It's important to point out that these are merely some of the roles each person takes on. We do much more to support our pharmacy and there are overlaps in our duties. For example, someone has to be "on call" 24/7, and the full-time members of our team (everyone except I) take turns to be that popular person. At one point last semester, I wanted to volunteer for this role once summer comes around, just to experience that wonderful feeling of being wanted by nurses, pharmacists, hospital staff, etc., during all hours of day and night. But, now that school's over, I think I'm actually reconsidering. Not sure why...

So, there you go. The first installment of six (a sextet!), documenting my experience with MCIT this summer. The photos I mentioned earlier aren't ready yet, but I'll post this anyway. ¡Happy Cinco de Mayo! Stay tuned for photos of my team, coming next week.

[edit 5/9] Here are the photos.