Publication Date 24/02/2011         Volume. 3 No. 2   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the March 2011 edition of i2P.
The month of February has seen free enterprise in the pharmaceutical industry breaking out of the mould that is regulated health and upsetting any semblance of balance within community pharmacy.
Government negotiated price reductions with Big Pharma collided head-on with the new business model from Pfizer Direct and its potential to destabilise the entire supply chain process and the supply of medicines under the PBS.
This process has been described in eloquent detail by Neil Retallick, in his article “New landscape, new directions, new Government role in community pharmacy?”

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News Flash

Newsflash Updates for March 2011

Newsflash Updates

Regular updates from the global world of pharmacy. 
Access and click on the title links that are illustrated.

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Feature Contribution

The IT Can of Worms in NSW

Neil Johnston

When a simple business transaction does not seem to make sense, one is led to speculate on the agenda  behind that transaction.
An observation I have noted from personal experience is that the presence of a major Australian IT system within a public hospital environment, is almost non-existent.
This does not make sense.
There are many excellent Australian IT companies.

Comments: 1

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WHAT VALUE LEGAL RESPONSIBILITY?

Rollo Manning

PHARMA-GOSS

It would seem that pharmacists do not value the legal framework that has been bestowed upon them to safeguard the public from the hazards associated with the dangerous chemicals they have on their premises.
A highly trained health professional is required to be “registered” by the State/Territory of the Commonwealth before they can have the privilege of being the custodian for the public with respect to these hazardous chemicals.
And yet – the award wage for “pharmacist in charge” (PIC) is in the order of $24 an hour.

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Clinical Pharmacist Roles Surging Ahead in US

Neil Johnston

The Journal of the American Medical Association ran an article in its 13 October 2010 issue regarding an alliance forming up that included the traditional triad of health professionals – GPs, pharmacists and nurses.
It also highlighted that each sector was seeking a full seat at the health provider table - not just GPs as head with others following on in meaningless roles.
Recognition for pharmacists was awarded in the comment by the JAMA that stated:
“JAMA points to community pharmacists as a key resource to help bridge the gap between doctor and patient, particularly for patients treated by more than one specialist in an often disconnected and dysfunctional health care network.”

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New landscape, new directions, new Government role in community pharmacy?

Neil Retallick

February has been a testing month for community pharmacy.
The anticipated price reductions that flowed from the MoU between Big Pharma and the Government became reality, reducing revenue and margin in the dispensary.
To exacerbate these reductions, the Pfizer Direct model was also realised as a seismic change in the landscape, further reducing dispensary profits.
As March unfolds and many begin to formulate budgets for the next financial year, the challenges just keep coming.

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Continuity of care – discharge from hospital

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Last month I wrote about medication reconciliation when a patient is admitted to hospital and the role of hospital pharmacists in continuity of care. 
The other significant time when a hospital pharmacist’s role is important in ensuring continuity of care is at the time of discharge from hospital. 
Communication of medication changes which have occurred during hospitalisation to those providing care in the community is essential.

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Pharmacy in the context of New Zealand primary health care

Dr Linda Bryant (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)

When looking at where pharmacy fits in the new scheme of things it is important to consider the wider primary health care environment, in what direction the government strategy is changing and, in particular, what will be different for general practitioners and practice nurses.
We cannot work or plan in isolation and must constantly look at what is happening outside our own four walls.
In New Zealand it has been made very clear that there will be transformational (read chaotic) change in the delivery of health care services. 
In the Auckland region (25% of the New Zealand population) there is a large network or consortium involving the Primary Health Care Organisation (PHOs), which are primarily large groupings of general practices, and the three District Health Boards (DHBs), which are the government funding bodies, as well as having a ‘provider arm’ (the hospitals).

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We can’t answer until we are asked

Pat Gallagher

Oh gosh.
The editor has been asking me for sometime now to pen an article about my ICT related subject - as in the news, views and visions.
I have steadfastly remained silent for months.
My negative response has been solely based on one strong human feeling; that being the one of apathy.
A ‘why bother’ state of mind.
Why bother talking ad nauseam about things that spin around uselessly in political circles.
Why bother getting uptight about things that never seem to offer any hope of real change.
Why bother indeed.

The WOFTAM1 mind set rules – OK!

Then, as often happens, stuff suddenly comes from nowhere and you think to yourself –‘ah maybe there is still a glimmer of hope, just over the horizon”.
Stupid of me and I know it.
Hope flickers eternally though.
What has happened?

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Pharmacists are not Primary Health Care Professionals

Rollo Manning

ABORIGINAL HEALTH

Primary health care (PHC) professionals are those at the front line of treatment of individuals for either acute or chronic diseases. Pharmacists are not members of the front line team – that is the domain of doctors, nurses and Aboriginal health workers.
Pharmacists are on the next level down for action with dieticians, dentists, psychologists, podiatrists, optometrists, speech therapists, physiotherapists, public health educators and other specialised practitioners.

So can pharmacists become front line professionals in primary health care (PHC)?

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Physicians Need Bar Coding Too

Mark Neuenschwander

I’ve been thinking about Car Talk, prayer, clinical documentation, and diagnostic errors.
What’s a Saturday morning without Car Talk?
After 30 years, I still enjoy eavesdropping on Tom and Ray Magliozzi taking calls from listeners about their automobiles’ ailments.
Between outbursts of laughter, the bantering brothers diagnose, prescribe, offer second opinions, and, with limited information, have to guess a lot.

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It's Not About Us - It's About Them

Barry Urquhart

First things first.
Establishing, refining and maintaining a marketing focus requires discipline.
It has as much to do with how we think, as what we think.
Therefore, saving time, improving efficiency, lowering costs and enhancing value must necessarily be viewed through the prism of life. That is, from the consumers and customers perspectives.
Any business initiative which negatively impacts on the perceptions, expectations and experiences of existing, prospective and past clients has questionable value to any public or private sector entity, big or small.
Consumer advocates by name, title or nature must necessarily be at the table for major decisions. Ideally, they need to be articulate, passionate and respected by their peers.
Such a position need not and, arguably, should not be found in a formal organizational chart.

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Freeze or Fry your Fat away? – If only!

Loretta Marron OAM BSc

Can’t shift those love handles? Diet not working? Sick of your cellulite? What about those new machines that freeze or fry your fat away?

Anything to do with cellulite or fat removal is bound to be a good money spinner. When it doesn’t involve diet and exercise it’s assured of getting considerable media attention. Cellulite is a problem encountered by more than 90% of women of all ages, both fat and thin, and most of us are overweight. So should we be rushing out for our non-invasive ‘liposculpting’ or is this yet another weight loss scam targeting some of our most vulnerable consumers?
There are quite a few high-tech body sculpting devices, which either cool or heat the dermis, that claim to be successful at permanently removing cellulite and fat.

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A Can of Worms- The Story Continues

Neil Johnston

The NSW state elections began in earnest 16 days ago on the 20th February, 2011, when Barry O'Farrell launched the NSW Liberal and Nationals Election Campaign.
The following is an excerpt from his speech titled “Time to Start Real Change for NSW”.

“I was first elected in 1995 – the year Labor went into government.
It’s been a sixteen year lesson in how not to run government.Never before has Australia witnessed such a scandal-plagued government, a parade of MPs hauled before ICAC Ministers sacked for corrupt, disgraceful and embarrassing behaviour.
A record number of MPs quitting because they lack the courage to front up and answer for their role in the sorry mess that is NSW Labor.
And that’s why the next 34 days are about starting real change.”

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Getting an Edge in Pharmacy Design

Peter Sayers

Existing pharmacy owners, particularly those with the experience of having upgraded their pharmacy design and presentation (with fittings to match the markets being serviced), are well aware that an internal change will attract customer/patient attention and a general sales and profitability increase will result.
However, I believe that pharmacy has reached the end of an era in terms of community pharmacy presentation(it died at the crossroads some years back) and pharmacists, despite the criticisms that have been heaped upon them by other health professionals, have been resilient and have tried to work their way through the maze of political and professional problems that hold back new creative and remunerative practices.

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Pharmacists - Do They Need Acting Lessons?

Neil Johnston

Recently when watching the popular ABC television program Q & A, David Williamson, the Australian playwright, featured on the panel.
The subject of Julia Gillard came up and Williamson commented that she needed acting lessons to improve her communication and to generate a more convincing performance.
My thoughts turned to whether a more convincing and communicative prime minister would really be of benefit to Australians when I came across a similar scenario directed towards pharmacists, albeit in a UK setting. It is worth some further thought.

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Big Pharma Sneezes- Community Pharmacy Catches Pneumonia

Peter Jackson

The world is changing rapidly for Big Pharma as indicated by the report that follows.
They have known about it for some time but have done little to replace the traditional approaches that have served them well for decades.
Immediate solutions focus on ensuring good outcomes from existing drugs. In many cases the solution is multi-faceted and can involve participation by health professionals.
This is a two-edged sword for pharmacy. Strategic partnerships will also be about information flow as well as product flow.
If pharmacy is selected as part of the solution, then no problem. Unfortunately the pecking order will still start with the prescriber and radiate out to those closest i.e.practitioner nurses.
Another strategy is to control the generic drugs, particularly where the original molecule is owned by a specific manufacturer. One of the links in this control is control of the supply chain, so a focus on logistic companies, rather than wholesalers, is the result.
As Big Pharma sneezes, so community pharmacy develops pneumonia, possibly for some, a terminal case. The balance is upset and costs increase for the weaker participants viz the smaller community pharmacies.
The problem is serious and the impacts are being felt now with the recent Pfizer decision to withdraw products from wholesalers. The following patent expiry report illustrates the magnitude of the problem

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Community Pharmacy Under Attack

Neil Johnston

When the AFR’s economics editor, Alan Mitchell develops an opinion piece about pharmacy, you can be sure that it is the “tip of the iceberg” and is the precursor of a well-planned onslaught on pharmacy – its ownership rules and its scale of economy in regard to PBS costs.
This has happened today, 14th March 2011.
To i2P this smacks of an orchestrated beat up by supermarket operators Woolworths and Coles and maybe from another quarter from the old arch-enemy of pharmacy, Roger Corbett, who is still a director of Wal-Mart, the world’s largest pharmacy chain.

Comments: 1

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Wholesaler Guarantees Lose Value.

Neil Johnston

It is no secret that pharmaceutical wholesalers in Australia are under stress.
It is described in mainstream media as “massive reform” – with the word “reform” always having connotations of bad news.
PBS “reforms” have drastically altered profitability expectations; Pfizer direct distribution “reform” has taken a substantial slab of turnover out of the system (and in the process causing community pharmacy to have an increase in costs); banking “reforms” are now the latest problem with bank guarantees for pharmacists coming under the spotlight.

Comments: 1

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New plastics can conduct electricity

Staff Writer

A newly discovered technique makes it possible to create a whole new array of plastics with metallic or even superconducting properties.
Plastics usually conduct electricity so poorly that they are used to insulate electric cables but, by placing a thin film of metal onto a plastic sheet and mixing it into the polymer surface with an ion beam, Australian researchers have shown that the method can be used to make cheap, strong, flexible and conductive plastic films.

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Getting Protein & Nutrients from Insects

Staff Writer

Respected restauranteurs are becoming drivers for a sustainable planet by embracing the "slow food" movement (as opposed to "fast food").
Produce for their restaurants tends to be fresh, organic and local.
Now there is a move to replace as much of the wasteful and energy-consuming foods (beef, prork, wheat corn etc), with better alternatives.
Experiments in serving high-end reastaurant meals of insects and worms have already been trialled, and now Dutch entomologists Marcel Dicke and Arnold Van Huis propose farming insects as a alternative and sustainable source of protein.

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The Move to Sustainable Local Food

Staff Writer

THE Australian Food Sovereignty Alliance has chosen Slow Food’s Terra Madre Day to call on community and government to debate and support the development of resilient and democratic local and national food systems in the face of profound risks and uncertainties.
Alliance national spokesman Michael Croft – also co-leader of Slow Food Canberra – said that a manifesto launched today by the alliance proposed a framework and direction for tackling the many sustainability and sovereignty issues confronting Australian food supply.

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Nutraceuticals - Going Global & Mainstream

Staff Writer

Editor's Note: Food as medicine is a concept that has been around for a long time.
Now the "big end" of town has decided that this market is too good not to be part of.
It is also a market area, unlike drugs, that is only moderately regulated.
On the surface it appears good news that nutritional therapies will be developed that will prove better primary or complementary treatments for lifestyle disorders.
In practice, natural molecules will be distorted to gain the "edge" of obtaining a patent.
However, it will be a better alternative than popping a drug every day for the rest of your life.
Local supermarkets in Australia are already embracing this market, and a range of "health foods" is already established as a separate department.
Pharmacy will need to engage this market and individualise it with specialised information.


Recent decades have witnessed much criss-crossing between the food and pharmaceutical industries. Nestle SA on January 1 2011 placed a very big bet on a nutraceutical future with the creation of a Nestlé Health Science business unit. Much of how the Switzerland-based multinational will "pioneer a new industry between food and pharma" will be pieced together by a trusted insider, Luis Cantarell, the inaugural president/CEO of Nestlé Health Science.

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Next Steps to Establish Medicare Locals

Staff Writer

The Gillard Government has released new guidelines for Medicare Locals to help health practitioners provide more responsive and targeted services for local communities.
Launching the guidelines, the Prime Minister Julia Gillard and Minister for Health and Ageing, Nicola Roxon, also encouraged primary health care organisations to apply to become Medicare Locals through the invitation to apply process, which opened today.

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Insufficient beds for the aged-New Study

Staff Writer

From the Intergenerational Reports of recent years and the observation of many commentators, the average age of Australia's population is rapidly increasing, primarily due to the maturing of the "Baby-Boomer" segment.
It has been widely postulated that there would be insufficient nursing home beds and public hospital beds to meet the demands of this medically-intensive group, particularly in the latter part of their lifespan.
For this reason i2P has been urging pharmacists to take up the concept of a "Pharmacy in the Home" as a means of supporting aged people with nowhere to go.
The problem is going critical right now.

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New Australian honey - a powerful anti-bacterial treatment

Staff Writer

Honey sourced from an Australian native myrtle tree has been found to have the most powerful anti-bacterial properties of any honey in the world and could be used to treat antibiotic-resistant bacterial infections that commonly occur in hospitals and nursing homes.
A Brisbane-based research group found that Australian native myrtle honey has very high levels of the anti-bacterial compound, Methylglyoxal (MGO), and outperforms all medicinal honeys currently available on the market, including Manuka honeys.

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Focus on Glaucoma

Staff Writer

More than half of Australia's glaucoma cases remain undiagnosed according to University of Sydney Professor of Ophthalmology, Paul Healey. The alarming statistic underpins this year's World Glaucoma Week and confirms the perils of driving with the condition and the need for regular eye tests.

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Cutting cholesterol: find may yield better treatments

Staff Writer

A promising new way to inhibit cholesterol production in the body has been discovered, one that may yield treatments as effective as existing medications but with fewer side-effects.
In a new study published in the journal Cell Metabolism, a team of researchers from the UNSW School of Biotechnology and Biomolecular Sciences - led by Associate Professor Andrew Brown (pictured below) – report that an enzyme - squalene mono-oxygenase (SM) - plays a previously unrecognised role as a key checkpoint in cholesterol production. The team included doctoral students Saloni Gill and Julian Stevenson, along with research assistant Ika Kristiana.

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Pharmacy Practice Incentives registration opens

Staff Writer

Community pharmacies all over Australia will soon have access to a range of Pharmacy Practice Incentives (PPIs) which will lead to improved health outcomes for Australian consumers.
The incentives are funded by the Commonwealth Department of Health and Ageing, and are part of the
Fifth Community Pharmacy Agreement which commenced in July 2010. Eligible community pharmacies
are being encouraged to register for the incentive payments.
The payments are a new way for pharmacies to be rewarded for their contribution to delivering quality
health services. To be eligible, pharmacies must be approved Section 90 pharmacies, accredited by a
pharmacy accreditation program (i.e. QCPP), and agree to comply with and display a patient service charter.

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Slanted Media - GP's Imagined Turf Infringement?

Neil Johnston

Every now and then you see something in print that does not seem to fit.
The following report printed in the Medical Observer (25/02/11) is one such item.
It presumes to be a commentary on a patient study involving 155 Perth pharmacies.
The patient was a simulated person who asked for over the counter assistance for a cough.
Progressive information was released depending on questions asked and the final result of the survey was not flattering to pharmacy.
I am wondering what the other side of the coin might have produced if a patient made an appointment with a GP for one condition, and then attempted to add this simulated condition as part of the total consultation?
We will never know unless the researchers go back and balance their study to find out the quality of the diagnosis (and the treatment) in a similar group of GP's.

We have asked Mark Coleman to make a comment:

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Physicians Need Bar Coding Too

Mark Neuenschwander

articles by this author...

Mark Neuenschwander has earned his reputation as one of the nations' leading authorities on dispensing and point of administration automation. Whether writing, lecturing or problem solving with a client, Mark communicates in terms and concepts that are easy to grasp and apply. His fresh perspective and keen insight stem from having invested thousands of hours in research and in-depth consulting with clients.

I’ve been thinking about Car Talk, prayer, clinical documentation, and diagnostic errors.
What’s a Saturday morning without Car Talk?
After 30 years, I still enjoy eavesdropping on Tom and Ray Magliozzi taking calls from listeners about their automobiles’ ailments.
Between outbursts of laughter, the bantering brothers diagnose, prescribe, offer second opinions, and, with limited information, have to guess a lot.

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This week, the Tappet Brothers gave a $26 gift certificate to the winner of their weekly puzzler—“The exact price,” said Ray, “of kid’s T-shirts available at cartalk.com’s Shameless Commerce store, which say, ‘Help! My parents make me listen to Car Talk.’” Sign of a good parent, in my opinion.

Sad to say, these shirts weren’t available when we were schlepping the kids to Saturday soccer. Happy to say, however, my children have matured to the point of making their children listen to Click and Clack on Saturday mornings.

Last week, Ray and Tom, whose radio show emanates from Harvard Square, read through a list of course evaluations written by students at their nearby alma mater, MIT. My favorite was, "The course was very thorough. What wasn't covered in class was covered on the final exam." Reminds me of a student who trumped a debate over prayer in schools by suggesting, “As long as we have exams, there will be prayer in schools.”

Students who sporadically attend lectures shouldn’t be surprised when they must resort to asking for miracles during finals. But what’s a student to do if she doesn’t play hooky, daydream in class, or snooze through lectures only to confront an exam that requires information the professor failed to cover?

Now, drive across the bridge and down the St. Charles from MIT to Brigham and Women’s Hospital (BWH). What are their docs to do when diagnosing patients whose medical records contain incomplete or errant documentation? Do they even have a way of knowing anything is wrong? In any instance, no physician is smart enough, no computerized physician-order entry (CPOE) system is robust enough, and no prayer is sincere enough to create missing or heal inaccurate documentation.

In case you haven’t read my previous Thinking on the value of bar-code medication administration (BCMA) to physicians, let me summarize. First, the obvious and most touted benefit of BCMA is ensuring the drugs doctors order are given to the right patients as ordered. Of equal or possibly greater value is BCMA’s lesser-understood role in improving the accuracy of documentation on which physicians must rely when diagnosing patients.

Want a second opinion?

Toronto physicians, David Cescon and Edward Etchells (more from them below), said it simply: “BCMA automatically generates an accurate electronic medication administration record, improving both patient care and hospital invoicing,” to which I would add “physicians’ diagnosis.”

There are a couple safety-talk guys in Boston whose opinions we all take even more seriously than the Car Talk guys. In a recent New England Journal of Medicine (NEJM) Perspectives” column, Gordon Schiff and David Bates state the obvious and then surprise us. "A fundamental part of delivering good medical care is getting the diagnosis right. Unfortunately, diagnostic errors are common, outnumbering medication and surgical errors as causes of outpatient malpractice claims and settlements.”

Their “think piece,” as Gordon called it in an e-mail exchange I had with him, addresses the question, “Can Electronic Clinical Documentation Help Prevent Diagnostic Errors?” They answer with an opinion: “EHRs [ed. electronic-health records] promise multiple benefits, but we believe that one key selling point is their potential for preventing, minimizing, or mitigating diagnostic errors." Though it was not the focus of their article, I would suggest this is as true for the electronic medication administration record (eMAR) and CPOE as any other clinical documentation piece in the EHR universe.

Beyond think and opinion, in their landmark study published in NEJM entitled, “Effect of Bar-Code Technology on the Safety of Medication Administration,” researchers at the Brigham (including Dr. Bates) identified an “80.3 percent reduction in administration documentation errors with bar-code technology, along with significant reductions in potential adverse drug events associated with administration documentation errors.”

“Our study,” they report, “suggests that the prevention of many of the potential adverse drug events could be attributed to the reduction in documentation errors. This finding may lead some to conclude that the eMAR component of the bar-code eMAR may have greater effect than the medication-verification component.”

A couple of Boston beans tossing up car advice based on half the story is fun—a great way for passing time. Students taking exams based on incomplete lectures isn’t fair. It could be the difference between passing and failing. Physicians diagnosing patients with incomplete or inaccurate documentation isn’t right. It could lead to their patients prematurely passing on. I’m not opposed to prayer in hospitals, but there’s no substitute for accurate documentation.

In their excellent JAMA “Commentary” entitled, “Barcoded Medication Administration—A Last Line of Defense,” Cescon and Etchells don’t mince words: “The healthcare system must wait no longer to provide them and all patients, with the systematic safety net that they deserve.” I realize that the “them” they refer to is nurses, but I’d argue that their BCMA “safety net” is just as important for doctors who want to diagnose accurately.

What do you think?

Mark

Mark Neuenschwander a.k.a. Noosh

BTW. I’ve met some nurses, who at the beginning of BCMA implementations might have been willing to wear T-shirts that read, “Help! My hospital makes me use bar coding at the point of care” (sign of a good hospital, in my opinion), who eventually became more enthusiastic about the technology than I am about Car Talk.

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