OCTOBER, Edition # 35, 2001

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On the 2nd August 2001, the Australian Medical Association (AMA) in Western Australia, and the Optum IT group of companies, entered into an agreement to design and develop e-commerce solutions for medical professionals and patients.
The AMA will receive a royalty from all revenue generated by the venture and will have the option to nominate two directors to the board of Optum. It also has the option to forsake part of its royalty in return for an allocation of the issued capital of Optum Group Ltd.
For its part of the agreement, the AMA will provide substantial market "muscle" in the form of:
* the use of its name and trade marks;
* standards and guidelines based on its intimate knowledge of medico-legal risks, regulatory requirements and business intelligence, to ensure that products and services offered are both legal and ethical;
* lawful access to its database of medical practitioners;
* where agreed, lawful access to the national health market via AMA offices throughout Australia, and;
* the marketing and promotion of Optum's business solutions to the healthcare sector.

Optum will maintain its focus on core business, leveraging its investments in healthcare technology and using its expertise to develop new products and services.

The model that has been established appears to be workable and economically sound. Optum has a large number of global alliance partners, and because of the political and financial muscle of the AMA, is liable to attract other top IT companies "like bees around a honey pot".

It is not clear, as yet, to what extent pharmacy has been factored in, but you can be certain it will be relegated to a minor role.

The strength of this new medical e-health alliance is yet to be matched by a system to be defined for pharmacy.
The Pharmacy Guild has been given $10 million by the Federal Government to develop an e-commerce platform, but is still to announce plans and future directions for this development. This money must be spent wisely, and in such a manner that it provides a sound return on investment.
The AMA/Optum business model appears to be a good one to copy, for the Pharmacy Guild (and Pharmaceutical Society) can offer a similar range of support activities for a potential IT partner.
The AMA is off to a good start.
Can pharmacy match the pace?

Pharmacy has a number of basic strengths in that it has been involved in the development of computer systems and information technology for a couple of decades, and so has a core base of skills.
On the negative side, pharmacy has rested on its laurels and has allowed a large proportion of its technology to become outdated, which now must be replaced or upgraded.
Another pharmacy strength is that the public hospital system is developing an e-commerce platform in earnest, which places hospital pharmacy very centrally in the provision of e-clinical services and e-inventory management.
It may well be that the Pharmacy Guild can acquire hospital derived technology for its own purposes, at a much cheaper cost than initiating its own system from scratch. Utilising a hospital system would have the further advantage that all clinicians (doctors, pharmacists, nurses, pathologists etc.) would be trained on a system that they would be familiar with, should they have to link up with it in community practice.
Better still, the Pharmacy Guild may be able to forge an alliance with a major teaching hospital(s), not only to share development costs, but assist in the universal promotion of the system.
This type of approach may lead to the creation of a pathway for a hospital/community hub, and may offer opportunities for community pharmacists to partner hospitals in a range of support services.
Government thinking is moving in this direction as evidenced by the growth of Mayne Health.
Could this represent one way of upstaging the AMA/Optum model and provide a presence, to offer alternatives to future Mayne Health initiatives?

The South East Area Health Service in NSW is developing a system which will give electronic prescribing support for clinicians, financial information for hospital administrators and a supply chain process that is capable of managing drugs into a ward with minimum handling processes.
The primary goal of this system is to improve the quality and safety of patient care. The expected outcomes are:
* An improvement in prescribing practices and medication management;
* A reduction in the number of adverse drug events (ADEs);
* A decrease in the number of complications due to ADEs;
* A reduction in the cost of health care due to a reduction in inappropriate prescribing;
* A reduced length of stay through reduced ADEs and through better prescribing practices;
* Better integration of information across NSW public hospitals to improve all aspects of medication management reporting, for trend analysis and peer review;
* Improved staff and consumer knowledge about drugs and drug interactions.

A number of potential barriers have emerged, such as;
* The compliance of electronic prescribing decision support software via HL7 standards with other systems, including pharmacy systems;
* Insufficient IT infrastructure;
* Acquisition of funding;
* The current information culture.

However, all these barriers are being progressively overcome.

The proposed system links to all other systems within the hospital, and is accessed by personnel with different levels of password security.

Pharmacy System		Pathology		Patient Administration System		Discharge Referral System
	Electronic Prescribing Decision Support * Prescribing * Administration * Medication Record
Pharmaceutical Benefits Scheme		Better Medication Management System (BMMS)		Electronic Health Record		Adverse Drug Reaction Reporting System

This model could be adapted for community pharmacy by deleting systems and linkages that are not applicable and substituting alternatives.
The heart of the system, the Electronic Prescribing Decision Support, is intended to deliver;
* Management of prescribing and administration of drugs;
* Electronic transmission of scripts to the pharmacy system;
* Documentation of every component;
* Decision support, best practice guidelines and context sensitive prompts.

The pharmacy system utilised in the above is the STOCCA system, which is a system developed by Paramedical Pty Ltd, a wholly Australian company.
The STOCCA system has now been adopted by all the major teaching hospitals in NSW and is set to become the standard across all NSW hospitals within three years.
The system is highly sophisticated and can be operated across multiple sites.
Paramedical is developing the following initiatives;
* Keeping in touch with government developments for the electronic health record, including interfacing to Clinical Information Systems and participating in projects such as the Better Medication Management System, developing practical methods of implementation;
* Developing a smart interface with AusDi under licence. Context sensitive information is available on a product search window;
* Negotiating with other equipment suppliers to develop interfaces;
* Developing Electronic Pharmacy Orders (Prescribing) in conjunction with Orion Systems (NZ). This system will select products from the pharmacy product file, illustrate any restrictions to prescribing, drug interactions, incompatibilities etc, and then transmit these products to the dispense section of the program for dispensing;
* Developing a full PBS module;
* Researching hand held technologies (Palm Pilot, Windows CE, and Notebooks within a Radio Local Area Network (LAN) or using Wireless Application Protocol (WAP) and others.
This development will have application for hospital pharmacists and community consultant pharmacists, and its wider applications include bedside prescribing, medication chart creation, nurse administration and ward imprest use.
Already, companies such as Micromedex have a cut down version of their system for use in hand held devices. Another drug database, ePocrates, is offered totally free with Palm Pilot.
Hand held devices can also be adapted for clinical activity recording, workload statistics, laboratory results and are set to become a major clinical tool in hospitals and community pharmacies.

The inventory management functions of STOCCA which can provide EDI orders to suppliers, catalogues and supplier price comparisons are also state of the art and at a level of sophistication which would be difficult to match in most community pharmacy systems.

The system is able to incorporate EAN barcodes, which are a global standard, and are necessary if supply chains and clinical records are to be integrated on a portable basis.

Mayne Health, through its own IT resources, is also moving to adopt EAN codes, and so presumably will Fauldings, when the Mayne takeover is completed. There has been a slight hiccup in the takeover process as Mayne has only received 60 percent of shareholder acceptances to date, instead of the 90 percent it requires.
As a result, the outcome is still uncertain, and if for some reason the process collapses, the chess board will have to be rearranged once more.

So there are a lot of elements of an e-health/commerce system already developed and available within the pharmacy environment.
The Pharmacy Guild has a lot of money to spend on developing a suitable system, and hopefully it will come up with the goods.
Perhaps some of the above may attract some Guild attention.
With the budget it has at its disposal, it could even set itself up as an Internet/Intranet Service Provider (ISP) for all community pharmacies, the technology being available, quite economically, from Microsoft.

As this article started on the theme "crunch time", it is concluded on the basis that there is now no room for complacency whatsoever.

Ends
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