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In the good old days the early IT gurus coined the phrase 'GIGO'.
Garbage-in-garbage-out became part of the everyday vernacular.
A cute, memorable and yet largely ignored truism.
When I say ignored, it was never the goal of the IT community to worry too much about the accuracy of non-financial data. Big, better, faster was always more important than whether it was really timely, accurate and useful information for the customer.
The customer?
What's a customer?
Oh, the bloody user!
Life would be blissful with out dumb and demanding users.
I always wince when I hear the client being referred to as the 'user'. Addicts are users - it is against the law, usually, to be a 'user'.
Anyway, user, customer or client, the base-line people who put in the garbage or get out the garbage, never had much of say.
They were never really asked to influence the IT planners and thinkers.
Most systems required people to bend and change, rather than IT bending to deliver a better way of doing things at the sharp end of the business.
Remember the early dispensary systems?
Do you recall asking yourself - 'who designed this stupid thing' - and slowly learning that the designer was not initially a pharmacist?
Eventually, commonsense came to he fore and slowly the systems were modified to reflect what the 'user' needed, NOT what the IT designer thought the bloody user wanted and in line with what the machine, system, could and could not deliver.
This has been the way of the IT world since day dot.
And it is still much the way of the dot.com world today.
The dot.com.bombs, many at least, failed because of this blind spot.
More and more the good old technology "uber alles" is a doomed attitude.
The b2b technology is often whizbang while the 'last mile' is usually rubbish. Meeting the needs of the user and delivering better convenience is still the most elusive task that the IT industry struggles to deliver.
Certainly in most early reiterations of new IT systems.
Simple and convenient is superior to complicated and unfriendly.
Collaboration is better than obfuscation.
Smart is better than dumb.
One would hope the message is getting through.
Why you may ask am I even mentioning such mundane things?
Because we still make mistakes!
We have always made mistakes.
Changing to an on-line world will not miraculously change the fact that we make mistakes - 'to err is to be human.'
An observation of the phenomenon of Internet driven change is to re-state the old GIGO as - garbage at the speed of light. If the manual mistakes and poor data are still present, it is still rubbish, and all that will happen is that mistakes will travel faster than a fax, and may not be detected in time.
Put another way, it is still and will always be a matter of people first, standards second and technology a long way back, at third.
People are intelligent, intuitive, and make mistakes and fix mistakes.
Machines are on the other hand are dumb.
Machines cannot make mistakes nor fix mistakes, but they can process undetected mistakes. A way of putting this, as I have before, is that the 'superhighway' has to be connected to the 'dirtway'. The 'dirtway', the actual workplace, is where it all happens.
The actual 'thing' we do.
Not what technology does or does not do that may not be remotely suitable to the job at hand.
What has this to do with mistakes?
In business mistakes cost big bucks.
In health mistakes cost much more - medical misadventures or adverse reactions, whatever they are politely referred to, are very serious.
No one wants e.enabled death-by-data.
Let's just consider a few quick facts.
The Australian grocery industry, which is very efficient in world terms, commissioned a report a few years ago.
It was breathtaking.
Here is a quote:
"The grocery retailing sector loses sales of between $500 million and $1 billion a year from running out of stock, and the cost to their suppliers is $450-$750 million a year. The key cause of lost sales is errors, particularly reworking mistakes in the daily supply chain process", unquote.
In another section of the report it talks about the need for collaboration, saying in part:
"We need to share information and to jointly tackle technology issues, particularly the issue of interoperability, proprietary systems and unaligned data identification'.
Essentially, it says that every retailer has 10% of empty shelf space, every day, that is largely a preventable problem.
Will slambam technology investments, the Internet, a web site, an e.catalouge, fix this?
Nope, not alone it won't.
If the problem exists now, it will still be there when the mess is e.enabled - it will just go on being bad practice and doing bad things, faster.
What did the grocers do?
They initiated a common repository of common identified products, created electronic document standards and are now well on the way to fixing a hundred year old problem.
Old problem, being fixed with new processes and practice solutions to maximise the value of the evolving e.enabled marketplace.
I doubt that any reader is going to debate that this as not relevant, common or a familiar problem in pharmacy?
If the grocers have clearly identified such a scope of joint loss, what could we do in pharmacy?
Simply the same things.
Which is happily one initiative of what the Medicine Coding Council of Australia (MCCA) is currently establishing.
A central repository of scheduled/PBS products.
Based on a global standard of the EAN unique identifier of one number, one barcode for all commercial and clinical steps in the chain, from manufacture to mouth.
The other is the work underway at Standards Australia (IT14.10) in developing the commercial and clinical electronic document formats. The purchase order, the prescription, the payment and the patient record. IT14 is developing more than fifty 'templates' of which 16 are supply related.
All coming to you very soon, particularly the clinical standards in the form of the BMMS and Healthconnect national patient history, on-line programs.
That is, we hope, if the BMMS and Healthconnect system designers understand what the tedious, boring, practical and professional 'dirtway' requirements are. The question today is - 'do they'?
Next, let me quote from a letter, dated July 2001, from 40 000 USA pharmacists to the Secretary Of Health and Human Services, (our DHAC).
The first paragraph says:
"The American Society of Health-System Pharmacists urges the Department, through its regulatory authority of the FDA, to develop regulations that mandate the drug manufacturers provide standardised, machine readable codes (bar codes) on all containers and packaging".
Cop that - in the land of the free, land of minimum government intervention, and the two words that stand out are - 'regulate' and 'mandate'.
And this -
" While ASHP realises that the FDA has long considered a requirement for bar coding on prescription packaging, we believe that because of the irrefutable patient safety benefits of such coding, the time for discussion is over, and that the time for substantive action has arrived".
What jumps of the page is - "patient safety".
In a relatively long letter, the following sums up the tone quite well, in stating the three primary goals of bar coding (abridged) that are:
· Eliminate errors and other preventable adverse drug events by ensuring accurate drug product and patient identification
· Improve monitoring of drug-use trends within a population to ensure staff allocation to optional patient care
· Improve efficiencies in the medication-use process, including the purchasing, storage, and distribution of drug products.

Another set of figures (and I am sure if you are an avid reader of global professional trends), these figures will not shock you. A Coopers and Lybrand Report (USA Hospitals) on error reduction strategies.
One introductory statement is:
" That preventable medication errors lengthens the US patient hospital stay by 2.2 days".
The gob smacking set of statistics is where the errors come from:
· prescribing - 39%
· transcribing - 12%
· dispensing - 11%
· clinical administration - 38%

If this does not ring true, you will find that the numbers, often presented here in Australia, are in the same ballpark. In fact the Victorian Branch of the Pharmacy Guild, a very good body, have a report conducted by the Pharmacy Defence organisation some time ago.
It is worth a read.
Now remember GIGO.
If this mistake regime is merely replicated, without process and practice correction, before we put prescriptions and patient records into cyberspace, we will just be doing the bad things faster, not the right things seamlessly nor safely.
Scary stuff.
If you are following the trend of these articles, the simple, interlinked message I am conveying is that on the Internet there is nowhere to hide mistakes.
Visibility on electronic network platforms is profound and irrefutable.
People can correct any mistake made by people - but if it gets into the e.enabled networks, it is there until the machine or systems fails.
If it does not fail, 'in time' someone will get hurt.
If the mistake results in a simple out-of-stock, it is not just a dollar, loss cost issue. It also, very much, a patient care issue.
Not being able to supply the medication is poor care.
If the mistake contributes to making adverse situations worse then that's more than undesirable.
If it ends up resulting in serious medical misadventures then - roll-on the lawyers.
Very serious stuff.
And then it gets really serious, really tough stuff.
Which is the matter of (the lack of) ICT interoperability.
The broken, disconnected, dysfunctional and otherwise flawed data reticulation 'pipes and plumbing' of the ICT infrastructure within the Australian healthcare sector.
Another story for another day.
In the meantime what should you, what can you do?
Ask questions. Speak to the IT vendor, the wholesaler, the Guild, DHAC, whoever you rely on to ensure that your pharmacy is not going to be a foot soldier in a plot that will fail.
For example the papers I have quoted above are available on-line or in hard copy and any inquiry to the editor will be promptly answered.
Mistakes, like the grocers discovered, are everyone's business.
One of the most impressive executives, I have met, from one of the two largest supermarket chains puts it this way:
"The only way to manage information (on the Internet) and truly benefit from adapting to e.commerce is to fully collaborate with, and share all information based on open and common standards, with all of your partners"
The three-dimension question of course is - is the pharmacy and health sector of the community aware of this truism?
Perhaps, in a one way dimension sense they are, which is the technology dimension.
I doubt that the people in pharmacy and health policy, politics, management and dare I say it, the user community dimension, are yet to be fully engaged in the big picture.
And, until the 'people' dimension adopts the dimension discipline of common, open, shared and collaborative standards - then we will all get an 'F' for fail.

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