Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Editor's Note: In some ways, it is very frustrating for people like Pat Gallagher, other i2P writers and myself, to know that problems exist out there in pharmacyland and nothing is being done about them.
Complacency, narrow mindedness and downright stupidity all come together to put off having to make a decision. This is the malady of bureaucracies!
Patrick's article for this edition shows just how prophetic he was, but I think even he was overwhelmed by the size of the PAN catastrophe.
Makes you think--would you really like to be in partnership with the gentleman pictured below? You are, in practical terms, in partnership or alliance with all your suppliers.
Use this opportunity to review all your suppliers and the products offered for retail sale, because, as you discovered, you are the face of the Pharmaceutical Industry, you are at the coalface, and you will collect most of the mud, irrespective of the initial cause.

HELP!

Let's say it again, but this time with feeling ……

HEELLLP! .

Pan Pharmaceuticals -
how bad was that?

What a hoot!
Would be one way to see it. If it were not so seriously sad it would be darkly funny to think what was and what could be.

Readers may recall my last contribution to this newsletter, December 2002, was a lengthy piece titled; "HELP is getting closer"?
It was my attempt to summarise a lot of good things and not so good things, underway here in Australia, in the e.commerce and e.health landscape.

It included this mission/vision quote from me that said:

"To enable medication related data capture and reticulation, including clinical supply and reference information, to be electronically shared using open, global standards to deliver the community accurate, timely and useful information with full consideration of participant consent and adoption of appropriate measures to ensure security and accuracy"

It is easy to be the debating winner in hindsight, but it has to be said that the TGA, the wholesalers, others and of course Pan as a manufacturer could do worse to ponder these words.

As I outlined in my previous article, which the editor may reprint in part or whole, all of this is very close to being a reality. We have activities and programs 'almost' in place to deliver non-panic reaction to the very pan-panic outcome of this massive recall effort.

And wow, did the panic get some air and print play? Overwhelming. TV and radio for days, parliaments and politicians pontificating, metro and serious press, notably the Financial Review's extensive coverage, and of course the industry and professional press.

Please indulge me as I quickly list the set of articles I wrote for this newsletter that cover, overlap, this recall matter:

Article 1 Death by data
How we will increase medical misadventures without getting clean, aligned and standard data regimes in place

Article 2 Order by numbers
Why community pharmacy should move away from using wholesaler PDE numbers to using global unique product Identifiers - the EAN system

Article 3 If it is outside the door, you should use it
To enable e.health applications, and a recall is such an application, pharmacy needs to move from the telephone line to broad band capability

Article 6 People, machines, e.health and mistakes
Where I mention the really good and necessary government initiative to implement a single data repository of product ID - which is still to be established as the 'Medicines Coding Council of Australia - MCCA" repository.

Article 7 Lets get virtual, get your Sunday's back
A outline of how e.commerce will reduce repetitive, manual paper work - GST/BAS - and in this context,
product recalls

Article 8 I guess it is nearly Christmas
A summary of these issues. Why it is important to have common numbers, standards and other data alignments in place to ensure that we get the most out of the investment in ICT for e.health applications

Article 10 HELP - is getting closer
But, still not here yet

In fact the essence of all of this is in a Macquarie School of Management Report (www.noie.gov.au/the peec story) that started the awareness raising that, today, is covered by many separate programs, projects, jurisdictions and governance models. None that are quite getting it all together though except one.

That 'one' is the Defence Department.

Since the very early days of PeCC, the ADF has been diligently developing a system now known as PILS - Pharmaceutical Integrated Logistics System. Which is now fully rolled out and operates in all 40 ADF medical sites.

Put simply PILS has the following components:

· A catalogue of clean, aligned, synchronised and common product identification - the EAN number - no other number is used unless absolutely necessary. What is fascinating, is that when the program first begun the ADF, trading in all States and with most suppliers, had 63 000 pharmacy products on file. When 'cleansed', removing duplications, spelling mistakes, deleted and obsolete data, this was reduced to 16 000 'real' products. Today 98% have an EAN number. That's correct 98%! What's more, they have now achieved a similar level of data management with over 50 000 products that would be purchased, variously, by a large hospital.
· They then developed a business system for reporting and inventory control that also acts as the front-end ordering system. Again, as a 1st, it transmits all orders in an ISO (UN/EDIFACT/ebXML) IT14 set of purchase order and supporting electronic data templates. The only entity in the Australian health scene to currently do so.
· Dispensing is conducted using FRED as a front-end system. With the connection to prescribing capability is the only system in Australia that can tie product to patient records seamlessly - that is, an EHR - that is a defacto MediConnect leading to a defacto HealthConnect capability.

Not bad eh? While everyone is talking and planning, meeting and presenting, the ADF has 'just done it".

Back to pan-demonium, pan panic as a practical example of what can be done and what should be done and will, one day, be done by all pharmacy.

The clinical head office equivalent of the ADF sent out an electronic message listing all Pan product by EAN number at 4PM on Day 2 of the published recall date to all 40 medical sites. The vast majority being very large, pharmacy run, operations. By 8.10 AM on Day 3 the recall had been 100% completed. Overnight, a large entity demonstrated what every other pharmacy, hospital, health food shop, etc, could have and should have been able to do.

Defence personnel exist in a world where every product is commonly recorded, using the MCCA principle of one single master repository cascading quality, safe and accurate electronic medical data to and from all sites -without re-keying. Without faxing. Without writing. Without separate e-mails. Without hassle. Without errors and therefore with full medical/clinical reliability and safety.

Wouldn't that be nice? It is not blue sky. Not a gunnado. It is here and now - e.health as it is meant to be.

What to do? How to make this happen for everyone? What is the problem?

Well, if we sit back and wait it will eventually come to pass. MediConnect and HealthConnect are just not viable without this foundational, national, all encompassing capability being universally in place.

Eventually the 'government', DoHA, HIC and the TGA will engage with the suppliers, work with the wholesalers, cooperate with the ICT vendors and viola - a totally collaborative, interoperable health information system.

It has to be said it is not a trivial task. Natural observation I guess, if it were 'easy' we would have already. It is boring and unsexy stuff. Tedious hack work. Painfully (or should that be pan-fully) slow to organise all of the elements and all of the participants to sing the same song - but hey, it must be done, can be done, sooner than later.

Just last week there was a Sydney local press story claiming that, among other disastrous statistics 18 000 Australians die due to medical misadventures. This is along with 90 000 Americans ('To Err is to be Human" report) and 30 000 UK citizens ("The Sugar Coated pill' report) who meet death by bad data at warp speed. Or to put it plainly and provocatively, if we do not have this regime in place we will just kill people, faster, more efficiently. If I can use that macabre description to make the point.

What to do?

Let's remember a golden-oldie - 'the customer is always right".

In the US and the UK the drive, the demand for change is coming from pharmacists. It is pharmacy that is at the coalface. Government has lofty policy attitudes that put this issue way down the line, suppliers and wholesalers are comfortable with the private, PDE number - ICT vendors just do what the 'governors' want. Leaving the pharmacy sector with the problem.

And the Pan episode demonstrates the problem succinctly, dramatically and ruthlessly. A total stuff up. With the workload and customer confusion and anger transferred to the coalface. You!!!

Get mad. Get angry. Get even. Get it underway.

After all, no one can resist the proposal to implement such a regime. The "Health Online Report" and the "Setting the Standards Report" (www.health.gov.au) say so.

All the industry and professional associations have signed off on the policy and the strategy - the level of awareness, as to what to do, is very high.

NHIMAC and Standards Australia, IT14, the MCCA/MediConnect and the HIC/HealthConnect are well along this path. For example, late in 2002, the AMA, the Pharmacy Guild and the Medical Software Industry Association jointly wrote to the Health Minister supporting these initiatives.

So, who needs to hear your point of view? Assuming of course you agree and are convinced that we should get a wriggle on? Well you can ring, write and otherwise contact the 'governors', and give them, in your words an opinion and a request, that suits your point of view - including:

· The Minister
· DoHA
· HIC
· TGA
· Pharmacy Guild must be high on the list to champion this issues
· SHPA
· PSA
· And if inclined, the nasty route of the press

Perhaps a simple method would be to register your feelings and questions with the editor of this newsletter who can then disseminate the information both ways. From pharmacy and back to pharmacy.

Good luck!