s A Can of Worms- The Story Continues | I2P: Information to Pharmacists - Archive
Publication Date 24/02/2011         Volume. 3 No. 2   
Information to Pharmacists


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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Rollo Manning


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


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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A Can of Worms- The Story Continues

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

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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The 26th March 2011 is election day and Labor is tipped to retain only 13 seats and that will prove a massive loss for Kristina Keneally, the first female premier of NSW.

Against this election backdrop there are still real people trying to survive in business and make a difference in their chosen vocation. They are also trying to come to grips with a government in NSW and elements of the bureaucracy, who have forgotten what ethical boundaries are.

They seemingly exhibit behaviour and an absence of standards that make it impossible to sustain a progressive business relationship.

In the home page edition of i2P published on March 1st 2011, the feature article described a small business involved in health information technology systems, that was caught up in a NSW governemnt quagmire, where sevices had been provided for NSW Health but remained unpaid in excess of 45 days.

Many invoices in fact, alleged to have not been paid for up to six years.

Phil Clare, the owner of the business, was not only deprived of his cash flow, but also had to stand by and watch his current contract cancelled with no hope of a renewal.

Effectively, he had been blacklisted for simply asking for his money, and in desperation threatened to resort to legal action for recovery.

During the preparation for, and in the implementation of various contracts undertaken for NSW Health, it was found that that in a number of instances, NSW Health was in breach of an alleged range of regulatory and legislative issues that could prove extremely embarassing for the entire government.

When the contract with Phil Clare was cancelled, these issues still remained.

While the original contract called only for surplus asset management, what Phil was able to demonstrate was that if they did not manage all assets of value less than $10,000, (they were only trying to manage assets above that value), they would simply need a better system than the on they had.

Phil described this as a “turning on the lights” experience for the decision-makers of NSW Health because of their low level of experience, and he even had to brief and educate their consultants, Ernst & Young, so that they could better advise their client on the process.

These numerous reports and information papers prepared have now been used as a base by Health Support, the agency involved in the preparation of tenders for governement, to prepare the current tender (number HT10005) for “Integrated Asset and Facilities Management Software Support and Implementation Services”. It has been prepared with uncharacteristic speed given the time between cancelling Phil's contract and the preparation of a new tender.

Applicants are to lodge their tender by March 29 2011, just a few days past election day but well within a time frame to officially lock in the winner of this tender.

Of course, the above tender replicates the exact work that Phil Clare had successfully tendered for at an earlier date, most of which still remains unpaid.

It will be intriguing to find out who the winners of this tender will be.

I2P is betting that it will be IBM in conjunction with Thiess as part of the Infrashore Consortium, or an alliance partner with a different name.

Scott Gartrell, an original employee of Thiess and the short-term adviser to Carmel Tebutt (Minister for Health) has now recently emerged as CEO for Infrashore, the consortium with the contract to develop the Royal North Shore Hospital in Sydney.

He is a person who would have had access to a range of confidential government-held information, including the “know how” of Phil Clare's organisation.

It is a requirement for all government tenders that full information be disclosed so that government can evaluate whether the various systems are practical and will actually work.

He has been reported to ICAC by the Opposition health spokesperson, and he appeared last November During his appearance at the commission in November, Jeremy Gormly, SC, asked a final question.

''You'll appreciate the issue concerning cooling-off periods for people who have come out of government positions and then move into private positions where relationships or knowledge can appear to be sold.

''The only question I have about that is whether you consider that there is a material difference between the departmental officer on the one hand and the ex-minister on the other in terms of the length of the cooling-off period.''

Gartrell: ''I don't see any reason for any difference.''

It is also a fundamental condition of a government tender that the tenderer has no knowledge of any other tender, including prices.

While Phil Clare's original tender and his numerous reports are regarded as obsolete by NSW Health, it does give a basic blueprint for price and method that would be invaluable for a new applicant.

But where are the boundaries?

There is supposed to be a twelve-month cooling-off period for ministers and senior advisers when they move into private enterprise and begin dealings with their old department.
Here we have Scott Gartrell with a long history of moving in and out of Thiess (or associated entities) seemingly at will, and not missing a recent beat when he took up his position at Infrashore.

How can this be?

i2P has a proposition for Barry O'Farrell, the likely premier after the election.

If he wants to bring the state health budget back into line, he needs to move towards encouraging (even funding) consortiums of Australian-controlled vendors.
Only then will he stop the haemorrhage of taxpayer funds that eventually benefits other countries to Australia's detriment.

It is a given that it might take a little while to come up to speed and development mistakes would be made.
But Australia has the potential to provide a first class health system using its own local brains – it only needs the chance and a different government culture to rise from the current mess.

Global vendors are renowned for transplanting systems into Australia that have been developed in countries like the US or in Europe and finding, quite cynically, that they do not work under Australian conditions. Nor will these vendors rewrite their code to properly adapt these systems for Australian conditions.

The IBM system called “Maximo” for use in asset management and tracking has been utilised a number of times by NSW Health with problematic results and wasted dollars. It is possible that it may resurface again under Tender HT10005.

Only recently, another debacle occurred through the use of Cerner's FirstNet System that runs the Emergency Departments of NSW public hospitals.

“Difficulties retrieving patient records could delay treatment, and the system - on which $115 million has been spent - automatically cancelled pathology and radiology requests if the person was transferred from the emergency department without checking whether these were still needed”, according to the study by Jon Patrick, the director of the University of Sydney's health information technology research laboratory.

The Cerner system is so compromised that it has been recommended that it be scrapped.

''When do we stop throwing good money after bad?" said Dr McCarthy, who heads the emergency department at Prince of Wales Hospital. "Anything that takes staff off the floor to spend their working time on an inefficient IT system is a detriment to patients."

The project, part of a 10-year electronic medical records plan intended to make patient histories, X-rays and test results accessible from any hospital in the state, had proceeded too fast - apparently because of contractual obligations - for clinicians' feedback to influence it, Dr McCarthy said.

The potential for records to be linked to the wrong patient raised a serious risk they would be given incorrect treatment, she said, and the inability to compile multiple patient records into reports meant doctors could no longer evaluate new treatments or disease epidemics. "Simple audits and research projects are just impossible now," she said.

Phil Clare stated, “I also reported to NSW Health that that the Cerner/EMR First net was flawed, and I wasn’t picking on the software, ( it had enough of its own problems). My interest with the “blowout “of revenue was to do with the hardware.”

Meanwhile, i2P will be keeping a watching brief on the activities surrounding Phil Clare's difficulties and we hope that at some early date this injustice will be reversed.

Look out for the winners of tender number HT10005.

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