s Advancing to garbage at the speed of light | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

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

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Advancing to garbage at the speed of light

Pat Gallagher

articles by this author...

Patrick Gallagher is well known in Information Technology circles. He has a vital interest in e-health, particularly in the area of shared records and e-prescriptions, also supply chain issues. He maintains a very clear vision of what ought to be, but he and many others in the IT field, are frustrated by government agencies full of experts who have never actually worked in a professional health setting. So we see ongoing wastage, astronomical spends and "top down" systems that are never going to work. Patrick needs to be listened to.

I am going to preach to you dear reader.
So what is new with that you will say?
Plenty, because I truly do believe in this creed, which is the belief that without rigorous control of core data integrity the whole e-health plot is flawed.
This boring subject has been raised in these pages several times and there is no doubt the message has sort of got through, but ‘sort of’ is way, way too far from being acceptable. You see this mishmash problem in the pharmacy daily as you use different PDE numbers for the same product when you buy from more than one wholesaler.
You cope with different proprietary product identification and then use the GS1 barcode, on the product pack, to close the sale at the POS (you do, you do use that barcode don’t you!).
All of this means you have to use the wetware technology tool to interpret and map information from one system to another; and the minute you introduce wetware you introduce errors.

 

As I have said here before, using more than one single, unique product identifier defeats the upside of the technology’s ability to automatically reticulate common, error free transactions. All the hardware, middleware, software and broadbandware come to grief holistically when wetware gets involved.

You do understand this?

No - well, wetware is a euphemism for people – you, your staff, catalogue managers, anyone who is going to enter or use multiple systems (interoperability) and multiple identifications to manually exchange information about the same things. Wetware basically dilutes the value of the technology mix enormously.

The two technologies that combine to deliver a level of garbage data are wetware and paper – put them together and errors are assured.

The elementary discipline of a data alignment and integrity practice 101 is to ensure one accurate identification number for any one data item is the rule that rules the world of automatic data exchange.

Yet, there is always a yet, and that normally comes before the but, in Australia we still do not have a single source of product data electronically feeding and linking the working catalogues and data files. Files that today are being used by prescribers, dispensers, suppliers and hospitals to exchange common product data electronically. All based on the belief that it will all be without risk.

This is not referring to a financial risk; this is referring to a clinical risk. As in unintentionally substituting 50mg for 0.5 mg, because that is what the ‘computer’ said ‘to do’. The descriptor that best fits this linking of clinical and product data is: “every clinical decision is a procurement decision”

Is there truly a risk that we can introduce harm faster and more ‘efficiently’?

Surely not?

Sorry, the answer is - yes we can and yes we will

Driving to work this week I caught a garbled snatch on the radio along the lines of: “electronic prescriptions threaten safety due to an increase in errors” (sic).

C’mon! How crazy is that?
The act of replacing handwritten scripts with clearly printed forms must be a huge improvement.

And, of course that is certainly, to a degree, the case.

When a script is printed it is easier to read, as the ink on *paper is clearly readable. The question is all about how reliable is the information and how much work is required to routinely interpret that description, on the paper form, and ‘get it right’ for the patient.

(* Paper! Of course the whole e-health framework is based on saying bye-bye to paper in all its inefficient, time consuming, error inducing and costly, pun intended, printed forms. Easy to say, very hard to do and a subject too big to digress with here today)

Imagine this scenario if (and when) the process is totally electronic.

That is, all data is exchanged by machine-to-machine transactions whereby, over time, the inclination is to rely more on the middleware than the wetware and then discover that mistakes occurred due to the source of the data being less that 100% accurate.

The prescriber used a faulty file and the dispenser’s file didn’t mismatch and the process was concluded, in error.

It can, will and does happen.

This was all researched exhaustively in 2001/2002 by a committee of over thirty stakeholders and the report urging total compliance for the Australian e-health industry of a single data repository, was tabled to the then Health Minister.

Yet, here we are in mid-2009 and (and no buts) it still has not been put in place.
It is useful to have a snapshot of what this model is designed to look like without soaring to nosebleed country of complex mind maps and PowerPoint jargon.

 1. First we should have the small core repository or database with only static identification data in it:

• Only the manufacturer or supplier (as is the TGA requirement) can add, delete or alter any product data centrally;

• Because they own the identification (GS1/GTIN barcode) data and as such must take responsibility for its accuracy - ‘relying’ on second hand or third parties to do this work will introduce errors;

• Even worse, introducing proprietary numbers, not used by the manufacturer or supplier, as a high order ‘number plate’ to link to product information, is sacrilegious;

• Like we do for the TGA, and to limit the workload and maintain enthusiasm and cooperation, the data fields for this central repository should be the minimum required to ensure total, risk free, accuracy of the information, to be electronically shared between users;

• In Europe and the USA, in respecting this barrier of potential and real non-cooperation, the rule is that a supplier can start to become compliant by entering a mere seven (7) fields – the maximum being forty (40) fields of commonly required information;

• The obvious benefit to a manufacturer/supplier is that they are only doing this information task once for thousands to share, and not a thousand times for one user to be reached; and

• This asset would be administered and operated, in terms of QA and service delivery , by an accredited agency who would triple check the data before releasing it to ‘working’ catalogues

2. What is a working catalogue?
It is the business level where different disciplines and professions use the core data seamlessly and then add the dynamic fields of data they require (and by definition) are not required by other users.
One such group is the clinical users:

• Prescribing software vendors and their clients;

• Dispensing software vendors and their clients;

• Hospital clinical software vendors and their clients;

• Clinical service software vendors and their clients; and

• Clinical date exchange hubs and gateways

Whereby these accredited users then add their ten (10), twenty (20), thirty (30), or whatever, fields of data that only they use and need for their catalogue

3 And then we have the supply chain community as a second group of catalogue users:

• Pharmacy, hospital and other health sector procurement and other buying entities;

• Wholesalers - that by association will feed into your computer inventory files that, ergo, will be identical to your dispensing files that came from the clinical group;

• Please think carefully about the future consequences of having or not having your POS and Dispensing system aligned; and

• Transport, logistics and other support service providers

These wholesale enablers and other users would add their ten (10), twenty (20), thirty (30) odd fields of supply and packaging data; such as: a) packs in a carton; b) cartons an a pallet, c) weight and dimension; d) pricing and all that good stuff for the guys in supply that no clinician ever wants to see, needs to see or should see.

4. And then there would be and are ‘other’ types of combined users, like accounts, record keepers, researchers and academics - which we will call group 3.
And they too can happily add their unique data field requirements that the supply tribe do not need nor do the group 1 clinical people as a general rule.

Summary: this model will suit all users, who are disparate in their own requirements, but share a common need for the same core, static data. In doing so they will never make a mistake with the core data and thereby never endanger any patient due to human induced of otherwise undetected, errors

If a price is wrong, or a weight is wrong, or a delivery instruction is wrong, then the cost is financial or inconvenient; but the error will not kill or harm anyone

Secondly, the other big point is they should only receive, store and use the minimum data set required to do their job. Only store and pay for transacting ‘X megabytes’ of data and not the unnecessary total set of ‘Y megabytes of data.
So compellingly, so sensible, logical and usable that even an Einstein could understand and accept it.

To the background tune of ‘Advance Australia Fair” let us review what has happened, more or less, in the lucky country since 2002.

We have the NPC (National Product Catalogue) and the NBN (National Broadband Network). Yippee?

Nope – neither is in place.

The latter is not that critical because most of us have reasonable access to reasonable broadband; so the people most likely to benefit from the rainmaking, of such a huge investment, is the ICT sector. While they might be panting in lustful anticipation, I for one am a sceptic.

I do not believe the NBN financial numbers will pan out so that investors will get a return on their money; of course if the comrades decide that we the taxpayer noddys will pay, then we will see the NBN roll on to a MFP (Multi Function Polis) result.
If you don’t compute the MFP thing, just think of a black, failed, wet dream.

I think we can forget about advancing society of ‘girt by broadband’ being in place anytime soon. For example, last weekend the press reported that the Tasmanian effort seems likely to deliver a whimpish 22% take up at $20,000 per household. Gee, isn’t that just grand. I think I will put my dough into pork belly futures.

What about the NPC?

Deep, mournful sigh and silent gnashing of teeth.

I said above - ‘sort of’. The powers to be, or not to be, or not yet seen to be, as whatever is the case, took the concept mentioned above and decided to improve it (I am being unusually polite).

How can they improve it? Well make it uncomplicated. Dissolve the four tier model, briefly outlined above, and just have one gigantic, one-size-fits-all edifice to out-do any comparable effort anywhere in the entire world. Advance Australia – where?

Breathtaking isn’t it?
I can’t help but say we’ll be ‘girt by data’ and loving it all, I’m sure (not).

In advancing Australia’s e-health capability this means that the manufacturers/suppliers will be asked (I do agree with the ’M’ word by the way) to mandatorily enter not seven (7), not forty (40), not one hundred (100) but one hundred and fifty plus (150+) fields of data. Can you imagine the thousands of SME suppliers going - whoopee, where do I start?

Sure, the cynics out there will say that there are only 500 real important suppliers and they have the staff to manage the work load. Perhaps, and then perhaps not.

That isn’t the point.
This is healthcare.
Near enough is not good enough.
All the metaphors about ‘for the want of nail’ or the ‘weakest link’ are more than true in this context. Any gap, any error, any omission will potentially do harm, faster than we now do harm.

And then we have you the pharmacist – you the data user.
You as a buyer of products and you as a dispenser of product.
Girt by data indeed.
You will be swimming in data – 150+ bloody fields of useful and useless data.
Makes you wonder whether this brilliance came out of a gaggle of undergraduate MBAs trying to impress the Professor after happy hour.

What is certain is that the authors of this concept have not worked in all of the various and separate communities they are attempting to service with this one big bang bubble.

And, to date that is what it is – a bubble. A handful of suppliers, a few thousand products and no clinical users.
What clinical users?

Well, there are now three if not more e-script hubs up and running.
Where and how is the common data being aligned, synchronized and otherwise safely presented to a prescriber and dispenser - huh?

We can now send a script from point A to point B at warp speed. The question is - is sending data at the speed of light the benefit we are looking for, or is it merely the carrier component? Rhetorical question and you are welcome to answer it.

What if, one-in-one thousand, or one-in-a-million even, has wrong data?
Who are you going to blame?
Girt is a silly word, garbage is a nasty word, but they seem made for each other.

The lucky country is advancing fairly amateurishly to a collective oh, oh moment of - ‘how did we girt into this nasty mess’

Seeya

PS

Can’t help myself - again. In the movie ‘Kenny’ there is a wonderful gag about ‘Advance Australia Fair’. He confesses that at school he always thought the line was;

"Let us meet Joyce"

rather than

"Let us rejoice"

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