s Health Informatics - The State of the Nation | 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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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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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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Health Informatics - The State of the Nation

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.

Editor's Note: Pat Gallagher departs from his usual format this month and has sent a recent paper provided to an industry group with links to Standards Australia.
Any health professional who has an interest in e.health will find the paper interesting, as well as disturbing, and you might ask why the issues seem to be so hard to resolve. 

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Health Informatics Sector - overview

1 Preamble: the most common description used today regarding any matter pertaining to change in the health sector is the word ‘complex’. While this is not strictly true, a constant chattering of the mantra takes on a life of its own encouraging a belief in relationship complexity that inhibits rational problem solving. There are three ‘P’ that reflect complexity – people, policy and practice. To take a very simplistic comparison let us consider that a hospital is a hotel in basic functionality. In a hospital the tribal attitudes and administrative processes are all disparate; in a hotel all systems work seamlessly to one set of goals. Helps explain a raft of otherwise bewildering claims of complexity that merely hides an unwillingness to face the fact that health costs will become unsustainable without efficiency evolutions that are widespread in all other sectors of the national economy.

2 Standards and E-scripts: prescriptions touch more Australians, more often, than other clinical application. Prescriptions represents, other than procurement and wages, the highest taxpayer funded component of the annual health spend. Yet the conversion from paper to pixels has been slow to implement

2.1 NeHTA - have carriage of the terms of reference and use specifications that were only made public in late 2009 in an ETP document;

2.2 Standards - IT-014-6-4 has the responsibility to publish the messaging standards (HL7 2.5) to replace an expired version of a standard. This work is well behind time and suffers from a lack of resources (standards work is carried out by time poor volunteers). Not before time IT-014-6-4 has opened up a formal and collaborative relationship with the NeHTA ETP cohort and is seeking access to funds to outsource much of the detailed work load. Timeframes – with funded expert assistance a messaging standard could be published by Q4 2010. With only volunteer effort it could blow out to late 2011 or even 2012. A scandalous situation

2.3 Hubs: fortunately, and I mean fortunately two industry players, tired of waiting for leadership from Canberra, launched ETP hubs in mid-2009. Messy as this is, at least now the policy level has stopped navel gazing and understand they have to ‘catch up’

2.4 Tree and branch: In e-health terms prescriptions can be seen as a standards making tree trunk that can foster branch links for other clinical services and applications. That is: a) messaging rules need to be common and interoperable (scripts and pathology reports); b) patient details and medical data content needs to be aligned for all clinical activities (scripts and any other medical procedure); and c) scripts need to end up in a IEHR archive as do all the other clinical events

3 Standards and Secure messaging: in the tree and branch analogy this could be expressed as the roots of the system. Rightly or wrongly this is seen as a high priority by the ‘governors’ to meet the concern, verging on hysteria, from consumer advocates regarding privacy and personal security issues

3.1 NeHTA - have held recent SMD workshops and have tried hard to get consensus on secure messaging rules

3.2 Vendors – even though, at last, they have been consulted and been given access to previously ‘secret’ thinking there is still a high level of anxiety that it is all still too rubbery for companies to invest in changing their software just yet

3.3 Handbraking - the inwards looking attitude of the ‘Canberra/Jurisdiction’ community over the past years has contributed to unnecessary confusion and mistrust that in turn created further delays due to a lack of belief, that is widespread in the community, that ‘this’ will happen anytime soon.

4 The health agenda - strategy versus reality: remembering that a decade ago, in 2000, the DoHA of the time held a three day “Health Online Summit”. Which spawned HealthConnect, MediConnect and a host of other then soon flawed and now failed models. This poor national leadership performance is still troublesome as while once there were many owners and defenders of ideas and projects; nowadays the odium of failure is all shovelled off to NeHTA.

On a brighter note we have:

4.1 Deloitte: National E-Health and Information Practical Committee-

National E-health Strategy: even though this was kept from public view for over a year, once it was released it was a breath of fresh air. If the right mix of stakeholders can use this guidance as a platform for focused and cooperative implementation, then something tangible occurring by a 20101/2011 timeframe is doable. Otherwise things will remain flaky and I believe more will happen from the industry side than from government, as they are not yet even in the tunnel, let alone ready to see if there is any light approaching

4.2 NHHRC Report - on the other hand, into this vacuum, we have this massive document with an unbelievable number of detailed recommendations that has little chance of traction until some form of a national body of stakeholder’s takes responsibility for setting priorities and ticking the actions off one-by-one. A tedious, laborious, unsexy task load that no group to date has exhibited the zeal required to attack the list of actions to completion. A lot of ink on a lot of paper is maybe all this will deliver in the mid term at least.

4.3 Blogs, promises and disappointments- as the e-health reform status and planned deliverables is still much of a mystery; it gives bloggers a field day, every day. Somehow a public information and awareness campaign needs to be undertaken to inform ‘us’ what will happen and why that will be better; and that’s just the taxpayer/voter, someone also needs to tell the doctors and nurses! There are today a myriad ways to get messages out and understood, including the phenomena of social media – Facebook, Twitter, iPhone – as well as more conventional information dissemination channels.

5 Major impediments: the single factor is a fear of failure. Many people will talk the talk but few are prepared or are even capable of actually doing something tangible at the coal face. We can blame the false cry of ‘complexity’, as well as a lack of leadership and notably a lack of accountability. The public ‘service’ culture is risk and invest adverse. This has to change. The broad church of the health community also refuses to learn from other industry sectors, under the nonsense of a ‘we are complex’ mindset, as to what works in an online setting. The banking, insurance, hospitality, retail and a host of others have moved into a new century – healthcare has not.

6 Industry ‘matters’: by this I mean industry does have a role to play as health is everybody’s business. Including access to a healthy workforce, raising national productivity, the overall cost to the economy of a dysfunctional business model and business links in supplying goods and services. I am encouraged by the BCA’s recent move to address this health sector malaise from a business leadership perspective. In 2009 they published a powerful paper – ‘Fit for the job’ – and wrote to the Prime Minister in October 2009 asking him to urgently raise e-health goals to a supreme kitchen-cabinet attention level. I would suggest that the AiG would be another very significant voice in this space

7 Clinically not much is broke: the silly thing is that while all this dysfunctionality merrily abounds, most Australians still receive world’s best clinical care. In spite of all the barriers, bureaucrats and naysayers our doctors and nurses deliver beyond any reasonable expectation, considering the administration and policy mess we are in. My contention is that perhaps we should go slow on the mad hatter intervention into the lives of clinicians and first concentrate on the fundamental business process gaps. By fixing basic ICT pipes and plumbing, controlling cash management visibility, with effective accounts payable and receivable systems, and make all hospitals function, like a good hotel, as a clean and pleasant place to work. The promise of an e-health world is undeniably powerful and desirable, but it will not be all that great if no one can electronically share basic data, while waste and money gushes into black holes and the working and service environments are dirty and unmaintained.

8 Summary : we need a jolt. Australia has a proud record of large national change management projects – think in particular of the Decimal Currency and Metric Conversion Boards. And using a long bow we could also include the Y2K Task Force model. Whereas these councils, boards and committees used and promoted proper and transparent guidelines in project management to achieve known deliverables. With a wide and comprehensive stakeholder involvement, adequate funding, effective secretariat support and executive leadership to foster a common commitment to succeed.

Australia needs an E-Health Conversion Board. Think NeHTA being re-engineered to work with industry associations and expert business leaders to meet mandatory milestones and to do all that on a fixed budget. As well as meeting a fixed sunset date - with the journey receiving the full backing of the Government of the day, treating the project as mission critical for the nation’s citizens. As opposed to merely being blind sided by complex elite self-interest; otherwise and usually called protectionism.

Please feel free to contact me with any comment or question - Pat Gallagher

Casprel P/L - Casprel@attglobal.net - 0418 976 069

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