s Man bites dog – mongrel rules needed | I2P: Information to Pharmacists - Archive
Publication Date 01/12/2011         Volume. 3 No. 11   
Information to Pharmacists

Editorial

From the desk of the editor

There is no other word for it other than depressing.
The world of pharmacy is falling on its own sword with pharmacist organisations at loggerheads with pharmacy organisations, principally the PGA.
Essentially it is wrong for a minority pharmacy organisation to dominate all others and leave in its wake some very unhappy people.
It is not a pretty sight seeing the juggernaut that is the PGA begin the process of decimation, wasting  resources in a negative fashion that ought to have been distributed more equitably.
It is neither smart or strategic to be entering into warfare when leadership would offer the more decent alternative.

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News Flash

Newsflash Updates for December 2011 & January 2012

Newsflash Updates

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

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Pipeline

Pipeline for Dec. 2011 & Jan.2012

Pipeline Extras

A range of global and local news snippets and links that may be of interest to readers.
Pipeline Extra simply broadens the range of topics that can be concentrated in one delivery of i2P to your desktop.

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Feature Contribution

A SUMMARY OF PHARMACISTS POTENTIAL, PROVIDING PROFESSIONAL PRACTICES.

Dr John Dunlop (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)

Over the past year I have written about the need to recognize and remunerate pharmacists appropriately in order that pharmacy can take a necessary step forward in the new Millenium. Following are some points that are worthy of note.

1. In New Zealand, we now have approximately four hundred owners of pharmacies. Within this group, incomes range between $200,000 and $600,000.00. The average income for an employed pharmacist working in community pharmacy is around $65,000.00, and the salaries for young graduates in Auckland, (and Melbourne too I believe) is $24.00 per hour - around $48,000.00 per year. Not much of a reward for 5 years of study and very indicative of the value and respect placed on the employed professional by the employer!!! 

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Inquiry into the PBS – GET IT RIGHT FIRST TIME

Rollo Manning

A failing in the push for a Senate Inquiry into the 5th Community Pharmacy Agreement is recognition that the Pharmacy Guild is named in the National Health Act as the party the Government must liaise with before making decisions on fees paid to pharmacists for supply and services.
It is not the Society of Hospital Pharmacists, the Pharmaceutical Society, the National Australian Pharmacy Students Association or APESMA - but the Pharmacy Guild.
It is therefore no wonder that the Guild is the party at the negotiating table.
An amendment to the National Health Act would be needed to change this and while there is a Clause that says another organisation can be included if it represents a majority of pharmacists this has never been tested.

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Who’s driving our Heath Robinson?

Neil Retallick

Last month I likened the community pharmacy industry to a “Heath Robinson”.
According to Wikipedia, “William Heath Robinson (signed as W. Heath Robinson, 31 May 1872 – 13 September 1944) was an English cartoonist and illustrator, best known for drawings of eccentric machines....
In the UK, the term "Heath Robinson" has entered the language as a description of any unnecessarily complex and implausible contraption...”
This month I’m worried about who’s driving it.

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It's Raining Training

Barry Urquhart

Some choice.
For most business leaders and owners the next decade will provide scope for two strategic options - "hard" or "bad".
A touch of reality is needed.
It will be a daunting prospect for some. For others, who do not recognise or appreciate the unfolding marketplace there will be blissful ignorance and a shortened business life.
Among those who are "hanging on until things turn up for the better", there will be disappointment.
This is not the time to hang in our hang out.
Let me emphasise, the circumstances being confronted at present are neither cyclical nor seasonal. They are structural and accordingly, changes are essential in philosophies, operations and outputs.
The next three years will inevitably be "bad" for those who adopt a "victim mentality" and do little or nothing. Those well-reported "headwinds" will remain and will eventually push the inert (becalmed) "boats" backwards and out of the race.
Rationalisations and consolidations will be in evidence across a wide sweep of industry sectors. Established companies, brands, products and services will disappear from the corporate landscape, replaced by high-energy, and focused new applications, innovations and belief-driven entrepreneurs.
Thus from "bad" will come "good".

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Man bites dog – mongrel rules needed

Pat Gallagher

Here I am.
Back from another lengthy and self enforced break and reporting in i2P on things and matters with ICT in pharmacy-land and health generally.
It is not that I am lazy.
It is that there hasn’t been much ‘news’ happening worth getting our knickers in a knot.
It is all the same old; same old in e-health playing field and that is rather uninspiring to say the least. So I have taken the view that if there is nothing positive to say it’s best to stay stum.
But now as 2011 is coming to a rattling death perhaps there are some things worth saying, usefully or otherwise.
What is a snapshot of some of the year’s achievements in the e-health community?
Hard to say that the world is on fire with overwhelming success, but a summary of the activities that might interest the i2P reader, in some order of oomph are:

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A TGA-Managed Database of Fully Evaluated Complementary Medicines Evidence – a Real Possibility

Neil Johnston

Last month when the controversy surrounding the PGA/Blackmore’s proposed alliance brought out a large number of critics, the PGA found itself in an extremely vulnerable position.
Some criticism was well-deserved - other criticism arose from misperception surrounding the proposed alliance, while other criticism evolved surrounding the “evidence” relied on by the alliance to underpin their clinical promotion - was blown out of all proportion, or negatively criticised.
More positively, academic Dr Ken Harvey called for the TGA to manage an evidence database for complementary medicines that have had a full evaluation.

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Hypnotherapists - Hero's or heisters?

Loretta Marron OAM BSc

He spoke softly as he lifted my arm while telling me it would stay afloat.  It didn't. 
In fact, several times during the session, it fell back to my side no matter he said. 
While I felt reasonably relaxed after my first visit to a hypnotherapist, I left disappointed. 
So does hypnotherapy work and why do some of my skeptical friends support it and, more interestingly, why do they say it is part of acupuncture?

Comments: 1

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Support services for pharmacists and doctors in the United Kingdom – Part 2 Practitioner Health Programme

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

In Australia the Pharmacists’ Support Service (PSS) provides a listening ear and support over the telephone to pharmacists in Victoria, Tasmania, South Australia and the Northern Territory and has plans for expansion to all states of Australia.  The medical profession in Australia has a range of state based Doctors’ Health Advisory Services including the AMA Victoria Peer Support Service which provides peer support over the telephone.  Victorian is the only state to have a state based health program for doctors; the Victorian Doctors Health Program (VDHP)
Funding from the Cyril Tonkin Fellowship enabled me to undertake a study tour of services which support pharmacists and doctors in the United Kingdom (UK) in March 2011.

The aim of the visit was to find out how these services support the health and well being of pharmacists and doctors, including the services provided and how they are funded.

The support services visited were Pharmacist Support, including participation in a Listening Friends training weekend; the Royal Pharmaceutical Society; the Practitioner Health Programme; the Royal Medical Benevolent Fund; the British Medical Association Doctors for Doctors program and the National Clinical Assessment Service.  In addition to obtain background material on the environment for health professionals in the United Kingdom visits were also made to the General Pharmaceutical Council; Manchester University School of Pharmacy and Pharmaceutical Sciences and the Pharmacy Department of the Central Manchester University Hospitals NHS Foundation Trust.
This article is the second in a series reporting on my visit and will detail the services available to doctors and dentists living in London through the Practitioner Health Programme.

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INTEREST HIGH WITH STUDENTS IN ABORIGINAL HEALTH

Rollo Manning

The future supply of pharmacists to work in Aboriginal health is healthy if the outcome of a National Australian Pharmacy Students’ Association survey is anything to go by.
While 83% of respondents felt it is important to be taught about Aboriginal and Torres Strait Islander health issues as part of their pharmacy course curriculum, only 60% have access to such education. Furthermore, only half of those respondents feel they are taught enough about this topic.

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Thankful for an MRI

Mark Neuenschwander

I’ve been thinking about magnetic resonance imaging, sleeping bags, allergies, and great hospitals.
Well, I went in for an MRI, and the diagnosis was not good: Claustrophobia. But I’m getting ahead myself.
While studying x-rays of my shoulder, my doc ordered an MRI. I told him we were nearing eight on the p
ain scale and pressed for the earliest appointment.
Seven o’clock the next morning, after being scanned for metal, a rad tech strapped me to the transport board and pushed a button.
Moving into the magnetic abyss, I felt like dead man walking. Except, I couldn’t walk. But I could talk. It took about two seconds to find my authoritative voice:
“I NEED OUT NOW.”
She got the hint, and I was pardoned.

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The power of 'why'

Harvey Mackay

Whether you're managing a team of employees or you're on your own, remember that although what you do and how you do it are important, it's the "why" that provides real motivation to succeed.
An experiment conducted by the University of Pennsylvania's Wharton School of Business demonstrates the power of "why." 
At a university call center where employees phone alumni to solicit contributions to scholarship funds, the staff was randomly divided into three groups:  The first group read stories written by former call center employees about the benefits of the job (such as improved communication and sales skills).  The second group shared accounts from former students about how their scholarships helped them with their education, careers and lives. 
The third, a control group, read nothing, just explained the purpose of the call and asked for a contribution.

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The Farmerscy Guild and the straw man argument

Geoff March PhD B.Pharm

Straw Man “An argument deliberately put up so that it can be knocked down, usually as a distraction from other arguments which cannot be so easily countered,”  - The Macquarie Dictionary.

Comments: 2

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Kos Sclavos Superstar

Peter Sayers

It appears that pharmacists, in general, are tired of the leadership style imposed by Kos Sclavos, the incumbent president of the Pharmacy Guild of Australia (PGA).
While criticism of PGA leadership style and policy has been building for some time, opposition solidified recently with formation of the Pharmacy Coalition for Health Reform – a body that boasts over 20,000 pharmacists among its membership.

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NAPSA and the PGA

Neil Johnston

Recently, i2P was sent a media release from APESMA, the pharmacist trade union.
It was embargoed until Saturday December 10, which was a point at the beginning of the i2P update cycle.
The release contained a link to an email that is alleged to have emanated from NAPSA – the National Australian Pharmacy Students' Association.
Because it was politically sensitive to that organisation and because it also contained a number of normally private contact details for their members, i2P decided to withhold the information unless it became public knowledge through other media sources - and that has happened..
The email provided the basis for published claims that the PGA was engaged in a bullying process with NAPSA to force their disengagement with the newly-formed PCHR- the Pharmacist Coalition for Health Reform, and it is hard to avoid this view when an examination of the pressures exerted by the PGA are examined in broad daylight.

Comments: 1

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Where is the Best Future Business Model for Pharmacy?

Neil Johnston

Because it is near the end of the year, I thought it appropriate to highlight one of our earlier articles published in July 2010, because it gave a foretaste of things to come -
 “The New Competitors- Wholesalers, Manufacturers, Pharmacists and Nurses”
The gist of the article was that because global pharma companies would be unable to sustain the “blockbuster” business model and that there would be only modest growth in future drug developments, an unstoppable chain reaction would begin to occur where global pharma would create a new disruptive business model that would remove wholesaler discounts and begin a process of different segments of the health services “scavenging” from each other.

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Pharmacy Needs a Peak Body

Neil Johnston

Once upon a time pharmacy was a small, typically one-person show that focussed on patients (as distinct from customers).
It was considered very bad form if a patient presented with a problem and ;
(i) they were not immediately attended to by a qualified pharmacist and;
(ii) they left the pharmacy holding a product in their hands that had not been personally compounded by the pharmacist.
Most patients asked for “their pharmacist” by name and entered into an obvious and valued pharmacist/patient relationship. The care was obvious and not substituted with branded medicines or had the patient interviews delegated to pharmacy assistants or technicians.
In other words the human relationships were respectful and this respect extended between pharmacists as a collegiate relationship.

Comments: 1

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Come to Shop – Return to Learn

Neil Johnston

I started the New Year by researching retail environments that could be adapted to pharmacy and deliver pharmacy 2012 marketing requirements, with emphasis on "professional".
When I got to the Apple retail environment, it simply jumped off the page.
This could be the most important article you read this year.
Few would realise that the title to this article is actually the slogan for Apple Retail Stores, and is in fact the base philosophy behind one of the most successful forms of retail enterprise experienced in the 21st century.
The story of the Apple retail experience has a direct translation across to the malaise that is currently being felt by most Australian pharmacists, so a brief history of the Apple company may help to illuminate a realigned direction for community pharmacy that would capitalise on its strengths and help get off the discount treadmill.

Comments: 3

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A New Escalation of Turf Wars - Is the best defence, offence?

Mark Coleman

Recently I noticed an article published in "The Conversation" authored by John Dwyer Emeritus Professor at University of New South Wales. The article opens with:

"It’s difficult enough to counter the massive amount of misleading information provided to consumers through the media and online. But the task becomes much harder when tertiary institutes give an undeserved imprimatur to pseudo disciplines by offering them as courses. Central Queensland University (CQU) is the latest to do so, announcing it will offer a Bachelor of Science degree (Chiropractic) from 2012. I’m one of thirty-four doctors, scientists and clinical academics who, in an attempt to protect health-care consumers from the dangers associated with unscientific clinical practices, have today written to the science deans at CQU urging them, as fellow academics, to reconsider this decision.
We want the deans to acknowledge the importance of our universities remaining champions of rigorous academic standards and remind them of the primacy of the evidence base for scientific conclusions and health-care practices." Read more at this link

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New Year Uncertainty

Peter Sayers

Coming up to speed after the festive break, I have been astounded at the number of community pharmacy prescription out-of-stocks, both short-term and long-term, that are mounting by the day.
This has a number of financial impacts on a community pharmacy and one assumes that the PGA has a strategy to lessen these impacts - but where is it?

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Take care of your customers or someone else will

Harvey Mackay

No business can stay in business without customers.
How customers are treated and sadly, mistreated, determines how long the doors stay open. Poor quality service has probably doomed as many businesses as poor quality products.
Enter the "guru of customer service," John Tschohl.
He earned that moniker from USA Today, Time and Entrepreneur magazines. After 31 years focused solely on customer service, he is president of Service Quality Institute, which has representatives in 40 countries.
He's authored hundreds of articles and six best-selling books. And he is willing to share his wisdom with my readers. I don't often devote so much of my column to one resource, but John is the best of the best.

 

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Nicola Roxon’s Parting Advice

Neil Johnston

I was thumbing through my January copy of the AJP when I noticed a small column covering a conversation with Nicola Roxon, the ex-Minister for Health and Ageing.
She, along with other commentators on the same page, was basically encouraging pharmacists to “jump in” to reform health.
The encouraged pathway was through fee for service arrangements, some of which are covered under the 5CPA.

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Big Pharma impacts on the pharmacy profession

Peter Jackson

“Staff in almost one fifth of pharmacies could be wasting more than five hours per week, the equivalent of one month's working time a year, trying to source out-of-stock medicines.”
So claims a report published in the UK newsletter Chemist & Druggist this month.
The report goes on to claim:

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Do you have the urge to speak out?

Mark Coleman

With all the change and distress that is apparent in all ranks of pharmacy at the moment, do you have the urge to lash out at someone or some organisation or just something?
All pharmacists want to evolve their version of an ethical practice, balancing some commercialism with professional core business – whether they own a pharmacy or not.
Multiple groupings of pharmacists have formed up around each special interest and this has created a range of competitive groups, some more aggressive than others, to compete for absolute dominance of pharmacy – and endeavour to create a single voice.

Comments: 1

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Drug Shortages Require Urgent Government Intervention

Neil Johnston

When something does not make sense I always find there is a political objective involved.
And underlying the politics always is the motivation of greed.
Make no mistake about it, Australian pharmacy is about to enter a period of manipulation never before experienced, and it involves supply chain manipulation by government and by Big Pharma.
It is globally orchestrated and tactics vary slightly country to country and the victims of this strategy are very ill patients and the pharmacies behind them desperately trying to bridge supply to keep them alive.

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APESMA PROPOSES NEW TERMS OF REFERENCE FOR SENATE INQUIRY INTO PHARMACY

Staff Writer

APESMA today proposed a new Terms of Reference for a Senate Inquiry into pharmacy which focuses on new potential benefits to the pharmacy profession including providing a role for pharmacists in medicare locals and GP clinics and new measures to reform the health care system.
Mr Walton said despite incorrect and mischievous claims by the Pharmacy Guild there was nothing in the Senate Inquiry before the Senate that would cause the current Community Pharmacy Agreement to cease.

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Pharmacists heading to Hobart for Medicines Management 2011, the 37th SHPA National Conference

Staff Writer

More than 850 delegates will be in Hobart this week for Medicines Management 2011, the 37th SHPA National Conference.

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SHPA commences celebration of a milestone year at Medicines Management 2011, the 37th SHPA National Conference

Staff Writer

At Medicines Management 2011, the 37th SHPA National Conference, SHPA will celebrate 50 years as a national organisation and 70 years since its inception.
In 1941, 25 pioneer pharmacists from public hospitals in Victoria first conceived SHPA, and in 1961 SHPA moved formally to become a national organisation and held its first national conference in Adelaide.

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Bill Thomson receives SHPA’s highest award

Staff Writer

Medicines Management 2011, the 37th SHPA National Conference opened today in Hobart.  With over 800 delegates, 80 presented papers and 200 posters, this year’s conference is yet another example of the enthusiasm and dedication of pharmacists in hospitals and other parts of the healthcare system to share their work and learn from their peers.

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Australian Clinical Pharmacy Award 2011 to Adelaide Pharmacist, Greg Roberts

Staff Writer

During Medicines Management 2011, the 37th SHPA National Conference, held in Hobart last weekend, the SHPA Australian Clinical Pharmacy Award for 2011 was awarded to Mr Greg Roberts, Clinical Research Pharmacist at the Repatriation General Hospital in Adelaide.

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Pharmacist Coalition for Health Reform and the call for a Senate Inquiry

Staff Writer

SHPA believes that consumer interests should be at the centre of health delivery and the health reform agenda.  SHPA members have a strong ethos of working collaboratively within interdisciplinary healthcare teams and across the continuum of care.

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NTU-led research probes potential link between cancer and a common chemical in consumer products

Staff Writer

Editor's Note: Nano-particles have been adopted by various manufacturers of consumer products because they improve absorption of their active ingredients and the cosmetic appearance of the product.
Early researchers in this field warned that conditions similar to mesothelioma may result through exposure to nano-particles and that more research is required before endangering the general public.
Very few manufacturers identify that their products contain nano-particles, but recent studies have confirmed the potential for an association with cancer.
Certainly, the least that needs to occur is a warning label, particularly as some sunscreen preparations contain zinc oxide.
It is ironical that the Australian Cancer Council promote the message of "slip, slop and slap" yet allows for another form of potential cancer exposure through the "back door" involving nano-particles in sunscreen products, including the zinc oxide identified in the following study.

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Apply First Aid – Guild Clinical 2012

Staff Writer

Guild Clinical is pleased to announce the course dates for Apply First Aid 2012.
REVIVA First Aid Training provides industry specific, highly interactive training perfect for pharmacists, graduates and pharmacy assistants.

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Award Winning NPS IPhone APP Now Includes a Medicines Reminder Function

NPS Spokesperson

No more forgetting to take your medicine! NPS has introduced a range of new features to its award-winning Medicines List iPhone app that allow people to schedule in reminders to prompt them to take their medicine.
As part of the upgrade, people can also record whether they took their medicine on time — and if not, why not, which is useful information to share when they next see their doctor.

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ASMI response to TGA reform blueprint

Bob Bowden

The Australian Self-Medication Industry (ASMI) today welcomed the announcement of a series of significant reforms to the Therapeutic Goods Administration (TGA) and the regulation of non-prescription products.
The measures will impact areas including product advertising and promotion, regulation of complementary medicines, and the transparency of TGA decision-making.

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New test to indicate likely spread or recurrence of breast cancer

Staff Writer

A Queensland University of Technology (QUT) PhD student has developed a potential breakthrough test for predicting the likelihood of the spread or return of breast cancer.
"While in recent years there have been fantastic advances in the treatment of breast cancer there has been no way of predicting its progress," said Helen McCosker, a PhD student at the Institute of Health and Biomedical Innovation (IHBI).

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PSA Releases Guidance For Pharmacists Using Internet and Social Media

Staff Writer

In our July edition of i2P, Kay Dunkley wrote an excellent article relating to social media and its use by health professionals. In that article Kay noted:
The Medical Journal of Australia recently published an excellent article on the topic of social media and the medical profession. It was this article that prompted me to write this opinion piece and I recommend that it should be read by all health professionals who are users of social media. I believe that many of the issues raised for medical practitioners are equally applicable to pharmacists and other health professionals. That article can be found at http://www.mja.com.au/publicissues/194_12_200611/man10874_fm.html

Now the PSA have weighed in with an official version for pharmacists.

Comments: 1

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Athletes warming up incorrectly

Staff Writer

Dynamic warm-ups included range of motion activities like high-knee raises, leg swings and run-throughs or change of direction tasks.
Mr Zois said the study proved that, from a power point of view, static stretching was worse than no warm up at all.

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Last Pre-Christmas News Roundup- APESMA - Australian Prescriber - NSW Guild - NPS on Methotrexate - PSA - Competency Tool

Staff Writer

i2P news and articles will continue to be published weekly over the Christmas/New Year period, but not quite so "in-depth".
You are invited to explore the recent archives of i2P when you begin to plan for the coming year.
We also encourage you to post comments at the foot of each published item.
i2P knows that the coming year will be more challenging than in previous years.
It will be a year of sorting out priorities - those within the industry wishing to needlessly fight to prop up inappropriate structures will be seen to waste time and resources.
They will be judged harshly by participants at the "coalface"- the silent majority.

i2P hopes that all of its subscribers have a peaceful and safe festive season.

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No Deaths from Vitamins - America's Largest Database Confirms Supplement Safety

Staff Writer

The following news item from Orthomolecular.org adds one more dimension to the debate on nutritional supplements. It seems that safety is definitely not an issue where nutritional supplements are used.

Comments: 3

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Multiple medicines may double fall rate for young and middle aged

Staff Writer

Editor's Note: In Australia, criteria for generating a medication review includes a patient currently taking five or more regular medicines or taking more than 12 doses of medicine per day.
Patient falls are a major reason for patients being admitted to a hospital and quite commonly, patients are further damaged through falls while they are already in a hospital.
The system currently requires a referral by a GP to an accredited pharmacist, which is a slow and cumbersome (sometimes very unrewarding) process.

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Pharmedia: Academic Manipulation & the Growth of "Junk Science"

Neil Johnston

Editor"s Note: Global Pharma has an unusual and pervasive influence on politicians, regulators and statutory bodies around the globe.
I’ve always had a philosophy of recognising that when things do not go as they are supposed to, first look at the surrounding politics and then follow the money trail.
In the US the main regulator for drug registration and marketing is the Food and Drug Administration (FDA) which has come under greater scrutiny by industry commentators because of seemingly corrupt and improper decisions increasingly made in favour of drug manufacturers.

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Does the PGA Really Represent its Members

Neil Johnston

This month we have selected a media story that appeared in Pharmacy News on the 3 November 2011, and it is story of the continuing saga of direct distribution by Pfizer.
The bigger story underneath is - what is the Pharmacy Guild of Australia doing to represent its members in this ongoing dispute?
i2P has covered the direct distribution saga since its inception here in Australia.
The problem seems to be worsening rather than improving, so we have asked Mark Coleman to comment.
His comments appear below the media item that follows.

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Man bites dog – mongrel rules needed

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.

Here I am.
Back from another lengthy and self enforced break and reporting in i2P on things and matters with ICT in pharmacy-land and health generally.
It is not that I am lazy.
It is that there hasn’t been much ‘news’ happening worth getting our knickers in a knot.
It is all the same old; same old in e-health playing field and that is rather uninspiring to say the least. So I have taken the view that if there is nothing positive to say it’s best to stay stum.
But now as 2011 is coming to a rattling death perhaps there are some things worth saying, usefully or otherwise.
What is a snapshot of some of the year’s achievements in the e-health community?
Hard to say that the world is on fire with overwhelming success, but a summary of the activities that might interest the i2P reader, in some order of oomph are:

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* The Wave 1 PCEHR demonstration or development sites were created;

* The Wave 2 PCEHR demonstration or development  sites were created;

* The $400 million Health Identifier Service is in play;

* The PCEHR project is on everyone’s lips;

* The NPC (you should know the acronym) is being created;

* The ETP (ditto this acronym) specification is nearly ready for peer review by the standards community and consisted of six separate documents totaling  over 1000 pages;

* We still have work to do in secure messaging; and

* Nothing has actually worked (half empty), or failed (half full) to proceed, yet

Having more than my share of self nurtured cynicism it is rather easy to be a pot-shooter at the way ‘we’ are going about implementing e-health in Australia. I would prefer though to use cannon and say that we have spent over a $1billion and there isn’t much to see in terms of real world change.

It is over ten years since the National E-Health Summit was held. Over five years since NEHTA came into being. During the past three years we have had several hard hitting and very detailed reports with oodles of sensible recommendations and yet, as we approach 2012, we still have a very large inverted pyramid, teetering on a very narrow point of balance at the workplace level.

The upside base of that $1 billion pyramid is wide and deep with top down activity, with little coal face demonstrable change.

That is not to say that there aren’t islands of commercial success. Independent sites were the vendors and users have just got on and made things better, without any big brother involvement, because it makes business sense to do so.

To get a reasonable snapshot of this overall situation take a look at the NeHTA website and read the latest Annual Report published just this month. Without wishing to influence your take-away after reading the document I will say that it reads, still, like a prospectus. Flashy, eye catching, promising a lot with lots of fine print; but is there a scorecard to indicate actual change? Nope.

Let’s take a look at the landscape.

The most promising activity we have today, that involves process and practice change, is the Wave site concept. As with all my contributions I will keep it brief and expect you to ask if you do not know what (a Wave site) is.  Fingers crossed they deliver. Because they are closer to impacting on the real world than anything that has happened over the last ten years.

During my data capture business career, introducing technology-based change management outcomes, there were two words we never used to describe a new project that was (say) replacing order books with bar-coded data capture.

One was ‘pilot’ and the other ‘trial’.

That was because it was never the technology that was in question; the technology mostly proved itself to be ‘better’ – it was the people factor. Where people had to accept and embrace a work practice change. If the project was introduced as a pilot or as trial there was an instant reaction of –

“Oh well, it isn’t really going to happen, so why bother”.

Apathy and/or fear are always a powerful and constant barrier to success. 

The Wave sites, thank goodness, have been implementated as ‘demonstration’ sites’. Thereby giving a platform to road test and gradually define change and its inevitable tweaking as an ongoing shared experience between implementers and users. 

So we can give higher scoring points for the Wave sites than is usually the case and hopefully they might just deliver valuable and harmonized benefits.

It must also be said that a welcome and rare benefit is that some of the local SME vendors got a Wave site guernsey. This is not the norm. So for a really good change these vendor battlers got a (small) seat at the funding trough, err table, or dare I say gravy train.

Identifiers! I said above ‘in play’ and that’s pretty much the case. As we are all too aware technology and ‘machines’ need unique identifiers to process data. In health, as in most situations, that includes the who, the where, the what and the *why.

We need to identify people; both patients as well as service deliverers and care givers. Your pharmacy, a surgery or a hospital has to be known for electronic transactions and processing. That the transaction is a prescription or a discharge summary needs to be known and finally why a service is being delivered, which comes down to how is the claim going to be *paid and by whom.

Older readers will remember the ‘Australia card’ hullabaloo. All readers understand the MediCare numbering system. But how many Australians realize that we now all have been issued with an IHI; an Individual Health Identifier? Well we have and yet few of the hoi polloi have the faintest idea what this means. 

This problem clearly is that, outside the Wave sites, us Prols do not know that the new individual personal number will ‘soon’ replace the existing, generally family structured, Medicare number system. And this IHI will be used for all healthcare services and importantly, the subsequent health records.

It should be a concern that this planned ‘rollout’ is still much of an insider’s wet dream. Until we can all be electronically identified not much can happen – for good or for naught – and until we all have an IHI in play we are not yet on the starting blocks, at best.

Which leads to the PCEHR?

When I think of a PCEHR, in terms of my experience and prejudices, I hear an old joke. Whereby a certain community of a flavour of Christianity believes that sex is bad, because it might lead to dancing.

Perhaps this PCEHR, as we know it, offers a similar reverse analogy – dancing to this music may lead to an unintentional bad end

The first thing to know is that the ‘plan’ calls for the IHI to start becoming a real rollout event by 1 July, 2012. A little over six months away. As we are over 21 million people and counting, the scenario of all having an IHI ‘in time’ seems very remote. Before you ask, is ‘in time’ by 2013 or 2015? I don’t know.

Moreover the funding stops at the end of June 2012 and what happens next is not public knowledge. 

The thing to focus on here is the E, the H and the R words (I’ll come to the P and the C, below).

Electronic (E) processing mandatorily requires a machine to machine identification number; no number, no transaction. And, this needs to be the high end identifier on each and every transaction.

Then we have what was delivered (H). Who got the script, what were the test results, who was discharged, who is being referred and of course who just died.

Lastly we have the ongoing history and list of (R) events. Not much is usefully available for listing without an IHI to tie it to.

Of course, somewhat similar to the pilot/trail failure phenomena above, those who don’t like (whatever) is happening can use the IHI as a powerful weapon to prevent or to slow down change. The words they use are of course ‘security’, ‘privacy’ and not forgetting variations of the big bad bogie man.

To get around this formidable obstacle, the governors, the committees, the leaders, the directors or whoever is calling the shots, decided to introduce P and C as a high order identifying solution to allay all fears and robust hand braking.

What isn’t clear is the fear of failure stronger than the fear of success?

Perhaps there is too much twee going on. Someone, somewhere, needs to get a dose of mongrel into the process or we might all drown in work-around plots and pussy-footing.

It is just too easy to replace Personal with Political and Controlled with Correct to explain what has happened. It does, and it does explain regardless whether you are a cynic like me or not. It is easy to see that the loading of the P and the C soothers in front of EHR is just a lot of lead in the saddle bags of any simply effective and understandable (by said Prols) EHR development.

A reasonable person can swap ‘lead in the saddle bags’ for ‘complex’ if that is the polite way to explain the problem.

Essentially here is the simple rub. The patient entity has an opt-in, or opt-out option and that simply means you, me, him and her are in charge. We, not an authority of any kind, will decide whether there will be a (PC) EHR at all and whether the PCEHR will be complete. The immediate effect is to dilute and devalue the vital intention of delivering the benefits of e-health. If it isn’t complete, well, it isn’t complete enough to be used reliably.

To oil the wheels and accomplish this PC safety net there are rules and methods that I struggle to understand (and I attended two days of conferencing the issues); to assume that all levels of Australian society will understand, let alone embrace, a (PC) EHR is very questionable. But dear reader that isn’t the real problem.

The real problem is that beside the less contentious right to opt-in or opt-out, is the right to ‘control’ the system. The patient has the right to allow or disallow the recording of any or all personal medical activity. In simple terms; allow the recording of the script for Diabex but delete the record of any prescription for Viagra, as an example.

This subject matter is worthy of a lengthy article on its own but as this is a brief overview let me close on why this PCEHR barrier won’t go away.

Just as you would not (well would you?) allow a patient to decide what is, or isn’t recorded on their medication record within your dispensary system (think about it), the anecdotal view of the average GPs take on the patient control factor is a strong forgetaboutit. As they author prescriptions it is a very serious factor.

That the records will  be incomplete, for various reasons, is the #1 issue for GPs. Issue #2 then leads, reasonably in my view, that any diagnosis that cannot rely on the veracity and completeness of the patient’s record is ‘dangerous’. Not just in the obvious clinical meaning of dangerous but also the medico-legal meaning of dangerous.

So much then for any likely wins for anyone much in this space. As no one has asked me or many others for advice I will refrain from boring you with where the answer lies.  (Just think – keep it simple, deliver user benefits and work from the bottom up, one step at a time).

One place to look, and not to put the boot in any harder than necessary, is the UK. If you have been in any way across the e-heath ‘news’ you will know the UK has just dumped, after many years and $billions, their similar EHR plans. We can only hope our governors with this PCEHR responsibility have spent a lot of time in the UK benchmarking what happened there, with what is planned, to happen here.

What fun. Not.

Like an IHI regime being in place, the total e-health journey, from supply to consumption, to records (your medication records and into other EHR platforms) requires there is one, single, reliable, harmonized and available PRODUCT identifier, or any EHR is going to be flawed.

Way back in 2002 this was addressed by the Medicine Coding Council of Australia. Today it’s the MCCA presence has morphed into the NPC (oh, all right – the National Product Catalouge).

Unfortunately this is not the only product source data catalogue in use. Moreover the NPC is not in use for the EHR application – just the supply chain function. And therefore this is a huge flaw in the plan to rollout a PCEHR starting in July 2012.

Put simply it is a lengthy subject to understand properly, in the meantime we should remember this clue:

“every clinical decision is a procurement decision’’.

Meaning the decision to prescribe, is the decision to then use and trigger the ordering and resupply of a product. Because we are transacting in an ‘E’ world, and not with human interpretive and translated data, we must have one, single identifier, from womb to tomb, that does not require re-keying. And for efficiency sake the number should be barcode readable

What do we have?

Most of the dispensary systems use proprietary databases maintained by the system vendors. Nothing wrong with that. Then there is the use of the PBS codes where applicable and mandatory. Fully understandable as well.

These numbers are not machine-readable; nor aligned or electronically useful for an EHR. The proprietary numbers are not uniquely suitable for a cross-referenced EHR, and the PBS number isn’t usable for non-PBS items.

Then we have the AMT (Australian Medical Terminology) which has been developed for clinical purposes; it fails to automatically link the three elements in the data reticulation chain – supply, clinical and records – because it won’t be used in supply functions, nor is machine readable, the AMT will therefore need to be mapped or re-worked in some manner. It has a place but is not the practical answer.

Adding to this are the two (of many) Australian databases that can help solve the problem. One is the NPC. The other is the TGA. Neither is perfect. One has to be perfect for e-health and for PCEHR to deliver timely, accurate and usefully reliable, product related patient records.

The sooner we merge or deliver a perfect version of one catalouge the sooner the EHR records can be reliably and usefully populated.

Oh and what number should be used? Long standing readers will know I have covered this matter many times in i2P to the point of becoming a caricature of a nagger.

There are many on offer. The three that matter as I said above are: a) PBS; b) AMT; and c) GS1 (GTIN). Only one says ‘yes’ more often and that is the GTIN.

A compelling reason is that the GTIN is the responsibility of the source manufacturer/supplier to maintain (no third party) and is the only number that is barcode printed on the packaging. Happy to discuss. Because otherwise mapping is needed and that means re-working source data and that means errors.

Above I also added in the bullet of - ‘secure messaging’.

As obvious as this is dear friend we are not necessarily on the same technology page with the rest of the ICT world. It is very true that if we can’t rely on data, identifying us as patients and what clinical events have befallen us, all being used in a secure and private manner, then good night nurse. No need to keep on dancing, is there?

Here is the rub. One of  the perennial faults of the health community is the mantra that as health is especially complex (sic) and precious (sic) there needs to be clean sheet and we need to reinvent and ignore the developments from elsewhere in the ICT world. This, with the exception of HL7 and similar standards that are fit for purpose, is more or less rubbish. There needs to be more learn-and-use and less - ‘we know better’ - when it comes to technology that crosses IM ‘borders’.

This island mindset says that the ATO, the banks, the insurance and financial industries and may I say Defence, have not developed suitable methodologies to protect data content over the web so that the transaction is vulnerable to misadventure.

A case in point is a PKI; a digital signature. Surely we can surf off the rest of the web-based world here?  But no, we are designing a (well two actually) separate health only version (s) for what is a globally standard tool – the mongrel in me asks - why this is so?

An oldie to remember in this context is this statement:

The past is a rehearsal for the future’;

All the necessary web security tools exist. We merely have to put them in place, with perhaps some modification for the nuances in the health community.

But no siree, we have organizations writing new specifications, organisations setting new standards and others inventing rules and regulations that are not seamlessly interoperable to all other platforms of secure, private and sensitive ICT/web based exchange systems. Give me strength. GGRRRRR!

Let me repeat, it will be better for all if we merely modified what the world is already using, rather than add time, complexity, cost and interoperability barriers to a practical outcome. Meanwhile be in no doubt that there are many participants that will argue this point of view until the cows come home. And in a world where health is a separate planet, where time and money have no restrictions, they might have a case.

But after working for ten years these folk have not yet delivered the fundamentals of internet security, for health transactions. While other industry sectors have long ago made ‘it’ work. Says heaps about the mindset. A mindset of re-creating what already works in an attempt to deliver utopia. This yellow brick road is long, and to date, without a destination any side of a visible horizon.

Enough.  Enough already. The teasing stops here.

Let’s wrap this up just in terms of pharmacy. And we will leave the rest of the swamp to be drained by others better informed and capable than me.

That said I often wonder who on high has asked the question as to:

“what is it we want to do with ICT e-health tools?’

Followed by:

“what is stopping us from achieving that goal?”

The answer to the first question seems to me to “too much”. Rather than start small and grow tall we are working backwards and down from the theoretical stratosphere. That we may never reach back up to the lofty destination, as occurred in the UK, does not yet appear to be on the collective radar.

However in the community pharmacy context the answer to the second question is “not much”. Whatever the goal is of a PCEHR in pharmacy it can be pretty much done today. Given an IHI and a few tweaks.

* A GP can print and send a prescription over the web.

* Australia has two ETP vendors that will do that for them

These two vendors have world class software and benchmarked performance pedigrees – that is, it works!

Their transaction hubs are secure

Your dispensary systems can receive and process these transactions

You already transmit and claim the PBS component of the data

In Dick and Jane terms Australian pharmacy is already capable of contributing data into a PCEHR. With as I said, some tweaks. And when we consider that more Australians receive more prescriptions than any other clinical event it seems passing strange that this hasn’t been the bedrock strategy from the get-go.

That said the thing to fix still is that the product ID/NPC/TGA matter has to be resolved so that individual pharmacy medication records can be uploaded into a seamless and national PCEHR platform. A mandatory component

Secondly all your dispensary patients will have to know, and be able to use, their IHI. Is this mandatory? One would think so. Can it be done today? Aside from the Wave sites – the answer seem to be - nope

The governors then have to be responsible for the security and privacy of all data transacted. Certainly this is mandatory and not especially hard given what already exists in ICT-land.

And now we get to the sticky bits. Your client/patient has to opt-in and give permission for you to reticulate their records; and to instruct you as to who can see what detail in those records. If they want to hide their prescriptions relating to their HIV status they can do so.

Secondly is the issue of PCEHR database (s). We all have a rudimentary idea of how banks and other institutions can identify us, verify and protect data and then store and remove the data as and when authorized, and as appropriately required.

Well, honestly, I am not alone in struggling with understanding how this is going to work in terms of linking PCEHR sites. Where will this blancmange of numerous data mountains be stored? How will data be cross referenced and obtained. And, and, and, and……!.

Hence the title above. If a man does bite a dog and requires distemper shots (it can happen), how will that end up in a PCEHR?

Herein lies the dog poop in the crown.

So the best we can do is wait and see what happens closer to July 2012. Will the dog poop become a jewel? Will a PC focused (regardless of whether it is controlled or correct) EHR dazzle us all?

Time will tell.

And there isn’t much time or money left to play with.

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