s Pharmedia: The PCEHR and the Patient Perspective | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2011         Volume. 3 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2011 edition of i2P E-Magazine.
A range of strategic issues are looked at this month, primarily in the form of social media and its impact on pharmacy and other health professions.
Social media can adversely affect the reputations of pharmacists if forms of personal behaviour are picked up and populate various Facebook or other similar sites.
The facility for correct use to occur is even available on the i2P site when the need to share becomes important. Kay Dunkley explores these issues in her feature article “Social and Electronic Media and Health Professionals”.

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News Flash

Newsflash Updates for July 2011

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 July 2011

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

Social and electronic media and health professionals

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

Social and electronic media in its many forms including email, websites, blogs, mobile phones, texts, twitter, teleconferencing, voice chat and skype are everyday phenomena, especially in the lives of younger health professionals including pharmacists.
They are being used for social purposes, as a media tool, for education and in the provision of health care services. 
This website and the I2P E-Magazine are good examples. 

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Prescription Pricing Models

Neil Johnston

In recent times we have seen attempts by some pharmacy groups to attract additional prescription business through deep discounting or squeezing drugs into a “one size fits all” price model.
There is nothing new or imaginative contained in either model - simply an attempt to gain advantage solely on price.

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Pharmacist Problems -Oversupply, Reducing Salaries, Inadequate Training and Opportunities

Peter Sayers

It is becoming apparent that in the Australian market place an evolving pharmacist-surplus is occurring and is rapidly becoming critical.
What is probably not realised is that in the US a surplus is occurring there as well and the market is not able to soak up that surplus.
Perhaps the reasons for the US surplus are similar to that here in Australia, but there are no clear reasons given and the finger is generally pointed at those who benefit – pharmacy owners (through the PGA) and pharmacy schools (chasing full fee-paying students).
A closer look at the US problem may assist in understanding the Australian experience.

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Sued, sacked and slandered: but not silenced

Loretta Marron OAM BSc

In April this year La Trobe University academic Dr Ken Harvey submitted a complaint to the Therapeutic Goods Administration (TGA)’s Complaints Resolution Panel (CRP) challenging the advertising claims made for SensaSlim, a weight loss complementary medicine (CM). 
He is now being sued by them for $800,000.
SensaSlim claims
it has developed a product that can “desensitise taste buds and reduce hunger pains”, that it is a “revolutionary slimming breakthrough” and that a 20-year study involving 11,453 people substantiates their claims.

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Marketing Focus: Who's Listening

Barry Urquhart

Look behind the figures.
Statistics can be so misleading.In fact, they can be outright meaningless, particularly "averages".
One person who is sensitive to the issue is Peter Newman, the host announcer for the breakfast program on the high rating radio station Curtin 100.1 FM in Perth, Western Australia.
He is a graduate in English and respects the power of language and the value of words.
In regular interviews between Peter and myself he often waxes lyrical about means, medians and averages.
During a recent on-air discussion I shocked him when I described the average 100.1 FM listener as having one breast and one testicle. He was lost for words. However, he shouldn't have been, because the audience profile of the station and his program in particular is relatively evenly balanced between males and females.
He declared the statement to be nonsensical. I agreed. Averages are often like that.

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Listen if You Want to Learn

Harvey Mackay

Few things are more frustrating than having to repeat yourself because the person you are speaking to isn't listening.  It wastes time -- and time, as we all know, is money.
Perhaps a little further up the annoyance scale is the exchange -- I hesitate to call it a conversation -- in which both parties are so determined to get their own points across that they have little regard for what the other is saying. 
When everyone is talking at the same time, or planning their next remarks instead of listening and responding, the result is never positive. 
It demonstrates a real lack of respect for the speaker and the message.

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Ending the vaccine blame game: time for a no-fault compensation scheme

Staff Writer

Editor's Note: This article was originally written by Heath Kelly,Professor of Epidemiology at Victorian Infectious Diseases Reference Laboratory and appeared in The Conversation.

When someone is adversely affected by a vaccine in Australia, their only way to receive compensation is through the courts. But this is not the case worldwide.
Vaccines undergo rigorous testing to ensure they don’t have serious negative side effects. But very rarely, they can harm those they aim to protect. This is a very small recognised risk with some vaccines.
Internationally, 19 countries have no-fault compensation schemes
.
Germany, for example, has had a government-run no-fault compensation scheme for 50 years.
In these countries, governments recognise that vaccinations provide benefit to both the individual and the community.

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High Prescription Error Rates Prevail in E.Prescriptions and Hospital Settings

Peter Sayers

Recent reports indicate that prescription errors are not improving, even with the introduction of electronic prescriptions.
A paper recently published by the Journal of the American Medical Informatics Association found that e-prescriptions in the US were just as prone to errors as paper prescriptions, though most of these errors involved omitted information and could be eliminated via upgrades to current software.
In the UK new data reveal that lack of detailed medicines information was behind 4,041 medicine errors involving 3,091 medicines reconciliations carried out by pharmacists at 30 acute trusts in England last September.
This data was published by the Royal Pharmaceutical Society (RPS).

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Baby Boomers progressing to old age

Neil Johnston

The generation that symbolised youth is not yet ready to move up a “notch” and symbolise old age.
A recent US study (AP-LifeGoesStrong.com poll) found that around 75% of “boomers” consider themselves middle-aged or younger, and that includes those currently in the age range 57-65.
Around 25% insist that you are not old until you are 80.
They are more likely to be excited about the positive aspects of aging, such as retirement, than worried about the negatives, like declining health.

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Explainer – how is it that people can recover from serious brain injury?

Staff Writer

Editor's Note: This arrticle waas originally written by Daniel Blackmore, a post-doctoral research fellow at the Queensland Brain Institute at University of Queensland.

The human brain is often referred to as the most complex organ on the planet. It is responsible for an incalculable number of tasks, thoughts and functions every second of everyday of our lives.
The brain controls our emotions, our perceptions and our memories. In short, it is what makes us who we are.
Within the human brain, there are up to one hundred billion nerve cells, each with countless connections to each other. This complexity of connectivity is responsible for the limitless imagination and creativity of the human race.
This same complexity is also the reason for deficits in memory and function following disease and traumatic brain injury, such as those resulting from car accidents or gunshot wounds.

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A Call for a Moratorium on New Pharmacy Schools in Australia and Review of Accreditation Standards

Staff Writer

Editor's Note: Finally, a leading pharmacy school is speaking out in regard to the ability to sustain future pharmacists into a rewarding future.
The current situation is such a waste of scarce resources at a time when all health funding is deemed inadequate.
Pumping out an ever increasing number of graduates into an unplanned workplace that is in decline, is a very unrealistic situation.
Yet there is more than enough work for pharmacists who can be trained to deliver primary care.
Pharmacy schools need to look at the different roles for a pharmacist and concentrate on a specialty that can be delivered and continue to be supported after graduation.
In the face of a push from academia, maybe the PGA can also move back from its rigid supply chain view of the world and rejoin the pharmacy profession once again. Recent statements supporting Professor Charman's position (by the PGA) are encouraging.

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As The Wheel Turns

Peter Sayers

The pharmacy profession in Australia and the US is coming to terms with the fact that employment opportunities are drying up, and that payment for services rendered is stagnating or being reduced.
This is also being driven by the fact that consumers are finding the offerings of pharmacy less attractive than in times past.
Wal-Mart in the US has been in decline for the past two years and was recently forced to confront the fact that its smaller, more personal stores, were outflanking their superstores in financial return, to the extent that all future investment is being funnelled into the ”corner store” concept.
Make no mistake.
The same trend is appearing here in Australia.
Consumers are looking for value, particularly the value found in professional services delivery.

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Slackers a drag at work

Staff Writer

New research from the Australian School of Business (ASB) indicates that having just one person who is lazy at work can drag down a high performing team.
Benjamin Walker, a PhD student at the ASB, is studying the impact of a single "difficult personality" member on team effectiveness.

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Night owl's habits linked to depression in older men

Staff Writer

Men who have difficulty falling asleep are at greater risk of depression than those who nod off easily, researchers have found.
A study at the Western Australian Centre for Health and Ageing at The University of Western Australia found that difficulty falling asleep doubles the risk of depression in older men.
Sleep complaints are common in later life with nearly 50 per cent of people older than 65 years reporting trouble falling or remaining asleep.

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New global plant database will lead to more reliable predictions of climate change effects

Staff Writer

Macquarie University researchers are playing a leading role in the creation of the world’s largest database of plant traits.
The TRY Plant data came from more than 8000 locations world wide. Image: Max Planck Institute for Bi
Plant traits (their morphological and physiological properties) determine how plants compete for resources (light, water, soil nutrients), where and how fast they can grow and, ultimately, how plants influence ecosystem properties such as rates of nutrient cycling, water use and carbon dioxide uptake.

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Feed the world, cut greenhouse gases: QUT expert

Staff Writer

The world can produce enough food and cut greenhouse gas emissions if it learns to use nitrogen more efficiently in agriculture, a world-leading Queensland University of Technology (QUT) scientist says.
Professor Richard Conant, a Smart Futures Fellow at the Institute for Sustainable Resources (ISR) at QUT, said global agricultural activities accounted for 15 to 20 per cent of total greenhouse gas emissions, including nitrous oxide, which was released from soil following the addition of nitrogen-based fertilisers.

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Macquarie University Hospital opens new clinic to help weekend athletes.

Staff Writer

Macquarie University Hospital has launched a new service dedicated to treating professional and amateur athletes and school aged children who injure themselves playing weekend sport.
Opening a new weekend sports injury clinic last weekend, the Hospital hopes to give local sporting people access to immediate diagnosis and treatment at its state of the art facility.

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Macquarie climate change project to share in $4.2 million of research funding.

Staff Writer

The Australian Department of Climate Change and Energy Efficiency and the National Climate Change Adaptation Research Facility (NCCARF) announced a project by Macquarie University researchers as one the successful applicants to share in $4.2 million of funding.
Awarded in the category of Terrestrial Biodiversity, the project will determine future invasive plant threats under climate change.

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Tick September off for Lyme

Staff Writer

Editor's Note: This media release was presented by Dr Mualla Akinci Director, Karl McManus Foundation for Lyme Disease Research & Awareness (www.karlmcmanusfoundation.org.au).
Mualla's husband, Karl McManus, tragically died from Lyme's Disease and she is trying to create awareness throughout Australia of the seriousness of tick bites and their aftermath.

Mualla says:

"Our Lyme Disease Appeal is just around the corner, launching September 1 and continuing throughout the month of September. Soon you will have delivered to your pharmacies a Lyme Disease Appeal kit containing two A4 posters, a collection can and information leaflets (Kit 1).

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Healthy diets equal healthy minds and not just in Australia, new research finds

Staff Writer

Deakin University health researchers have found that people with healthy diets are less likely to have depression and anxiety – not only in Australia but around the world.
In a study, published in the journal Psychosomatic Medicine, researchers from Deakin University and the University of Bergen analysed data collected from over 5700 middle-aged and older adults from western Norway.

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Forests absorb one third our fossil fuel emissions

Staff Writer

The world's established forests remove 2.4 billion tonnes of carbon per year from the atmosphere – equivalent to one third of current annual fossil fuel emissions – according to new research published today in the journal Science.
This is the first time volumes of the greenhouse gas absorbed from the atmosphere by tropical, temperate and boreal forests have been so clearly identified.

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Cut caffeine in soft drinks and you can reduce sugar without affecting taste

Staff Writer

Reducing the sugar content of soft drinks without sacrificing the taste is as simple as cutting out the caffeine, a Deakin University study has found.
Deakin health researchers have found that 10.3 per cent of the sucrose in sugar sweetened drinks, such as colas and energy drinks, can be taken out without causing a noticeable flavour difference if the caffeine is also removed.
This reduction in sugar equates to 116 less kilojoules per 500 ml serving.

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Pharmedia: The PCEHR and the Patient Perspective

Neil Johnston

Editor's Note: This article should be viewed in full screen to allow space for the video below. The Full Scren link is located just below the video graphic. Make sure your volume control is turned on before you commence viewing.

Last week, Google announced that it’s online service for storing medical records and researching illnesses will be discontinued. Google Health was created by Adam Bosworth, who has since co-founded a new health and play start-up called Keas.
GP’s have been opposed to a patient managed and controlled PCEHR and so has the Pharmacy Guild of Australia.
The motivation by government is to create a patient-centric model for health placing the patient in a “hands-on” mode, theoretically being able to control their own health information.
Of course, if the patient is not computer savvy or feels that they don’t have a mentor to guide them in the process, the system will fail as Google has shown.
Adam Bosworth in giving an explanation for the lack of the Google uptake gave the following reason:

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Pharmedia: The PCEHR and the Patient Perspective

Neil Johnston

articles by this author...

Introducing current ideas, perspectives and issues, to the profession of pharmacy

Editor's Note: This article should be viewed in full screen to allow space for the video below. The Full Scren link is located just below the video graphic. Make sure your volume control is turned on before you commence viewing.

Last week, Google announced that it’s online service for storing medical records and researching illnesses will be discontinued. Google Health was created by Adam Bosworth, who has since co-founded a new health and play start-up called Keas.
GP’s have been opposed to a patient managed and controlled PCEHR and so has the Pharmacy Guild of Australia.
The motivation by government is to create a patient-centric model for health placing the patient in a “hands-on” mode, theoretically being able to control their own health information.
Of course, if the patient is not computer savvy or feels that they don’t have a mentor to guide them in the process, the system will fail as Google has shown.
Adam Bosworth in giving an explanation for the lack of the Google uptake gave the following reason:

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“It’s failure occurred partly because they really haven’t pushed to see what could they do that people would want. They basically offered a place to store data but our data shows that people don’t really want a place to store data per se, they want to do something fun and engaging. If it’s not fun and it’s not social, why would they do it? Yes they want to be healthy but they need more than that. They need the encouragement and even the pressure of friends.”

Given the money the government has already committed to the PCEHR system are we set for another IT failure coupled with a massive expense to the taxpayer?

As usual, i2P asked Mark Coleman to comment on the Google explanation and the following media story, illustrating the PGA point of view' published by Pharmacy News on 27 June 2011.

"Google Health discontinuation vindicates Guild strategy

Nick O’Donoghue

Australia must adopt personally controlled electronic health records (PCEHRs) that are managed by health professionals, according to the Pharmacy Guild of Australia, after Google announced it will shutdown Google Health.

On Friday, internet giant, Google, revealed it was giving up on its vision of helping users to live healthier lives by discontinuing its patient managed online health record system.

The announcement backs initial research carried out by the Guild, which found only a minority of people would be in a position to upload the necessary data, Kos Sclavos, Guild national president said.

“It’s something we expected. It [a PCEHR] needs a narrative from a health professional, such as a pharmacist, to explain the benefits and it’s also unrealistic to expect pensioners to be computer savvy and to be able to load up the records themselves,” he said.

Mr Sclavos accused the Australia Medical Association of being “hostile” over who will control the PCEHRs, and told Pharmacy News, “the negativity towards e-health by peak medical organisations is putting the viability of e-health at risk”.

“It seems to be a very doctor centric model [at the moment], as the pressure comes to bear from doctors, but at the end of the day it will require health professional groups, who are trusted, to explain the benefits of health records and I think that’s where pharmacy is ideally placed.

“This news [that Google Health will be discontinued] is very welcome for the Guild, because our early research showed that while consumers were very interested [in PCEHRs], they were just not in a position to be loading records themselves,” he said.

A statement on the Google Health homepage states the system will be available until 1 January 2012, after which users will no longer be able to upload their health data, however information stored through the system will be available for downloading until 1 January 2013"



Mark Coleman

 

I have been asked to comment on the stories noted above in brown text.

To date, I have not seen any published commentary on PCEHR by a range of health consumers, particuarly the elderly. Are they being included in the PCEHR debate?
The latter are renowned as being the fastest growing demographic and account for the bulk of prescriptions being dispensed. That group is ever growing and will not bottom out until somehere near 2050. They are also the group of people that have high IT literacy rates, often because they belong to groups such as U3A (University of the Third Age). They use a lot of their new-found knowledge to edit family photographs, write family histories and email family members, as well as communicate between members of their specific club or organisation they belong to.
So the generalisation by the Pharmacy Guild of Australia (PGA) that PCEHR's should be managed by health professionals would not necessarily rule for all patients.
And where a level of management exists, there has to be a process for delegation.
I agree with the PGA that pharmacists are well placed to provide some of this delegation through mentoring of patients, and as U3A already exists to educate seniors, there is a framework to develop patient education.
The depth of delegation will depend on what level the health professionals will sanction.
Many patients may feel uncomfortable in dealing with their negative GP's who have  already indicated they will disrupt the process by not using patient-controlled information.

In this event I would make two comments:

1. Those patients who wish to be involved will find a new network of health professionals to support them in managing their PCEHR's.

2. GP's (and others) who do not participate will eventually become marginalised.
I see Medicare Locals as being an ideal structure to deliver PCEHR mentoring and a great opportunity for pharmacists based within those structures to provide the majority of mentoring.

Two landmark US studies involving the management of patient information spanning a period of a decade proved conclusively that pharmacists provided the best information and records for patients, primarily because the patients were seen more often by patients in different forms of health purchases (prescription, OTC purchases, nutrition and diet purchases etc.). So superior was the pharmacist performance. government agencies commissioning services will now only deal with a triad of health professions (doctors, pharmacists and nurses) instead of a doctor-only negotiating team.

While it is true that many senior patients may initially struggle to perfect their PCEHR a start should be made with those who wish to participate.
Government are at fault here as well because they do not seem to have considered how patient education will be delivered, nor a range of incentives for health profesionals to provide mentoring.
Community pharmacists are ideally placed to be mentors and if they were paid on a direct basis by government, that may be sufficient incentive to get a program together.
Most pharmacists have sufficient IT skills to deliver such a program without any further training.

For the first time in many years I find myself agreeing with the thrust of some of the PGA comments, but they fall short of providing an ideal framework for PCEHR's.

One thing is for certain, if a patient is unable to control the flow of their own information, they will be forever suppressed by an oppressive doctor-patient relationship. Not only patients, but pharmacists and nurses will also be hindered in developing clinical services because of doctor-controlled information flows.
Unless the nexus is broken, Australia will be forever dogged by an expensive health system that is sytematically milked by doctor dominated groups.
For this reason, I would hope that some pharmacists may make a bid for some of the Medicare Locals that will become available in the second and subsequent round of offers. For the moment, the initial offerings will be taken up by GP Divisions of General Practice on a direct basis or through a subcontract arrangement.
Pharmacists need to embrace the concept of patient mentoring and become strong supporters of PCEHR in the real sense. By doing so, pharmacists will be respected by patients and any progressive health providers. doctors or otherwise.

The comments provided by the original developer of Google Health are interesting.
He is recommending a social component to be included within the PCEHR process.
It is interesting that he believes sufficiently to have developed an alternative to Google Health, and if you follow the link provided in the introduction to this discourse you can gain some insight into what he means.
Many seniors feel isolated because of their lack of mobility and many feel imprisoned by one of the chronic lifestyle illnesses that afflict the aged.
Social communication that creates friendship or the sharing of problems could prove to be a tool in breaking a depression cycle or assisting a person to access a service that they may not have known about.
That would be a benefit for an aged person and I think that Adam Bosworth may have a point that has not yet penetrated the thinking of government, doctor groups or the PGA.
But a social network is something that pharmacists could manage if they really set their mind to it.

With online activity growing daily and social networking sprteading virally each day, plugging in and learning how to support a social network may be the next big thing for pharmacists - if they are quick enough on their feet.

After all, the Internet is the fastest growing medium for e-commerce, information sharing and social networking.
It is huge and with aged care business set to become unmanageable because of sheer numbers of ageing people, only those pharmacists who are quick on their feet will seize this enormous opportunity.

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