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Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

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$75.5 million in 5CPA lying idle. Why is it so?

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James Ellerson articles by this author...

James Ellerson is passionate about developing primary health care services across the spectrum of all health care practitioners working in a practical alliance, whether in an urbanised or a remote setting. He sees a wide range of opportunities for all health professionals who are currently held back by lethargic leadership. Attitudinal change is now under way because of new directions being set by governments both globally and in Australasia, creating empowerment of patients, better systems of delivery, with all resulting in primary health care at an optimum level.

When I read the Guild’s Submission to the Senate Inquiry into the provisions of the Personally Controlled Electronic Health Records Bill 2011 and (Consequential Amendments) Bill I called upon the services of my trusty friend ‘Frank’ to sit with me and contemplate what the Guild meant when it wrote that it felt it “pertinent to raise some issues that will be key to the success of the PCEHR and e-health in general for Australia”.

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According to the Guild:

the reason for this is “because of an arbitrary description developed by the Department of Health and Ageing that only recognises doctor electronically generated prescriptions, ignoring the 60% of prescriptions that comprise the majority of prescriptions utilised by consumers – repeat prescriptions”and the consequential effect is that “this has led to only 2% of prescriptions being eligible under the DOHA definition thus starving the ETP systems of income required to continue development and compliance with the emerging technical specifications such as interoperability, contrary to the tenor of the Agreement to utilise the $75.5 million for infrastructure development and delivery.”

In its submission the Guild also said that:“by late 2011, 3.2 million prescriptions items, potential eHealth records, were dispensed through the [eRx] system per week.”

The Guild’s concerns reminded me of the enigmatic Professor Julius Summner Miller whose science show had a national following when it ran on the ABC from 1963 to 1986. He presented everyday household experiments that he would dream up, like "Which weighs more - a pint of wet sand or a pint of dry sand?" and “Why does the Dunking Duck keep bobbing its beak up and down into a glass of water?” “Why is it so?” he would ask and then proceed with his experiment to arrive at the answer.

Why is it so? I asked my friend Frank standing beside me. Why are we not using e-Scripts more widely? What is the problem? Is the Department being bloody minded? Are the doctors being difficult? Why is $75.5 million lying idle? Why is it so?

As Frank and I mulled over the problem we saw the $75.5 million shimmering like gold bars in the bright sunlight screaming out to be used. We saw sweaty palms reaching out to clutch the mother lode. But alas, the gold would not move. In frustration our leader and protector called out “Give it to us, trust us, we know how to spend it, we are the Pharmacy Guild, we are the centre, the pulse and the compass of Primary Care. Give us access to the gold and we will spend it wisely. It is irresponsible to leave $75.5 million lying idle.”

“Frank why is it so?” I asked once more. It seemed to us the Guild had represented itself as both good guy and victim and DOHA as the bad guy creating obstacles and preventing progress.

If only DOHA would let us pharmacists manually load prescriptions and repeats into the ETP service repository so we can draw them back down for dispensing. We would increase our revenue by 15 cents for every prescription including repeat prescriptions manually entered, downloaded and dispensed. The $75.5 million lying idle would get used up.

What then would be the end result? We would have access to more scripts which we could electronically download and dispense.

“Indeed” said Frank, “and you would have done a lot more work for nothing by ‘manually uploading prescriptions into the exchange in order to get paid 15 cents for downloading and dispensing the prescription before passing the 15 cents on to your ETP service provider.”

Frank, that seems to me like the Guild wants the Department to make us do more work by manually uploading prescriptions for no extra pay. Yes, James, it does look a bit like that. Perhaps everything will become clearer if we examine the problem a little more deeply.

After further thought, I said to Frank “The Guild knows the rules of the game, they set them up after all. Have they had a change of thinking on ETP since then? Why is it so?”

Possibly the Guild may have had a rethink James. You see James, the Guild may be confused about the ETP rules they set up and this confusion could be spilling over to you and your colleagues while the Guild is trying to entrap the Department of Health and Ageing. For example, how confusing is it to claim that “by late 2011, 3.2 million prescriptions items, potential eHealth records, were dispensed through the [eRx] system per week.”? This equates to 166 million prescriptions per annum and if it is true it implies that the eRx system is handling between 60-65% of all dispensing activity on a national basis! Now James, we both know that if this were true, the eRx system would be generating $22.9 million per annum! I would be surprised if the Guild was complaining if this were in fact true.

Furthermore James, it is also misleading for the Guild to assert that DOHA has acted contrary to the tenor of the 5CPA by enforcing the rule that, in order to be eligible for the government’s 15 cent script subsidy, a script and its repeats must be transmitted electronically from the prescribing source (ie the medical practitioner) to the hub and then downloaded from the hub and dispensed by a pharmacist before the subsidy can be claimed. After all, the Guild agreed to these rules when it signed the 5CPA in May 2010.

I recall you covered this on 8 January 2010 in your article “Guild’s eRx clarification camouflages the facts!! Why hide the truth?” and at the time you raised the very serious possibility that pharmacists could be perpetrating a fraud against Medicare if they claimed a 15 cent subsidy for scripts that were never delivered electronically to the hub from the originating prescriber; clearly well outside the 5CPA rules for the e-Script payment.

http://i2p.com.au/article/guild%E2%80%99s-erx-clarification-camouflages-facts-why-hide-truth?ed=15

Well Frank, I think the underlying problem is that the Guild does not want its members to work with the doctors. It wants absolute control; it does not want to share. As pharmacists working at the coal face most of us work very well with our patients’ doctors every day. We care for the same patient and we want to share the same essential information. As pharmacists we are not bothered by whether e-Scripts pass through the eRx or the MediSecure Script Exchange; just as long as they originate from an authorised prescriber, arrive electronically and are transmitted securely.

This seems both fair and reasonable to me James as it ensures all pharmacists will obtain maximum benefits simply by eliminating manual data entry of prescriptions. I find it curious that the Guild should object so strongly when all its members will enjoy substantial economic benefits from embracing e-Scripts. To my mind the argument for this is clear and compelling.

Is it possible Frank that the Guild has been too smart by half and unwittingly locked itself into an untenable situation? Is it possible the Department tricked the Guild? Is it possible that we as pharmacists are the victims of the Guild’s confusion? I have heard the Guild aggressively discourages pharmacists from using the MediSecure system in the vain hope that doctors can be made to send all their e-Scripts to eRx. If so Frank the Guild could be seen to be the root cause of ‘the problem’ - blocking the advancement of e-Scripts. They said as much in their Submission when referring to e-Scripts as being the “key to the success of the PCEHR and e-health in general for Australia”.

What should be done Frank? How can the barriers that the Guild has so diligently deployed to block progress be addressed?

Elementary, dear James; elementary. Interoperability between the two exchanges will solve the problem. It’s as simple as that. If the Department funded eRx and MediSecure to develop the software and interfaces to enable all e-Scripts to be passed securely between the two exchanges the problem would be quickly resolved and ETP would spread Australia-wide in a couple of months.

Could some of the $75.5 million lying idle be used to develop interoperability Frank? Of course James, why didn’t I think of that? It’s so obvious isn’t it? DOHA could claw some of its money back and redeploy it more appropriately. It’s the Department’s money so they can apply it however they want. They could then use it to make the two exchanges co-operate with each other and develop interoperability to enable the transfer of e-Scripts between the two exchanges.

Perhaps the Senators might come to the same conclusion James!
It’s certainly possible Frank.

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