Editorial

From the desk of the editor

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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Bridge over troubled effluent

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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.

Just once, I said, just once for a change I promised myself that when I write the next article for this prestigious rag, huh, publication, it will be in an upbeat manner.

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Take iPods for instance. I’m sure that in a few years we will look back and realise that this gadget was one of cultural tipping points in the past fifty years. Representing an emerging convergence point for all manner of applications, not all of them light entertainment.
Where can iPods be used in health? Wrong question. Right question is when will this little box be used for all types of patient centric applications: answer – sooner than we all think
Started off well. I did a bit of research on other matters clever and quirky. For a while there I was worrying what stream or theme to include and what to leave out.
Gosh. How about the fact that over time RFID tags are going to be a even bigger boon to specialty retailers, community pharmacy too of course, as well as the big boofheads, than POS was relatively speaking all those years ago.
Electronic barcodes that will control stock better, minimise shrinkage tighter, tie in with other technologies to raise sales higher and other wonders of our life and times will burst forth.
Did you know that, in the USA (where else), shoppers can now enter a retailer’s store, use an iPod type device to scan a product’s RFID tag and some modern barcodes types and go online for all sorts of exciting deals along with equally, what seem to be, silly reasons.
Got me thinking. I am at home. I need a prescription repeat. Using my iPod I scan the tag on the last dispensed pack. This whizzes of to my wonderful community pharmacy computer; and whammo the script is ready for me to pick up and that fact is conveyed to me by a return SMS or email message. With, the obvious next step being that the iPod stores away this as a medication record that can be cross referenced to other files that my iPod has transacted.
Boy. Then there was the local piece of news that a medical service office prints and supplies each departing patient with a bar-coded slip for the next appointment. On arrival for the next appointment the patient scans the barcode in, and boom, the inbound records and all the other details are updated and the clinician is informed that (you) are waiting. The article said that this had reduced the staff from four to two people (lets not go there) and smoothed out patient irritability regarding appointment slippages.
Which in turn reminded me that I have predicted that one day, when the current generation of ankle biters grow up, appointments with clinicians will be controlled by the patient, accessing web sites and booking themselves in.
Then of course we have the emerging e.script hubs. I thought I can also write positively about this. After all I have been advocating e-scripts for over ten years and who needs to be picky about who runs it and how it is done. Let her rip I thought.
Of course the hub word raised in my mind the ubiquitous internet and that in turn to the promises raised by the announcement of the NBN. Which a cynic might say stands for Not Bloody Now. But actually stands for National Broadband Network.
A good broadband story always hits the spot. Do you want to download a movie with that, to your iPod of course!
The NBN has all the State Premiers getting warm wet legs fighting over where the head office of this new business will operate from. I think the words: new, business, head office and operate may become oxymoronic; but hey I am suppressing my cynicism.
Or in other words I am trying to suppress my cynical nature towards bureaucrats and politicians so as not to sound too "un-nice".
And it isn’t a contention that we have only ‘bad’ bureaucrats throughout the (healthcare) public service system. There are the best and worst of Australians, in the public service, as there are in any workplace. The problem isn’t the quality of some hard working public service people; it is the overwhelmingly number of them collectively. We all intuitively know that trimming costs at the desk face and moving the savings to the front line, in salaries or in tools, is the way to go.
So, another positive subject to expand on rather than bemoan the negative aspects. The trouble is we don’t know the ratio of backroom salaries against those at the bedside or in the clinical service and support functions.
Talking about optimism and things happening at the front line. On TV the other evening there was an uplifting story about a particular doctor and his personal problems and struggles. What caught my attention was that he is also an advocate for hand held PDA units to be used by clinicians and care givers in Australia’s hospitals. Called Patient Track (sic) and it seemed to be a dynamic interface for access to, and reporting on, the patient’s journey.
A paperless method of recording what is being transacted, in a manner of speaking, for each patient. The rule being that less paperwork, less re-working and less delays will deliver fewer costs and less administrative burdens and inconvenience for all concerned.
Truly a good news story. However then my mood started to slip a little back into the dark side.
Because I also witnessed, first hand, the dreaded medical misadventure close to home. This is the PC description given to stuff ups. Medical misadventure is analogous to an Avoidable stupid mistake as the Department of Health and Aging is to the Department of Sickness and Death.
In fact an article this week said we lost 4500 Australians last year to medical misadventure. My unkind comment would be - ‘is that all’?
My dear old departed Mum was a frequent victim of avoidable stupid mistakes. And now a 90 year old relative has just suffered three awful events in one week. Not only is this unpleasant it is also obviously dangerous and costly.
Back to the good news again.
A small Melbourne pharmacy related technology company has a system to minimise avoidable stupid mistakes in the Aged Care sector using a combination of everyday technologies. The system links the imprest trolley’s medication package, to a photo ID, back through the trail to prescribing, dispensing and onto the database. Not a piece of paper in sight.
This is a tool to be used by the nursing home’s care staff in the Aged Care facility. Who are largely low paid and often struggle with English as their second language. This is no reflection on their care and dedication delivery, as far as it can go, but it isn’t the best environmental situation in which to avoid, avoidable stupid mistakes, based on reading and writing of (the) medical information.
Anyway, this nifty iPod type idea combines linking the bar-coded medication to the ID chart. Using a PDA, the care giver scan the pack, scans the ID board and up pops a photo of the patient in the hand held device. Once our Aunt Merle is verified the medications are delivered to the right person.
A very simple method of using technology to ensure that the five rights are met: right medication, right dose, right place, right patient and right time.
Which would have avoided my mother’s frequent upchucking experiences, and the other unpleasantness we subject our old folks to, including my 90 year old relative.
Yet we maintain the cause of this suffering and recurring cost merely because we continue to use and merge two faulty pieces of technology; a person and piece of paper.
Ah the ‘Ps’ in a ‘person and ‘paper’ always stir the vibes and sure enough my mood darkened further
Over the weekend and early in this week came the drum roll announcement that we are to have, in the future, a “Health Revolution”.
Spare me days. This is from the same team that promised to actually begin to make this happen, in health, ‘or else’, starting from June 2009. Which a few of us will now see as likely to join Grocery watch, Fuel watch and school computers as another ‘F’ for a failed promise.
However, I do not want to make this article a review of this very detailed report that naturally has a lot of good recommendations. There was a very good summary in Tuesday’s, 28 July, ‘Australian’ newspaper’s IT pages (Karen Dearne) titled – “Quicker pace on e-health needed”.
I noticed in a quick scan of the web site that the report, for example, mentions the issue of paper reduction quite prominently. However at the end of the day this is a top down policy paper. Makes no promises – just recommendations. Promises no actions – just an analysis of the macro situation to give direction to whoever are the decision makers. So, no promises made by the report’s authors – that is left to the politicians. And that is a hard thing to become upbeat about at any time.
‘P’ for promise. Merely another word that leads us to perdition.
Like this: politicians are particularly poor at performing as promised. This particular pool of powerful people aren’t about practice and process but are about public relations and spin. Governing via (news) print and endless paper reports and paper studies. My prediction is that there is a high possibility that the policy proclamations will turn out to be porous.
Oh stop it.
Seriously, it is enough to turn me back into a whinger.
There are few hard words in any of the political announcements about hard decisions to fix simple hard problems. For a start we have a waste factor of over 15% of every dollar spent in healthcare. And that is just the procurement and operating side. Gawd knows, as mentioned above, how much fat is in the payroll of the huge and largely unnecessary army of back room administrators.
Apparently one brilliant idea (not) is to emulate the NHS in the UK. Licensing and thereby locking-in patients to a single GP. Strangle the freedom of these rotten, rorting doctors and their ungrateful proles/patients by administrating the hell out them with rules and regulations better suited to North Korea. Just imagine the paper warfare in this mad, envy driven world.
Nothing at the macro policy side will make things better than introducing micro bottom-up time saving and convenience measures in administration and data reticulation matters. That means a war on paper and those that shuffle it all, because minimising paper equals maximising improvement in performances across the whole sector.
Think about the paper prescription and all the other bits paper that used to (and those that still do) flow through your pharmacy. Imagine still writing out the daily order!
Do you know that the average in-bound paper invoice is handled by various people around sixteen times from womb to tomb? Each event cost about $18 a time. An unofficial estimate is that over 100 million paper invoices are shoved through Australia’s hospital management systems, each year.
Then think about the mountains of paper forms that still clog hospitals that serve the administrators more than clinicians or the patient. Do the calculations. Imagine what sort of real revolution we could experience if we could obtain accurate, timely, useful and affordable information and visibility of it all, without writing and re-writing repetitively used data and getting a lot of it wrong
Political grandstanding and macro policy setting by press release and media manipulation isn’t going to immediately, or any time soon, attend to those basic micro problems as far as I can see. It is the many small, simple hard, boring and tedious bits that need attention; not so much the easier to manage pontificating about the political kudos.
We need a bridge that connects the good parts of the system to meeting the future needs of the nation using all the e-tools at hand now and what will emerge over the coming years.
One or two readers might recall a piece several years ago about an analogy on the sewers of nineteenth century London and the NHS. Where the writer equated the stink and rottenness in the NHS system to a lack of cleansing electronic pipes and plumbing that would be needed to pump away and solve the problems. Such a powerful word picture.
As I keep saying – our problem is not with the people at the front line; the problem is find ways to drain away the effluent they are working in and free up the decision making so it is empowered down at the lower levels.
Canberra and the army of advisers will plot to allocate OUR money to fund health in the way it best suits them. What should happen is that the people that get to spend OUR money, and micro manage the money, should be as close to the daily reality of life at the coal face as possible
The pipes we need to build, in the form of a data exchange bridge, is a network based on modern technology that is flexible enough to anticipate coping with more and more data automation; and not one that persists with paper as the bedrock of outmoded thinking and central control.
What we are hearing from Canberra and in the news media is that we will be getting, in the future, a weak bridge of promised sighs and grand dreams that will continue to weakly span the sea of crap.
Let’s hope that over time the thrust of the detailed report turns that around, in the future, for nothing it seems is going to happen all that quickly.
If it takes too long, sooner or later, we will all fall into the great sewer with the realisation being that, at that level, the smell is awfully bad.
Now, where are the happy pills.

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